Susan's Place Transgender Resources

Came across this article about progesterone and trans women, DISCUSS.

The Lowdown on Progesterone
By Dr. Richard J. Curtis
10th July 2009
The London Gender Clinic
Progesterone is a hormone naturally produced by the female reproductive tract. Many trans
women believe it has value in the physical transition process and particularly in relation to the
development of breast tissue. However, in the trans arena, there is much misinformation about its
benefits, little information on its adverse effects and little understanding of its action in the genetic
female.
Progesterone Physiology
Prior to the start of menstruation – usually around 12 years old1 – girls do not have any
appreciable level of progesterone. In the early years of menstruation, oestrogen levels fluctuate
but the typical monthly profile is not yet established and periods tend to be irregular in frequency
and duration. Early cycles do not result in ovulation, i.e. no egg is released from the ovary.
After 2 years of non-fertile menstruation – at around 14 years old – ovulation starts to occur and
an egg is released from the ovary.
Only when this occurs, do progesterone levels begin to rise from their low baseline during the
second two weeks of the menstrual cycle (Figure 1).
They are highest during the week prior to menstruation and rapidly decline contributing to the
stimulus for bleeding to occur. However, the average levels of progesterone during the full
monthly cycle are very low.
Figure 1: Progesterone levels in the 28 day menstrual cycle, once ovulation has
started, at approximately 14 years old.
It can therefore be seen that in genetic women, there is no progesterone before approximately 14
years of age. Consider this fact with the stages of natural breast development.
1 Chronological ages given throughout this paper are all based on averages. The variation in start times of
menses is wide and varies between populations.
Days
Breast Development
The average age at which a genetic girl commences breast development is 10 years old and
occurs according to well-defined milestones called Tanner stages.
Tanner Stage Average. Age
1 10 Increased nipple size
2 10 ½ Increased areola as well. Breast bud (small tender lump
behind the nipple)
3 11 ½ Nipple – areola complex increases. Breast size increases
4 12 The areola is a separate mound above the breast
5 13 ½ The areola becomes confluent with the breast leaving only
the nipple proud
Figure 2: Tanner stages and approximate ages of development prompted by oestrogen
It takes approximately two to three years to achieve the majority of breast growth at age 13. Until
stage 4, the growth of the breast in a girl takes place with the same oestrogen level as an adult
male, i.e. < 150pmol/litre, as periods have not yet started. (The reason teenage boys do not
develop breasts is because testosterone inhibits the effect of oestrogen. The development of
small breasts in teenage boys can occur; this is called gynaecomastia and is caused by the overconversion
of low levels of testosterone to oestrogen.)
As progesterone does not exist in genetic girls until age 14, it is clear that progesterone cannot
possibly have any effect on breast development in the genetic female.
To be clear, there is no direct involvement of progesterone in determining the size of breasts.
Oestrogen is the primary enabler of breast growth. And there is no reason to suppose that the
development of the breast in trans women is different.
Puberty is a complex process and, in addition to oestrogen, there are many other hormones
which regulate it. These include prolactin, insulin and growth hormone. Breast tissue is composed
of 80% fat. Prior to puberty, girls have slightly more body fat than boys. Therefore, women have a
head start in the breast fat accumulation race compared to the aspiring development in trans
women. At puberty, the effect of oestrogen further increases fat deposition. An adult female has
10 – 15% more body fat than an adult male, of which a proportion is obviously on the breasts.
The average breast size of a woman in the UK is a 'B' Cup. In fact, the average amount of breast
growth in a trans woman is also an 'A /B' cup. However, the reason it does not look the same is
due to the relatively larger frame of a trans woman.
9 10 11 12 13 14 15
Tanner stages
periods start ovulation starts
years old
progesterone
levels
1 2 3 4 5
The actions of progesterone in the natal female are:
o cerebral: causing mood change;
o uterine: to prepare the uterus for implantation;
o pregnancy: to maintain pregnancy;
o breast: enabling duct formation for lactation. N.b. Ducts are very small and contribute little to
breast size.
The first of these effects is undesirable, and the latter three actions are not relevant in trans
women who do not become pregnant and have no need for breastfeeding.
Myth
There is a commonly perceived myth that progesterone increases breast size, or improves shape
in the trans woman. This comes, in part, from a paper published some years ago documenting
the microscopic appearance of breast tissue. It indicated that progesterone increased the size of
the lactating ducts. Hence, this is in accordance with the functions detailed above. The paper is
not saying that breasts are bigger.
Further facts about Progesterone
Progesterone is produced in small quantities, in men and women, in the adrenal glands. It acts as
a precursor to the formation of testosterone. ANY form of progesterone, whether naturally
produced or artificially administered has the propensity for conversion into testosterone.
Commonly available progesterones / progestins.
Levenorgestrel (testosterone analogue) Most androgenic
Norethisterone (testosterone analogue)
Mexdroxyprogesterone Acetate (progesterone analogue)
Dydrogesterone (progesterone analogue) Least androgenic
Drospirenone (spironolactone derivative) Antiandrogen
Cyproterone Acetate (synthetic progesterone) Antiandrogen
Progesterone reduces the effectiveness of oestrogen as it:
a) increases the breakdown of oestrogen in the liver;
b) reduces the number of oestrogen receptors in the breast (oestrogen must bind to receptors in
order to work. Even if there are good oestrogen levels in the bloodstream, if there are no
receptors, it cannot work);
c) is converted into testosterone which inhibits the actions of oestrogen.
The following table shows the common side effects associated with progesterone; the
testosterone derived effects of progesterone are underlined.
Progesterone-only contraceptives stop menstruation and ovulation by inhibiting the actions of
oestrogen. Therefore, high doses of progesterone in trans women will also inhibit the actions of
oestrogen and thus hinder feminisation. All commercially available forms of progesterone are
'high doses' as they are made to inhibit the actions of oestrogen in natal women.
Bloating Nausea Fluid retention Body Hair Growth
Breast tenderness Headache Weight gain Loss of head hair
Dizziness Drowsiness Acne Increased
cholesterol
Depression Itching Jaundice
Optimising Breast Growth
In the trans woman, breast growth occurs due to oestrogen. It is achievable at low plasma levels
of oestrogen. It is thought that too high a dosage too soon can stunt breast development so that
only the early Tanner stages are achieved causing a conical effect with poor nipple growth. In a
pubertal girl, oestrogen levels increase very slowly over many months.
It is well known that the some trans women believe that more oestrogen is better. This would be
feasible if the body had more oestrogen receptors, but unfortunately, there are not a great
number of oestrogen receptors. However, they will soak up any available oestrogen from the
bloodstream.
Therefore, genetic predisposition largely determines the number of receptors and thus the
likelihood of breast growth. Oestrogen stimulates receptor synthesis with relatively low levels of
oestrogen in the natal woman pre-menstruation. There is a strong argument for commencing at
low dosage and gradually increasing towards typical adult female levels.
Breast growth takes 2-3 years as stated earlier. The body can only change slowly. Patience is
required and the understanding that growth is also phasic that is, there are periods when it is
active and periods when nothing occurs. N.b. breast / nipple tenderness does not always indicate
growth is occurring.
Growth occurs because oestrogen induces formation of glandular tissue and fat. Glandular tissue
is hard and nodular. It constitutes 20% of the size. 80% of breast size is due to the oestrogen
induced accumulation of fat. Simplistically, in pubertal girls, the calories eaten will preferentially
be laid down as fat, whereas in the pubertal boy, calories contribute to muscle accumulation. In
