Susan's Place Transgender Resources

My endo and I have been talking about HRT and I felt I should read up on the latest information available.

I found it very interesting and it seems to challenge the assumption that Testosterone must be combated using drugs like cyproterone acetate.  Hopefully this generates some conversations on how best to go with HRT.

<edit and link removed by moderator>

Several of us transwomen have been questioning the need for Testosterone blockers, since Estradiol alone will eventually reduce our bodies own Testosterone production. However, this does not happen right away and may take a year or more of significant Estradiol to reduce the Testosterone.

Once we make the decision to transition, many of us really want to speed up the transition process. T blockers for the first year or so is still the standard of therapy. Of course, once the testes are removed, there is no need for T blockers.

My understanding is that it depends on the person and the dosage of E. A "low" dose will not shut off production of testosterone, but a "high" dose can. There is no set amount for everyone. Again YMMV. It takes blood tests to monitor the hormone levels. What happens is that they keep increasing the E till the T starts to go down to the level wanted.

Quote from: Dani on December 24, 2018, 09:04:34 PM
Several of us transwomen have been questioning the need for Testosterone blockers, since Estradiol alone will eventually reduce our bodies own Testosterone production. However, this does not happen right away and may take a year or more of significant Estradiol to reduce the Testosterone.

Once we make the decision to transition, many of us really want to speed up the transition process. T blockers for the first year or so is still the standard of therapy. Of course, once the testes are removed, there is no need for T blockers.

now here I have a question for the pharmacist! My feet started to swell when I started estrogen (know possible side effect), my endo prescribed spiro to battle the water retention and do a little of testosterone blocking.  My feet are back to normal now. 
I plan to get an Orchidektomie, and would not need spiro anymore after it, would estrogen get my feet to swell up again?

Quote from: Dani on December 24, 2018, 09:04:34 PM
Several of us transwomen have been questioning the need for Testosterone blockers, since Estradiol alone will eventually reduce our bodies own Testosterone production. However, this does not happen right away and may take a year or more of significant Estradiol to reduce the Testosterone.

Once we make the decision to transition, many of us really want to speed up the transition process. T blockers for the first year or so is still the standard of therapy. Of course, once the testes are removed, there is no need for T blockers.

I am not an expert and the points about speeding up the process are certainly understandable but there seem to be a lot of studies that suggest serious health risks that go along with using too much estrogen.  At least from what I've read.  I need to say that my bringing up this study in no way is a description of, or suggestion to self medicate.  *This is why the link was removed. 

I hope it will be useful information to bring up with your doctor / endo as many are not expert in treating people with cross hormone therapy.  And while this is just one study I think the results are rather surprising and worth study.   I believe this was published in April of 2018 so its new stuff.   

Its been my understanding that Estrogen trumps Testosterone in a big way but this is the first study I've seen that tries to show this with a scientific study.

Again I am certainly no expert but the study shows that low dose estrogen (Only) reduces Testosterone to female levels.  The interesting part to me was that someone is finally doing a serious study with 51 patients and saw next to nothing different between the group that used estrogen alone.

Sex drive is a question that this study doesn't bring up but I think that dialing down testosterone levels this low is probably why that seems to be a problem with so many people.

Quote from: Dietlind on December 24, 2018, 09:50:25 PM
now here I have a question for the pharmacist! My feet started to swell when I started estrogen (know possible side effect), my endo prescribed spiro to battle the water retention and do a little of testosterone blocking.  My feet are back to normal now. 
I plan to get an Orchidektomie, and would not need spiro anymore after it, would estrogen get my feet to swell up again?

Dealing with edema (Feet swelling up) has been a chronic problem for me due to non related health issues.  Spiro is (I'm told) like Lasix *Spelled?   And that means rushing to the bathroom a lot.  If that gets old you might ask your doctor about compression socks / hose.

Quote from: GordonG on December 24, 2018, 09:22:47 PM
My understanding is that it depends on the person and the dosage of E. A "low" dose will not shut off production of testosterone, but a "high" dose can. There is no set amount for everyone. Again YMMV. It takes blood tests to monitor the hormone levels. What happens is that they keep increasing the E till the T starts to go down to the level wanted.

