Was sitting through a talk given by the London GIC consultant Endocrinologist and he was stressing why he does not subscribe spironolactone to his patients despite their insistence. Apparently spironolacatone inhibits the full development of the breast tissue to the point where breast bud tissue ends up fusing and the breasts have a far lower incidence of developing beyond tanner stage 3/4. He was referencing a paper published by the GMC dated last year. Now of course here i am thinking, my goodness i have been on spironolactone for nearly 9 months, and couldn't really settle for the rest of the talk as my mind was reeling. However at the end of the talk i asked if, coming off spironolactone would the breast buds be able to un-fuse, to which he replied there was no studies out there to give any real idea, but he would giess that it would depend on which tanner stage the breasts had developed to, and how early you can come off the spiro.
Anyone else read anything similar? It's another week to my next appointment with my endo, and i don't think he generally prescribes anti-androgens - preferring higher doses of estrogen and progesterone.
Never heard that but I'm talking to my endo tomorrow, she has 25 yrs experience in TG endo treatment.
Thanks for the comment
Can you send the endos name BY PM if you wish
The Endo's name is Dr Leighton Seal, i don't believe he published the paper himself, but was referencing a study published by the British General Medical Council. He also showed a graph correlating types of anti-androgens and the incidences of those that needed and didn't need breast augmentation for each medication. Of course needing and choosing a breast augmentation is entirely subjective, but the graph showed a ratio of 5 to 1 for those on spironolactone as their AA, needing breast augmentation, compared to far smaller ratio's with cyproterone Acetate, Finasteride, Dutasteride and GnRH.
Same with my endo, he never prescribes the stuff and scoffed at me when I asked him about it during my second appointment 10 months ago.
I hit a full B tanner stage III at around 7-8 months of HRT , very little fat despite gaining some weight and nearly all breast tissue. Now at Tanner stage IV and still at a full B even after losing about 15lbs. For sure, all breast tissue.
Spiro is not necessary, and I'm not surprised he was lecturing about it. Estrogen and progestins seem to be the most important from my own experience. I've never put a single tablet of estrogen, progesterone, or spiro into my mouth and I never will (it's all been pellets with a few booster injections). I hope nobody ever puts a pill in their mouth, but I know it takes time.
Come on modern medicine, wise up for us! This isn't the stone ages. You don't treat gender dysphoria with prostate medicine and horse hormones.
Sorry if my rant is a little brash. It frustrates me to know that people aren't getting the care they deserve.
This is the first place I've read this information and it seems to contradict what 90+% of Doctor's prescribe.
Any chance there's a link to this research paper, because something seems off about this....
And herein lies the problem, there's virtually no conclusive research to be found for those of us who seek cross gender hormone therapy- so most doctors rely on old methods without questioning it. They stick to the book, and they do not ask questions. What do they do (as endocrinologists for mainly cis people) if the book is old and there is nothing new? They stick to the book and tell you to shut up.
And herein lies the next problem, how do you research and develop new HRT methodology for treating a broad spectrum of people when every person has different needs both hormonal and preferentially? You can't. It's a black art science by nature because there are so many unique things at play for each individual... dependent on their individual eating, sleeping, behavioral, emotional intricacies. Endocrinology is not like general medicine at all, which is especially unfortunate for us- because we perhaps need the most special care considering the changes we are asking our bodies to make.
There are a few endos out there who truly (and wholeheartedly) care about advancing hormonal treatments for transgender people. It sounds like Dr. Seal is one of them.
Edit: Once again I feel the need to apologize. Apparently this is a really triggering topic for me. I am deeply sorry if I have upset anyone. Please have mercy on my gung ho attitude right now. Rargh.
I'm not upset by any means of the word don't think that... <3
I'm a scientist myself and its important to learn where information comes from since its a newer field of study.
Dr Seal does seem like a nice guy, but he is also unfortunately one of those who flat out refuses to consider progesterone, and does also subscribe AA's just not spiro. I believe the NHS prefers the GnRH injection which puts the gonads to sleep as he put it.
I'm sorry Kayla i haven't found the link for the paper.
Jenny don't feel the need to apologise, i totally agree with where your coming from.
It's also worth mentioning that the question was put to him whether an AA was always necessary, to which he replied that in 99% of cases an AA would be needed, and only in some cases if a patient was over 50 that they could possibly get away without prescribing one.
Quote from: Kayla86 on November 20, 2013, 06:14:19 AM
I'm not upset by any means of the word don't think that... <3
I'm a scientist myself and its important to learn where information comes from since its a newer field of study.
Ok wheeew. After I posted that last one, I realized you might take it as me directing something at you.. when really I was just venting about the currently accepted endocrinological methodology for transgender care. I guess I get off easy this time! Thank you for reading my comments objectively, and especially for the <3.
Quote from: Bardoux on November 20, 2013, 06:19:30 AM
Dr Seal does seem like a nice guy, but he is also unfortunately one of those who flat out refuses to consider progesterone, and does also subscribe AA's just not spiro. I believe the NHS prefers the GnRH injection which puts the gonads to sleep as he put it.
