Susan's Place Transgender Resources

I read the TOS and I think this is a kosher topic?

Anyways... So I have been going back and forth with my doctor on progesterone, which we both understand does not have a lot of clinical data behind it to show what kind of efficacy to expect (my HRT is prescribed by a dr that is part of the transgender practice at a large research university, so she did some digging locally and came up short). I have seen side effects reported of slowing breast growth, but I also see a lot of folks on here and other sites suggesting that it aided breast growth.

I am on spiro and estradiol and we are considering adding progesterone, so my question is if anyone who is on it has experienced any slowing of breast growth or other negative side effects? I appreciate hearing from others on this!

Nothing negative. I only take it 14 days out of the month and I do get moody right after stopping.

I did see a few positive effects ;-)

Oh: and as long as dosage or unsupervised use is not discussed, you can discuss medication. You are under professional care, so all good :-)

I cycle my progesterone 10days a month. I also did try all kinds of cycling it. Here are the results based on how my body react to it.

When I cycle it 20days a month or take it every single days with no off:
- Breast growth is more fuller
- My mind is somehow sharper
- My hair gets more alive
- gained me weight else where also specially in abdomen
- experiencing masculinizing effect specially on my fat redistribution on my face
- mood swings galore
- sleeping pattern is not good

When I cycle it 10days a month:
- not so much mood swings
- unnoticeable masculinizing effect
- dont get more food cravings
- seldom sleep issue
- hair gets only little dry

when not taking progesterone:
- mood is flat
- stable sleeping pattern
- no masculinizing effect
- hair is very dry
- always fresh and pretty

As you can see there are pros and cons when you take it. I did tried both oral and IM method of taking progesterone as well. My conclusion is you have to try it for yourself and see how your body reacts to it.

Hmm, I have been insatiably hungry since the last increase in estradiol (gained 10#, sadly, all in typical male areas sadly). Are you saying you had more cravings on progesterone?

I was on Provera which is kind of the same thing and I only took it 6 day out of the month. Initially it made me horny and hungry to the point that the doctor and I agreed to half the dose. Remember that in a woman, Progesterone levels go high during the time of the egg release so mother nature is preparing a woman to seek out a man I guess the food craving has something to do with either having the energy to outlast the man or preparing the body for pregnancy.   ;)

Well, scientifically , progesterone won't feminize your body tough, they just make breast cancer and thrombosis more likely.
https://transgenderteensurvivalguide.tumblr.com/post/108968885965/hello-i-was-curious-as-to-if-you-know-why-most

Quote from: Dena on September 23, 2017, 04:17:08 PM
I was on Provera which is kind of the same thing and I only took it 6 day out of the month.

It might be beneficial for those responding to be sure to clarify whether they're talking about Provera, medroxyprogesterone acetate, or Prometrium, a bio-identical progesterone. A lot of people use the terms interchangeably.

Quote from: Dena on September 23, 2017, 04:17:08 PM
Progesterone levels go high during the time of the egg release so mother nature is preparing a woman to seek out a man I guess the food craving has something to do with either having the energy to outlast the man or preparing the body for pregnancy.   ;)

It might be a dating response, "Sure, I'll go to dinner with you."  :)

Likewise I also took Provera for a period, and I think it helped contribute to a good bit of breast swelling.

--AshleyP

I have been on prometrium daily.  It has helped my skin and hair not be so dry.  It has helped quite a bit with fat redistribution.  My breast have gotten much rounder on it.  Also, I have noticed that my face has become softer looking on it as well.  I am currently experimenting with starting to cycle it instead of daily only because it makes me insanely hungry and is making gain almost too much weight.

I've only been on it a couple weeks and do think it makes me gain weight in the abdomen.  I'm going to cycle it as I'm not at my ideal weight yet, and still need to lose.

Bari Jo

I've read and researched quite a lot about its use in combination with HRT. There doesn't seem to be much consensus as to whether it helps or hurts breast growth one way or another. Depends on who you ask. Also let's ponder if the person taking it may have had just as much success without it. The hard core scientific research is scant to nonexistent.