the trans woman, the effect of the taking oestrogen is to help to re-dress this physiological
difference.
Many women experience an increased appetite whilst taking oestrogen and those who feminise
well tend to put on weight, typically ½ stone to a stone. As an oestrogen dominant individual, this
will manifest as gaining fat, at least some of which will be laid down on the breasts (as long as
there is the genetic predisposition) and some will accumulate on the hips / legs to create the
rounded female shape.
Therefore, to optimise the development of the female shape, trans women should avoid
excessive calorie restriction or large amounts of cardiovascular exercise at this point, because
this will lead to a suboptimal outcome, particularly in individuals who are very lean to start with.
The bottom line is that oestrogen alone grows breasts as long as other factors are favourable.
Progesterone and Trans women
Many trans women have a wish to take progesterone. For several reasons:
1) they feel they should because menstruating females have progesterone for two weeks in the
month,
2) they think it will make their breasts bigger
3) they are influenced by their friends
4) they want to feel more like a genetic woman
With regard to 1) the average age of presentation of trans women is 42 years old. Natal women
undergo the menopause at approximately 50 years old, after which time their progesterone is all
but zero and their oestrogen levels are the same as a man. So if 1) were desirable, NO trans
woman should be taking any progesterone, (or any oestrogen for that matter after the age of 50).
As already explained 2) is a fallacy.
Point 3) is a reflection of the pressure many trans women feel, and may put their friends under,
having accepted as true the many postings on the internet on the topic of the benefits of
progesterone. The majority of what is written on the internet about hormones is rubbish. It is
frequently written by non-medical people, who have copied and pasted their information from
other uninformed sources. The advice is laden with myth, out of date information and personal
opinion. Even the sites that seem to be written by 'doctors' are usually not actually medical
doctors. A science PhD does not indicate medical competence.
Sites abroad are also seldom written by doctors and very few sources are written by any who
have a reasonable degree of actual experience in dealing with the administration of hormones in
trans people.
Point 4) is understandable but somewhat bizarre since most genetic women would prefer not to
experience the effects of progesterone. Progesterone is largely what causes premenstrual
tension (PMT). It greatly affects mood, causing a whole array of mood destabilising effects;
anxiety, aggression, depression. The susceptible genetic woman will explain that these feelings
are neither pleasant nor desirable. Feeling bloated and spotty with painful breasts just prior to a
period is not welcomed by natal women. I believe trans women have a high placebo effect where
this scenario is concerned.
Anecdotal Findings
Many of my patients have reported their experience taking progesterone (not prescribed by me
and usually before they see me).
Their experience falls into 3 categories:
• Some tell me it made no difference at all, neither good nor bad.
• Many describe the side effects, particularly on mood as well as the full complement of effects
listed in table 3.
• Some report an increase in breast growth. In some individuals, this may be the case and I
suspect that this is due to two things:
1) The individual's appetite is greatly increased. This causes increased fat accumulation in a
straightforward calorie excess dependent fashion.
2) A sub-optimal oestrogen regime. Just because a person takes the dosages detailed on the
internet, does not equate to an optimised regime. Many women do not absorb oestrogen well.
There is no substitute for a professionally monitored oestrogen regime by someone who
understands oestrogen physiology and drug administration. Oestrogen levels need
interpretation in the context of the individual's observed effects, the regime administered and
the dynamics of drug administration.
Consider this. In my past life:
If I weighed 57kg (9 stone) my breasts were less than an A-cup.
If I weighed 60kg, they were a proper A-cup.
If I weighed 63kg or over, I was a B-cup.
This was regardless of hormone status and only depended upon how much I ate or exercised.
The Problems Associated with Progesterone
The forms of progesterone available to trans women are all DRUGS. Regardless of how they are
taken or what they are called, these drugs are not the same as a naturally occurring progesterone
hormone. ALL drugs have side effects.
The side effects of progesterone are significant and MUST NOT be dismissed.
Anyone with the following pre-existing conditions should be extremely cautious about taking
progesterone.
Cautions Epilepsy High blood pressure
Migraine Asthma
Heart disease Kidney disease
Abnormal liver function History of jaundice
Thrombosis (DVT / PE) Depression
Diabetes
Progesterone is contraindicated in people who have, or who have had, any of the following:
liver dysfunction, breast cancer, heart disease, stroke, arterial disease.
In the natal woman, progesterone is given largely in three scenarios;
1. as a contraceptive;
2. to suppress menstrual blood loss;
3. to protect the uterus from developing cancer.
Trans women have none of these issues therefore, progesterone administration is not indicated.
With regard to protecting the uterus from cancer, this is the only reason a post menopausal
woman is given progesterone as well as oestrogen as part of her hormone replacement therapy
(HRT) regime. Otherwise, if there is no uterus, oestrogen only is given, regardless of patient age.
The reason for not giving progesterone unless absolutely necessary, is because of the risk. The
most serious of which are breast cancer and thrombosis.
Studies and observation show well documented evidence for a significant contribution from
progesterone in the above. Of itself, oestrogen increases the risk of venous thrombosis and
breast cancer. Progesterone further contributes independently of oestrogen.
For Thrombosis (DVT):
50-59 years old 60-69 years old
No HRT 10 cases in 1000 women 20 in 1000
+ Oestrogen 11 in 1000 24 in 1000
Oestrogen + progesterone 15 in 1000 33 in 1000
These figures indicate that in the 50-59 age group, 4 more women in a 1000 will have a venous
thrombosis when progesterone is part of their regime.
And for breast cancer:
50-59 years old 60-69 years old
No HRT 14 in 1000 31 in 1000
+ Oestrogen 15 in 1000 31 in 1000
Oestrogen + progesterone 20 in 1000 35 in 1000
Venous thrombosis and breast cancer are obviously serious problems. Be aware that no one
knows the true incidence of breast cancer in trans women. There are no data on this. Figures
cannot be collected accurately as many women cease to attend gender clinics, and positive
diagnoses in trans women (where the trans history is disclosed) are not, in any case, ascribed to
a transgender category.
Another Myth
It is wrong to believe that venous thrombosis will not occur if aspirin is taken.
ASPIRIN WILL NOT PREVENT VENOUS THROMBOSIS.
The clotting processes which occur in veins are different to those in the arteries. Aspirin protects
the arteries.
Conclusion
The above are the reason the risk-benefit ratio associated with progesterone renders it unethical
to prescribe. The benefits of it are extremely limited and unproven.
Hormone protocols from well-informed gender clinics around the world do not routinely use
progesterone and ethical doctors who are up to date in their knowledge will not prescribe it.
It should NOT be self-prescribed and is only done by foolish, misinformed, risk taking individuals.
The overall effect of it with regard to feminisation is a negative one.
If progesterone contributed to breast growth it would be evident in natal women when they take
progesterone preparations. This is not the case. Any increase in breast size in natal women is
due to general weight gain.
Therefore the same effect in feminisation can be gained by exercising less, and a modest degree
of caloric over-consumption.
For those who wish bigger breasts, save your money, reduce the side effects and longer term risk
and just eat more pies. Without making yourself obese, feminisation is greatly dependent on the
oestrogen assisted accumulation of body fat which does not come out of the ether.
If you are disappointed with the eventual size of the breasts resign yourself to the fact that you
may need a breast augmentation; a procedure increasingly sought by non-trans women and
undertaken in 50% of trans women after two years on hormones.

