Susan's Place Transgender Resources

Before I visited my endo, I had been on a DIY hormone regimen for about four months utilizing an estrogen, an antiandrogen, and a DHT blocker. Standard stuff. I saw favorable results.

This particular endo, though, starts all patients off on only ethinyl estradiol. (Not as a contraceptive; just the ethinyl estradiol alone.) He does this because of the drug's potency and feels antiandrogens, or at least Spironolactane, aren't worth the effort when such a powerfully potent estrogen is introduced into the body. I was put on a lower dose (taken at bedtime) which will double after a month (and still be taken at bedtime, meaning only once a day).

Now as I was previously on my own regimen, I thought I should stepped myself down slowly as to not mess with my system too much. I did stop with the estrogen supplement altogether, but cut back on the antiandrogen and DHT blocker. A week has now gone by with the ethinyl estradiol and stepped down doses of the antiandrogen and DHT blocker I took before, and I'm not happy.

The tenderness of my breast buds has almost completely disappeared, and the buds themselves have softened considerably. My fat redistribution seems to be unaffected (it's continuing rather well, if anything), but the sudden change in my breasts worries me.

So given this should I trust my endo and eventually wind up on only the prescribed ethinyl estradiol? Should I continue stepping off of the remains of my old regimen or just stop taking them entirely? Should I maybe accompany the ethinyl estradiol with a lower dose of my original regimen? Has anyone else gotten satisfactory results from ethinyl estradiol alone (and once again, NOT as part of a contraceptive)?

I understand common wisdom claims antiandrogens are necessary for favorable results, but then I read stuff like this (http://etransgender.com/viewtopic.php?f=1&t=423) and wonder.

i've seen several fully qualified NHS endos and all prescribed both estrogen and spiro and it works physically and my blood tests shows minimum T and female range E.

But if he starts everyone off at same dose you have to wonder about differences between everyone?  Did he request or have you had a blood test at all yet?

If your endo is in the Houston med center, we may have the same endo. He is starting me off slow too. I don't think it is so much that he won't prescribe spiro as he slowly ramps it up E to see what effect it has on your T. At 30 days I am to double my dose too, but I will also get a blood test at 30 days to monitor my change in T level as well as DHEA. He mentioned prescribing something else if DHEA doesn't change. After 2.5 weeks on just E, the only changes I have noticed are very subtle. Given the lever at which you were self-medicating, I doubt you would notice anything at all.

Did you tell him what you were doing before he prescribed you E? I would think that following your own regimen plus his might lead to complications.

Yip, Melody, we have the same endo. I remember learning that when you answered someone else asking about him. :)

I had told him during a previous visit of my self-regimen, including doses. He didn't think much of any of it, and after I got my first blood tests back I saw why. Despite my body's favorable reaction to it all, everything sat in male ranges. A few were above or below the median where appropriate, but still all in the male ranges. I knew before seeing him he starts everyone the same, but had no idea about whether or not he deviated much beyond the start. I only vaguely recall him mentioning he'd address DHEA, and only because you brought it up. XD

I'm not so worried about the changes in my breasts, though, as much as I'm worried about potential changes in my hair. I'm sure I'll eventually make-up any loss of breast development, but I'm not so sure about hair. I was already taking Propecia by prescription and using minoxidil long before I began self-medicating, and relatives have marveled at how well my hair is filling back in.

I'm also concerned about my emotional resilience. From the first day I started self-medicating I felt a newfound strength and capability; I finally felt as if I could exist in this world as effortlessly as I imagined other folks did. Negative emotions also stopped lingering and accumulating. I've noticed all of those effects are slowly fading.

But if Dr. Smith is more than willing to adjust my regimen based upon my future blood work, then I believe I'll follow his orders to the letter and drop my other meds altogether. I'll still use minoxidil, though, albeit at 2% instead of 5%.

Thanks! :D

My endo put me on estrogen first, then a few months later when the estrogen was elevated put me on spiro... I'm very pleased with the results.

