Susan's Place Transgender Resources

Hi everyone,

Please help?!

Will keep this concise. I took myself to a proper Gender clinic here in Thailand today for private tests. I've self-medicated for 18 months, had ups & downs, got into the UK GIC system and will be seen for apt no. 2 in c. two months. But I felt for various reasons I needed to be checked.

General health: good. Bp good, Cholesterol ok, no infectious diseases. Electrolytes all good though chloride is low. I'm also slightly low on hemacrit and haemoglobin but no signs of infection etc and they're in range.

The feminising indicator results are quite confusing and disappointing. Let me give background. 12 months ago I span out really horribly. I isolated Spironolactone as the cause and cut it, since when I haven't taken a proper AA. Instead I've controlled DHT through Finasteride and then, once Dutasteride (horrible drug). So today's tests did NOT cover DHT which is disappointing as I'd hoped they would.

Tests taken on a 12-hour water only fast including medications.

Testosterone 458 ng/dL (4.58 ng/mL) [High but see above re. DHT]
Prolactin 14.7 ng/mL
Folicle Stimulating Hormone FSH 0.57 mIU/ml [this is really really low?!]. Does this relate to body hair? If so mine has virtually stopped altogether.
Progesterone 0.18 ng/ml [this is very low too. Why?!]
Lutenizing Hormone 4.60 mIU/ml
Estradiol  E2 74.2 pg/ml [This is disappointingly low?]
Thyroid Stimulating Hormone 2.420 uIU/mL
Free T3 3.31 pg/mL
Free T4 1.31 ng/dL

Is there anyone on here who can contribute to the interpretation of all this?

My consultant at the clinic thinks I may have dud E tablets i.e. lower dose than they say on the packet. He wants to put me on Estradiol Gel + Spironolactone, carefully monitored.

Note: if I get medication through the GIC instead they will most likely NOT use Spironolactone. I don't know what they would use instead?

I'm sooooooo confused :(

Breasts are good though :)

Progesterone is low, but if you don't say your taking progesterone? I'm on Microgest and find it works well.

Hi, no am taking nothing along the progesterone line :/
x

That would explain the low progesterone. I'd say more, but I'm sure KayXo will be along so I don't think there's much point. I will say my estrogen is far far higher.

Your T is in the middle of male range and your E is pretty low.  Why are you concerned about spiro?  How do you know it caused you problems?


Sapere Aude

Because I woke up one morning, just, with the world a tumble dryer, incapable of sitting up let alone standing, my blood pressure under the floorboards and my heart hardly beating. I nearly died. I'm not exaggerating. It wasn't finasteride or progynova.

That's what Spiro can do, or one of the things it can do, which is why I believe the NHS in Britain will not use it for MtF.

I am not a doctor and you should seek advise from a doctor. With that said, your T is high and E is low. You need to be under a doctors care and have bloodwork done more frequently. There are alternatives to spiro. I take E injections (high dose) and spiro. My T is les than 3 ng/dl.

I had a bad time on spiro. I did not eat enough salt or drink enough water and I drank a lot of coffee. One time I fainted and hit my head and was out for a few minutes. I went down 2 other times bad. I stopped drinking caffeine and eat a lot more salt. I also do 24 to 30 flights of steps 5 days a week.   

Its a bit off topic, but whats a proper gender clinic in Thailand actually like?

What kind of services do they offer, and what kinds of HRT? Any implants? What blood levels do they recommend?

I think I recall discussing this before, but you're in Thailand - good place for some surgical work... Skip all the GIC hassle.

Many endos strive for levels of estrogen of 180-200 pg/ml and testo of below 60 ng/dl.

All anti androgens have side effects. Some people report depressions from fina and duta.

There is one form of hrt which works without anti androgens by raising levels well into the female range which by itself can drive down t into the female range as well. This is considered safe only with internal appication like implants and injections.
With injections a weekly cycle might be preferred because this way levels are more stable.
People with implants and injections usually report good results unless there are adverse conditions.

With pills bioidentical estrogen sublingually does not raise clotting as much as swallowing.
Some non bioidentical forms may have serious side effects.
With sublingual intake levels rise fast and drop hours later so spreading the daily dose in a few small doses throughout the day may help keep levels more steady. It might affect mood.

You might discuss with them their target levels and how fast they intend to reach them.

And you might think about adding bioidentical progesterone.
There are studies showing for a fully developed tissue it may be necessary.
It may also help with mood.
If its too pricey it may be cycled, with 10 or 20 day cycles for example. Just watch out for mood then.

Talk all of it through with your doc/endo.

hugs

Argh just lost a long reply on my mobile so will keep this brief and reply properly to the last one soon.

My estrogen was over 300 in December. I'm currently lactating. Weird 'eh?

Another thing that's odd is that, despite lots of transgender people in Thailand, endocrinology is historically weak here. Many Kathoey self-medicate, often at dangerous levels.
Hence I had to travel 160kms to find a proper gender clinic and even then it's a place founded by an American. They have a good business plan by also pitching to the male body builders.

I'll reply some more soon :)

X

Quote from: Richenda on May 14, 2016, 11:08:06 AM
Argh just lost a long reply on my mobile so will keep this brief and reply properly to the last one soon.

My estrogen was over 300 in December. I'm currently lactating. Weird 'eh?

pg/ml ?  Otherwise its about a third.

