Ok well I keep seeing people on here sayin they wasn't on estrogen for a few months n only was on Spiro. So wat r some reasons a endo doctor would do that?
Caution and a chance to double check that the client isn't going to freak out and back off of transition, if there are doubts of any kind (and there often can be) about the dysphoria.
Or with very young transfolk, simply trying to prevent the onset of puberty, while treatment and talk therapy continues before making a choice that will require surgery, should the client regret growing breasts and becoming permanently infertile.
Infertility is probably one of the major concerns as well with those transitioning at later ages, unless the client already has a family and would be unlikely to want to parent any more kids at their present age. Malpractice charges that involve claims of reproductive harm can generate very heavy damage claims, since calculations can be based on the speculative life long value of not just the plaintiff's lifetime, but those of any children he might have generated, plus pain and suffering of not having such offspring.
I am one who was on Spiro for almost four and a half months before I started Estradiol.
The main reason is that Spiro can be justified as medically necessary for a male without relating it to transition. Add to that the fact that Spiro has very little effect that cannot be reversed by stopping it. In my case, even though my GP is VERY supportive of trans folks, she told me she wanted me to get a gender therapist's letter referring me for HRT to protect her against things like a family coming after her for malpractice or something.
Another minor factor, which may be helpful, is the ability to monitor T levels and other blood chemistry in the presence of changing just one thing at a time. My doc started me on a very low dose of Spiro and then doubled it three times spread over that span of four and a half months. Now I began taking a moderately low dose of Estradiol and she will be able to see how my body reacts to that before she increases it to a more typical level. Of course I have had blood tests at every step.
So the short answer is that this is just a very careful approach, both ethically, and medically. Some might argue unnecessarily so, but I'm good with it.
My endo gave me the "one thing at a time" answer too. I'm fine with it.
Plus, Spiro did a great job knocking out my anger and impulsiveness. In so doing, it freed me up to think and plan the next steps in my transition. I'm very happy with how things are flowing.
I just need to get that darn low dose restriction off me...
Quote from: Misato33 on January 05, 2013, 09:52:46 PM
Plus, Spiro did a great job knocking out my anger and impulsiveness. In so doing, it freed me up to think and plan the next steps in my transition. I'm very happy with how things are flowing.
Yeah, me too! I had been having trouble with beginning to develop a reputation for being difficult sometimes, and I really didn't think it was fair. I still think I was generally justified in my feelings, but I had trouble backing down and letting go of frustrating things. Looking back on it now, I think I didn't realize how profoundly dysphoria was interfering in my daily life.
I am definitely more easy going now. Mostly from Spiro.
The Estradiol effects are still subtle on a low dose, but definitely there.
I was on spiro alone for about a month I think before starting estrogen. I think its becasue if your testosterone levels are high, the estrogen wont actually do anything anyway, so they lower the testosterone first, then introduce the estrogen.
Quote from: HthrRsln on January 05, 2013, 08:50:46 PM
I am one who was on Spiro for almost four and a half months before I started Estradiol.
The main reason is that Spiro can be justified as medically necessary for a male without relating it to transition. Add to that the fact that Spiro has very little effect that cannot be reversed by stopping it. In my case, even though my GP is VERY supportive of trans folks, she told me she wanted me to get a gender therapist's letter referring me for HRT to protect her against things like a family coming after her for malpractice or something.
Another minor factor, which may be helpful, is the ability to monitor T levels and other blood chemistry in the presence of changing just one thing at a time. My doc started me on a very low dose of Spiro and then doubled it three times spread over that span of four and a half months. Now I began taking a moderately low dose of Estradiol and she will be able to see how my body reacts to that before she increases it to a more typical level. Of course I have had blood tests at every step.
So the short answer is that this is just a very careful approach, both ethically, and medically. Some might argue unnecessarily so, but I'm good with it.
so r u basically sayin they really would only do that if u havnt seen a gender tharapist yet?
Quote from: Isabelle on January 05, 2013, 10:56:43 PM
I was on spiro alone for about a month I think before starting estrogen. I think its becasue if your testosterone levels are high, the estrogen wont actually do anything anyway, so they lower the testosterone first, then introduce the estrogen.
do u think my Testosterone is high since I'm 18? Or does age hav nothing to do wit how high it is
Quote from: Isabelle on January 05, 2013, 10:56:43 PM
I was on spiro alone for about a month I think before starting estrogen. I think its becasue if your testosterone levels are high, the estrogen wont actually do anything anyway, so they lower the testosterone first, then introduce the estrogen.
