Susan's Place Transgender Resources

I was DIY for 30 years. At 59, I decided to "come clean" to all the doctors, start taking their actual advice, and all that. (Yeah, yeah. I know. Really...) Both GP and Endo were very supportive in every way. And, they both said, "No More E. There is too little information out there about the effects, but the risk of DVT over 60 is very high. And that is likely independent of sex." So, I stopped the estradiol and remained on Spiro about 11 months ago.

And, I don't feel like myself. I haven't felt "normal" for the last 6 months. It's very difficult to put my finger on the precise symptoms, by the big ones are insomnia, tired, and feeling blah/depressed.

I am going back to the Endo later this week for the quarterly appointment. I don't think I will beg, but I thought I would share anecdotal evidence from y'all about whether you continued HRT past 60, and if so, were there any adaptations, concerns, or problems?

Thanks for your insights!

K

I'm into my mid 60's and still on E via patches.  My doctor recommended this method due to age, DVT, and other medical concerns I have.  There are lots of us older women on E.   

I asked my endo about this and he said as long as your body doesn't have any problems with hrt he just keeps it the same. He does blood tests to check health, things like liver function, etc. He dose really high estrogen blood levels too. Plus 3500 trans patients and decades of experience.

Personally I'm not stopping hrt unless I'm dying, and maybe not even then.

I'd get another doctor.

I am 68 and I take my E sublingual. I know the risks, but I feel the benefits outweigh the risks.

If you are indefinitely on a T-blocker without any E, I'd be concerned about an increased risk of osteoporosis unless your test results somehow show the correct balance.  In fact it is bone density that pushed me into a faster transition - when I realized I had lost 4 inches (10cm) height between college and my 50's.  My body's endocrine system wasn't producing enough T or E, and I was told I would need to take one or the other (easy decision).  When I started HRT my endo ordered a bone density test to set a baseline.

Frankly if I was faced with your situation I would look for a different doctor. 

No wonder you feel crappy. I get from your message, that your body still produces T (spiro?), so you don´t have any hormones in your body and to keep us going, this body needs hormones, be it T or E...though I guess you would feel crappy too, if the T would rise.

Get another doctor.

If a doctor refuses you all HRT without a medical reason, you should consider another doctor. I went that route and was off HRT for 10 years. I am now back on it but at about half a transition dosage. I was careful with my calcium intake so it appear my body didn't suffer but there were other effects. My body fat migrated to my belly and I lost it from my breasts, hips and the worst was from my face. My face looked gaunt and it aged my appearance. Your estradiol should at least test in the menopause range, preferably around 40-60 pg/ml. I am 66 and on pills without any harmful effects though I can understand it if the doctor wants you to use patches or some other delivery system.

You're feeling like crap because you are hormone-deprived - you need adequate levels of either E or T to operate. I'd suggest to your doc they need to hit the books, as the crap they've spouted was what I got taught 20 years ago and I know things have changed since then..

At your age, I'd avoid oral meds. However, you should find gel or patches work fine and are fairly safe. IM injection is also an option, depending on location.

I'm 58 and my Dr has me on a pretty high dose of oral E.  As long as you're healthy and taking care of yourself the risk is negligible.


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Patches have shown to be safe in older populations and in populations at risk. A doctor must be abreast of the most recent studies to most effectively treat their patients. They may be thinking of oral conjugated equine estrogens, DES and/or ethinyl estradiol. Bio-identical estradiol is a whole other ball game!

Several studies have been published about the use of estrogen patches in men with prostate cancer who needed high estrogen to reduce testosterone to castrate levels. Despite high estrogen levels in these men, aged 49-91, and with cancer, there was no increased risk of DVT. A reduced risk was even noted. :)

Since the 1930's, estrogen pellets have been used in menopausal women, in some women, for the rest of their lives and, in general, such studies find no appreciable risk and several benefits despite quite high levels, up to 700-800 pg/ml.

Thank you, thank you, all!

Seems like a unanimous vote...

K

Make that unanimous + 1.