Thats been my understanding as well.  The reason I brought up this study is that they did an actual test and looked at the results.  I'm not saying this study is right and everyone else is wrong but... I wonder if its just been assumed to be one way (And no one questioned it) and now we have some results worth talking to our doctors about?

Quote from: Dietlind on December 24, 2018, 09:50:25 PM
now here I have a question for the pharmacist! My feet started to swell when I started estrogen (know possible side effect), my endo prescribed spiro to battle the water retention and do a little of testosterone blocking.  My feet are back to normal now. 
I plan to get an Orchidektomie, and would not need spiro anymore after it, would estrogen get my feet to swell up again?

While Estrodiol sometimes causes edema (swelling of the extremities) it is not the only cause. Many of us over the age of 60 may have edema just because we are older and our kidney function is not the best. Also, a high salt diet (potato chips) can be just as bad.

Whatever the cause, your Endocrinologist prescribed the proper medicine for your condition. Whether or not you need to continue Spironolactone or any other diuretic (drugs that help the kidneys filter out water from the blood system)  after an orchiectomey, it depends on your general health and especially your kidney functions.

One thing you can do now is to go on a low salt diet to help prevent edema in the future. You do not have to completely eliminate table salt from your diet, just avoid salty foods and use salt sparingly when you cook your food. Also, do not add any salt once your meal is on your plate. After a while, you never notice it being gone.  :'(

Quote from: Dani on December 25, 2018, 05:22:11 AM

One thing you can do now is to go on a low salt diet to help prevent edema in the future. You do not have to completely eliminate table salt from your diet, just avoid salty foods and use salt sparingly when you cook your food. Also, do not add any salt once your meal is on your plate. After a while, you never notice it being gone.  :'(

I went pretty much salt free several years ago, The only salt I ingest is that contained in the foods.  And I don't eat chips at ll.  I keep a pretty well controlled diet because of my Type II diabetes, which I manage, 20 years after being diagnosed with it, still with Medformin.
the edema in my foot correlated pretty much exactly with me starting estrogen, and went away after a few days on spiro. 
What I really want to know, how it will be after an Orchidektomie, when spiro might be stopped.  Is here anybody who has experience of the swelling of the feet will return at that time?

I hope you don't have to deal with edema.  My feet swell up like balloons and its pretty uncomfortable.  i can barely remember the last time I wasn't wearing compression hose.  I will say this - they work great.  Salt stopped being a problem for me after avoiding it for a few months.  Then food with salt tasted just awful.  Like it seemed like it was 10x saltier. 

Once I stopped spiro post SRS, I started to get mild bloat and edema. It comes and goes now. Almost cyclically as a cis woman might experience. It is frustrating as my shoes and rings become problematic in regards to fit. Otherwise, it doesn't bother me. As to the OPs original question, IM Estrogens will overpower the gonads and kill T in the proper amount. That amount is dependent on the subject as everyone is different.

One thing I found interesting in this study is that they used Premarin for this study.  Does anyone still use this?  I thought most transgender people are using estradiol now.

Also it looks like they had substantial testosterone reduction on low dose.  I've been on a low dose of estradiol for over 3 years and my last test in July had my testosterone levels at male normal range.

Paige :)

Quote from: JanePlain on December 27, 2018, 01:54:43 AM
I hope you don't have to deal with edema.  My feet swell up like balloons and its pretty uncomfortable.  i can barely remember the last time I wasn't wearing compression hose.  I will say this - they work great.  Salt stopped being a problem for me after avoiding it for a few months.  Then food with salt tasted just awful.  Like it seemed like it was 10x saltier.

My fee are OK now after I take spiro.  My wife stopped to use extra salt in our food about 20 years ago, and yes, everything with salt can taste terrible.  I have he same with sugar, being diabetic I try to avoid any extra sugar.  Now I am so sensitized to sweetness, I can taste it in almost every prepared food, bread included!  Because of this, I started to bake my own bread, using mostly ancient grains in it.