Yes I'd agree. That makes good sense.
Quote from: Angélique LaCava on January 05, 2013, 10:59:08 PM
so r u basically sayin they really would only do that if u havnt seen a gender tharapist yet?
I suppose my doc might have given me both from the beginning if I already had a therapist's letter and I insisted on it, but I haven't asked.
Quote from: Angélique LaCava on January 05, 2013, 11:03:14 PM
do u think my Testosterone is high since I'm 18? Or does age hav nothing to do wit how high it is
At 18 your testosterone levels are approaching their peak. Your body, at the moment, will be undergoing full scale masculinization. The sooner you get on testosterone blockers the better.
I am also only on Spiro, for over a month now. I won't be starting oestrogen for another 2 months.
Spiro stops the damage testosterone is causing, so for me it was the most important thing first up.
It's just being cautious, theres no reason to rush, it's not a race.
Quote from: Misato33 on January 05, 2013, 09:52:46 PM
Plus, Spiro did a great job knocking out my anger and impulsiveness. In so doing, it freed me up to think and plan the next steps in my transition. I'm very happy with how things are flowing.
Sorry if this is a tangent for this topic, but I have been considering going on Spiro for just this reason. I was on full HRT for a short time before my wife pulled me back. She doesn't support transition, but I'm considering a low dose of Spiro to help bring down the dysphoria. I've heard others make this claim also that Spiro helped calm the noise in their head. I know this is a little off of what the OP asked, but there are some who do just Spiro for this reason, I believe.
Quote from: Isabelle on January 05, 2013, 11:40:57 PM
At 18 your testosterone levels are approaching their peak. Your body, at the moment, will be undergoing full scale masculinization. The sooner you get on testosterone blockers the better.
thats wat I'm confused bout everyone keeps saying 18 is wen u masculinnise but I havnt even noticed any masculine changes yet if anything I look more femine than I did last year but Its better to be safe than sorry haha. I'm prolly gonna be startin hrt in February or march
.
Quote from: Angélique LaCava on January 05, 2013, 11:56:39 PM
thats wat I'm confused bout everyone keeps saying 18 is wen u masculinnise but I havnt even noticed any masculine changes yet if anything I look more femine than I did last year but Its better to be safe than sorry haha. I'm prolly gonna be startin hrt in February or march
Well, wether you're noticing it or not, it's happening.
Quote from: muuu on January 06, 2013, 12:03:03 AM
I started having beard growth at about 17 or 18, and I bet a lot of other horrible things developed too, so there's something up with that age. Not to stress you but :p, you should really start as soon as possible, I guess February/march would be that.
i started beard growth at 13 n 14
Beard growth would be a "masculine change"
Quote from: Angélique LaCava on January 06, 2013, 12:11:06 AM
i started beard growth at 13 n 14
They do level tests on all these things in part because, while most people do show levels within expected ranges, everyone is different. Also, your T levels are just one part of the story. I've seen some studies that suggest that for at least some transfolk, their responsiveness to T can be quite a bit less than what's seen in others without gender dysphoria. But there is no One Size Fits all version of this ... every single person has their own levels and their own sensitivities. Some may also respond far more to estrogen, and it's wise to monitor all of this, to avoid dosing more than needed, and minimize the various risks. Excellent info in all the other posts on this, by the way.
Quote from: Isabelle on January 05, 2013, 11:40:57 PM
At 18 your testosterone levels are approaching their peak. Your body, at the moment, will be undergoing full scale masculinization. The sooner you get on testosterone blockers the better.
Yes!!! If you even think you want to transition. Spiro seems to be a relatively safe way to stop puberty while you figure out what you want to do, but many effects of Testosterone cannot be undone later, or at the least require expensive cosmetic surgery. The sooner you shut down the T factory the better. I would give anything to have been able to do it sooner, and I mean ... anything. So much harder now. If you change your mind and stop Spiro, puberty will take over right where you left off. Estrogen will only partly reverse, mainly breast growth reversal requires surgery.
