Susan's Place Transgender Resources

Hello everyone. I already semi-introduced myself in another thread, but I'll do so again here, since the background I'll give is relevant to my question.

I've been coming here every once in a while when I've been feeling particularly lost/lonely for awhile now. Reading all your posts has been very helpful for me, so thank you.

So. First things first. I'm 23. 5'3". ~104 lbs. (yes... underweight). MtF. Have wanted to start HRT since Feb 2009. I went through the proper channels (Got a therapist, got a trans-friendly GP) in order to get started on HRT, but hit a snag a while back. In Dec 2008, my new GP wanted to refer me to an Endo, but before doing that, wanted to check me out to make sure HRT was even viable. I got a bunch of blood tests done for various things, and a bone scan to check the strength of my bones (since, depending on your HRT path, a lack of both T&E can lead to bone loss). I got the scan in Jan 2009 and it came back positive for osteoporosis. A second scan a few weeks later on a different machine confirmed it. This came as a shock to everyone since I've never broken anything... which is (in a way) a prerequisite to a diagnosis of osteoporosis (along with being 2 or 3 times my age). This put a big delay on me starting HRT as this was looked into. My endo is baffled and so is my GP, but they both agree that a proper HRT regime will only help the situation, since my overall T+E levels will be higher after HRT then before.

So, finally, I started HRT 3 weeks ago today. Before starting, I did plenty of research (some of which on this site. Thanks for providing it) on what to expect, but so far, the only thought that has crossed my mind is: "Is something wrong? Is this not working?".

The original plan was estradiol patches + spiro. However, a week before I saw my endo to talk about getting my first prescription, my endo went to some conference where he saw a presentation by some other doctor from Chicago. This other doctor described a new technique for treating TG patients that he used successfully on... some number of his patients (somewhere from 1-5 I think). This technique, apparently, is a single shot of Lupron (I won't say the dosage, or method) that is given once. Then, E is started at a specific time. Apparently, the result of this method is that the patient stops producing T all together, forever, so long as E is present. No AAs are required.

Honestly, when my endo told me this, I was skeptical, and just wanted to stick to the plan. I had never heard about this method, and the internet was of no help. I told him I'd rather not do it. My endo really wanted me to try it though, so we ended up with a compromise. I'd take this, and spiro, with E. A blood test after a couple months should confirm if it worked or not, and if it didn't, the spiro would take care of me. However, when I went to pick up my prescription (finally), the pharmacist basically told me that sprio is discontinued... (he actually said that it was unavailable and would never again be available and also isn't available at any other pharmacy) which I didn't believe for a second. Either way, he didn't give me any so I took the Lupron and E patches and left. I told my GP and endo about this and they were both baffled... I asked my endo to prescribe me cyproterone instead, but he said why don't we wait till my next appointment (now near the end of Feb 2011) to look at the results of my first blood test since starting to see if the new method worked or not.

So now I'm waiting... I'm still taking my E patches and have been this whole time. Assuming the method worked, I should have practically no T as of 3 weeks ago. However, since I started all of this, I've felt no changes at all. Physical, or emotional. I'm really wondering if any of this is working... I've got no changes in my hair, skin, fat, muscle. I haven't been crying or teary more then usual (i.e. at all), angry or sad. Everything seems unchanged. Issues relating to my "junk", as far as I can tell, remain normal as well. I know that mileage may vary, but I was expecting that I'd get some sort of painful sensitivity in my chest pretty early on. After a few days of E and no signs of that I figured I was just assuming too much of E, so I figured by 2 weeks in, I'd definitely have something. Now that 3 weeks are gone though, I'm really losing faith that this is working. I feel like I'm just throwing away the patches while all the precious E is still on them.

Anyways, I've been reading all these posts lately from other girls saying that their progress is/was much better then what I'm getting. I feel really happy for you all, but I'm wondering if anyone out there has had results like mine (i.e. none) after this length of time. I'm also wondering if anyone has heard of this Lupron method or if anyone thinks that my low weight or bone condition has anything to do with my results. I've always had a low appetite. I'm not forcing myself to not eat if thats what you're thinking. I'm also not ultra thin, since I have compression fractures (unconfirmed, but I'm beyond 100% sure I have them) in my vertebrae and have lost (at least) 1 inch of height (I distinctly remember being 5'4") in my abdominal area, which has caused my abdominal area to balloon out kind of like if you squish a tennis ball with your hands. However, this has a strange psychological effect on me since I know I'm underweight, but I appear to have a belly and muffin top...