Here is some info about lactation :

https://www.susans.org/forums/index.php/topic,206787.msg1839298.html#msg1839298


Important for good feminization is the combination of estro and testo in the female range.


hugs

Thanks Laura, right I'm back on the laptop.

Yes same measurement: down by a third. I would say that, anecdotally, my libido has rocketed this past fortnight and I'm producing sperm again (tmi sorry) so perhaps he's right about the dodgy Estrogen tablets. He says 30% of all products in Thailand are fake. Most likely, he says, is that a typical pill may have 1/3rd to 1/4 the actual dosage.

It's certainly very odd to go from 320 to 74 in 5 months. I don't really know what to make of it.

Laura, re the levels he said he'd basically like to see the T and E swap positions! Which is the one type to which you are referring by the way?

It's depressing. I'm tempted to get my testicles removed tbh.

Hugs back x

Just to add to all this, I'm one of those people caught betwixt and between. I'm in the GIC system but not yet officially prescribed the meds nor officially monitored by the NHS. Can I wait? No. Without being melodramatic I'd rather not be on the planet than stop my meds altogether. That's the terrible tension in which so many of us find ourselves. The most important thing is that I'm currently safe. But the second thing is to get these darned levels right.

Today's appointment cost me £120 c. $150. Cheap I guess but also not cheap. To come under their care, including tests, will cost me £180 or $260 a month.

Units are very important in this.
If your previous measurements were in pmol/l and now are in pg/ml they are on about the same level.

I personally would aks for weekly estradiol valerate injections. It may be possible to adjust levels so no anti androgens are needed.

Another option may be an endo doing implants in Australia:
https://www.susans.org/forums/index.php/topic,209284.msg1855337.html#msg1855337


Its only one or two visits possibly. It may be possible to do blood tests locally and send them in.



Or you might think about bridging treatment.

https://www.susans.org/forums/index.php/topic,208198.msg1845578.html#msg1845578

https://gendergp.co.uk/

They also have materials to help with the NHS.


hugs

Quote from: Richenda on May 14, 2016, 11:41:53 AM
Today's appointment cost me £120 c. $150. Cheap I guess but also not cheap. To come under their care, including tests, will cost me £180 or $260 a month.

That seems amazingly expensive for Thailand. Its way more than anything in Sydney is costing me. Any idea why?

Well I don't want to bad mouth them as they have been really friendly to me but it's clearly pitched to westerners. Their take would be that 1. you're screened as often as needed. If you need 30 tests a month they will do that and 2. they source their meds properly.

But I agree it's very expensive. A few months of that and I could have my goolies whipped out ;)

Quote from: Richenda on May 14, 2016, 11:38:43 AM

Yes same measurement: down by a third.

Laura as I said, down by a third. It was in a good female range in December as confirmed by the test and endo report.

Very disappointing :(

Quote from: Richenda on May 14, 2016, 04:52:16 PM
Laura as I said, down by a third. It was in a good female range in December as confirmed by the test and endo report.

Very disappointing

Quote
Tests taken on a 12-hour water only fast including medications.

Hm 12 hours is a long time. Levels are very likely to be low.
Was it 12 hrs for both measurements ?

What is your kind of intake ? Swallowing or sublingual ?

I have heard from people on fina and duta having depressions.
Would you consider switching to injections ?
Usually people have good effects, and it may be possible to go without anti androgen.

With pills you might prefer bioidentical micronized estrogen.
An example is estrace or a generic.
Estradiol valerate would also be a possibility though it may take longer to dissolve.
Its usually written in the description what the pills contain.

Your endo should be able to provide both kinds.


hugs

Hi Laura,

I must admit I did wonder if the 12 hour fast had an impact as he told me not to take the meds either: so a total water only fast. The half-life of progynova is, as you probs know, max of 6 hours so the test would have been for latent oestrogen in the system I guess?

Progynova = estradiol validate which I take sublingually. Are you suggesting I consider switching from the e.v. then?

Yes, I'd definitely consider switching to injections. Injections of what, may I ask? I've not noticed any issues with Finasteride and depression, although I know some people do. I appear to tolerate it well. Dutasteride is very powerful: my ejaculate vanished entirely for instance, but I found it made me dizzy, which I now discover to be a well-known side effect that they don't like to publicise.

Sorry, don't think I actually explained in my first post. I take:

Progynova and Finasteride. Can't put dosages but nothing outlandish by trans standards.

Quote from: Richenda on May 14, 2016, 05:16:41 PM
Hi Laura,

I must admit I did wonder if the 12 hour fast had an impact as he told me not to take the meds either: so a total water only fast. The half-life of progynova is, as you probs know, max of 6 hours so the test would have been for latent oestrogen in the system I guess?

Progynova = estradiol validate which I take sublingually. Are you suggesting I consider switching from the e.v. then?

With sublingual intake levels rise fast, and drop after a few hours...
here is a graph showing that this has an influence on levels and that they are far away from an average after 12 hrs:
https://www.susans.org/forums/index.php/topic,186946.msg1665088.html#msg1665088

Estradiol valerate should be good if you want to stay on sublingual.

You might consider switching to injections because they can make for higher levels and it may be possible to go without anti androgen.

Often endos test levels two to three days after injections. Its possible testo levels may be lower then.