Quote from: HthrRsln on January 06, 2013, 01:55:09 AM
Yes!!! If you even think you want to transition. Spiro seems to be a relatively safe way to stop puberty while you figure out what you want to do, but many effects of Testosterone cannot be undone later, or at the least require expensive cosmetic surgery. The sooner you shut down the T factory the better. I would give anything to have been able to do it sooner, and I mean ... anything. So much harder now. If you change your mind and stop Spiro, puberty will take over right where you left off. Estrogen will only partly reverse, mainly breast growth reversal requires surgery.
me n my mom asked my gender thArapist bout a T blocker n she told me that I don't need it cause I already look like a girl, But my gender thArapist said no on the T blocker
Quote from: Angélique LaCava on January 06, 2013, 02:00:15 AM
me n my mom asked my gender thArapist bout a T blocker n she told me that I don't need it cause I already look like a girl, But my gender thArapist basically said no on the T blocker
I wouldv'e thought they should base this on bloodtests and not how you look?
Angelique, that makes no sense. A gender therapist is not an endocrinologist and isn't qualified to give an opinion on the the matter, beyond being able to say you're emotionally capable of making the choice to start hrt. Hrt has precisely nothing to do with weather you or anyone else thinks you look like a girl.
Your shoulders are going to continue to get wider, your ribcage will continue to get bigger, your facial features will continue to harden and you'll develop more and more facial hair. Within the few years you may even begin to grow chest and back hair.
Quote from: Bex80 on January 06, 2013, 02:02:54 AM
I wouldv'e thought they should base this on bloodtests and not how you look?
my gender thArapist is a idiot. My first appointment wit her she even asked me if I was ever on hrt cause of how pretty I looked
Quote from: Isabelle on January 06, 2013, 02:08:14 AM
Angelique, that makes no sense. A gender therapist is not an endocrinologist and isn't qualified to give an opinion on the the matter, beyond being able to say you're emotionally capable of making the choice to start hrt. Hrt has precisely nothing to do with weather you or anyone else thinks you look like a girl.
shes been keepin me from hormones cause she thinks I'm not mature enough n she wanted my parents to give her a good report for atleast 3 months n my parents gave her a good report so now next appointments she gonna prolly write the letter but she said she was gonna talk bout writing the letter so idk but I'm pretty sure she's gonna write it
There are two broad areas of concern in treating MtF Testosterone levels that are not incompatible with each other, and the decisions are usually based on the endocrinologists previous experience.
Most 'males' produce testosterone and blocking testosterone involves several steps. One is to block the production of T and another is to block T receptors.
Some endocrinologists like to block production first but other prefer to stimulate the bodies system of removing testosterone and then block the production. In the former people are usually put on oestrogen with no anti-AAs. This stimulates an increase in Sex Hormone Binding Globulins (SHBG) which remove circulating T. Once circulating T has been removed then anti-AA can be given to reduce the production of T. The use of anti-AAs can be double edged. Androcur which is popular in Europe and Australia is arguably the most efficient anti-AA has significant side effects, the major one being the the induction of or deepening of depression. Spironolactone has significant effects on cardiac function, and in fact that is what it is most used for clinically. It is also a diuretic, which is what it was originally sold as. So in both cases keeping people on the lowest levels of anti-AA is a desire for most endocrinologists.
So depending on the base levels of T the endocrinologist may decide to promote SHBG and see what happens and then go for anti-AA. Or reduce the circulating levels of T with anti-AA and then go for oestrogen.
The decision is, or should be made on a case by case situation.
Also, of course, this is where the relationship between the endocrinologist and the therapist becomes important. If the therapist, in my case in Australia a psychiatrist who specialises in gender problems, decides that there patient has a gender identity complex and requires full treatment, then the endocrinologist goes for full treatment. If the therapist is unsure then the endocrinologist will be slower to go to full hormonal treatment.
As we know hormone changes can have profound and irreversible effects on people. The patient can very quickly have a dangerous response that can be life threatening. Hence we need the care of qualified people to look after us.
As a Doctor I trust my professional colleagues to look after me. There is no way I would self medicate.