In my case after a couple of years of HRT I added it, and as far as I can tell it made no difference. Wishful thinking could have as much effect as anything else.

I think we all want success but at what cost?

Leslie

Quote from: Leslie601 on September 24, 2017, 10:29:41 AM
I've read and researched quite a lot about its use in combination with HRT. There doesn't seem to be much consensus as to whether it helps or hurts breast growth one way or another. Depends on who you ask. Also let's ponder if the person taking it may have had just as much success without it. The hard core scientific research is scant to nonexistent.

In my case after a couple of years of HRT I added it, and as far as I can tell it made no difference. Wishful thinking could have as much effect as anything else.

I think we all want success but at what cost?

Leslie

This is kind of where the current thinking is in the academic community, that it neither helps nor hurts but can cause some increased risks. My dr is willing to do whatever I want (they are informed consent model, and seem pretty liberal about it), but I don't want another pill to remember to take if there's no real benefit. god know I carry around a small pharmacy in my bag these days!

Quote from: chinee on September 23, 2017, 03:17:31 PM
I cycle my progesterone 10days a month. I also did try all kinds of cycling it. Here are the results based on how my body react to it.

When I cycle it 20days a month or take it every single days with no off:
- Breast growth is more fuller
- My mind is somehow sharper
- My hair gets more alive
- gained me weight else where also specially in abdomen
- experiencing masculinizing effect specially on my fat redistribution on my face
- mood swings galore
- sleeping pattern is not good

When I cycle it 10days a month:
- not so much mood swings
- unnoticeable masculinizing effect
- dont get more food cravings
- seldom sleep issue
- hair gets only little dry

when not taking progesterone:
- mood is flat
- stable sleeping pattern
- no masculinizing effect
- hair is very dry
- always fresh and pretty

As you can see there are pros and cons when you take it. I did tried both oral and IM method of taking progesterone as well. My conclusion is you have to try it for yourself and see how your body reacts to it.

I also found that progesterone helped with making my hair/skin less dry, made it look brighter/better, temporarily improved my mood although tended to make me more depressed overall, made me gain TOO MUCH weight and made cellulite worse, made me quite bloated, made face look less feminine, temporarily made breasts more swollen and fuller. On it, I slept worse and often woke up in the middle of the night, also had muscle cramps at times and headaches.

I'm doing better without it and adding a little bit of testosterone (I'm post-op) has given me the benefits of progesterone (nicer skin/hair, increase in libido although weaker effect, mood is less flat). E + T is the perfect combo for me, my skin is the softest and in the best condition it's EVER been, I feel quite good, am losing fat in the abdominal region, sleeping soooo much better, feeling prettier/sexier and more feminine, sexual sensations are amazing and none of the side-effects of progesterone. No masculinizing effects either as the E is high enough to prevent this from happening. I do have to take a shower more often now cause my hair gets oilier faster and so what??!

Ciswomen tend to feel their best and sexiest at the time of ovulation and the days before as both E and T start to climb back up following their periods. :)

Quote from: Dena on September 23, 2017, 04:17:08 PM
I was on Provera which is kind of the same thing

There are very important differences between Provera and bio-identical progesterone as, in addition to triggering progesterone receptors, they have very different effects on other receptors which make Provera the riskier and less suitable progestogen.

QuoteRemember that in a woman, Progesterone levels go high during the time of the egg release so mother nature is preparing a woman to seek out a man

Progesterone levels really increase significantly at the time that the egg is already fertilized, past the date of copulation to prepare the womb and body for the implantation of a fetus/embryo. I believe both the increase in estradiol and testosterone actually trigger a woman to seek out a man as they tend to increase libido and make a woman feel good, sexy/attractive/feminine. I can attest to that as I feel better on E + T vs E + P.

QuoteI guess the food craving has something to do with either having the energy to outlast the man or preparing the body for pregnancy.   ;)

Lol, the latter. A woman gains weight, has more appetite to prepare her reserves for the baby to come and to help nourish the embryo/fetus.