Stardust

Quote from: stardust on February 18, 2011, 07:43:52 PM
The actions of progesterone in the natal female are:
o cerebral: causing mood change;
o uterine: to prepare the uterus for implantation;
o pregnancy: to maintain pregnancy;
o breast: enabling duct formation for lactation. N.b. Ducts are very small and contribute little to
breast size.
The first of these effects is undesirable, and the latter three actions are not relevant in trans
women who do not become pregnant and have no need for breastfeeding.

Whilst I am sure Dr Curtis is right on many things in this he is talking out of his proverbial backside.

Worse still he is sure that he is right.  ::) I am equally sure that he is being over simplistic and is wrong.

I have done a double blind test with my GP. I do get a mood alteration but in my case it is positive. I feel better when I take the stuff. That is the reason I chose to do so.

Secondly, Dr curtis ignores the effect on female libido, which being a testosterone fueled man he obviously wouldn't recognise.

Take T and you get a massive and urgent sex drive. Without it you have very little if any.

Take Progesterone instead and you get a subtle and gentle yearning for closeness and intimacy - which works as a jolly good pre-cursor to sex. It is probably all about preparation for motherhood, but the psychological effect is to give me an interest in sex which without it I simply don't have.

I will not take testosterone, and I don't like the almost violent drive that it gives. This is different, and much nicer, but it works and it makes me a sexual and sensual woman.

That is why Curtis is talking tosh, and it is typical of a man to think that this would all be about the size of boobs. It isn't. It is so much more complex that than.

Finally all this argument about synthetic drugs. Most of us take bio-indenticals these days, and anyway MY BODY MY CHOICE.

I am the one who will decide on what I do or don't put into it.

Quote from: rejennyrated on February 19, 2011, 03:00:11 AM
Whilst I am sure Dr Curtis is right on many things in this he is talking out of his proverbial backside.

Worse still he is sure that he is right.  ::) I am equally sure that he is being over simplistic and is wrong.

I have done a double blind test with my GP. I do get a mood alteration but in my case it is positive. I feel better when I take the stuff. That is the reason I chose to do so.

Secondly, Dr curtis ignores the effect on female libido, which being a testosterone fueled man he obviously wouldn't recognise.

Take T and you get a massive and urgent sex drive. Without it you have very little if any.

Take Progesterone instead and you get a subtle and gentle yearning for closeness and intimacy - which works as a jolly good pre-cursor to sex. It is probably all about preparation for motherhood, but the psychological effect is to give me an interest in sex which without it I simply don't have.

I will not take testosterone, and I don't like the almost violent drive that it gives. This is different, and much nicer, but it works and it makes me a sexual and sensual woman.

That is why Curtis is talking tosh, and it is typical of a man to think that this would all be about the size of boobs. It isn't. It is so much more complex that than.

Finally all this argument about synthetic drugs. Most of us take bio-indenticals these days, and anyway MY BODY MY CHOICE.

I am the one who will decide on what I do or don't put into it.

Thanks Jenny,

I posted this because my clinic and my doctor because of the clinics decision not to prescribe this for me will also not give it to me. I have asked on several occasions but the answer is still no. I don't know how to proceed about this as I don't want to self prescribe and the cost to of getting it for myself. I already pay the NHS with a prepayment card so I feel why should I have to pay again. The article is what they use to uphold their decision on this. My clinic say they would look at it again if there were any medical evidence that has been proved that the benefit outways the non benefits. Is there any scientific tests that have been done that I can use that would persuade my doctors to change their minds?

Stardust   

There is no formal study that I know of.

However when, in effort to save money, my doctor twice attempted to remove the progesterone, we found my sex drive totally collapsed, I also became depressed and lethargic. On both occasions when the progesterone was restored things returned to normal.

It isn't scientific, but anecdotally it is interesting. Progesterone is not an expensive drug to prescribe, besides which Dr Curtis is not an NHS expert on this. He is in private practice, as is Dr Perring who does prescribe progesterone. There are also plenty of NHS clinics that will prescribe progesterone including Charing Cross.

Dr Curtis has no clinical data to back up his claims, so using one unproven OPINION as a basis for a major decision of that nature, and ignoring other doctors like Perring who hold an equally valid expertise and opposing opinion, is to my mind, unprofessional and unsupportable. You can bet your bottom dollar that if I was there I wouldn't let them get away with it.

Quote from: rejennyrated on February 19, 2011, 04:30:53 AM


You can bet your bottom dollar that if I was there I wouldn't let them get away with it.

I've just compiled a two page letter that I'm going to send to my Dr at the clinic requesting progesterone again and outlining why and see what happens. I will have to go private if it's still a no. I don't want to have to do that as I already pay for my HRT via the prepayment system for NHS meds and that seems unfair as I'd be paying twice. I don't know what else to do other than what I am doing.

Stardust

Quote from: stardust on February 19, 2011, 06:43:50 PM
I've just compiled a two page letter that I'm going to send to my Dr at the clinic requesting progesterone again and outlining why and see what happens. I will have to go private if it's still a no. I don't want to have to do that as I already pay for my HRT via the prepayment system for NHS meds and that seems unfair as I'd be paying twice. I don't know what else to do other than what I am doing.

Stardust

If I were you I would keep your letter brief and to the point.

The main thing you want to do is explain that the reasons why those of us who take it do so are more complex than Dr Curtis seems to understand.

You can also cite some anecdotal evidence but the main thrust of your argument should be just my closing para from my previous post.

Dr Curtis has no clinical data to back up his claims, so using one unproven OPINION as a basis for a major decision of that nature, and ignoring other doctors like Dr Michael Perring and indeed some of the Charing Cross doctors who hold an equally valid expertise and opposing opinion, is to my mind, unprofessional and unsupportable.