Heck, I started HRT past 60.  The clinic I go to only handles HRT for low-risk cases.  Anyone else gets sent to an endo.  They took me, put me on patches due to my age, and monitor my levels regularly.  Starting in June, I'll be on annual checkups instead of quarterly, since everything about me appears stable.

So there is nothing inherently risky about being over 60.  You'd have to have some other risk factor for it to be a problem.

I started at 59 and was post op at 61. My doctor keeps my estrogen at 400-500 pg/ml. As long as my blood work keeps coming back normal I will stay at that level.

I don't want to take E  at a transition dose indefinitely. 16 year old emotions in a 60 year old body isn't a phenomenon I'm happy about. I  know some of the women here want to continue on that way. I suggest you reevaluate your wishes.  :laugh:

Hugs, Devlyn

My emotions didn't really change.  Maybe they were perpetually stuck at 16 since 1976.  On the emotional level HRT just eliminated all the bad stuff.  I would be concerned that stopping would let the bad stuff back in.


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Quote from: Devlyn Marie on April 18, 2018, 12:27:09 PM
I don't want to take E  at a transition dose indefinitely. 16 year old emotions in a 60 year old body isn't a phenomenon I'm happy about. I  know some of the women here want to continue on that way. I suggest you reevaluate your wishes.  :laugh:

Hugs, Devlyn

OMG lol! I'm super super emotional since starting HRT. I mean I always was but I'm way more now. I can cry so easily...It's good in a way because I can let it all out but other times I'm like, for F's sake grow a pair!!  :D :D (funny since I just had orchi).

And to @KatieP, I'm not over 60 but I've read so many stories of fellow transwomen here who are over 60 and on hormones that I also believe your doctor is giving you inaccurate or outdated information.

Quote from: Devlyn Marie on April 18, 2018, 12:27:09 PM
I don't want to take E  at a transition dose indefinitely. 16 year old emotions in a 60 year old body isn't a phenomenon I'm happy about. I  know some of the women here want to continue on that way. I suggest you reevaluate your wishes.  :laugh:

Hugs, Devlyn

That doesn't last forever. In fact, I'd be worried if it did.

Quote from: Charlie Nicki on April 18, 2018, 04:03:56 PM
OMG lol! I'm super super emotional since starting HRT. I mean I always was but I'm way more now. I can cry so easily...

I tend to cry more and easily when my E is low. High levels keep me stable and good.

I saw the endo today. Although she had seen previous labs, when I saw her last time, she ordered another set of labs. I presume, at this point, that she just wanted to make sure about the lab results before going back to Estradiol. And, she put me on patches, which was completely expected given the replies here.

As it turned out, I didn't even have to tell her all the stories from here. But I was ready, and I REALLY appreciate all your responses!!

Kate
PS. First time on patches. I really have to figure them out. Put on the first one, rolled up my panties, and the patch rolled right up with them. Geesh. Is this PEBPAB? (...Patch and Butt... :-) )

Just ask Laurie and Michelle [emoji23] they seem to enjoy their 16 year old emotions [emoji23]

Ask me and I can tell you 16 year old puberty raging teeny emotions in a 45 year old can get quite messy at times. So I get your point. But then... there is also a lot of fun in it. Got to go back to beer pong now.

Quote from: Devlyn Marie on April 18, 2018, 12:27:09 PM
I don't want to take E  at a transition dose indefinitely. 16 year old emotions in a 60 year old body isn't a phenomenon I'm happy about. I  know some of the women here want to continue on that way. I suggest you reevaluate your wishes.  :laugh:

Hugs, Devlyn

I started at 61, 9 months ago, on patches.  Everything points to hrt being safer than it once was, and the patches are the safest.

There is no long term scientific study of the effects of E on TGs. We were just such a mminority that no one cared, I understand that records are being kept now, and the next generation will benefit. The most important thing is to have a very experienced doctor who has treated TGs for over 10 years. This in itself is difficult as there are not many out there, though each year this number increases. They are not taught at med school about us as a specific subjecf until recently, resulting in so many who are just quacks when it comes to hrt for us.

I was blessed with a truly wonderful therapist and guide. He was one of the pioneers in treating TGs, with over 30 years of experience. Thank you Dr Bushong, you made this journey safe and wonderful.  I am 70 years, feel, think and look in the fourties.  E has been a fountain of youth for me. I am at peace, happy and live each day enjoying the wonders of life. A balance of exercise, university,  diet and just great partying.