I'd trust them, they did get that big fancy medical license somewhere.

Does your endo know that you were self-medding?  He may be starting you on a low dose to allow your body to adjust to the "new" medication. 

Quote from: long.897 on October 25, 2010, 03:05:33 PM
Does your endo know that you were self-medding?  He may be starting you on a low dose to allow your body to adjust to the "new" medication.

According to Ashley's post, he does. In my case, I have (had?) a T level of 269 and an E level of 45 without any medications. I think he is indeed starting me slow to see how my body reacts.

Ashely, like you I was a bit disappointed at first that Dr. Smith did not immediately prescribe an AA. However, like you, I am willing to see what my blood work says and how things progress. He has been doing this a long time and must know something. However, I will be my own advocate when it comes to this and won't simply follow his advice on blind faith. I am especially interested to see what doubling my dose does. That will happen at the end of next week.

Quote from: MissAshley on October 25, 2010, 09:39:18 AM
Before I visited my endo, I had been on a DIY hormone regimen for about four months utilizing an estrogen, an antiandrogen, and a DHT blocker. Standard stuff. I saw favorable results.

This particular endo, though, starts all patients off on only ethinyl estradiol. (Not as a contraceptive; just the ethinyl estradiol alone.) He does this because of the drug's potency and feels antiandrogens, or at least Spironolactane, aren't worth the effort when such a powerfully potent estrogen is introduced into the body. I was put on a lower dose (taken at bedtime) which will double after a month (and still be taken at bedtime, meaning only once a day).

Now as I was previously on my own regimen, I thought I should stepped myself down slowly as to not mess with my system too much. I did stop with the estrogen supplement altogether, but cut back on the antiandrogen and DHT blocker. A week has now gone by with the ethinyl estradiol and stepped down doses of the antiandrogen and DHT blocker I took before, and I'm not happy.

The tenderness of my breast buds has almost completely disappeared, and the buds themselves have softened considerably. My fat redistribution seems to be unaffected (it's continuing rather well, if anything), but the sudden change in my breasts worries me.

So given this should I trust my endo and eventually wind up on only the prescribed ethinyl estradiol? Should I continue stepping off of the remains of my old regimen or just stop taking them entirely? Should I maybe accompany the ethinyl estradiol with a lower dose of my original regimen? Has anyone else gotten satisfactory results from ethinyl estradiol alone (and once again, NOT as part of a contraceptive)?

I understand common wisdom claims antiandrogens are necessary for favorable results, but then I read stuff like this (http://etransgender.com/viewtopic.php?f=1&t=423) and wonder.

First off I suggest you do some research on ethinyl estradiol (aka Estinyl) as it has some serious side effects not associated with the other more commonly prescribed forms of estradiol (Estrace, Estrofem, TDS Patch, etc). Yes it's potent, but none of the endos I've talked to use it for their MTF patients due to the side effects.

Second, you might want to shop around as far as docs go. I visited several and asked several questions (such as what is their usual HRT regimen for MTF patients) before picking one. You'll quickly find there's a good bit of variance between docs and their methods of treatment. Such as meds, dosages, etc. Too many people I think get caught up with going with the first endo they visit or simply go to the one their therapist recommends. As with all things, it's always best to shop around.

As for why an endo wouldn't prescribe any AA along with E is beyond me. Unless they are being super-careful or you have some sort of pre-exsiting medical condition that might cause complications. One of the endos I talked to prior to choosing, prescribed this method of a low dose of E only (no AA until several months later). After talking to several other endos and a SRS surgeon, I found that this method of treatment was in the minority. Again, unless there is something else in your medical history.

I'd at least talk with another endo and explain your concerns. Nothing wrong with getting a second opinion.

Quote from: JennX on October 25, 2010, 10:34:00 PM
First off I suggest you do some research on ethinyl estradiol (aka Estinyl) as it has some serious side effects not associated with the other more commonly prescribed forms of estradiol (Estrace, Estrofem, TDS Patch, etc). Yes it's potent, but none of the endos I've talked to use it for their MTF patients due to the side effects.