Any comments/input is appreciated.
Thanks everyone. (Hope this isn't too long of a post  :P)

Hi,

You don't mention the country you are living in. Spiro is popular in the USA and Australia, Crypto is much more popular in Europe and the UK (which is part of Europe :embarrassed: even if they don't think so :laugh:) according to Google both are in production. Crap Pharmacists are just that, change to a competent one, the pharmacist may be phobic to TG people.  My Pharmacist warned me on the use of the components of my HRT, telling me it could do this that and the other to a male body. I agreed and told him I certainly hoped so. He understood but he had to follow the law and warn people of side effects. Since the first script there has been no comment beyond the normal bantar ::). 

Point of message ? Deal with professionals.

Cindy

..

,give it time hon. Transitioning is a long term process. It took years to complete. I heard of late bloomer ladies who undergone HRT where in it took them a while before seeing the first changes. Though in my situation, I start noticing changes when I mix spiro in the process. Just wait and you'll see :D Goodluck hon.

Hugs,
nicksy

3 weeks? Try 3 months.

Quote from: Vexing on January 08, 2011, 04:26:11 AM
3 weeks? Try 3 months.

,better idea :D

Quote from: Vexing on January 08, 2011, 04:26:11 AM
3 weeks? Try 3 months.

And even then I'm seeing minimal changes.

No one has mentioned whether or not they'd heard of the "Lupron technique" to block T.

I'm intrigued by this.

Depot Lupron is a well know AA and works great! It is used extensively for androgen ablation for prrostate treatment. The reason it is not usex more extensively is due to cost. I would worry more about T voing TOO low with lupron and it sounds likd he is using you as a guinee pig.  I would find another endo if possible ifhe wont listen to you. you are not an experiment!

IMPORTANT! : Lupron often causes a "biological flare" which means T will rise dramatically for a few weeks.  KETOCONOZOLE is usually prescribed with it for a few weeks to keep this from happening. There is a to of info available on the net on this...

Lupron Depot is a GnRH agonist.

Discussion of using a GnRH agonist + estrogen instead of an AA can be found in this endocrine guideline publication which was issued in 2009:
http://www.endo-society.org/guidelines/final/upload/Endocrine-Treatment-of-Transsexual-Persons.pdf (http://www.endo-society.org/guidelines/final/upload/Endocrine-Treatment-of-Transsexual-Persons.pdf)

It cites to a 2005 study by Dittrich, Binder, et. al.  of 60 MTF patients who were treated successfully with a GnRH agonist + estrogen instead of an AA.
Dittrich, R., Binder, H., Cupisti, S., Hoffmann, I., Beckmann, M. W., Mueller, A.:
Endocrine Treatment of Male-to-Female Transsexuals Using Gonadotropin-Releasing Hormone Agonist
Exp Clin Endocrinol Diabetes 2005; 113: 586-592

Also, 3 to 6 months is a common window for seeing changes.

Thanks for the encouragement. I guess I'll have to just keep waiting. Maybe I misunderstood, but I thought I could expect to at least feel different by now (psychological effects).

To CindyJames: I'm living in Canada.

Currently, I've been putting the patches on my bottom. I've been thinking that maybe I should start placing them on my sides instead (i.e. where your elbow contacts your ribcage if your arms are at your sides). The directions say that both locations are viable. Has anyone noticed that one location is more effective then the other? Note that I sit on my tush for the majority of the day. I don't know if sitting on the contact area of the patch would be bad since it might limit blood flow to the patch area. Any thoughts on that?

Thanks again everyone.

Quote from: caitlin_adams on January 08, 2011, 06:55:34 AM
No one has mentioned whether or not they'd heard of the "Lupron technique" to block T.

One of the first doctors I saw as part of my early education, exploration, acceptance of being transgender said this is the method he uses. I guess he starts patients out on Lupron for some period of weeks until the T levels are in the normal female range, from there he adds E to bring it up to the normal female range I believe.

He's the only doctor I've heard talk about using this method. Maybe it's more common than I think, but it just seems like most use Spiro + E. The main problem is the cost, Lupron shots are not cheap.

Yeah, the Lupron shot was pretty pricey, but if I only need one of them then I'll be avoiding the costs of daily Spiro or Cyproterone. That is... assuming it'll work.

Quote from: Britney♥Bieber on January 08, 2011, 05:58:04 AM
And even then I'm seeing minimal changes.