Quote from: Undead Cat on September 23, 2017, 05:05:06 PM
Well, scientifically , progesterone won't feminize your body tough, they just make breast cancer and thrombosis more likely.

Studies have shown that progesterone does NOT increase breast cancer, nor does it affect coagulation or increase the risk of thrombosis as opposed to some other progestogens. It's important to differentiate between the various progestogens.

Quote from: jill610 on September 24, 2017, 12:07:31 PM
This is kind of where the current thinking is in the academic community, that it neither helps nor hurts but can cause some increased risks. My dr is willing to do whatever I want (they are informed consent model, and seem pretty liberal about it), but I don't want another pill to remember to take if there's no real benefit.

Those increased risks are with some other progestogens as bio-identical progesterone is quite safe in the vast majority of people. Remember, progesterone levels skyrocket during pregnancy and women aren't dying left and right. The problem is doctors group all progestogens together not differentiating between progesterone and other progestogens. Science has unequivocally shown its role in stimulating certain structures in the breast and making it look fuller, more mature BUT whether worthwhile in regards to its other, less desirable effects like gain weight or increased hunger, that is for the doctor and patient to decide together. I do better without, it seems and I've given it a fair trial, taking high doses for several years, continuously.

My endocrinologist did not recommend it.  He seems to swayed by the (limited) data suggesting increased risk of thrombosis and paucity of evidence suggesting that it helps in feminization.  Nevertheless, after 2 years of HRT, I had breast growth, but very male nipples.  I asked to start prometrium and he wrote the prescription.  I did it for a few months.  I didn't see anything specific in terms of breast growth, particularly the broadening of the areolae that I was hoping for.

Fast forward.

I'm now 1 week post breast augmentation.  As my implants haven't settled into the pocket and are medium/large, my skin is stretched fairly tight.  Already, my nipples are 50% larger in diameter.  YMMV, but I have concluded that the best thing for nipple development is a good load of breast mass behind them.

Quote from: rmaddy on September 28, 2017, 11:08:27 AMHe seems to swayed by the (limited) data suggesting increased risk of thrombosis

The increased risk of thrombosis has NEVER been observed with bio-identical progesterone. This specific hormone does not affect coagulation.

Quotepaucity of evidence suggesting that it helps in feminization.

There is, however, plenty of evidence pointing to progesterone's stimulatory effect of lobuloalveolar structures in the breast. It can also help with increasing fat in women who have trouble gaining weight. Each case is different, perhaps. Trying to remain objective about the whole matter.  ;D

QuoteI asked to start prometrium and he wrote the prescription.  I did it for a few months.  I didn't see anything specific in terms of breast growth, particularly the broadening of the areolae that I was hoping for.

Was dose high enough? Doctors tend to be VERY conservative, at times. I actually did notice an increase in nipple and areola size on it. I took a high dose as progesterone taken orally has poor bio-availability.

Quote from: KayXo on September 28, 2017, 11:15:03 AM
The increased risk of thrombosis has NEVER been observed with bio-identical progesterone.

Correct

Quote from: KayXo on September 28, 2017, 11:15:03 AMThis specific hormone does not affect coagulation.

That we know of.  The development and prescription of bioidentical progesterone is based on the speculation that molecularly equivalent hormones will not cause the same thrombotic risk as non-equivalent progestins.  In my opinion, that speculation is probably correct, but the track record of bioidentical progesterone is brief.  It is a relatively new drug.

Full disclosure.  I take it.  I may or may not continue.  I wasn't personally deterred by risk of thrombosis.  All I am saying is that it may be awhile before the promises of bioidentical progesterone are evidence based.

Quote from: rmaddy on September 28, 2017, 07:42:37 PMthe track record of bioidentical progesterone is brief.  It is a relatively new drug.

QuoteAll I am saying is that it may be awhile before the promises of bioidentical progesterone are evidence based

Progesterone is a hormone that is in existence for millions of years and secreted endogenously in high quantities during pregnancy, with levels up to 300 ng/ml in the blood, far higher than those reached when taking bio-identical progesterone at doses usually prescribed for transwomen. The risk of thrombotic incidents in absolute terms, during pregnancy, is VERY low, despite these very high sustained levels over the course of 9 months, around 0.1% for DVT, 0.01% for pulmonary embolism. This, with the dozens of studies confirming that the risk is not augmented with the use of bio-identical progesterone, is, in my opinion, all the evidence that we need to assert with enough confidence that progesterone has a negligible effect on coagulation.