Quote from: Isabelle on January 06, 2013, 02:16:42 AM
Well, you do write like a five year old.... Just saying...Anyway, You seem to have some really weird views on this stuff. I suggest you get a new therapist. What you look like has no bearing on your treatment.
im on a iPhone n I always write like I'm texting. So I'm sorry of I'm writing like a 5 year old
Watever Idc. So yea dont worry bout how I type. On a side note my mom won't let me see a endo doctor till my gender thArapist approves of me seein one
Quote from: Angélique LaCava on January 06, 2013, 02:00:15 AM
me n my mom asked my gender thArapist bout a T blocker n she told me that I don't need it cause I already look like a girl, But my gender thArapist said no on the T blocker
Okay, so this is just my opinion, and I'm just nobody special, but I would immediately find another Gender Therapist. There are apparently a bunch of people calling themselves gender therapists that don't think anyone should transition.
This is not a reason not to begin Spiro. There are no non-reversible effects from Spiro, and there are irreversible effects of Testosterone. You can probably get a friendly doc to prescribe Spiro if you just ask for it. I know mine did.
Quote from: HthrRsln on January 06, 2013, 02:23:22 AM
Okay, so this is just my opinion, and I'm just nobody special, but I would immediately find another Gender Therapist. There are apparently a bunch of people calling themselves gender therapists that don't think anyone should transition.
This is not a reason not to begin Spiro. There are no non-reversible effects from Spiro, and there are irreversible effects of Testosterone. You can probably get a friendly doc to prescribe Spiro if you just ask for it. I know mine did.
she has wrote the letter for other transgenders btw
Angelique, is your mum in charge of your medical treatment? It's not her choice. Your therapist is possibly right, you need to grow up.
Quote from: Isabelle on January 06, 2013, 02:27:51 AM
Angelique, is your mum in charge of your medical treatment? It's not her choice. Your therapist is possibly right, you need to grow up.
i can't drive yet so yea she's in charge of where she takes me ok so I'm done talkin bout this. I'm not gonna get into a argument cause I've been workin on my anger n I'm not gonna let u piss me off
:police:
OK lets calm down please.
There are no reasons for personal attacks.
Quote from: Angélique LaCava on January 06, 2013, 02:22:39 AM
Watever Idc. So yea dont worry how I type. On a side note my mom won't let me see a endo doctor till my gender thArapist approves of me seein one
Did your mom pick the gender therapist? Will she let you find a better one? Have you asked this therapist how many transgender patients she has had, and how many of those she approved for transition?
Actually, I believe the newest WPATH Standards of Care do not absolutely require a therapist's letter for HRT or SRS, but only require "informed consent", meaning you have to know what you're doing, but I don't know if that's at 18 years of age, or maybe 21. I would think it would be 18, but really not sure.
I can't stand the idea that some so-called gender therapist would block even Spiro. That just makes no sense, and suggests to me that the therapist is opposed to transition.
I wish you the all the best.
Cheers!
- Heather
Quote from: HthrRsln on January 06, 2013, 02:32:52 AM
Did your mom pick the gender therapist? Will she let you find a better one? Have you asked this therapist how many transgender patients she has had, and how many of those she approved for transition?
Actually, I believe the newest WPATH Standards of Care do not absolutely require a therapist's letter for HRT or SRS, but only require "informed consent", meaning you have to know what you're doing, but I don't know if that's at 18 years of age, or maybe 21. I would think it would be 18, but really not sure.
I can't stand the idea that some so-called gender therapist would block even Spiro. That just makes no sense, and suggests to me that the therapist is opposed to transition.
I wish you the all the best.
Cheers!
- Heather
i found her n picked her cause she's the closest. My mom already said that if she dosnt write the letter next appointment she's gonna tell her that its bull->-bleeped-<-, n to eather write it or I won't be seein her again
Quote from: Angélique LaCava on January 06, 2013, 02:37:29 AM
i found her n picked her cause she's the closest. My mom already said that if she dosnt write the letter next appointment she's gonna tell her that its bull->-bleeped-<-, n to eather write it or I won't be seein her again
Good for your mom! ;) Sounds like she's on your side. That makes a lot of difference.
Cheers!