Quote
Yes, I'd definitely consider switching to injections. Injections of what, may I ask? I've not noticed any issues with Finasteride and depression, although I know some people do. I appear to tolerate it well. Dutasteride is very powerful: my ejaculate vanished entirely for instance, but I found it made me dizzy, which I now discover to be a well-known side effect that they don't like to publicise.

Injections of estradiol valerate. It may stay longer in the system than other forms.
One example might be progynon depot.
Another might be multidose vials.

Just talk about it with your endo.


hugs

Quote from: Laura_7 on May 14, 2016, 05:34:44 PM
With sublingual intake levels rise fast, and drop after a few hours...
here is a graph showing that this has an influence on levels and that they are far away from an average after 12 hrs:
https://www.susans.org/forums/index.php/topic,186946.msg1665088.html#msg1665088

Blimey!! That's amazing. Wow. A question though: for tests should we be reliant on intake levels i.e. those that are spiked by intake or by residuals in the system?

It does kind of explain the difference though. In December my tests were a couple of hours after my progynova intake.

Quote from: Richenda on May 14, 2016, 05:42:53 PM
Blimey!! That's amazing. Wow. A question though: for tests should we be reliant on intake levels i.e. those that are spiked by intake or by residuals in the system?

It does kind of explain the difference though. In December my tests were a couple of hours after my progynova intake.

With sublingual intake your levels are alwas spiked.

So imo most sense would make a test after a few hours to have some kind of average between spikes as a result.

Yes of course a few hours after intake levels are still higher.
That would explain the difference.

If you changed anti androgens that would explain some male features coming back.

Quote from: Laura_7 on May 14, 2016, 05:34:44 PM

Just talk about it with your endo.

Not being polemical, but I wonder for how many of us 'having an endo' is an aspiration we never attain? In Thailand endocrinology has historically been little studied and wasn't an available discipline to study within medicine. In the UK, if you are in the GiC / NHS system the people to whom you are referred from your GP are primarily psychiatrists (which I think is dreadful). These Psychs may have branched into endocrinology but that's not their first subject, nor do the guidelines come from that angle. It's more about RLE and the psychological profile of the patient. Indeed you are expected to live in your 'chosen' gender before being prescribed meds, something in my view akin to sending a soldier to the front line in order to train.

I suspect the majority of us on here have to settle for less-than-perfect most of the time. It's part of that living on the edge of a knife.

So, concretely, what do I do? Do I shell out $260 a month for treatment I'm not 100% sure is right for me?Do I wait, wait, wait for the GiC hopefully to prescribe me? Or do I wander down to Boots the Chemist and change my meds as someone bearing my description might have allegedly been seen doing last night? ;)

That's why this forum is so helpful, providing everyone pitches in as much as possible. The fact is that, clinical testing aside, we probably collectively know as much as the professionals.

Just analysing and cross-referencing the results again it's not all bleak.

The FSH of 0.57 mIU/ml is extremely low against a normal male range of 1.5 to 12.4. This is the test that indicates sperm production, so I pretty much don't have any sperm. So something is clearly working. I suspect the T to DHT would look really good, but that still doesn't explain the relatively low E2 level. I say 'relatively' because the E2 reading of 74.2 pg/ml is still above male range of 25.8 to 60.7 albeit not where I'd hoped it would be. 12-hour fast?

Quote from: Richenda on May 15, 2016, 12:48:51 AM

So, concretely, what do I do? Do I shell out $260 a month for treatment I'm not 100% sure is right for me?Do I wait, wait, wait for the GiC hopefully to prescribe me? Or do I wander down to Boots the Chemist and change my meds as someone bearing my description might have allegedly been seen doing last night? ;)

That's why this forum is so helpful, providing everyone pitches in as much as possible. The fact is that, clinical testing aside, we probably collectively know as much as the professionals.

Imo its necessary to get informed yourself so you can dicuss with them. Or consider options.

You have a few options:
- you could look for someone doing implants in Australia or the us
- you could look for someone doing bridging treatment in the UK
- you could stay with the thai cinic and ask them for specific target levels and times when to achieve them.
An altenative to tablets would be injections of estradiol valerate with the possibility to go without anti androgens.
The possibility to go without anti androgens may also be there with implants.


hugs

Quote from: Richenda on May 14, 2016, 09:12:24 AM
Because I woke up one morning, just, with the world a tumble dryer, incapable of sitting up let alone standing, my blood pressure under the floorboards and my heart hardly beating. I nearly died. I'm not exaggerating. It wasn't finasteride or progynova.

That's what Spiro can do, or one of the things it can do, which is why I believe the NHS in Britain will not use it for MtF.

This was most likely due to low blood pressure when taking Spiro you need to drink a lot of water and eat extra salt. I had this happen I passed out my BP was 60/40 was taken to hospital and put on saline IV. Was scary as hell, but Dr. told me it was not life threatening. This happened early in my transition I was afraid to use any restrooms when I went out shopping with my spouse and I avoided drinking so as not to have go, apparently this is not a good idea when taking a diuretic.
stephanie

A few things to add:

- estradiol levels fluctuate over time and aren't useful in this context as science has not established an ideal level or range for us, purely speculative (nothing more). Levels in women can be anywhere from 20 - 75,000.
- FSH will reduce as E increases and with some anti-androgens so the more of either of these, the lower FSH will be and this will have an effect on spermatogenesis.
- half life of progynova (estradiol valerate) is actually around 13-17 hours as confirmed by this study.