You may want to tone down the last couple of words - maybe say irrational rather than unprofessional...

Good Luck.

Dr perring prescribes progesterone because as far as he's concerened it has a balancing effect on moods...I'm sure it might be possible to ask him why him for clinical reasons why he prescribes progesterone. Logically his arguments should carry as much weight as Dr C's.

Knowing nothing makes it easy for me to jump in. Is it possible that natal girls develop breasts without progesterone, but that sexually active women need some progesterone to support libido?

S

Quote from: Simone Louise on February 20, 2011, 11:13:13 AM
Knowing nothing makes it easy for me to jump in. Is it possible that natal girls develop breasts without progesterone, but that sexually active women need some progesterone to support libido?

S

Exactly my experience!  ;D

...and inevitably Curtis who is a transman probably doesn't know anything about female libido ::)

We also have to remember transwomen are not genetic females. Isn't it hard to compare puberty? And later in life the size of the breast can change dramatically. Either grow larger or shrink. My ex-wife said she used to have huge breasts but when we were together they were small.

I also found this and I have some of the symptoms so its not just about breast growth.

Stardust

For women suffering from low levels of the hormone progesterone, many of the symptoms go unnoticed until they have caused significant health damage. Fortunately, early warning signs may be able to help women avoid additional health risks associated with the condition. Knowing these early signals of lowered progesterone levels can be one of the most important things a woman can do to ensure her future good health.
1.   Significance
o   Low progesterone is a condition in which the female body does not produce enough of the hormone to effectively regulate estrogen. The female body naturally produces this critical hormone during ovulation cycles via the ovaries and the adrenal glands. At times, the body may not be able to produce enough progesterone due to a variety of causes, resulting in low progesterone levels and subsequent problems.
Causes
o   The causes of low progesterone in women may include the following: liver dysfunction, estrogen dominance created by environmental pollution, insulin resistance, stress, diet, lack of exercise and certain medications.
Early Symptoms
o   Many conditions associated with low progesterone levels, such as water retention, uncontrollable weight gain and vaginal dryness, may often be dismissed as being minor health concerns associated with stress. Women rarely seek treatment for these disorders until they begin to have a greater impact upon their health and well-being. Unfortunately, these symptoms will not just fade away if they are ignored.
Secondary Symptoms
o   Although the early signs of low progesterone levels may be easier to dismiss, the secondary symptoms may lead women to talk to their health care providers. These symptoms include migraine headaches, depression, panic attacks, abnormal menstrual cycles and blood sugar problems. Each symptom is serious within its own right, but when it could be the predecessor to a health problem associated with low progesterone, it is all the more important that the condition receives prompt medical attention. Without proper care, low progesterone levels can create further health problems.
Effects
o   If low progesterone levels are left undiagnosed and untreated, a variety of dangerous health conditions can develop. Women with untreated low progesterone levels have a higher incidence of several forms of cancer, osteoporosis, fibroid tumors and high blood pressure, along with the increased risk of heart disease and stroke associated with elevated blood pressure.
Infertility is also a side effect of low progesterone. Millions of women who long to be mothers are denied the common miracle of pregnancy and childbirth by low levels of progesterone. While women become pregnant and have children every day, women with low levels of progesterone may experience years of infertility and miscarriages due to their low hormone levels.
Considerations
o   Low progesterone levels may accelerate the aging process. The body responds to the lack of progesterone by causing thyroid dysfunction, loss of hair, thinning of the skin and wrinkling of the skin associated with the loss of hydration.
The lowered levels of progesterone may also manifest themselves in the early onset of senility and Alzheimer's disease. Other symptoms may include the inability to handle stress and an increase in body aches and pains as the low progesterone level causes the breakdown of the myelin sheath that protects nerve cells.

Quote from: stardust on February 20, 2011, 06:29:00 PM
I also found this and I have some of the symptoms so its not just about breast growth.

Stardust

For women suffering from low levels of the hormone progesterone, many of the symptoms go unnoticed until they have caused significant health damage. Fortunately, early warning signs may be able to help women avoid additional health risks associated with the condition. Knowing these early signals of lowered progesterone levels can be one of the most important things a woman can do to ensure her future good health.
1.   Significance
o   Low progesterone is a condition in which the female body does not produce enough of the hormone to effectively regulate estrogen. The female body naturally produces this critical hormone during ovulation cycles via the ovaries and the adrenal glands. At times, the body may not be able to produce enough progesterone due to a variety of causes, resulting in low progesterone levels and subsequent problems.
Causes
o   The causes of low progesterone in women may include the following: liver dysfunction, estrogen dominance created by environmental pollution, insulin resistance, stress, diet, lack of exercise and certain medications.
Early Symptoms
o   Many conditions associated with low progesterone levels, such as water retention, uncontrollable weight gain and vaginal dryness, may often be dismissed as being minor health concerns associated with stress. Women rarely seek treatment for these disorders until they begin to have a greater impact upon their health and well-being. Unfortunately, these symptoms will not just fade away if they are ignored.
Secondary Symptoms
o   Although the early signs of low progesterone levels may be easier to dismiss, the secondary symptoms may lead women to talk to their health care providers. These symptoms include migraine headaches, depression, panic attacks, abnormal menstrual cycles and blood sugar problems. Each symptom is serious within its own right, but when it could be the predecessor to a health problem associated with low progesterone, it is all the more important that the condition receives prompt medical attention. Without proper care, low progesterone levels can create further health problems.
Effects
o   If low progesterone levels are left undiagnosed and untreated, a variety of dangerous health conditions can develop. Women with untreated low progesterone levels have a higher incidence of several forms of cancer, osteoporosis, fibroid tumors and high blood pressure, along with the increased risk of heart disease and stroke associated with elevated blood pressure.
Infertility is also a side effect of low progesterone. Millions of women who long to be mothers are denied the common miracle of pregnancy and childbirth by low levels of progesterone. While women become pregnant and have children every day, women with low levels of progesterone may experience years of infertility and miscarriages due to their low hormone levels.
Considerations
o   Low progesterone levels may accelerate the aging process. The body responds to the lack of progesterone by causing thyroid dysfunction, loss of hair, thinning of the skin and wrinkling of the skin associated with the loss of hydration.
The lowered levels of progesterone may also manifest themselves in the early onset of senility and Alzheimer's disease. Other symptoms may include the inability to handle stress and an increase in body aches and pains as the low progesterone level causes the breakdown of the myelin sheath that protects nerve cells.

Yes I think I had found that one before - or something like it.

It is clear that right there you have enough solid medical evidence to blow that, in my opinion, frankly silly and arrogant little man and his idiotic amateur endocrinology theories straight out of the water.

If those effects hold good for anyone running on the estrogen system then most of them will hold good even when there is no uterus present.