Quote from: Dietlind on December 24, 2018, 09:50:25 PM
now here I have a question for the pharmacist! My feet started to swell when I started estrogen (know possible side effect), my endo prescribed spiro to battle the water retention and do a little of testosterone blocking.  My feet are back to normal now. 
I plan to get an Orchidektomie, and would not need spiro anymore after it, would estrogen get my feet to swell up again?

That's a sign of estrogen dominance.  Mine have done that too.  I just went from 100 mg Progesterone to 200 mg Progesterone.  One can also cut back in estrogen.  But who would want to do that 🙂

I quit taking AA's 3 years ago..  They are not healthy and are synthetic.  Remember nicotine is also FDA approved for human consumption.

My T stays in the 30's.

Quote from: CindyLouFromCO on December 27, 2018, 09:06:20 PM

I quit taking AA's 3 years ago..  They are not healthy and are synthetic. 

My T stays in the 30's.

As a person with a pretty extensive education in biochemistry, I would like to mention that "synthetic" means nothing.  Many medications are synthesized from natural substances (very often plants), by extracting the essential substances and using those pure substances to make medications.  Cannabis oil is one example for this or quinine is another one.
This si the reason why the term synthetic means nothing in the pharmaceutical field.
A pharmacist can certainly explain this even better!

Quote from: Dietlind on December 27, 2018, 09:38:15 PM
As a person with a pretty extensive education in biochemistry, I would like to mention that "synthetic" means nothing.  Many medications are synthesized from natural substances (very often plants), by extracting the essential substances and using those pure substances to make medications.  Cannabis oil is one example for this or quinine is another one.
This si the reason why the term synthetic means nothing in the pharmaceutical field.
A pharmacist can certainly explain this even better!

Yeah I'm clueless.  It's probably not synthetic at all.  What could it be synthetic if in nature anyways?

However it's made, it's not natural.  It's not good for you in the long run. 

I don't think synthetic pot is good for people in the long run also.

Cindy pointed out that P helped her as a diuretic, unfortunately, I personally didn't enjoy that side effect.  In fact, I gave up on the stuff since all I noticed as change  was that it drove me a bit mad. :P

QuoteThey are not healthy and are synthetic.  Remember nicotine is also FDA approved for human consumption.

I get annoyed at those who assume something that's created or manufactured is somehow harmful, while anything natural is good..  We can't forget that poison mushrooms are natural.  As for nicotine, it is used to help reduce & stop smoking.  It is also far from being the most harmful component of smoke.  It's a matter of balancing the risks vs benefits.

Smoking pot is definitely harmful, just like tobacco.  However, there may be some components that are medically useful, so extract or synthesize them.

Quote from: AnneK on December 28, 2018, 06:14:13 AM
I get annoyed at those who assume something that's created or manufactured is somehow harmful, while anything natural is good..  We can't forget that poison mushrooms are natural.  As for nicotine, it is used to help reduce & stop smoking.  It is also far from being the most harmful component of smoke.  It's a matter of balancing the risks vs benefits.

Smoking pot is definitely harmful, just like tobacco.  However, there may be some components that are medically useful, so extract or synthesis them.

Crude oil and uranium are all natural. Don't fall for buzzwords.  ;D

Quote from: Devlyn on December 28, 2018, 06:56:01 AM
Crude oil and uranium are all natural. Don't fall for buzzwords.  ;D

I prefer organic uranium!   ;)

That's another thing that annoys me, people misusing the word "organic".  It means carbon based, but somehow got hijacked into meaning healthier.  Well, just about everything we eat or drink, other than water, is organic as it's all carbon based.

http://projects.thestar.com/organic-milk/ (http://projects.thestar.com/organic-milk/)

Quote from: AnneK on December 28, 2018, 07:45:18 AM
I prefer organic uranium!   ;)

That's another thing that annoys me, people misusing the word "organic".  It means carbon based, but somehow got hijacked into meaning healthier.  Well, just about everything we eat or drink, other than water, is organic as it's all carbon based.

http://projects.thestar.com/organic-milk/ (http://projects.thestar.com/organic-milk/)

I am so with you on this!  Clever marketers hijack a word, and change it into a buzz word, and the masses fall for it!