Quote from: warlockmaker on April 19, 2018, 09:06:37 PM
There is no long term scientific study of the effects of E on TGs.

We have data dating back to the 1960's and there have been studies disseminating everything so far gathered. IMHO, the data is sufficient to already draw certain somewhat solid conclusions like for instance, that breast cancer risk barely rises in this population (less than 20 reported since 1968) despite being prescribed for, at least 2-3 decades, very high doses of E (more often that not, non bio-identical) and sometimes progestogens like medroxyprogesterone acetate, 17-alpha hydroxyprogesterone caproate and cyproterone acetate. We also know that non bio-identical E increases the risk of DVT far more than bio-identical E in this population, similar to cismen and ciswomen. Prolactinoma is extremely rare (8 reported), as is prostate cancer (7 cases). Meningioma (10 cases) only seen with cyproterone acetate use, except one case and that is quite rare too.

There may be underreporting, of course.

Quote "We have data dating back to the 1960's and there have been studies disseminating everything so far gathered. IMHO, the data is sufficient to already draw certain somewhat solid conclusions like for instance, that breast cancer risk barely rises in this population (less than 20 reported since 1968) despite being prescribed for, at least 2-3 decades, very high doses of E (more often that not, non bio-identical) and sometimes progestogens like medroxyprogesterone acetate, 17-alpha hydroxyprogesterone caproate and cyproterone acetate. We also know that non bio-identical E increases the risk of DVT far more than bio-identical E in this population, similar to cismen and ciswomen. Prolactinoma is extremely rare (8 reported), as is prostate cancer (7 cases). Meningioma (10 cases) only seen with cyproterone acetate use, except one case and that is quite rare too."


Interesting comment and such wonderful technical medical terms. However, we need to employ stastics and very specific description of the population. The stastical data, population size, the time frame and the data gatheting methodology etc. is totally inadequate, at this time, to provide any scientific conclusion. It will take another generation or more for a definitive scientific conclusion as to the long term effects of E on TGs. We cannot use the HRT studies on cis females and draw any reliable scientific conclusions as we are anatomically very different. It will be very interesting a read, for all of us, when this data is sufficient.

As a personal view from very limited data and some  understanding of the medical aspects of HRT, from Dr Bushong, who has 35 plus years of treating tgs, I would say that our lives are not shortened and hopefully lengthened. And maybe HRT on tgs is a mini fountain of youth.

Quote from: warlockmaker on April 20, 2018, 07:49:50 PMThe stastical data, population size, the time frame and the data gatheting methodology etc. is totally inadequate, at this time, to provide any scientific conclusion.

I personally disagree. 50 yrs and tens (perhaps hundreds) of thousands of transsexual women provide plenty of info from which we can draw already some pretty adequate conclusions.

QuoteWe cannot use the HRT studies on cis females and draw any reliable scientific conclusions as we are anatomically very different.

We are genetically different and have different hormonal histories but it can still give us clues because we belong to the same species...in addition to studies on other primates and animals...in addition to recent studies in men with advanced prostate cancer prescribed high doses of bio-identical estradiol.

Taken together, the findings so far gathered are promising and would suggest estradiol has an overall favorable impact on our bodies, even at higher doses and little to be worried about.

Interesting thoughts and responses to this thread, and most of all, they remain civil, even in disagreement. I am as most would call, a senior citizen just turning seventy. I did not start HRT until the age of 68 with my doctor increasing my dosages at intervals during this time. I have now reached levels that I am comfortable with as well as my doctor. During this time he has done blood work every four months to monitor where I am at and to ensure that everything else remains in a normal range. At no time has he indicated that because of my age there is any increased risk to overall health. I take it in pill form, sublingual under my tongue. Exercise five days a week for an hour is also part of my daily routine and feel physically and mentally twenty years younger than my age. With continued monitoring of ones blood work, and physical well being, I suspect, that should be what determines HRT use and not the age of the individual.