Quote from: Angélique LaCava on January 05, 2013, 11:56:39 PM
thats wat I'm confused bout everyone keeps saying 18 is wen u masculinnise but I havnt even noticed any masculine changes yet if anything I look more femine than I did last year but Its better to be safe than sorry haha. I'm prolly gonna be startin hrt in February or march
My question would be, have you had your levels tested yet? Like many others here, you may have naturally low levels.
Quote from: Angélique LaCava on January 05, 2013, 07:49:44 PM
Ok well I keep seeing people on here sayin they wasn't on estrogen for a few months n only was on Spiro. So wat r some reasons a endo doctor would do that?
Lol I was one of those I was on spiro only for 6 months before I got on E, fact is if your young they think your crazy and dont want to have you get any permanent changes you may regret.
I am also guessing your quite young seeming she wants your parents opinions so yea, youth=spiro only with most endos for a while lol.
Quote from: HthrRsln on January 06, 2013, 02:32:52 AM
Did your mom pick the gender therapist? Will she let you find a better one? Have you asked this therapist how many transgender patients she has had, and how many of those she approved for transition?
Actually, I believe the newest WPATH Standards of Care do not absolutely require a therapist's letter for HRT or SRS, but only require "informed consent", meaning you have to know what you're doing, but I don't know if that's at 18 years of age, or maybe 21. I would think it would be 18, but really not sure.
I can't stand the idea that some so-called gender therapist would block even Spiro. That just makes no sense, and suggests to me that the therapist is opposed to transition.
I wish you the all the best.
Cheers!
- Heather
Thailand has a Law that you need parents consent for 18 to 21 years of age. no one below 18 in thailand can get a SRS.
I am pretty sure most practioners of a SRS will want the letter as this is a choice which could ruin someones life so they dont risk it.
Quote from: Bex80 on January 06, 2013, 02:02:54 AM
I wouldv'e thought they should base this on bloodtests and not how you look?
A therapist (unless she's a psychiatrist) is not qualified by training to make judgement calls on drugs or hormones by any stretch of the imagination. Those who attempt to do this are acting irresponsibly and it really does sound (from this one-sided version of the story) like the therapist has no clue what she's doing and may have very little real understanding of gender dysphoria or the current state of medical research.
Inconclusive as some of it is, the evidence keeps growing that this is essentially neurological in those cases where dysphoria is profound and mostly unambiguous, at least, and it's probably true in other cases too.
As long as society continues to enforce a false gender binary, getting rid of the emotional effects of inappropriate hormones can be a huge relief. If she's only focusing on appearance she has no business treating transgendered people. My opinion, but it's pretty strong at this point. I'd be looking for a second opinion or a therapist who actually understands gender dysphoria and is not trying to interpret it as some sort of delusional state.
Quote from: HthrRsln on January 06, 2013, 02:23:22 AM
Okay, so this is just my opinion, and I'm just nobody special, but I would immediately find another Gender Therapist. There are apparently a bunch of people calling themselves gender therapists that don't think anyone should transition.
This bears repeating, over and over. It's critical not to wind up spending tens of thousands of dollars working with someone whose mind was made up before you even walked in the door. Pretty sure my ex therapist was one of these, in his case, rooted in his being gay and more or less assuming most of us would just get better once we accepted we were gay. How he managed to keep not listening to my POV on this, as someone who had no problem with people assuming I was gay, if it had actually been something that could have worked for me is mainly a testament to my extreme passivity and desire to please others at my own expense.
My wife's endo did it the other way around - estrogen first, then spiro if needed - on the same logic that has been cited of "try one med at a time, so if there's a reaction, you know what caused it." (Since she and I both *are* allergic to certain antibiotics, it made sense immediately why a doctor might want that!)
The endo chose to begin with estrogen because it's absolutely required to transition, whereas some women end up not needing spiro at all, since E is able to suppress T to a limited degree. My wife turned out to be one of those, actually; she's on a very very low dose of E and nothing more, and still got down to cis female levels of T right away.
Quote from: blueconstancy on January 06, 2013, 10:40:15 AM
My wife's endo did it the other way around - estrogen first, then spiro if needed - on the same logic that has been cited of "try one med at a time, so if there's a reaction, you know what caused it." (Since she and I both *are* allergic to certain antibiotics, it made sense immediately why a doctor might want that!)