Arzneimittelforschung. 1998 Sep;48(9):941-7.

"A randomized, single-dose cross-over study in 32 postmenopausal women was performed to demonstrate bioequivalence of two estradiol valerate containing formulations"

"The terminal elimination half-life of estradiol was calculated at 16.9 +/- 6.0 h (Test) and 15.0 +/- 4.8 h (Reference)"

- it's normal your T levels are relatively high since you are not taking enough E and no anti-androgen that reduces T. There are alternatives to Spiro like bicalutamide, that block androgen or higher E through injections.

Please have a doctor address your concerns and be safe. 

Quote from: Stevie on May 15, 2016, 10:14:30 AM
This was most likely due to low blood pressure when taking Spiro you need to drink a lot of water and eat extra salt. I had this happen I passed out my BP was 60/40 was taken to hospital and put on saline IV. Was scary as hell, but Dr. told me it was not life threatening. This happened early in my transition I was afraid to use any restrooms when I went out shopping with my spouse and I avoided drinking so as not to have go, apparently this is not a good idea when taking a diuretic.
stephanie

Wow Stevie that's scary. I've since heard of some people who never woke up again from that issue :(

The day before it happened was very hot and I was very dehydrated. Bingo.

I think I may have fathomed some of the potential reason for the E to have dropped so sharply.

I'm taking dicloxacillin for a belly button piercing infection. It's actually the only med the doctor told me to continue, so I took it 2 hours prior to the blood test (and for 4/24 for 5 days prior). I've just discovered that there is a known interaction with all forms of oestrogen intake because it suppresses the bacteria in the stomach that are important for reabsorption of oestrogen in the blood stream. Hence why it becomes a risk of causing birth control pills to stop working.

This makes sense to me.

And just as an aside, I've been studying all the blood results carefully: there are pages of them. I've been flagged for low:

Haemoglobin
Hemacrit
Sodium
Chloride
Protein
Iron

Interesting. I went two months without red meat or, indeed, any meat. Going to address this.

Meantime I'm going to look into bicalutamide (as per KayXo's message) and reintroducing low dosage of dutasteride (1 per week raising to max 2 per week).

I just cannot see myself taking spiro again after what happened. I'd sooner have an orchiectomy.

Oh, re injections: it's not difficult to get them done in Thailand if I really wanted. I'll await my next GiC clinic before any radical steps like that.

p.s. breasts & nipples are large, sensitive and I'm lactating. Body hair has virtually stopped entirely and sperm has vanished. So I know something's right.

Quote from: KayXo on May 15, 2016, 04:30:07 PM
- half life of progynova (estradiol valerate) is actually around 13-17 hours as confirmed by this study.

Arzneimittelforschung. 1998 Sep;48(9):941-7.

"A randomized, single-dose cross-over study in 32 postmenopausal women was performed to demonstrate bioequivalence of two estradiol valerate containing formulations"

"The terminal elimination half-life of estradiol was calculated at 16.9 +/- 6.0 h (Test) and 15.0 +/- 4.8 h (Reference)"

Although administered sublingually the half-life of estradiol valerate is actually 3-4 hours and the 12 hour figure is 1/8th of peak concentration. Conclusion of the study:

'Conclusion:

Sublingual administration of micronized 17β-estradiol results in a rapid, burst-like absorption into the systemic circulation, yielding high E2 levels that fall rapidly over the first 6 hours.'

http://www.sciencedirect.com/science/article/pii/S0029784496005133

xx

Can you get implants in Thailand?

Yes I could but as with most things out here it would probably mean self-administering which is kind of scary :(

xx

Quote from: Richenda on May 16, 2016, 03:32:15 AM
Yes I could but as with most things out here it would probably mean self-administering which is kind of scary :(

I don't think it would be feasible to self-administer implants. It's more like a minor surgery, and not many people would be up for that. I wouldn't anyway.

Its worth it if you can find it as they last a very long time, 6+ months, and well over a year in time if you're lucky.

Ah thanks. They are definitely here because kathoeys are always telling me about it. Thy whack them into each other. That's Thailand for
you ;)

Quote from: Richenda on May 16, 2016, 07:34:24 AM
Ah thanks. They are definitely here because kathoeys are always telling me about it. Thy whack them into each other. That's Thailand for
you ;)

Well what about a cooperation with the thai clinic then ?
They could administer the implants and have levels tested.


hugs

Quote from: Richenda on May 16, 2016, 07:34:24 AM
Ah thanks. They are definitely here because kathoeys are always telling me about it. Thy whack them into each other. That's Thailand for
you ;)

I guess its not that difficult, but that's actually a bit scary.

Do they get blood tests?

No generally they don't. Actually I haven't met a single one who does and I've chatted to loads of them: as an aside I thoroughly recommend doing this if you're in Thailand or Cambodia. Some of them have such fascinating stories and it's not all about the sex industry at all. I was listening to one the other day telling me how she knew aged three that she wanted to transition.

But Thailand's carefree attitude to many things (not all, there's no same sex marriage) coupled with Buddhist rebirth/karma does tend to lead to a slightly reckless approach. It helps explain why the roads are the second most dangerous in the world. In our topic it also contributes to self-medication of over the counter medicines without supervision.