So basically what you just proved is that Curtis and his thinly disguised misogynist theories is putting the long-term health of his female patients at risk, and probably all because he didn't enjoy the female hormone regimen when he was unfortunate enough to suffer it and is therefore trying to prove that it is inherrently over complex and parts of it are redundant. Well sorry, but that proves it isn't.

This situation is not good enough, and in my opinion it needs to be corrected. This one sided rubbish that he is putting round needs to be challenged and exposed.

(Its a damn good job that I never saw him, because I honestly would probably have thumped him! I hate arrogant opinionated men like that! I really do... grrrrr!)

Hi Jenny,

I've just attached the report to my letter to my clinic which I'm posting tomorrow so fingers crossed, lol. They will not like me though I'm sure. I'm also going to make an appointment with my GP and show him the report as he knows I've been to him with some of those symptoms mentioned. I want him to write to the clinic too. They wont like me when I'm angry, I turn green, lol.

Stardust

Well, I was on a refresher course at work today which finished early so as I had the letter to my clinic doc in my bag I decided to phone them and see if I could speak to my Dr for five minutes and hand him the letter. I don't know if it was luck or not, time will tell, but my doctor was in today and I asked to see him. They said I could in between his other clients. So I arrive there waited with baited breath and after 30 mins was called in. I told him the reason I wanted a quick word, plainly and to the point that I wanted to add progesterone to my HRT and handed him the letter and said he could open it and read then if he wanted.

What pursued was a debate on the pro's and con's. I had included the report which I had included here. He said he couldn't give a yes or no there and then as he'd have to read my letter and digest what I said. He admitted that he was not an expert but in the same breath he does NOT prescribe or recommend it. He did say he doesn't mind if my doctors would but he could not recommend him to do so as it would be against his own thoughts on it. I said there's the catch 21, my doctor would but only if the go ahead came from the clinic. To say by this time I began to fume is an understatement. I quoted from the report the areas pertaining to me and he then wanted to know its source so I have to email him that as I couldn't remember. He did say that if I could find enough evidence that it has real benefits then he reconsider. He said I'm not saying no.

So I would like some help to find and source other evidence that is backed by studies. If anyone here at Susan's can help PM me with links (I hope this doesn't breach any protocols).  I need this info quickly as I also have another appointment with my GP to ask him if he'd give me the progesterone as My clinic Dr said he wouldn't mind him doing that.

I hope I'm making sense to everyone.

Stardust

Interesting stuff for sure.

I take progesterone (started 6 months after I started HRT) and I can't say I experienced a huge breast growth jump although I feel like maybe they are rounder....that could be all in my head.

I didn't experience a mood change (except maybe 3x in the last year where I just had a bad day for no reason).
I did experience some re-masculinization for a month or 2 when I started P and I didn't pass as well during those months (quite odd). But otherwize my T-levels have stayed at 40 since I started HRT (down from 300).

I've read and heard about so many articles talking about P being good or P being bad. I wish there could be a study that was an end-all cuz when it comes down to it, I just want optimal breast growth whether it's with or without P.

I did find the parts about gynecomastia and weight gain/loss interesting. As someone who had small breasts and even duct tissue before HRT, I always wondered about the mechanisms behind it.

As for weight gain and loss, I won't stop my cardiovascular program (I run 2.5 to 3 miles 5 to 6 days a week) because I am, well, fat. I've lost 30lbs so far and I do have quite a large appetite too. I have noticed a layer of fat collecting under the skin of my arms and legs and my breasts have indeed grown larger. What I have noticed is that I lose weight and then eat and put a bit on, then lose more weight and get a craving to eat and put some more on. The net effect is overall weight loss, so I will continue on with this until I reach my desired goals.

My endo in Houston told me transwomen do not need progesterone. 'Course I am not in Orlando, so hopefully I can find a more agreeable endo here.

Update.

Sent the clinic my research and my Dr at the clinic sent me back an email saying, "We are going to discus the administration of progesterone at our next group therapist meeting" end quote.

I don't know how to take this. Its either a ploy to stall things, a fob off, or he is genuinely looking into the possibly of prescribing progesterone for me.   

Stardust

Quote from: stardust on February 23, 2011, 05:00:13 AM
Update.

Sent the clinic my research and my Dr at the clinic sent me back an email saying, "We are going to discus the administration of progesterone at our next group therapist meeting" end quote.

I don't know how to take this. Its either a ploy to stall things, a fob off, or he is genuinely looking into the possibly of prescribing progesterone for me.   

Stardust

Odd. I will say that all this talk of P inhibiting breast growth makes me want to do some research before going back on it after surgery.....

Quote from: Dana Lane on February 20, 2011, 11:26:11 AM
We also have to remember transwomen are not genetic females.

Exactly!  Most of us are not in puberty either.  There is a good case that we don't need pro.  But I think pro likely does contribute to breast growth in adult women, particularly pregnant women.  I think therapy should strive to give us working breasts that we could use breast-pumps to lactate, for better looking boobs to help us pass better.

Quote from: GinaDouglas on February 23, 2011, 05:00:05 PM
Exactly!  Most of us are not in puberty either.  There is a good case that we don't need pro.  But I think pro likely does contribute to breast growth in adult women, particularly pregnant women.  I think therapy should strive to give us working breasts that we could use breast-pumps to lactate, for better looking boobs to help us pass better.

Except that As I said this is categorically NOT repeat NOT about bigger breast growth for many of us.

For me it is a simple equation. With progesterone I have a sex drive and am happy and calm. Without it I have NO SEX drive and am depressed and agitated.

It may be that my biology as an intersex woman is slightly different, but I don't think it is THAT different.

Progesterone is not just all about boobs. It is also a psycho active compound in that there are progesterone receptors in parts of the brain and it acts as a mood modifier. It makes you feel good.

THAT is why I take it. I don't NEED big boobs. The ruddy things are F/G cup and I wish they were smaller. What I do need is a sex drive and that is why I take it.

I take it to simulate a natural cycle.  If I bigger boobs from it great.  If not it was not in the cards.


I do notice I get a little bitch about 4 or 5 days before my cycle.

Hi girls!

Well, since HRT I haven't been feeling so well physically....
I have joint pains... osteoporosis....fatigue...very dry skin, low libido....mood changes...
but endo did not help me so I am looking around for a second opinion now...

Its so difficult when you experience problems... I know something needs to be changed
but I dont know what....

i want to try progesterone... simply just to see if it helps me in any way....
my current endo says he wont prescribe because he things its too dangerous and ineffective...

I have an undetectable T level and he thinks that is fine as well...

I dont really trust him anymore, and I just dont know who to believe  and what to do

as a response to this article:

---- What would be considered a "high dose" of progesterone?


Commonly available progesterones / progestins.
Levenorgestrel (testosterone analogue) Most androgenic
Norethisterone (testosterone analogue)
Mexdroxyprogesterone Acetate (progesterone analogue)
Dydrogesterone (progesterone analogue) Least androgenic
Drospirenone (spironolactone derivative) Antiandrogen
Cyproterone Acetate (synthetic progesterone) Antiandrogen

------- So what about micronized progesteron?