The endo chose to begin with estrogen because it's absolutely required to transition, whereas some women end up not needing spiro at all, since E is able to suppress T to a limited degree. My wife turned out to be one of those, actually; she's on a very very low dose of E and nothing more, and still got down to cis female levels of T right away.
Thats pretty lucky ^^ I am on the opposite end where nothing can properly supress mine. However yea most doctors like to take it 1 med at a time for safty concerns^^.
.
Quote from: muuu on January 06, 2013, 11:55:33 AM
Hm... Basically here all they did was making me see a psychiatrist that wanted to know about how things were when I grew up and also doing quite a few psychological test (intelligence, personality, some other tests, rorschach test). After that it was simply waiting on their "has to be in contact with us for one year" standard, though I had some issues that made them have to hold off HRT for a bit longer because of medical reasons.
Don't they do this in the US too?
You also did those horrible long tests???(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.pic4ever.com%2Fimages%2Fbf6.gif&hash=dbae05b330e1b40bc07fb69be8f5f3ef50cab119)
I thought it was only South Africa who did that seeming no one mentioned them on the site(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.pic4ever.com%2Fimages%2Fbl9.gif&hash=f250d38c96764d0eec714d8f7ea7830156bf7058)
No psych tests here, anyway. Endo wanted a therapist's letter - not necessarily a psychiatrist - saying the patient had been seen for at least 3 months, and that was it.
(And yes, my wife was lucky; not least b/c my insurance will pay more easily for HRT if it's at accepted menopausal cis female levels/methods! I have had SUCH battles with the insurance company's mail-order pharmacy over any medication not being taken "as directed by standard practice," even stuff like allergy meds.)
Angelique, I've removed some of my comments. I'm sorry, I was in a bit of bitchy mood while I was posting and it wasn't cool of me to be snarky in your thread just cause I was having a bad day. Anyways, sorry about that x
Quote from: muuu on January 06, 2013, 11:55:33 AM
Hm... Basically here all they did was making me see a psychiatrist that wanted to know about how things were when I grew up and also doing quite a few psychological test (intelligence, personality, some other tests, rorschach test). After that it was simply waiting on their "has to be in contact with us for one year" standard, though I had some issues that made them have to hold off HRT for a bit longer because of medical reasons.
Don't they do this in the US too?
Not in my experience. I am sure everyone has different experiences. As I understand it, the WPATH (World Professional Association of Transgender Health) SOC (Standards of Care) previously recommended 3 mo of gender therapy before recommending HRT, and one year of gender therapy before SRS.
I have not read it fully (been meaning to, but have not yet), but I gather that in the latest version of the SOC, the requirements have been changed to only recommend that the patient be capable of "informed consent," which is to say that all the medical profession has to do to be compliant, is be confident that you understand what you are doing, and are competent to make that judgement.
That said, many medical professionals do not keep up on all the latest changes in the SOC. I know of people who have printed out a copy and taken it with them to their medical provider with the pertinent sections marked. And, the WPATH SOC does not have any legal power, it is merely the recommendation of the most widely recognized authority on the subject. Any physician is free to require whatever they choose before supporting your requests.
Quote from: girl you look fierce on January 06, 2013, 09:47:53 AM
Actually my endo put my diagnosis code as hormone imbalance and it seemed to work :)
I get coded for "gynecomastia" on my T, E, and P level tests.
Quote from: HthrRsln on January 07, 2013, 02:24:30 AM
That said, many medical professionals do not keep up on all the latest changes in the SOC.
This is true, and even within the same health organization you can find differences. After seeing a therapist, she issued me a letter of recommendation which I took to an endo doc. The doc wouldn't accept the letter and instead required me to see a psychiatrist from within their health organization for three months. This didn't seem right to me so I asked people in my local TG community for the name of an endo doc with more experience working with trans folk, I got a name, requested to my health provider to switch to this doc, they complied, and he accepted the letter and immediately put me on HRT on my first visit to him.
The lesson I took from this is that you may have to push and even educate docs sometimes about these things.
My endocrinologist feels spiro is more potent than estrogen when it comes to feminizing. He has observed better breast development with spiro and estrogen than with estrogen alone..He says he even advises some of his post-op patients to continue taking spiro..but a very low dosage!