I have, though I wasn't acquainted with Estinyl's history. (As in the history behind that brand name.)

Most of the severe side-effects I've read about seem associated with pairings of ethinyl estradiol and other drugs when delivered via contraceptives. I've learned of some of the issues with ethinyl estradiol alone, but I hadn't seen anything near as damning as I have for those contraceptives.

I'll start looking for a second endo for second opinions and/or back-up. I'm not really so enamored with this one for him being my first as much as for him being the most available to me at the moment.

Quote from: MissAshley on October 25, 2010, 09:39:18 AM
The tenderness of my breast buds has almost completely disappeared, and the buds themselves have softened considerably. My fat redistribution seems to be unaffected (it's continuing rather well, if anything), but the sudden change in my breasts worries me.

That sounds reasonable, actually. That describes what I observed after a few months on HRT. If you've seen a decrease in size, that might be an issue, but I don't think what you describe is reason to worry. Breasts are supposed to be soft.

Still, I'm happier with the prospect of taking estradiol, since it's the molecule that is in all human bodies. "More potent" doesn't sound terribly appealing, when I've got plenty of estrogen as it is -- and it's pretty cheap. If the idea is to avoid potential risks from T blockers, I guess that might make sense. My doctor is more concerned with keeping T levels down, since that alone provide a lot of the feminizing effects of HRT. But the bottom line is seeing results and avoiding complications.

bye

E by itself will partially surpress T. So will an AA, but neither suppress it fully by themselves. Basically what your endo is doing is giving your body something before supressing the more prevalent hormone in your body and giving the AA the best chance to work. They'll likely put you on an AA after a few months when the levels of estrogen have gotten to a point where the endo thinks an AA will do enough to make it worth your while.

This is what my endo did and I'm experiencing any ill effects because of it.

Quote from: Alyssa M. on October 26, 2010, 12:21:34 AM
That sounds reasonable, actually. That describes what I observed after a few months on HRT. If you've seen a decrease in size, that might be an issue, but I don't think what you describe is reason to worry. Breasts are supposed to be soft.

Still, I'm happier with the prospect of taking estradiol, since it's the molecule that is in all human bodies. "More potent" doesn't sound terribly appealing, when I've got plenty of estrogen as it is -- and it's pretty cheap. If the idea is to avoid potential risks from T blockers, I guess that might make sense. My doctor is more concerned with keeping T levels down, since that alone provide a lot of the feminizing effects of HRT. But the bottom line is seeing results and avoiding complications.

Well yeah, breasts are supposed to be soft, but the sudden cooling of the nipples and loss of the buds alarmed me. I really can't tell if my breasts have gotten smaller or if the softening of the buds has just made them spread out more.

And I believe his idea is to use the minimum amount of drugs to achieve the desired results. I could be wrong, but I thought AAs (or at least Spiro) only reduced T-levels because they gunked receptors which makes the body produce less T in response in an effort to stabilize levels. Natal women may have low T-levels, but their receptors for T are still fine despite being few in number, right? So if their bodies' development is less reliant blocking T and more reliant on having less of it compared to E, then shouldn't a similar approach work for MtFs? If it does, then I guess he's trying to force my body to produce less T on its own by introducing an "overpowering" (my word, not his) amount of E. . .maybe?

All I know for sure is Dr. Smith's been at this for a long time, and I'll never know if his approach works or not if I bail. If it ultimately doesn't work, I can take heart in him knowing it didn't, figuring out why, and possibly reconfiguring his approach for others in the future. As for the risks involved with ethinyl estradiol, I already accepted transition itself as a risk, though I know I should avoid "putting another bullet in the chamber" when I can.

(One quick note: I have to drive 60-90 minutes to see him, and between his schedule and mine I can only see him on Tuesdays. Yet, he's still the most available endo to me. I thought I should give some perspective on what factors into my options.)