Hi Denni, great to meet another health concious 70 year old. I also run 5k every other day in the Bangkok heat in 30 minutes and daily 40 minutes of yoga. My father is 96 and maybe I get to test out the long life gene combined with hrt.

All of us with peace of mind and  a positive attitude will lead a fuller life.

Quote from: KatieP on April 17, 2018, 09:03:42 PM
I was DIY for 30 years. At 59, I decided to "come clean" to all the doctors, start taking their actual advice, and all that. (Yeah, yeah. I know. Really...) Both GP and Endo were very supportive in every way. And, they both said, "No More E. There is too little information out there about the effects, but the risk of DVT over 60 is very high. And that is likely independent of sex." So, I stopped the estradiol and remained on Spiro about 11 months ago.

And, I don't feel like myself. I haven't felt "normal" for the last 6 months. It's very difficult to put my finger on the precise symptoms, by the big ones are insomnia, tired, and feeling blah/depressed.

I am going back to the Endo later this week for the quarterly appointment. I don't think I will beg, but I thought I would share anecdotal evidence from y'all about whether you continued HRT past 60, and if so, were there any adaptations, concerns, or problems?

Thanks for your insights!

K

This information is Incorrect. - DVT risks are relative to Complications with Premarin and like medications. Bio-Identical Estrogens don't have the same Cardiovascular risks as conjugated estrogens such as Premarin.

Please ask your physician to read the updated Risks and Concerns released in 2016/2017 by the World Health Organization, and the Peer Reviews done by Endocrinologists treating Patients outside of Lab-Studies. Outlining the risks associated with Depo-Estrodiol(Estradiol Cypionate) and like Medication. As they carry a Significantly Reduced, Cardiovascular Risk.

---

In personal experience, low-dosage Estradiol is not a risk but rather a benefit. Estrogen reduces cardiovascular stress.(It has a blood thinning effect), When taken with a low-dosage of Bio-Identical Progesterone(Progestins), the risks of cardiovascular complications are reduced by a Average of 81%.

Ref:(http://www.nejm.org/doi/full/10.1056/NEJMoa030808 - Note use of Equine Conjugated Estrogens, for all the tests. Which are not normally used in the treatment of patients, as it carries high Cardiovascular Risks. Skewing the tests.)

Ref:(https://www.tandfonline.com/doi/abs/10.3810/pgm.2009.01.1949 - and further proof, of intentional skewing as a result, as well as showing clinical data to support that BioIdentical Hormones have a Significantly reduced risk of complications)

Ref:(http://annals.org/aim/article-abstract/2645553/cardiovascular-disease-among-transgender-adults-receiving-hormone-therapy-narrative-review - Amongst all information, the only risks [While lacking proper research] Come from the lack of understanding. Please note that Delivery Methods such as IM-Injections and Topical Patches have shown the least risks of Cardiovascular Complications. Vs the preferred method of an Oral Tablet(Estrace), Thus increasing statistical likelihood of complications.)

Please Keep informed, Remember, Not all doctors review all documentation available. As Medical Practitioners have there preferred methods of treatment. Your doctor is your choice, choose one that is most update with treatments relative to you and be cautious of people even though they are nice. Your health is a Service, not a requirement and Treatment of Transgender Patients Still comes with a lot of Risks. Most Doctors prefer to stop Hormonal Treatment, to reduce the risks of Complications and Patients Families Suing for the Associated Risk.
Stay Informed.

Quote from: warlockmaker on April 21, 2018, 10:08:00 AM
Hi Denni, great to meet another health concious 70 year old. I also run 5k every other day in the Bangkok heat in 30 minutes and daily 40 minutes of yoga. My father is 96 and maybe I get to test out the long life gene combined with hrt.

All of us with peace of mind and  a positive attitude will lead a fuller life.

Agree with your last comment, keeping a positive attitude, along with a physical life style leads to the peace of mind and full life that we all wish for in our life. I don't know what is worse, your heat or our cold, I am up here in the frozen north land of Wisconsin. Thankfully we are now seeing some moderation, it has been a long cold winter here with way to much snow. Our spring and fall seasons make up for the cold and snow, though spring has been MIA up until this week. Take care, stay safe, hugs