Good lord, there's barely anything to speak of at 6 months. I just hope the next six months step up the pace.

Quote from: Rebekah with a K-A-H on January 09, 2011, 01:19:24 AM
Good lord, there's barely anything to speak of at 6 months. I just hope the next six months step up the pace.

Having had rampant acne and generally horrible skin prior to HRT, the changes after 3 months looked quite profound on me - just with the clearing of my skin.
I was also rail thin prior to HRT and the appetite I gained lead to rapid weight gain in those first 3 months as well, which made me appear fuller in the face and more 'jolly'.

Quote from: Vexing on January 09, 2011, 02:35:20 AM
Having had rampant acne and generally horrible skin prior to HRT, the changes after 3 months looked quite profound on me - just with the clearing of my skin.
I was also rail thin prior to HRT and the appetite I gained lead to rapid weight gain in those first 3 months as well, which made me appear fuller in the face and more 'jolly'.

My skin was terrible and acneic, and it still is.  I was a skinny bitch who couldn't gain weight and was perpetually in the bottom 5% of the curve in terms of weight, and I still am.  The most that occurred was a little bit of fat redistribution around the face, I guess.

This is probably because I'm 18, though. Some of my friends still have acne, too, so I guess it's unavoidable at this age, even with magic pills of wonderment.

Quote from: Vexing on January 09, 2011, 02:35:20 AM
Having had rampant acne and generally horrible skin prior to HRT, the changes after 3 months looked quite profound on me - just with the clearing of my skin.
I was also rail thin prior to HRT and the appetite I gained lead to rapid weight gain in those first 3 months as well, which made me appear fuller in the face and more 'jolly'.

That's the one thing my uninformed parents do notice when I come home while on HRT - acne pretty much drops to zero.

As far as three weeks go, try three months... I know some people say they feel changes on like day one or two (and if the do, more power to them - I'm happy for them!), but these may just be side effects from the meds they are experiencing.

Quote from: nicksy23 on January 08, 2011, 02:33:46 AM
,give it time hon. Transitioning is a long term process. It took years to complete.

I've learned the hard way that none of this happens quickly.  Relax and give it time.  It will happen.   :)

Quote from: HitOrMiss. on January 08, 2011, 01:42:29 AM
Hello everyone. I already semi-introduced myself in another thread, but I'll do so again here, since the background I'll give is relevant to my question.

I've been coming here every once in a while when I've been feeling particularly lost/lonely for awhile now. Reading all your posts has been very helpful for me, so thank you.

So. First things first. I'm 23. 5'3". ~104 lbs. (yes... underweight). MtF. Have wanted to start HRT since Feb 2009. I went through the proper channels (Got a therapist, got a trans-friendly GP) in order to get started on HRT, but hit a snag a while back. In Dec 2008, my new GP wanted to refer me to an Endo, but before doing that, wanted to check me out to make sure HRT was even viable. I got a bunch of blood tests done for various things, and a bone scan to check the strength of my bones (since, depending on your HRT path, a lack of both T&E can lead to bone loss). I got the scan in Jan 2009 and it came back positive for osteoporosis. A second scan a few weeks later on a different machine confirmed it. This came as a shock to everyone since I've never broken anything... which is (in a way) a prerequisite to a diagnosis of osteoporosis (along with being 2 or 3 times my age). This put a big delay on me starting HRT as this was looked into. My endo is baffled and so is my GP, but they both agree that a proper HRT regime will only help the situation, since my overall T+E levels will be higher after HRT then before.

I am sorry to hear this I have had the same problem for the past 3 years, and it has already impacted my life, I can no longer run or walk for long distances without receiving painful stress fractures .

Though I am only 6 years older than you my Endo also ordered the blood work and dexa-scan prior to any HRT. The results showed that I had osteoporosis, and the following scans have shown a 10% decrease in bone density per year.
The doctors are stumped and they cannot explain why it is happening. The Endo suspects that it may be related to my PAIS though she has never seen such rapid bone loss in someone my age.

Did your blood tests reveal anything unusual? Were your Testosterone levels too high or too low?

Seems your situation is much more dire then mine.  :o :(
To answer your question, no my blood tests all came back normal. My endo briefly thought it might be some sort of genetic disease but it didn't take long for that to get ruled out since I have none of the markers for it.

PAIS seems like a possible cause of your bone issues. 10% bone loss per year is crazy through. My next scan is in a few weeks. I hope it comes back with good news.