Thanks again for all the comments. I'll keep everyone posted on how this goes. :)

If you don't mind Ashley, I'll post my T levels once I get them back from the lab. I will be going in next week for blood work. I will be at 30 days next Friday. I will be doubling my dose then.

FYI, what Dr. Smith told me is that if you put enough E into your system, you can fool the pituitary into shutting down T production in your testes. DHEA may be another matter and may require additional medication. I guess my blood work will tell the tale. 

He told me the same, I just couldn't recall the exact process. I had mentally filed it away under "overwhelm the system."

My next blood test isn't for another three weeks, so by the time I get those results back I can compare them to both your upcoming one and my previous one from when I was still self-medicating.

bye

Sada,

There are many different HRT regimens, and which one is the most popular seems to vary with time and location. In the U.S., a combination of 17β-estradiol and spironolactone seems to be the most popular these days, with the spironolactone taken orally and the estradiol taken orally, transdermally (using a patch or a cream), or via intramuscular injection. MissAshley is taking a different estrogen, called ethinyl estradiol.

There are feedback mechanisms by which estrogens can act as anti-androgens (as suggested above), so it is not necessarily required to have a separate anti-androgen, although many endocrinologists seem to think it is important (including mine, who generally prescribes 17β-estradiol). MissAshley's endocronologist seems to think that a sufficient dose of ethinyl estradiol can have this effect without increasing the risk of complications too greatly, at least based on what MissAshley has said.

Again, what should matter most is getting results with a minimum of serious consequences, so if this doctor has seen good results is others using his preferred approach, is willing to answer MissAshley's questions, and adjust the treatment depending on the outcome, then there's no problem.

bye

I don't know mucha bout that certain kind of E but most doctors I talk to say that T needs to be blocked.....thats why FTMs dont need an E blocker, because T will just ravage the system and push the E back automatically.

Based on a little research...
What the endo is trying to achieve is called "negative feedback inhibition of T" via a high E level. The increased level of E, will suppress the production the of GNRH (Gonadotropin Releasing Hormone). GNRH is produced by the hypothalamus, and ultimately thru a chain of chemical signals causes production of T from the testes. No GNRH... no T. This is what your endo is trying to achieve.

Here's a good link for more info: http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/S/SexHormones.html (http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/S/SexHormones.html)

However, T is still free floating around in your system and is still being produced in small amounts. Spiro acts as an inhibitor of T production and action via inhibiting enzyme activity and blocking receptors.  So it's basically a two-pronged attack by adding Spiro.

The high E level (via Estinyl) achieves a similar result, thru a different mechanism.

Quote from: Sada on October 29, 2010, 03:04:16 PM
Alyssa M. are you sure your not an endo~^^ That was an incredible reply I am impressed. :D

Thank you for the compliment, but I'm definitely not a medical doctor or expert of any other sort! I have done a little searching with Google (really, not very much), and also tried to read carefully what people have said in this thread. I really hope nobody makes the mistake of substituting posts from strangers on message boards with real medical expertise.

I'm posting here only to reassure MissAshley that neither what she is experiencing physically nor her doctor's methods seem out of line compared with what I have experienced myself or heard from others.

Going in for blood work Friday. That is also the day I double my dose. Appointment with Dr. Smith two weeks later to go over results. I will keep you posted.

Most docs are not going to throw multiple meds at you right off the bat.  If you have a bad reaction, they're not going to know which medication you're reacting to until they stop all of them and start them over one at a time and see how you do.  So why risk it in the first place?

Transition is an ocean, you can either cross it in a speedboat or an oceanliner, its your choice.

Quote from: Alyssa M. on October 31, 2010, 11:41:39 PM
Thank you for the compliment, but I'm definitely not a medical doctor or expert of any other sort! I have done a little searching with Google (really, not very much), and also tried to read carefully what people have said in this thread. I really hope nobody makes the mistake of substituting posts from strangers on message boards with real medical expertise.

I'm posting here only to reassure MissAshley that neither what she is experiencing physically nor her doctor's methods seem out of line compared with what I have experienced myself or heard from others.