Progesterone is contraindicated in people who have, or who have had, any of the following:
liver dysfunction, breast cancer, heart disease, stroke, arterial disease.
In the natal woman, progesterone is given largely in three scenarios;
1. as a contraceptive;
2. to suppress menstrual blood loss;
3. to protect the uterus from developing cancer.
Trans women have none of these issues therefore, progesterone administration is not indicated.


------ yeah ehm but woman have higher progesterone levels then men and transwoman....just because we dont suffer from any of those conditions does not mean it is not reasonable to think about creating a hormone balance in transwoman?

Quote from: Birgitta on February 23, 2011, 05:38:08 PM
Hi girls!

Well, since HRT I haven't been feeling so well physically....
I have joint pains... osteoporosis....fatigue...very dry skin, low libido....mood changes...
but endo did not help me so I am looking around for a second opinion now...

Its so difficult when you experience problems... I know something needs to be changed
but I dont know what....

This is precisely what some of the evidence is suggesting. That without progesterone some women after menopause have experienced just these same symptoms. The research I have done suggests that the prescribing of progesterone alleviates these symptoms and protects against osteoporosis in particular. As we are similar to menopausal  women in that our hormone production is unbalanced with unopposed estrogen we may need progesterone to balance it. I am particularly worried about osteoporosis as my mum has it and therefore I to could be susceptible.

Stardust

PS Brigitta, thank you, this highlights my concerns. We need trials and not just trials from a genetic female standpoint but from trans women.

hI Stardust :D
nice name :D

I probably had osteoporosis before starting HRT though,
and probably because of the anxienty of years before,
Still, it made me investigate my situation, because I am still young 32,
and I want a hormone balance that will support my health in the long run.

But my endo is so arrogant... he put me on androcur alone for 7 months under my protest
and said it would not harm my health but it did, so I don't trust him anymore and
am actually very angry because of this...

so I am going for a second opinion....

Well, I thought I'd post. I saw my GP today and he is happy to prescribe progesterone for me. So that's the good news. He however wants to wait for the clinics decision and take it from there. He couldn't understand either, why the clinic does not prescribe it as a matter of course and so I quoted what they had told me. He still didn't see why not. So kind of cool outcome.

I'm so glad I have a supportive GP.

Stardust

PS, sorry Brigitta about your experience, I hope you get sorted out too.

Even GGs need a certain level of T to be physically and emotionally healthy so it would throw up a HUGE red flag if he told me it wasn't a concern. I have a TG friend in Chicago that was having a lot of the same problems you are having and a small dose of T made a huge impact in her well being.

Hopefully, he is also monitoring your thyroid functions as a defective thyroid can cause many of the same symptoms that you have described. I hope you get it all sorted out soon...  :-(

I would not take any kind of synthetic progesterone at all. When I lived in the States I was taking Prometrium which is bio-identical micronized progesterone. Once I got to Australia that brand was not available, so I had to go almost 2 weeks without it until I made an appointment with a very good local endocrinologist who told me about the compounding chemists. Basically this is a pharmacy where they make your drugs to order on the premises. He prescribed me pure progesterone in troche form (dissolves in the cheek or under the tongue, butterscotch flavor mmm) at double the dose of Prometrium I was previously taking.

I can verify that during the 2 weeks I was off, my emotions went through the roof. To call it "roller coaster" would be a vast understatement. I was overwhelmed with such a horrible feeling of weltschmerz (http://en.wikipedia.org/wiki/Weltschmerz) I literally wanted to kill myself. After just a few days back on progesterone however, my moods leveled off and I'm a happy girl again. :) The reason I mentioned about the synthetic progesterone is because my endo also told me that the synthetic types cause more of the adverse side effects, and the synthetics do not have the same mood leveling effect as the pure stuff.

My SRS surgeon, Dr. McGinn, originally prescribed me the progesterone for 3 reasons:

• mood leveling- I can confirm it works ;D
• excess progesterone metabolizes into a type of testosterone in the body, therefore its effect on enhancing the libido, and
• breast development- all I can tell you is that since being on progesterone I have developed apricot-sized areas of very firm tissue behind my areolas which has caused them to expand, and more filling out in general. They're also quite tender to the touch.

For all those things, the benefits to me outweigh the risks. I would take it for the mood leveling alone, as that for me is its greatest benefit. But anyone who says the benefits are unproven is simply not taking it. lol

I had to stop Prometrium for 2 weeks before surgery. I hope my mood doesnt go crazy.....

Quote from: Jerica on March 02, 2011, 01:04:47 PM
I had to stop Prometrium for 2 weeks before surgery. I hope my mood doesnt go crazy.....

Eeewwwww, I remember it well, lol. I had to be off my HRT for six weeks before and three after it was a nightmare. Night sweets, hot flashes, etc, etc. Anyway Jerica, I see you have less than two weeks, yay, you go girl. Keep us up to date.

Stardust

as a response to this article:

"As progesterone does not exist in genetic girls until age 14, it is clear that progesterone cannot
possibly have any effect on breast development in the genetic female."

It showed that estrogen without progesterone is sufficient for breast growth for most genetic females. But some genetic females do developing breasts after 14. The presence of progesterone in the breasts could be the contributing factor in those cases.

"Puberty is a complex process and, in addition to oestrogen, there are many other hormones
which regulate it. These include prolactin, insulin and growth hormone. "

According to an article by Jenn (http://www.estrogendominanceguide.com/about (http://www.estrogendominanceguide.com/about)): "Estrogen can also direct cells to make receptors for other hormones, including progesterone, which is another hormone that instructs cells in the breast to multiply. "

This indirectly explained that HRT is more effective for MTF persons in their puberty, the higher amount of growth hormone present in this age group could be the contributing factor.

Dr. Richard J. Curtis:
"b) [progesterone] reduces the number of oestrogen receptors in the breast (oestrogen must bind to receptors in
order to work. Even if there are good oestrogen levels in the bloodstream, if there are no
receptors, it cannot work);"

The assertion that progesterone reduces the number of oestrogen receptors is incorrect according to data of C.W.Xiao and A. K. Goff
Centre de Recherche en Reproduction Animale, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 Rue Sicotte,
St-Hyacinthe, Quebec J2S 7C6, Canada:

"Progesterone (50 nmol l\m=-\1)had no
effect on the number of oestradiol or progesterone receptors (P > 0.05). However,
progesterone inhibited the stimulatory effect of oestradiol. In epithelial cells, the lower
concentrations of oestradiol (0.1 and 1 nmol l\m=-\1) stimulated the number of progesterone
receptors (P = 0.05) after 4 days culture, whereas the highest concentration of oestradiol
(10 nmol l\m=-\1), progesterone (50 nmol l\m=-\1) and progesterone (50 nmol l\m=-\1) plus oestradiol (1
nmol l\m=-\1) had no effect. After culture for 8 days, the stimulatory effect of oestradiol
decreased. In contrast to progesterone receptors, the number of oestradiol receptors
increased with oestradiol concentration (P < 0.01). These data show that the number of
progesterone receptors was higher in the stromal cells than in epithelial cells, whereas the
number of oestradiol receptors was higher in the epithelial cells than in stromal cells.
Oestradiol upregulates its own receptor and increases the number of progesterone
receptors in both cell types in vitro, whereas progesterone has little effect, but inhibits the
effects of oestradiol on progesterone receptors."

