Susan's Place Transgender Resources

I just read about this study concerning HRT and breast development in a Reuters article:

https://www.reuters.com/article/us-health-lgbt-breasts-hormones/transgender-women-may-get-small-breasts-with-hormones-idUSKBN1E82UT

I wanted to see what others thought about this.  Out of a study group of 229 transwomen, it found that "

• nly 21 of the trans women attained a bra size of an A cup or larger after one year of hormone therapy."
  
  That means that 90% of the transwomen in the study could not even get to an A cup.  Now I'm sure that many of us may have expectations that are too high going into HRT, but this doesn't sound like the results I would expect after reading of others' experiences on here.  For some reason, I thought that transwomen on HRT obtained breast development that was more on par with ciswomen. 
  
  Am I wrong?  Is there something about this study that's off?   I know HRT results are always a YMMV thing, but I just felt like something may have been off in the article. 
  
  
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Well, it's a European study, so I'm not familiar with the protocols over there, but I do think in the US many HRT medical providers are hesitant to give the doses that are required to achieve maximum feminization.

I've heard of many trying to aim for a mid cis-women level of Estradiol around the 100 pg/mL range.
They seem to ignore the fact that we're NOT cis-women and have X number of years of "man" growth we have to reverse.
They also ignore the fact that cis-women's level go as high as the 400s depending on the time of their cycle.

Also, they only studied a year of HRT? It takes cis-women around 10 years to achieve maximum breast growth.
I'm not quite sure what the expectation if the study was with such a short time frame.


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Yeah, those numbers seem off. Either the time frame, the dosing, or the sample itself (too many girls with no body fat to have breasts, etc.).

Quote from: LexiDreamer on December 17, 2017, 06:17:33 PM
Well, it's a European study, so I'm not familiar with the protocols over there, but I do think in the US many HRT medical providers are hesitant to give the doses that are required to achieve maximum feminization.

I've heard of many trying to aim for a mid cis-women level of Estradiol around the 100 pg/mL range.
They seem to ignore the fact that we're NOT cis-women and have X number of years of "man" growth we have to reverse.
They also ignore the fact that cis-women's level go as high as the 400s depending on the time of their cycle.

Also, they only studied a year of HRT? It takes cis-women around 10 years to achieve maximum breast growth.
I'm not quite sure what the expectation if the study was with such a short time frame.


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my doctor told me the other day that he usually aims for the 100-200pg/mL range, and I'm only around 47 right now :( but yeah, a lot of factors seem to be missing from this article, they should have done it over 4 or 5 years, 1 is definitely way too short

According to Google, the average male chest is 42" and the average female chest is 36". The breast tissue volume for a D cup on an average women would be an A cup on an average man. So, over a one year period, I think they're reporting the results accurately.

I think using only a cup size is a poor way of relating breast tissue volume. You would think a scientist would realize that. :)

I totally agree with the others. This seems off! You can't do such a short time. How many ciswomen after a year of puberty reach an a and I think you would find a correlation to each other. Most doctors don't do top surgery until after 1 year mark because of the fact that we are still growing after a year. Plus what kind of women did they interview? All skinny or what. I would like to see how they obtained their results and figures and things. It's one thing to post percentages and it's totally something different to show your whole results and how you obtained them.

Quote from: LexiDreamer on December 17, 2017, 06:17:33 PM
It takes cis-women around 10 years to achieve maximum breast growth.
I'm not quite sure what the expectation if the study was with such a short time frame.

My sentiments exactly.

My understanding is normal breast growth is up 5-6 years for cis women. I am b cup and about 18 months on HRT. I don't have the $$ for breast Augmentation and will be happy to make it to a decent c cup in the next couple of years fingers crossed. I still expect growth for at least the next  2-3 years. I have read a number of stories where girls have had augmentation at the 2 year mark only to find they increase by at least one more size due to long term growth.

I read the entire study. For one, yes, it's too soon to conclude anything. It takes several years before breasts reach their final size and even then, they will continue to change for an entire lifetime in accordance with several factors (diet, stress, age).

Segundo...estradiol levels were quite low. Mean estradiol levels in the 4th quartile, where those were the highest, were 567 pmol/L (154 pg/ml) and lowest were 110 pmol/L in the first quartile (29 pg/ml).  Is it any surprise that breast development was poor? Except for oral estradiol, the doses prescribed were typical of those prescribed to menopausal women to stave off vasomotor symptoms and maintain bone density but perhaps (IMO, most certainly) too low to trigger development of female secondary sexual characteristics (i.e. breast growth).

Given our context and history, it may be perfectly plausible that, at least some of us need higher levels and doses to achieve the same degree of breast development (or even greater, to fill out our chests) as ciswomen. For the most part, we have much lower growth hormone levels at the moment of development, are older (different telomere length), and were exposed to a very different hormonal environment in-utero which may possibly (based on studies in rats/mice) make us less sensitive to estrogen.

Horm Metab Res. 1994 Sep;26(9):428-31.

"Estradiol increased from 34.8 +/- 7.5 pg/ml to 3226 +/- 393 pg/ml after 3 months and to 2552 +/- 254 pg/ml after 6 months, respectively, in group A." (six patients, 49.5 +/- 4.8 yrs old)

"In group B estradiol increased from 27.8 +/- 6.5 pg/ml to 3028 +/- 728 after 3 and to 2491 +/- 684 pg/ml after 6 months."

"The treatment was well tolerated. No adverse effects were seen, the patients expressed a feeling of particular well being, 3 of them wanted to have the injections repeated and none of them wanted to stop treatment because of troubles or side effects."

"Pseudopregnancy had been used in sterile patients with hypoplasia of the uterus and for hypoplasia of the breasts (Kaiser 1959; Lauritzen 1992)."

"We have experience with therapeutic pseudopregnancy in about 200 patients with mammahypoplasia (Lauritzen 1992). Its rate of objective and subjective tolerance is excellent."

"Investigations of lipids, liver enzymes and haemostasiology to be published later will show the absence of unwanted metabolic effects of this regimen."

"The increase of bone density in our patients with gonadal dysgenesis was associated with an impressive secondary sexual development, especially of the breasts."

"In conclusion, our data show, that the treatment (...) by means of high parenteral estrogen-progestogen depot injections is effective. Virtually no side effects occurred. The therapy is well accepted by the patients."

"In addition, pseudopregnancy may be useful and effective in osteopenia and lacking secondary sexual development due to gonadal dysgenesis like in Ullrich-Turner syndrome (after completion of growth), where substitution doses of ovarian hormones may be not sufficient enough to guarantee satisfactory response."

Interesting study. I've been on HRT for 5 months and based on what I see in my family, I don't think I'll get much breast growth so I'm getting implants anyway, hopefully at the 1 year mark.

Searching for 'breast growth timeline' I found people documenting their progress, which is a lot more interesting to me than some half-baked study which misses about every obvious point you can name.

Speed of development seems to be all over the map, just like peoples' testimony here. 

Thanks for the usual detailed analysis, Kay.