Your reassurance is very much appreciated, Alyssa. :)

I've been resisting the temptation since I posted last to abandon Dr. Smith and just go back to my regimen. I want to see his treatment through not out of stubbornness but out of self-discipline. I want to make every effort to allow this to work for me so that if it doesn't I can part with him on pleasant terms and appear as responsible and level-headed as my therapist's letter says I am.

I'm looking forward to your results, Melody. I'm very curious to see how they look compared to my starting test and my one month test next week. Hee hee. . .I'm right on your heels. ;)

They told me that if I call tomorrow (Wednesday) after 4 that they would give me my test results.  So, hopefully I will be posting that tomorrow. However, I will say that I doubled my dose as prescribed this past Friday and this evening my boobs are KILLING me! I take that as a good sign.  ;D

Ok, called for results and not good. My T level went up! Or as Dr. Smith said "Your testosterone is not being suppressed." Well duh! My first test had me at 269 and the one this past Friday had me at 446. His nurse passed on his recommendation to double the dose, which I had already been instructed to do this past Friday as well. Now, the only sign of encouragement I have had is that my boobs have ached with the occasional shooting pain since about Tuesday. Those pains are not "in my head" like any other effects I speculated I might be having in the first 30 days. I am scheduled to see Dr. Smith next Friday and I will have some questions!

Quote from: MissAshley on October 25, 2010, 09:39:18 AM
He does this because of the drug's potency and feels antiandrogens, or at least Spironolactane, aren't worth the effort when such a powerfully potent estrogen is introduced into the body.

I do not know about the effects of ethinyl estradiol. My post is not about this type of estradiol, but rather about your endo's approach.

I think your endo's approach may work, but it depends on your needs (if you want quick breast development, this may not be the right approach for you), your health, your patience, and various other factors. It would be best to discuss with your endo about his rationale and ask how he expects your progress in the next few months. Being on the same page and having the same expectations is important.

Quote from: Melody on November 11, 2010, 11:41:03 AM
Ok, called for results and not good. My T level went up! Or as Dr. Smith said "Your testosterone is not being suppressed." Well duh! My first test had me at 269 and the one this past Friday had me at 446. His nurse passed on his recommendation to double the dose, which I had already been instructed to do this past Friday as well. Now, the only sign of encouragement I have had is that my boobs have ached with the occasional shooting pain since about Tuesday. Those pains are not "in my head" like any other effects I speculated I might be having in the first 30 days. I am scheduled to see Dr. Smith next Friday and I will have some questions!

That's not very encouraging, but it is mostly consistent with what I'm experiencing. Most of my weight distribution has reverted now, which is very distressing since I'd gradually gained weight the four months I self-medicated so now I have a belly I didn't have before I even started. :( The pores on my face started enlarging, with oiliness more than what I had while self-medicating but less than before I started. My breasts aren't tender and my nipples aren't overly sensitive, but what tissue that had developed before seems to be very slowly growing.

My depression, persistent negative emotion, and distress are starting to ease since I hit the .05 mg x2 mark, but my body's slow backslide is grating on me. Still, there's not too much longer before I get reevaluated, and if it doesn't work out then I'll go with someone else. The most important thing for me right now is to realize that ultimately all I've permanently lost is time, and even then only a few months. As long as I remember that, I'll be okay. :)

Quote from: marissak on November 11, 2010, 05:45:49 PM
I think your endo's approach may work, but it depends on your needs (if you want quick breast development, this may not be the right approach for you), your health, your patience, and various other factors. It would be best to discuss with your endo about his rationale and ask how he expects your progress in the next few months. Being on the same page and having the same expectations is important.

I'm not looking for anything quick. I just became bothered when what I viewed as a step forward, medically supervised HRT, became a step back for my mind and body. The only thing I want quickly is an end to this backslide, and I'll be fine if it takes as long as four months or so to get back to where I was. Quick note, too: I stopped taking any element of my original regimen a week-and-a-half into this new regimen. I've taken only ethinyl estradiol for about five weeks.