Laura, I've never had any desire to visit Australia (well perhaps Perth on the west coast) and anyway I can't really see the point in shelling out $500 dollars for a 10-hour flight + all the costs whilst there. As you say, I might as well go to the clinic here for six months for the same money. But I've lost some confidence in that clinic tbh. My spironolactone reaction is uncommon but not unknown and I wouldn't be suggesting someone who had experienced ultra low blood pressure with the drug to be going back on it, monitored or not. There are other options.

I'm going to look into either flutamide or bacilutamide as mentioned earlier, alongside a better form of oestrogen administration. I think these might very well provide a viable option alongside taking myself for regular tests in Bangkok and in the UK system when I can get there. I think these might provide the best and still safest overall options.

So, Flutamide or Bacilutamide. Any thoughts anyone? xxx

Well here's an oddity. 4 days on and after buying new oestrogen from Boots, my libido, which suddenly flushed back ten days ago, has vanished again and I have zero sperm production: it has just gone altogether now.

So maybe the clinic were right about dud tablets before. I was on that batch for about 10-14 days.

As a suggestion being an ex-spiro user, can you look into Cyproterone Acetate as your AA since it's a lot more potent in reducing T. It actually stops your body from producing LH which in turn signals your body to stop producing T if I have read that correctly.

I was on spiro for 1yr and half with very bad side effects. I have switched to CPA/Adrocur and never looked back. I recently had my blood work done and I was at 1800 pm/ol estradiol and 1.4 ng/dl T with 4 as my free T.

Yes, the estradiol was super high since I just took my E sublingually a few hours before my blood test.

With regular monitoring from a health professional, side effects will be managed.

Hope this helps and Good luck.

Quote from: Richenda on May 15, 2016, 07:55:30 PM
And just as an aside, I've been studying all the blood results carefully: there are pages of them. I've been flagged for low:

Haemoglobin
Hemacrit

Both of these naturally reduce due to HRT and are lower in females. Are you in female range or is male range still used?

QuoteSodium

Spiro?

QuoteOh, re injections: it's not difficult to get them done in Thailand if I really wanted. I'll await my next GiC clinic before any radical steps like that.

Injection is a radical step?

QuoteI'm lactating.

Are you stimulating your breasts? Otherwise, lactation would concern me. Did you check prolactin levels? It is sometimes a symptom of prolactinoma, a pituitary tumor, that has been associated with non bio-identical estrogen and cyproterone acetate.

Quote from: Richenda on May 16, 2016, 01:52:45 AM

Although administered sublingually the half-life of estradiol valerate is actually 3-4 hours and the 12 hour figure is 1/8th of peak concentration. Conclusion of the study:

'Conclusion:

Sublingual administration of micronized 17β-estradiol results in a rapid, burst-like absorption into the systemic circulation, yielding high E2 levels that fall rapidly over the first 6 hours.'

http://www.sciencedirect.com/science/article/pii/S0029784496005133

I thought you were taking it orally. The figures I provided were for oral intake.

Quote from: Richenda on May 16, 2016, 08:23:36 PM
I'm going to look into either flutamide or bacilutamide

QuoteSo, Flutamide or Bacilutamide. Any thoughts anyone?

Better is bicalutamide as there is no hepatoxicity, less side-effects and you only need to take bicalutamide once daily due to much longer half-life.

Urology. 1996 Jan;47(1A Suppl):70-9; discussion 80-4.

"Bicalutamide is a new antiandrogen that offers the convenience of once-daily administration, demonstrated activity in prostate cancer, and an excellent safety profile. Because it is effective and offers better tolerability than flutamide, bicalutamide represents a valid first choice for antiandrogen therapy"

Arch Ital Urol Androl. 1999 Dec;71(5):293-302.

"As regard as pure antiandrogens clinically important adverse events including gastrointestinal events, particularly diarrhea and occasional disturbances of liver function related to flutamide treatment and antabuse effect, problems with light-dark adaptation and rare interstitial pneumonitis related to nilutamide indicates the bicalutamide, due to its better tolerability profile, together with its once-daily oral administration regimen, could be considered the antiandrogen of first choice"

Fertil Steril. 2012 Oct;98(4):1047-52.

"Hepatotoxicity is a rare but possible event using low- and ultralow-dose regimens of flutamide."

Quote from: April_TO on May 17, 2016, 08:32:08 AM
As a suggestion being an ex-spiro user, can you look into Cyproterone Acetate as your AA since it's a lot more potent in reducing T. It actually stops your body from producing LH which in turn signals your body to stop producing T if I have read that correctly.

Cyproterone acetate can cause depression in some, has been associated with prolactinomas and meningiomas, interferes with adrenal steroidogenesis and can adversely affect coagulation. In some, it can also cause too much weight gain and extreme tiredness. At high doses, it can be hepatotoxic. Based on all the studies and reports I read, I personally don't consider this anti-androgen to be the best out there and there are better, safer alternatives like bicalutamide, lhrh agonists and E injections.

My 2 cents...but I'm not a doctor. You need to research this and discuss this with a doctor.

Wow thanks for such detailed replies April and KayXo.

First up Cyproterone Acetate. Yep I'm not keen. I took it briefly whilst out here last year and did not enjoy the effects of it. Lots of Thai kathoey use it either in the unmentionable form or alone with separate androcur. I've got to say, I'm not a fan and do think the side effects are worrying.