Quote from: AnneK on December 28, 2018, 07:45:18 AM
That's another thing that annoys me, people misusing the word "organic".  It means carbon based, but somehow got hijacked into meaning healthier.  Well, just about everything we eat or drink, other than water, is organic as it's all carbon based.

http://projects.thestar.com/organic-milk/ (http://projects.thestar.com/organic-milk/)

Hi Anne,

There are lots of words in the English language that have more than one meaning.  Organic is one of them. 

As for the Star piece, I remember when it came out.  Their testing was anecdotal at best.  They tested one sample of organic milk and one sample of normal.  I also noticed they didn't test for glyphosate which is probably the most widely used pesticide right now.  Also passing a pesticide test doesn't guarantee a healthy product.  There's a  lot more to milk than being pesticide free.

All that aside, if I was going to develop a test to discredit organic agriculture, I would sure pick this example.  Canadian dairy cows are treated like gold whether organic or not.  Dairy farmers in Canada make a lot of money because of the supply management system.  They have the money to spend on improving their farms.  They're much less likely to cut corners than struggling dairy farmers in other countries.

It's funny they didn't do the expose on apples or strawberries.  If you want to get a good dose of pesticides that's where you should start.

Take care,
Paige :)

QuoteIf you want to get a good dose of pesticides that's where you should start.

Well, as long as they're organic pesticides.   ;)

Closer to the original topic, I've finally got my endocrinologist appointment booked for April.  I'm looking forward to seeing what effect hormones have on me.

A study was done in the early 1980's concerning men and heart disease. A group of older men was given low doses of E with another group, with placebo, to see if that would decrease the chance of heart disease as women in that age group has less of a chance. The result was the opposite. No mention in the article back then of mood swings, just a heart disease study.

Joelene

I disagree that words don't (always) have meaning.  Yes however to the misuse of "natural"   Such as Natural Uranium versus what?  Supernatural?  Uranium is indeed natural but never a good choice for adding to breakfast foods.  How you make Uranium supernatural is?  Satanic magic uranium? 

That said I prefer human identical hormones over equine (Horse urine) based types.  I thought the results of the study that told women not to use HRT after menopause was flawed because all they tried were equine hormones.   If the study had half of the women using human bio identical hormones and half using equine (horse) Hormones I think the study would have been more useful..  I think it was also an error to take much older women (Far from going into menopause) large doses of equine hormones and assuming that age was not a factor.   

Stating it more simply.  Women who have been in menopause for 20+ years given large doses of oral equine hormones had increased health problems.  Really?  Well Duh!  If the study was taking 80 year old men and injecting them with teenager levels of testosterone caused health problems it would have been laughed at but do this study with horse urine testosterone?  Doctors would pass out laughing.  The people doing these "tests" that change the way care is given need more supervision or oversight.  Or possibly just education on how a test should be conducted?

Show results using a specific age range.  Such as women who have been in menopause for 1 year or less.
Use more then one form of estrogen.  *And insist one be bio/human identical. 
Use more then one form of delivery.   Maybe not bother with forms already not considered safe.

I'm tempted to suggest that no one wants to study bio identical (Human) estrogen because you can't patent something that God invented. 

Oh, and I didn't bother to mention it because I'm not 100% sure it was done this way but I believe oral forms of equine hormones were not tested versus transdermal forms.  Since its common knowledge that this route (which hammers the liver) is not healthy so...  why limit the study in this way?   

And then waving this thing around like its not highly flawed and freaking out doctors and patients?  All that test proved to me is that I don't want to take oral equine hormones.

I have read also that men taking estrogen have seen health improvements as odd as that might sound.

As a medical professional who was/is a study object (National Lung Study,  Global Human Genome Mapping), and a person who initiated studies (preoperative shaving vs clipping, slow release iodophor for the reduction of surgical infections), i can only say that it is important to know, who initiated a study, who financed it, what was the purpose/expected outcome of a study, was the study peer reviewed, and how was the study/results published.

If those identifiers are unknown, the results are nothing but "nice to know", and I have to take a look at this in the future.