I can attest to this, as well, as I was on a high dose of progesterone (and even higher dose of estradiol), and my clotting times remained normal during those 3 years.

Lots of great information here and the discourse really highlights the uncertainty in the professional and academic circles around efficacy. My dr has left the decision up to me, and it's unclear to me from this thread if there are any actual benefits aside from gaining weight, which estrogen alone is doing enough of job of for me (gained 10# in first two weeks of HRT, stable since then.  I had lost 120# before starting).


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Quote from: KayXo on September 29, 2017, 11:04:27 AM
Progesterone is a hormone that is in existence for millions of years and secreted endogenously in high quantities during pregnancy, with levels up to 300 ng/ml in the blood, far higher than those reached when taking bio-identical progesterone at doses usually prescribed for transwomen. The risk of thrombotic incidents in absolute terms, during pregnancy, is VERY low, despite these very high sustained levels over the course of 9 months, around 0.1% for DVT, 0.01% for pulmonary embolism. This, with the dozens of studies confirming that the risk is not augmented with the use of bio-identical progesterone, is, in my opinion, all the evidence that we need to assert with enough confidence that progesterone has a negligible effect on coagulation.

I can attest to this, as well, as I was on a high dose of progesterone (and even higher dose of estradiol), and my clotting times remained normal during those 3 years.

Clotting times do not accurately predict thrombotic risk.  And pregnancy, a high progesterone state, still is a risk factor for thrombosis.

Again, I take it.  I agree that the risk is very low.  It just isn't zero.  Cis women do not shy away from pregnancy because of progesterone risk.  I am not suggesting that trans women shy away from progesterone as long as they understand the risk. 

Quote from: rmaddy on September 29, 2017, 11:52:29 AM
Clotting times do not accurately predict thrombotic risk.

A study has shown that aPTT is strongly associated with thrombotic risk.

QuoteAnd pregnancy, a high progesterone state, still is a risk factor for thrombosis.

Risk of thrombosis is actually HIGHER post-partum when both progesterone and estradiol levels drop markedly, to almost nothing. The increased risk of thrombosis during pregnancy has been unequivocally attributed to the high levels of estradiol, not progesterone.

QuoteI agree that the risk is very low.

Considering progesterone levels are in the hundreds of ng/ml during pregnancy, that the absolute risk of DVT and pulmonary embolism is equal or less than 0.1% during pregnancy and that, at doses typically prescribed to us, levels of progesterone will be several fold lower, I personally consider the risk to be so low as to not even matter.

QuoteIt just isn't zero.

Contraception. 1987 Oct;36(4):373-402.

"No side effects have been reported as far as lipids profile, coagulation factors and blood pressure are concerned. Therefore oral micronized progesterone appears suitable for hormonal replacement therapy in various areas"

Climacteric. 2012 Apr;15 Suppl 1:11-7

"Micronized progesterone has also been shown not to increase the risk of venous thromboembolism"

Maturitas. 2015 May;81(1):28-35.

"When taken with oral or transdermal estrogens, no significant association of venous thromboembolism (VTE) with concomitant micronized progesterone"

Quote from: KayXo on September 30, 2017, 02:23:07 PM
A study has shown that aPTT is strongly associated with thrombotic risk.

I can get into of a discussion of why I don't think this statement means what you seem to think it means.  Diagnosis and treatment of thromboembolic disease is actually a significant portion of what I do for a living.  While I frequently use aPTT in the management of patients who have been diagnosed with PE or DVT, it does not enter into the workup at all in assessing their aggregate risk before the diagnosis is known.

Quote from: KayXo on September 30, 2017, 02:23:07 PMRisk of thrombosis is actually HIGHER post-partum when both progesterone and estradiol levels drop markedly, to almost nothing.