Interesting about the lower Haemoglobin & Hemacrit from HRT. I didn't know that. The low sodium: I haven't taken spiro for over a year. It's probably sweating in the Thai heatwave.

Injections: yes I do think it's quite radical, especially if unsupervised.

Breasts: confession, yes I stimulate them. Actually I use a breast pump 2 x day so I guess that's why? ;)

Estradiol valerate: I do indeed take it sublingually.

I am really interested in bicalutamide. I've got to say that I'm leaning 90% that way.

I like the way KayXo you said I need to research and discuss with a doctor. My own 2 cents is that's often how we do it. A lot of doctors won't have trained in transgender care and may even have less background knowledge than we do. When I saw my GP she was great and dialogued with me: she asked me what I knew about certain regimes and we negotiated. She was really impressed that I took the oestrogen sublingually (protecting the liver). My view is that doctors are at their best for us in the realm of endocrinology i.e. monitoring levels of all the key indicators. They work with us not dictating to us and that's important. My biggest gripe is the way the UK set up works. I'm in the GiC system but they won't yet prescribe the meds. To me that's craaaaaazy. How many of us are left to self-med as a result? That's the reality and we can tell people off, place as many caveats as we like, but the fact is that lots of us do self-med. The key thing I've learned is that, if we do have to be in that situation, we should be monitored.

All of this is temporary though. I want GRS and that's my primary focus now: https://www.susans.org/forums/index.php?topic=209474.new;topicseen#new

xx

Quote from: Richenda on May 17, 2016, 06:58:33 PM
Injections: yes I do think it's quite radical, especially if unsupervised.

Plenty of girls (including myself) do them (supervised though), nothing uncommon or radical about it.

QuoteBreasts: confession, yes I stimulate them. Actually I use a breast pump 2 x day so I guess that's why? ;)

Most probably, yes.

QuoteShe was really impressed that I took the oestrogen sublingually (protecting the liver).

Bio-identical estrogen will likely NOT harm your liver, alcohol or acetaminophen is significantly more harmful to your liver, so is sugar. Clotting may slightly be less affected but a different matter.

Studies have shown high doses of non bio-identical estrogen to affect liver function.

QuoteInjections: yes I do think it's quite radical

It may look that way first.

But its one stab per week, compared to daily intake of pills.

And it can make for anti androgens to fall away, which have side effects and also need to be taken.

There are multidose vials so it may not look too uncommon if crossing borders.

And it may be relatively cheap.

You may talk it through with the clinic. It may be possible you have well feminized until the NHS even starts :) .

hugs

The clinic don't use them Laura (they use gel) and I'm not travelling 160kms and paying $260 a month just for the privilege of asking how to stick a needle in. That's not feisty back, promise, just the reality of the situation.

They're intra muscular, right?

I just have no experience with them so the most 'radical' part for me is the fairly inevitable self-med and self-administration it would require out here in Thailand. I'm not sure if the NHS in the UK use them so that's another possibility.

What happens if you have a reaction? Or the dosage levels are haywire? Many questions.

Quote from: Richenda on May 18, 2016, 04:53:00 PM
The clinic don't use them Laura (they use gel) and I'm not travelling 160kms and paying $260 a month just for the privilege of asking how to stick a needle in. That's not feisty back, promise, just the reality of the situation.

They're intra muscular, right?

Have you asked them if they would oversee injections without anti androgens, keeping testo levels in the female range ? They might be interested, it may be a niche for them. Imo there are advantages they could offer other people too.

Its intramuscular but quite common, maybe a doctor from the clinic or a nurse could show you how it is done.

I personally would definetly ask the clinic about it. The same about implants, if they are available locally.

If they do gel this may be the reason they are more pricey. Its possible its not easy to come by there and considered premium.


hugs

That clinic is a business, primarily aimed at male body building which operates a flat rate non-negotiable $260 a month (I asked). It's 120 miles or 4 hours from my home which is admittedly less far than flying 5000 miles to Australia. The nurses seemed lovely people but for reasons already set out the clinic's not the right choice for me.

For those recommending injections, I'm guessing you mean as opposed to implants, which were also mentioned earlier, right? Can you be really specific without going into dosages? Exactly what are you recommending? Which brand are we talking about? As an aid to answering there are three injections currently available in the UK: http://www.nhsdirect.wales.nhs.uk/encyclopaedia/c/article/contraceptiveimplantsandinjections/

The reason I'm asking for specifics is based on how things work in Thailand and possibly when I see the UK GiC too. There's a sort of two-way process about this akin to what KayXo you were hinting. If I go to a doctor or nurse in Bangkok forearmed with some ideas, they will be able to talk it through with me and assist with the injection if necessary.

As for the anti androgen I'm going to give bicalutamide a go and will keep on with my finasteride. Yes.