The scientific value, and any recommendation based on his, would be close to zero!

Quote from: Dietlind on December 29, 2018, 11:47:01 AM
As a medical professional who was/is a study object (National Lung Study,  Global Human Genome Mapping), and a person who initiated studies (preoperative shaving vs clipping, slow release iodophor for the reduction of surgical infections), i can only say that it is important to know, who initiated a study, who financed it, what was the purpose/expected outcome of a study, was the study peer reviewed, and how was the study/results published.

If those identifiers are unknown, the results are nothing but "nice to know", and I have to take a look at this in the future.

The scientific value, and any recommendation based on his, would be close to zero!

Yup. You can get a study to prove anything you want it to...and no one does a study without being paid, by someone, to do it. Here's a prime example.

Study 'Proves' Parachutes Don't Save People Who Fall Out of Airplanes (https://www.google.com/amp/s/amp.livescience.com/64307-parachutes-work.html)

Added bonus, this study is all natural and organic.  ;) :laugh:

QuoteOur groundbreaking study

The test subjects must have landed really hard!   ;) :D :D :D

Quote from: AnneK on December 28, 2018, 02:00:48 PM
Well, as long as they're organic pesticides.   ;)

Closer to the original topic, I've finally got my endocrinologist appointment booked for April.  I'm looking forward to seeing what effect hormones have on me.

Congrats! 

Quote from: Dietlind on December 29, 2018, 11:47:01 AM
As a medical professional who was/is a study object (National Lung Study,  Global Human Genome Mapping), and a person who initiated studies (preoperative shaving vs clipping, slow release iodophor for the reduction of surgical infections), i can only say that it is important to know, who initiated a study, who financed it, what was the purpose/expected outcome of a study, was the study peer reviewed, and how was the study/results published.

If those identifiers are unknown, the results are nothing but "nice to know", and I have to take a look at this in the future.

The scientific value, and any recommendation based on his, would be close to zero!

Another study that seems (to me) to have been done so badly is the one that says the PSA (Prostate Cancer test) is of no value because most prostate cancer grows slowly.  Really?  Too bad for the people I know that didn't get the nice kind of cancer.   

Quote from: JanePlain on December 30, 2018, 02:38:39 PM
Another study that seems (to me) to have been done so badly is the one that says the PSA (Prostate Cancer test) is of no value because most prostate cancer grows slowly.  Really?  Too bad for the people I know that didn't get the nice kind of cancer.

I know some of them, too.  And once they found out (like my brother in law) it had already advanced into bone caner and killed them shortly thereafter!
I am getting my annual PSA test, and don't want to end up with the horrible bone cancer others got!
Us girls, who were born as males, still have to deal with the male stuff, but on the positive side, most of us do not get ovarian cancer!

Quote from: Dietlind on December 30, 2018, 03:04:53 PM
I know some of them, too.  And once they found out (like my brother in law) it had already advanced into bone caner and killed them shortly thereafter!
I am getting my annual PSA test, and don't want to end up with the horrible bone cancer others got!
Us girls, who were born as males, still have to deal with the male stuff, but on the positive side, most of us do not get ovarian cancer!

Of the people I know that had prostate cancer none of them died from something else first.  It might be me being paranoid but things that cost money seem to more and more be suddenly no longer needed.

Quote from: JanePlain on December 30, 2018, 03:09:55 PM
Of the people I know that had prostate cancer none of them died from something else first.  It might be me being paranoid but things that cost money seem to more and more be suddenly no longer needed.

Don't forget, the US health insurance system is a for profit system!  If the shareholders don't see a return on their investment, they pull out and the CEO's are sitting there without money to pay their salaries!

Not spending money means increased profitability!

If you would have come to me with the request to do a study for XY, and you would have waved with a big bundle of money, I would have asked you what your desired outcome is, and I would have delivered this outcome, bundled in a nice scientific report!  Money talks, scientist need to feed their families, too!

The corruption involved in US insurance or just the totally bad science is an abomination.   

Quote from: JanePlain on January 05, 2019, 08:50:54 PM
The corruption involved in US insurance or just the totally bad science is an abomination.