You are absolutely correct.  Post partum, additional risk accrues from tissue trauma, hemorrhagic loss of clotting factors, hemodilution and other factors.

Quote from: KayXo on September 30, 2017, 02:23:07 PM

Considering progesterone levels are in the hundreds of ng/ml during pregnancy, that the absolute risk of DVT and pulmonary embolism is equal or less than 0.1% during pregnancy and that, at doses typically prescribed to us, levels of progesterone will be several fold lower, I personally consider the risk to be so low as to not even matter. (emphasis added)

I don't disagree with that, but only on the basis of the words "I personally".  What makes me somewhat more skittish is that that your personal calculus could potentially be read as "don't matter in any case".  The collective experience of this and other transgender forums suggests that endocrinologists are still reluctant to prescribe progesterone to us.  Mine certainly was.  I don't think that this is because they are ignorant, anti-trans, or deceived by the wretched monograph by Dr. Curtis.  I think that there are two more significant reasons:

1.  They are reluctant to apply the results of studies on thromboembolic disease in pregnant women to the undeniably different population of transwomen on HRT. 
2.  They would like to more convincing evidence that progesterone actually makes a discernible difference to trans patients.



Let me ask you this.  I have tried to be really clear that I think your personal reasons for wanting to be on it are valid, and that I came to the same conclusion. What is the difficulty in accepting that the evidence regarding the risks and benefits of micronized progesterone is not especially deep?

Any kind of progesterone will still make you more likely to develop hormonal induced breast diseases like cysts, fibroids,  fibroadenomas,  adenomas, etc.

Cis women also suffer from cyclical breast pain so I'm sure Trans women do too.

Quote from: rmaddy on September 30, 2017, 03:23:15 PMThey are reluctant to apply the results of studies on thromboembolic disease in pregnant women to the undeniably different population of transwomen on HRT.

There are several studies in transwomen and in men (XY, like us) with prostate cancer of an advanced aged showing that high doses and levels of estradiol did not increase risk, actually decreasing it in those men prescribed transdermal estradiol. In addition, several other studies in ciswomen on high dose/levels of estradiol showed that the risk did not increase (or negligibly on high dose oral estradiol) and in general, proved to be quite safe. Doctors are usually ignorant of such studies but I do my best to share these with them, in person or by email.

Given such similar responses to estradiol in different populations as regards to the incidence of thromboembolic events, one can assume the same would apply to progesterone.

QuoteThey would like to more convincing evidence that progesterone actually makes a discernible difference to trans patients.

It could be YEARS until we find out what the effects are in transpatients and most probably, these effects would also differ from one individual to another. Such studies may also never be undertaken. As such, given what we already know about progesterone in ciswomen and the anecdotal evidence in transwomen, one can be quite confident that it will very rarely lead to serious side-effects (and assuredly much less likely to do so compared to another progestogen prescribed to transwomen for decades, cyproterone acetate) so that this is not a good reason NOT to prescribe it.

Being so reluctant to prescribe it because of potential side-effects when non bio-identical drugs with a much riskier profile are routinely prescribed to transgender women worldwide makes absolutely no sense to me and seems quite strange.

QuoteWhat is the difficulty in accepting that the evidence regarding the risks and benefits of micronized progesterone is not especially deep?

The evidence so far gathered, as far as I am concerned, points to progesterone being quite safe relative to other drugs currently prescribed to transwomen and seems substantial enough. Just the fact that doctors are ready to prescribe other, riskier drugs to transwomen justifies at least trying to prescribe this seemingly, safer, bio-identical hormone to transwomen who may or may not benefit from it. Some transwomen have anecdotally reported benefits from it so why deprive other women who may potentially also benefit from it when the evidence in support of its safety seems, at least to me, pretty strong and substantial, even if only in ciswomen, pregnant or not. I doubt, for reasons stated above, the response in transwomen would be that much different as regards to potential serious side-effects.

Being this prudent about prescribing such a hormone, given all of the above, is irrational. Fortunately, more and more doctors share my view and do prescribe progesterone to their patients, if they ask for it. :)