Interesting thread on injections: https://www.susans.org/forums/index.php/topic,97015.100.html

Quote from: Richenda on May 19, 2016, 12:51:01 AM
If I go to a doctor in Bangkok

There are basically two forms of injectable estrogen, one is estradiol valerate which may be of advantage because it tends to stay longer in the body (less faster metabolized).
One brand name would be progynon depot.
Additionally there are different forms of suspension oil, cotton seed oil, sesame oil, etc. If there should be adverse reactions a different form might be tried.
There are resources on the internet showing the injection process for trans people. As said the first time a doctor or nurse should be able to show you.
Warlockmaker and I have given you hints to transgender clinics in Bangkok. Telling them exactly what you want should help them start you out. Again I also would consider implants as you say they are also available there. You might ask for quality products if possible, not the cheapest ones because they might make for a more stable release.
A good clinic or doctor should be able to help you. Just talk to them imo.

hugs

That's really helpful Laura: thank you. I'm back to Bangkok tomorrow. I'll wait and see if anyone adds to yours then go and seek out a medic to do the deed.

Brilliant :)

Kind of off topic, but have you been to visit the various SRS surgeons while you are there?

Hi not yet but I have been in touch by email. If I can go ahead this autumn then I'll do my homework though I know there are some justifiable favourites with forum members here.

Wow I've found a great clinic in Bangkok. They will do me regular tests and the prices are excellent.

The drug regime is interesting. The prescription for the IM hormone injection is two vials. One is estradiol valerate Progynon Depot 10mg/1ml

The other vial is Proluton Depot (hydroxyprogesterone).

Would you advise taking both or just the estradiol?! That kind of finer detail is outside their expertise: the prescription comes with both vials.

Quote from: Richenda on May 21, 2016, 06:39:12 AM
Wow I've found a great clinic in Bangkok. They will do me regular tests and the prices are excellent.

The drug regime is interesting. The prescription for the IM hormone injection is two vials. One is estradiol valerate Progynon Depot 10mg/1ml

The other vial is Proluton Depot (hydroxyprogesterone).

Would you advise taking both or just the estradiol?! That kind of finer detail is outside their expertise: the prescription comes with both vials.

Imo bioidentical progesterone as capsules and proluton depot are forms of progesterone that may be considered.

There are studies showing for fully developed breast tissue progesterone may be necessary. It may also help with mood.
I personally would use it. Its present in the hormone setup of cis females.


hugs

That's fab: thank you so much Laura :) x

Quote from: Richenda on May 21, 2016, 06:39:12 AM
Wow I've found a great clinic in Bangkok. They will do me regular tests and the prices are excellent.

Would you mind posting the name/address of this clinic, or pm it to me. You never know when it might be useful. Others may benefit as well.

Hi, yes of course. This is the clinic: http://www.brianet.com/en/

It's close to Lad Prao which is on the MRT line. Prices are extremely competitive as can be seen from the table of comparison: http://biohacked.net/getting-blood-tests-in-bangkok-private-labs-vs-hospitals/

Thanks

Both the estrogen and progestogen appear to be good choices. 7-10 days interval between injections for both seems to be optimal, based on studies and anecdotal evidence. Some may do ok with even greater interval for Proluton.

Too much Proluton (progestogen) relative to Progynon (estrogen) may result in oily skin, less than optimal breast development as progestogens have some anti-estrogenic effect so watch out for those and also headaches, irritability, pms symptoms, less than optimal feminization.

Best of luck. :) And discuss with health professionals so that all may be safe.

That's really helpful: thank you.

I had a big hot flash off the IM oestrogen last night. I guess a little more of the Depot dissolved at that moment :)

Does anyone have a link to the bioavailability of injections? I saw it a few days ago but failed to note the link and can't now find it. I'm specifically after injections of oestrogen, preferably the estradiol valerate version. Thanks in advance if anyone can help. x

The bio-availability should be 100% but slowly released into the blood over days to weeks.

Quote from: April_TO on May 17, 2016, 08:32:08 AM
As a suggestion being an ex-spiro user, can you look into Cyproterone Acetate as your AA since it's a lot more potent in reducing T. It actually stops your body from producing LH which in turn signals your body to stop producing T if I have read that correctly.

I was on spiro for 1yr and half with very bad side effects. I have switched to CPA/Adrocur and never looked back. I recently had my blood work done and I was at 1800 pm/ol estradiol and 1.4 ng/dl T with 4 as my free T.

Yes, the estradiol was super high since I just took my E sublingually a few hours before my blood test.

With regular monitoring from a health professional, side effects will be managed.

Hope this helps and Good luck.

April I've just realised on the cusp of taking bicalutamide that I've never actually taken straight Androcur. I checked back my medical records and the one I used was Diane 35 which, as we know, is dangerous and I would never go near again. (Note, we're allowed to mention it in order to warn others: https://www.susans.org/forums/index.php?topic=19242.0)

So now I'm in a dilemma. On advice mainly from Kay I've forked out for a pretty expensive private prescription of bicalutamide but having dug deeper into it, have some reservations. My physician doesn't know much about bicalutamide, especially in HRT use. Maybe I should ask him about Androcur instead?

Quote from: Richenda on June 01, 2016, 09:17:53 PM
On advice mainly from Kay I've forked out for a pretty expensive private prescription of bicalutamide but having dug deeper into it, have some reservations.

I don't advise as I am NOT a doctor. I share information and my own personal opinion which you can then use to further explore the matter. You should follow your DOCTOR'S advice and do your own research as sometimes doctors are also not always right. Discussion with them is useful. In the end, you are responsible for your own actions. We are all adults here.

Good. But to be fair, Kay, you have championed bicalutamide all over the internet, rather carelessly declaring it to be a 'safe drug' when that is, at the very least, unproven. The links I have posted raise concerns. I think you should be much more circumspect in the future about advocating its merits. It is so untested and unused in our MtF world that I want to caution those who read your posts to be careful. I, for instance, had a very nasty reaction to it.