The article by Dr. Richard J. Curtis is biased in favour of other hormones to the exclusion of progesterone in the contribution of breast growth, if progesterone is also present in the system, estrogen can also direct cells to become progesterone receptors, these receptors will in turn cause cells to multiply. 

"The actions of progesterone in the natal female are:
o cerebral: causing mood change;
o uterine: to prepare the uterus for implantation;
o pregnancy: to maintain pregnancy;
o breast: enabling duct formation for lactation. N.b. Ducts are very small and contribute little to
breast size."

The article failed to mention other beneficial actions of progesterone in the natal female which according to the article by Dr. Michael Lam, MD, MPH:

"*progesterone acts as an antagonist to estrogen.*
For example, estrogen stimulates breast cysts while progesterone
protects against breast cysts. Estrogen enhances salt and water
retention while progesterone is a natural diuretic. *Estrogen has been
associated with breast and endometrial cancers, while progesterone has a
cancer preventive effect.* Studies have shown that pre-menopausal women
deficient in progesterone had 5.4 times the risk of breast cancer
compared to healthy women."

Regarding progesterone causing mood change, according to the same the article by Dr. Michael Lam,

"    Symptoms
      include water retention, breast swelling, and fibrocysts in the
      breast, depression, headache, gallbladder problems, and heavy
      periods. The excessive estrogen from ERT also lead to increased
      chances of DNA damage, setting a stage for endometrial and breast
      cancer. **"

Again...

"***Stress. Stress causes adrenal gland exhaustion as well as
      reduced progesterone output.* This tilts the estrogen to
      progesterone ratios in favor of estrogen. Excessive estrogen in
      turn causes insomnia and anxiety, which further taxes the adrenal
      glands. This leads to a further reduction in progesterone output
      and even more estrogen dominance. After a few years in this type
      of vicious cycle, the adrenal glands become exhausted. This
      dysfunction leads to blood sugar imbalance, hormonal imbalances,
      and chronic fatigue.**"

It states estrogen dominance (higher estrogen to progesterone ratio) is cause of depression and anxiety, a mental condition (same as mood) cause by hormonal imbalance.

Regarding hormonal imbalance effecting the physical health condition:

"*According to the late Dr. John Lee, the world's authority on natural
hormone therapy, the key to hormonal balance is the modulation of
progesterone to estrogen ratio. For optimum health, the progesterone to
estrogen ratio should be between 200 and 300 to 1. * **"

Dr. Michael Lam:

"**What is so bad about estrogen dominance?  It is the root cause of a
myriad of illnesses. Conditions associated with this include fibrocystic
breast disease, PMS, uterine fibroids, breast cancer, endometriosis,
infertility problems, endometrial polyps, PCOS, auto-immune disorders,
low blood sugar problems, and menstrual pain, among many others. * *"

Out of these illnesses breast cancer, auto-immune disorders, low blood sugar problems can equally happened to MTF transgenders due to estrogen dominance.

Dr. Richard:
"Progesterone is contraindicated in people who have, or who have had, any of the following:
liver dysfunction, breast cancer, heart disease, stroke, arterial disease.
In the natal woman, progesterone is given largely in three scenarios;
1. as a contraceptive;
2. to suppress menstrual blood loss;
3. to protect the uterus from developing cancer.
Trans women have none of these issues therefore, progesterone administration is not indicated."

Trans women do share liver dysfunction, breast cancer issues.

Dr. Richard:
"The reason for not giving progesterone unless absolutely necessary, is because of the risk. The
most serious of which are breast cancer and thrombosis."

In term of breast cancer risks, studies show estrogen contribute 75%, progesterone can reduce the breast cancer risks contributed by estrogen, although progesterone itself contribute 65% to breast cancer risks. In theory, if progesterone reduce the risk contributed by estrogen to 0%, what is left is 65% risk.

In term of venous thrombosis, usage of progesterone may indeed increase the risk.

Dr. Richard:
"Progesterone reduces the effectiveness of oestrogen as it:
a) increases the breakdown of oestrogen in the liver;"

Progesterone support optimum oestrogen metabolism, that result in reduction of bad oestrogen (16-OH metabolite) which can lead to development of breast cancer. In the optimum oestrogen metabolism, 2-OH metabolite (good oestrogen) is produced which generates harmless estrogenic activity in the body.

Infer to Douglas C. Hall, M.D. :
"The ultimate biologic effect of estrogen in the body depends on how it is
metabolized. The metabolism of estrogen takes place primarily in the liver
through Phase I (hydroxylation) and Phase II (methylation and glucuronidation)
pathways, which allow the estrogen to be detoxified and excreted from the body.

Hydroxylation —Hydroxylation yields three metabolites that vary greatly in
biological activity: 2-hydroxyestrone (2-OH),16-OH, or 4-OH.14 The 2-OH
metabolite is generally termed the "good" estrogen because it generates very
weak (and therefore potentially less harmful) estrogenic activity in the body.
In contrast, the 16-OH and 4-OH metabolites show persistent estrogenic activity
and may promote dangerous tissue growth.14-17 In fact, women who metabolize a
larger proportion of their estrogen via the 16-OH metabolite may be at
significantly greater risk of developing breast cancer.1,14-16,18,19 Therefore,
shifting estrogen balance toward a less estrogenic state through promotion of
the 2-OH pathway may prove very beneficial in improving a variety of conditions
related to elevated or imbalanced estrogen levels. "

Dr. Richard:
"c) [progesterone] is converted into testosterone which inhibits the actions of oestrogen."

Small amount of testosterone in trans-women is required to maintain healthy libido. If trans-women is pre-op and can produce small amount of testosterone, then progesterone is not needed for this purpose.

In general, progesterone is needed if:

1. additional breast growth is sought
2. maintain libido in post-op trans-women
3. partial prevention of breast cancer (still left 65% risk)
4. money is not an issue

Progesterone is not needed if:

1. additional breast growth is not sought
2. maintain libido in pre-op trans-women
3. prevent venous thrombosis is important
4. saving cost

Thanks jyoti

Good information on the progesterone.  I use it as a part of my HRT for the moderating influence of the estrogen, for breast growth and to help quell the problems I have with the prostate, so far it did!  So far, I haven't notice any mood swings on and off the progesterone cycles.... so far as I know?!  I read a few articles on the effects of breast growth on estrogen alone.  In some cases they grew tubereous breasts.  This was also seen with natal women that didn't produce enough progesterone on their own.
Joelene

You are welcome, Stardust! I tried to reply you in private, but didn't work.