I think you have this kind of corruption in those businesses all over the world.  I worked for many years in Europe, and did not see a lot of difference, once the top cover up layer was pulled away!

Quote from: JanePlain on December 30, 2018, 03:09:55 PM
Of the people I know that had prostate cancer none of them died from something else first.  It might be me being paranoid but things that cost money seem to more and more be suddenly no longer needed.

Hi JanePlain,

This is anecdotal as well but I've had a different experience.  My father had prostate cancer in the 1990s, he died last year of old age / heart failure at 86.  I had a friend who got prostrate cancer in the late 90s, he was 51.  Lucky for him the new radioactive seed technology had just been developed.  He's still alive.

I believe both found out originally by high PSA tests.  They would probably have died earlier without this.  It's a tricky thing though, the test isn't that accurate.  If there are too many false positives you can cost the medical system a lot in biopsies.   I think the same problem exists with mammograms. 

I thought the general rule of thumb was to worry much more if the person was younger.  For older men (70s+) their's isn't usually as aggressive and many die from other things first.

There's a lot of nuance to this.
Take care,
Paige :)

Quote from: Paige on January 07, 2019, 09:43:13 AM
Hi JanePlain,

This is anecdotal as well but I've had a different experience.  My father had prostate cancer in the 1990s, he died last year of old age / heart failure at 86.  I had a friend who got prostrate cancer in the late 90s, he was 51.  Lucky for him the new radioactive seed technology had just been developed.  He's still alive.

I believe both found out originally by high PSA tests.  They would probably have died earlier without this.  It's a tricky thing though, the test isn't that accurate.  If there are too many false positives you can cost the medical system a lot in biopsies.   I think the same problem exists with mammograms. 

I thought the general rule of thumb was to worry much more if the person was younger.  For older men (70s+) their's isn't usually as aggressive and many die from other things first.

There's a lot of nuance to this.
Take care,
Paige :)

The first line of defense for guys (and for us ladies) should be the friendly palpating finger of your physician in our rear end. And for us ladies it should be self examination of our breasts that we are so proud of.

Hardly any of the cis women I know, do it.  I wonder how many trans girls do it? 
We are really scre***, we can get the prostate thingy and the breast stuff!  Life can be fun sometimes!

Quote from: Dietlind on January 07, 2019, 05:39:43 PM
The first line of defense for guys (and for us ladies) should be the friendly palpating finger of your physician in our rear end. And for us ladies it should be self examination of our breasts that we are so proud of.

Hardly any of the cis women I know, do it.  I wonder how many trans girls do it? 
We are really scre***, we can get the prostate thingy and the breast stuff!  Life can be fun sometimes!

I wonder if there's been any research on trans-females likelihood of getting prostate or breast cancer.  I would suspect the HRT would reduce the likelihood of prostate. 

I would also wonder if the new development of breast tissue in older transitioners would mean that breasts would be less likely to develop cancer?  And would young transitioners' cancer risk be the same as cis-women of the same age? 

Interesting topic I wish there was research on this.
Paige :)

Quote from: Paige on January 08, 2019, 03:54:25 PM
I wonder if there's been any research on trans-females likelihood of getting prostate or breast cancer.  I would suspect the HRT would reduce the likelihood of prostate.

I would also wonder if the new development of breast tissue in older transitioners would mean that breasts would be less likely to develop cancer?  And would young transitioners' cancer risk be the same as cis-women of the same age? 

Interesting topic I wish there was research on this.
Paige :)

I've had this discussion with my doctor. No idea if it lessens the chance of cancer, but it doesn't lower the chances of getting the exam.   >:-)

She said that after five years of HRT, I'll start getting mammograms, too.

Best when we still have the organs to get tested, trans girls need to get their prostrate and breasts checks and guys their ovaries if they still have them and breasts if there is any breast tissue left after top surgery

Quote from: Devlyn on January 08, 2019, 04:22:51 PM
I've had this discussion with my doctor. No idea if it lessens the chance of cancer, but it doesn't lower the chances of getting the exam.   >:-)

She said that after five years of HRT, I'll start getting mammograms, too.

Mammograms... Ouch...