Quote from: Richenda on June 16, 2016, 12:43:09 AM
Good. But to be fair, Kay, you have championed bicalutamide all over the internet, rather carelessly declaring it to be a 'safe drug' when that is, at the very least, unproven.

I was basing myself on the following, and I take special care in making assertions. I also make it clear I am not a doctor and I share information/studies for others to come to their own conclusions with their doctors.

Urology. 1996 Jan;47(1A Suppl):70-9; discussion 80-4.

"To evaluate bicalutamide as a therapy in nearly 3000 patients with advanced prostate cancer and to determine the dose-ranging, pharmacodynamic, and pharmacokinetic properties of bicalutamide. To evaluate bicalutamide as a monotherapy or in combination with luteinizing hormone-releasing hormone analogue (LHRH-A) therapy."

"With a total exposure of > 2800 patient-years, bicalutamide has been shown to be a well-tolerated therapy with a low incidence of treatment-related withdrawals."

"Bicalutamide is a new antiandrogen that offers the convenience of once-daily administration, demonstrated activity in prostate cancer, and an excellent safety profile."

Eur Urol. 1994;26 Suppl 1:15-9.

"Over 3,000 men, the majority of whom were patients with prostate cancer, were treated with Casodex (ICI 176,334), an oral anti-androgen, at doses ranging from (...) daily, corresponding to a total exposure to the drug of over 1,500 patient-years"

"Over this period, the tolerability of Casodex and its effect on quality of life were closely studied. Information on tolerability is presented from three large randomized trials of Casodex"

"The most commonly reported adverse events were those that would be expected with an anti-androgen (i.e. breast tenderness, gynaecomastia and hot flushes). Overall, Casodex was well tolerated; there were no reports of light/dark adaptation problems or pulmonary fibrosis, and only one case of alcohol intolerance, which was not considered by the investigator to be treatment related. Only 0.3% of patients in the whole trial programme had to be withdrawn because of changes in liver function, and there were no clinically significant changes in mean liver function tests."

Eur Urol. 1998;33(1):39-53.

"To evaluate the efficacy, tolerability, endocrinological effects and the pharmacokinetics of Casodex, when given as monotherapy"

"A total of 390 patients with advanced prostate cancer were treated for a minimum of 12 weeks with a daily monotherapy dose of Casodex."

"Casodex was well tolerated at all doses with no effect on haematological or cardiovascular parameters and no effect on renal function."

"Casodex has a favourable side effect profile compared with the known safety profiles of other antiandrogens and has demonstrated intrinsic efficacy."

AND A RECENT STUDY:

Expert Opin Drug Saf. 2014 Nov;13(11):1483-99.

(from full article)

"Diarrhea has been reported in only 2 – 6% of patients in Bicalutamide monotherapy studies [29-31,43,44] and only isolated cases of elevated liver enzymes were observed [67]. To date, only one case of Bicalutamide-induced hepatic failure has been reported in the literature [68]. This hepatic failure was attributed to Bicalutamide because of the absence of other etiologic factors, the temporal relation with drug administration and the resolution of hepatitis following drug discontinuation [68]. However, the authors note that the patient was previously treated with Cyproterone and Flutamide and hypothesize that these drugs might have sensitized the patient to Bicalutamide toxicity [68]."

"Interstitial pneumonitis induced by Bicalutamide is an extremely rare event [69]."

Given the above, I consider this anti-androgen quite safe but as with most non native molecules, there are risks but I find these are very low. I'm sorry you experienced negatives with this drug (were you taking a high dose?) but there is no guarantee nothing will happen. Overall though, the drug seems quite safe.

QuoteThe links I have posted raise concerns. I think you should be much more circumspect in the future about advocating its merits. It is so untested and unused in our MtF world that I want to caution those who read your posts to be careful. I, for instance, had a very nasty reaction to it.

Studies have shown good tolerability in men (also XY), of an advanced age and stricken with cancer, at high doses. This is why I personally consider this anti-androgen to be relatively safe for our population. As always though, I repeat, I'm not a doctor.

No I was taking a low dose.

We can trade studies but I won't, except to say this. Yours from 1994 and 1996 have been superseded since by a significant number of more recent post-trial studies that raise concerns about the safety of this drug. This is a potent anti-cancer drug, has only ever been approved for that purpose and only ever trialed for that purpose. I posted links to these more recent post-trial studies which raise safety concerns and will leave it at that. It may be fine for some people. It might kill others.

I urge people to be very careful when a non-medic declares a drug to be 'safe.'

Quote from: Richenda on June 16, 2016, 08:56:26 PMYours from 1994 and 1996 have been superseded since by a significant number of more recent post-trial studies that raise concerns about the safety of this drug.

The last study provided is from 2014, not much appears to have changed.

QuoteIt might kill others.

Men with prostate cancer are more likely to die, for obvious reasons. Transwomen aren't in the same situation.

QuoteI urge people to be very careful when a non-medic declares a drug to be 'safe.'

I consider bicalutamide to be relatively safe. Studies are provided to support statements, further research is encouraged, and doctor monitoring as well. Anyone who declares anything should be questioned, I think, whether medic or not. Health professionals are fallible and human beings too.