Here's Dr. Michael Lam's link you requested: http://www.drlam.com/ (http://www.drlam.com/)

Dr. Richard is the doctor who wrote the article you posted in this thread.

This is so confusing. After 5 months of e and spiro my doc (a trans woman) put me on
Progesterone.  This is making me have second thoughts .
My sex drive  has gone down , but not too low. I'd say its at 70% or so.
I'm to take it everyday.

Quote from: jyoti on March 04, 2011, 10:20:22 PM
You are welcome, Stardust! I tried to reply you in private, but didn't work.

Here's Dr. Michael Lam's link you requested: http://www.drlam.com/ (http://www.drlam.com/)

Dr. Richard is the doctor who wrote the article you posted in this thread.

Thanks jyoti, sorry you couldn't message me because you don't have enough posts I think.

Stardust

Quote from: Stephanie.Izann on March 05, 2011, 02:24:51 AM
This is so confusing. After 5 months of e and spiro my doc (a trans woman) put me on
Progesterone.  This is making me have second thoughts .
My sex drive  has gone down , but not too low. I'd say its at 70% or so.
I'm to take it everyday.

Stephanie

trust me on this one. You should not be having second thoughts.

Dr Curtis is in my opinion a progesto-phobic idiot who talks out of his proverbial backside. There is good evidence of the psychological and physiological benefits of having small levels of progesterone and indeed if you think your sex drive is low now you just see how low it can go without! With progesterone I have sex drive. Without it I have absolutely none whatsoever!

This whole thread only arose because Stardust wants progesterone but has come up against a set of doctors who have been swayed by Curtis. The rest of us are on progesterone and convinced of it's benefits and therefore trying to give Stardust the ammunition she needs to win the debate.

Inevitably as a Transman Curtis would not like Progesterone, with its association with PMS and pregnancy. That prejudice however, coupled with a very over simplistic model of the hormones effects on the body, is not a good basis for writing it off. Put simply I, and many others, believe he is seriously wrong on this, and it is quite likely that the true reason why many UK NHS clinic go along with his advice, and ignore the contrary evidence, is that it saves them money by reducing the drugs bill! (don't forget in the UK all medicines are supplied at state subsidised cost)

Quote from: Stephanie.Izann on March 05, 2011, 02:24:51 AM
This is so confusing. After 5 months of e and spiro my doc (a trans woman) put me on
Progesterone.  This is making me have second thoughts .
My sex drive  has gone down , but not too low. I'd say its at 70% or so.
I'm to take it everyday.

I would wager that it's not a case that your sex drive has gone down, but rather changed. I was in a relationship from starting hrt, though it's rather tailed off now  :( and it took 4/5 months for my mae libido to subside. However my sex drive is still there, just the nature of the thing has changed. This could be the same for you.

Quote from: rejennyrated on March 05, 2011, 02:53:31 AM
Stephanie

trust me on this one. You should not be having second thoughts.

...I DO trust ya! :)  That's why you're my mentor! Thanks for taking care of me.
HUGS!
Stephie

Yeah, its true what Jenny has said. I started the post cus I am building my case for prescribing progesterone. I may be hopefully breaking new ground for the clinic I attend. May be they had yes people before. I'm not a yes person if they don't give me a valid reason.

keep the ammunition coming girls, I will wear them down, lol.

Stardust

Quote from: stardust on March 05, 2011, 07:09:28 PM
Yeah, its true what Jenny has said. I started the post cus I am building my case for prescribing progesterone. I may be hopefully breaking new ground for the clinic I attend. May be they had yes people before. I'm not a yes person if they don't give me a valid reason.

keep the ammunition coming girls, I will wear them down, lol.

Stardust

Ok, this does not look good. I got an email yesterday from my dr at the clinic who said for me to send him my research. To put it bluntly he addressed the email Ms B****** instead of my christian name which he had previously used and he said that I am not to send him any more articles or use his email. He said he was going to write to me this week with his decision. Yeah right, I know it already, I'm not stupid.

So I guess I know what the answer will be and I am so angry.

So my next question would be to ask if I need to be with the clinic any more and ask them to discharge me. I believe that being post op I only need someone to oversea my HRT. I am planning on asking my GP to find me an endocrinologist who could do this for me.

Stardust

You don't need anyone to oversee your HRT. The GP can do that perfectly well.

My GP has always worked with me to do that between the two of us. Yes there have been some mistakes made, mostly because I refused to let him do my bloods for quite a time, but we have worked together to solve them and the bottom line is I am still alive and fighting fit!

I honestly don't understand why any of you girls let the clinics hang on to you postop. Ok I wasn't an NHS patient and in any case I went my own way, but Alison was NHS. The day she walked out of the hospital postop - she discharged herself from any further contact with the clinic.

Quote from: rejennyrated on March 08, 2011, 06:42:52 PM
You don't need anyone to oversee your HRT. The GP can do that perfectly well.

My GP has always worked with me to do that between the two of us. Yes there have been some mistakes made, mostly because I refused to let him do my bloods for quite a time, but we have worked together to solve them and the bottom line is I am still alive and fighting fit!

I honestly don't understand why any of you girls let the clinics hang on to you postop. Ok I wasn't an NHS patient and in any case I went my own way, but Alison was NHS. The day she walked out of the hospital postop - she discharged herself from any further contact with the clinic.

Thanks Jenny, I think my relationship with the clinic has broken down so I guess I don't need/want them anymore. I think the only reason THEY like to hold on to me is because they still get money for me from the NHS.

Thanks again, you have answered my question.

Stardust

Quote from: stardust on March 09, 2011, 02:50:28 AM
I think the only reason THEY like to hold on to me is because they still get money for me from the NHS.

A noble act on your part - but be aware that it is paradoxically one which can have unintended consequences.

Back in the 1990's the then head of the CXH GIC one Dr Don Montogomery, otherwise known as Dismal Don to his patients, was trying to prove that SRS did NOT improve peoples lives.

One the facts that he cited in his papers was that most of the postop patients still felt the need to attend the clinic and this was presented as evidence that the SRS had not been a success. Which all just goes to show how things you do with good intent can be twisted by those with hidden agendas.

The irony was that he was the one who encouraged them to "stay in touch," but even back then I always wondered why people fell for it.  :laugh:

If the clinic doesn't want to prescribe you progesterone you probably can't convince them with your head.

Use your feet instead.

Thanks to Rejen. I found out that I was taking a synthetic form of Progesterone (a progestin) which has been known to cause more harm that help for both Trans women and CIS women.
I'll be asking for micronized Progesterone as soon as I can.