Your doctors can't explain why its happening, but can they at least help you regain some of your lost bone mass?

Quote from: HitOrMiss. on January 10, 2011, 09:04:35 PM
Seems your situation is much more dire then mine.  :o :(
To answer your question, no my blood tests all came back normal. My endo briefly thought it might be some sort of genetic disease but it didn't take long for that to get ruled out since I have none of the markers for it.

PAIS seems like a possible cause of your bone issues. 10% bone loss per year is crazy through. My next scan is in a few weeks. I hope it comes back with good news.

Your doctors can't explain why its happening, but can they at least help you regain some of your lost bone mass?

HitOrMiss thanks for replying, I hope your next scan comes back with some improvement, just stay on top of it and make sure your Endo does also.

Yeah 10% per year is unbelievable considering most menopausal women are only losing approx= 2% to 3%  per year.

My Endo said that she has not seen anyone my age with this amount of bone loss, and neither has her colleagues (they are all interested/confused with my case, and these are all teaching Doctors associated with the medical school).

They have only been able to give me HRT (same reasons that you stated) and I was prescribed a daily injection of FORTEO to stop the bone loss.


I am sorry to hijack your thread, but I often hear of young people with GID who suffer from Osteoporosis long before they ever begin to transition. This always interests me and I wonder if there is some type of genetic problem that makes TS people more likely to develop Osteoporosis.
This is why I always ask questions when someone mentions that they have been diagnosed with it, I want to hope that some smart doctor has figured it out.

Quote from: Jesslee on January 10, 2011, 10:39:44 PM
I am sorry to hijack your thread, but I often hear of young people with GID who suffer from Osteoporosis long before they ever begin to transition. This always interests me and I wonder if there is some type of genetic problem that makes TS people more likely to develop Osteoporosis.

As I was getting ready for bed last night, it hit me that the reason this happens probably has more to do with pre-HRT people getting bone scans done while everyone else doesn't get them at all unless they're over 50 (or something) or have had several fractures. Any random person who goes through their childhood+young adulthood without breaking anything or only breaking 1 bone for a good reason (like falling down the stairs or something) won't get tested at all. However, we get tested regardless of previous history. So, it might be that the pattern you see is merely due to the lack of non-TG people who get scans done before their golden years.

And don't worry about hijacking the thread  :P

By the way, it seems I lost hope in my HRT regime just a couple days early. I can confirm now that my chest is getting quite squishy and my nipples are sore and constantly erect. Seems like its working after all.  ;D
Did one of you cast a spell? 3 days ago I had nothing, but since I posted this thread the changes have been rapid. Seems like past 3.5 weeks of E finally got put to work all of a sudden. Who is the HRT fairy among us?  :P

Quote from: HitOrMiss. on January 12, 2011, 11:33:18 PMWho is the HRT fairy among us?  :P

That sounds like an interesting position.  But I'm not sure if I'm qualified to be an HRT fairy.

Hit and miss did you develop as a man? As in did you have a male puberty? Or did you remain extremely willowy and with a high voice?

Part of me is wondering if you have Estrogen insensitivity syndrome which would suck if you do.

the only reason T helps with bone density is because it's aromatized into E and interacts with the bones.
E of course works directly with the bones.

:/ if your estrogen receptors don't work then that would explain why you have osteoporosis and  haven't experienced anything at all with E exposure thus far.

Another effect of E insensitivity would be extreme height as the growth plates can't fuse without E.
--------------

The other possibility of course is that your Testicles are in horribly unhealthy state for some reason or another and are close to failure. No T means no Aromatized E means bone thinning. Whitch is why I ask if you ever really turned into a guy.


:::Edit::: Nevermind if your chest is growing it's certainly not E insensitivity.

Thanks for your concern, but it doesn't sound like I fit your description. I'm 5'3" and have always had a really low voice. Everyone commented to me that my voice was so low even before puberty. Then again, its not like it got any lower during puberty...
As for your second comment, before I started HRT I banked some sperm. As a prerequisite to banking though, I did have it tested. Results were normal & fertile... so presumably that means everything fine with the factory... Also, in some of the many blood tests I've gotten my T levels were measured. I can't say what the results were (I don't know exactly) other then that they were normal.

I'm not sure if my absorption rate was tested by my doctors or not. I figure they would have tested that since it's kind of an obvious thing to check after checking the levels themselves. Maybe I'll pop the question to my Endo when I see him in 3 weeks.