I'm sorry Kayla i haven't found the link for the paper.
Jenny don't feel the need to apologise, i totally agree with where your coming from.
I still think he's taking a step in the right direction which is to get endocrinologists questioning something (anything really). It will hopefully lead to further questioning and more research (the root of all scientific process).
And thank you for the reassurance on my standpoint not being too harsh. I know it's a touchy subject with some, and it was risky for me to elevate it- especially considering how many people may only have one choice for an endocrinologist depending on location. The last thing I want to do is start triggering people.
Hmm, that's interesting. I admit I've often wondered where this theory that trans women's breasts never fully develop came from, and wondered if it was a myth.
(I'm Tanner Stage V except that I'm not sure they're at the "final adult size," as clearly some fat is still being deposited there. [it can stop anytime - 42DDD is big enough!] But I also never used spiro or any other AA at all; I've been fortunate enough to get by with a very, very low dose of E all along, and obviously there's no risk of a future need for AAs now that I'm post-op.)
Aaah, this is kinda scary lol. I wants mah boobies! I guess maybe I'll take Spiro until I talk to my endo again in 3 months, and definitely use that time to monitor my progress. I'm already a bit skeptical about whether I need it or not. I was actually more insistent about it than my endo was. :/
Just saying im being treated by the nhs and they have me on Gnrh injections for aa too lol
Quote from: AlexisB on November 20, 2013, 02:41:59 PM
Just saying im being treated by the nhs and they have me on Gnrh injections for aa too lol
Sounds interesting. I'm assuming it's working well for you? How often do you do it, and what's the cost? I'd rather an injection every few months than popping a couple spiro's every day. :/ As long as it works of course...
Actually the research he was referring to were published (as lead author) by him.
Seal, L. J.; Franklin, S.; Richards, C.; Shishkareva, A.; Sinclaire, C.; Barrett, J. (9 October 2012). "Predictive Markers for Mammoplasty and a Comparison of Side Effect Profiles in Transwomen Taking Various Hormonal Regimens (http://jcem.endojournals.org/content/97/12/4422)". Journal of Clinical Endocrinology & Metabolism 97 (12): 4422–4428. doi:10.1210/jc.2012-2030.
It's behind a paid wall I don't have access to though. :(
The research itself may be relatively new, but it's long been the case that UK endo prefer GnRH, whereas spiro have been preferred or at least prescribed in the US/Canada. Even if we accept the conclusion, do remember that while two and half times more sounds like a lot, we are talking about "4.8 vs. 1.8%". Still a relatively small proportion of the population. Though that may be down to external factors such as money rather than breast size / shape.
Quote from: Ashey on November 20, 2013, 05:48:01 PM
Sounds interesting. I'm assuming it's working well for you? How often do you do it, and what's the cost? I'd rather an injection every few months than popping a couple spiro's every day. :/ As long as it works of course...
The standard one, at least in my experience seems to be goserelin (i.e. Zoladex). 4 or 12 weeks option. If you ever think spiro is expensive....
Quote from: Keroppi on November 20, 2013, 05:57:44 PM
The standard one, at least in my experience seems to be goserelin (i.e. Zoladex). 4 or 12 weeks option. If you ever think spiro is expensive....
Found the price... Wheelp spiro it is. :-\
I was able to read the article and figure I would point a few things that were interesting
1. 16 people who took Spiro wanted BA, compared to 6 people who didn't
2. Spiro is not common in the NIH and self medicating people were included. No differentiation of who took what for how long other than self medicating people were more likely to request BA.
3. Average breast size is consistent with adult women, but 60% of trans-women still want BA
4. Minimum breast size used in the study was a tanner IV.
5. CEE had a higher likelihood of causing a clot
6. People on AA were more likely to be depressed (Could this could also play into a role of self perception and BA?)
For what its worth, my HRT physician I am seeing is in charge of the LGBT sector of her hospital group. (Only been on meds for 3 weeks so far)
She's had many patients in my state and knows what she's doing so I'm going to follow her advice and go from there.
Much less scary with the 4.8% marker being noted!
While this is a bit worrying to hear given that I'm on a Spiro regimen, I'm going to trust the experience of my doctor and her clinic for now. I'd rather be safe and healthy than sorry. She told me that most patients generally achieve an A to B cup development, and while some would consider that small I would personally be over the moon if I got there and wouldn't want to be any bigger. I'm more concerned about them looking weird than getting big. I would never consider a BA.
Thank you all for this informative discussion and issues to discuss at my next endo appointment.
Our very personal development and safety are reasonable issues to discuss with you who are there and our clinicians.
I will be very interested to hear the feedback any of you receive when raising this issue with your health care provider. Hopefully there will be some discussion about the various up and down-sides to the various AAs.
Quote from: Jennygirl on November 20, 2013, 05:21:49 AMI hope nobody ever puts a pill in their mouth, but I know it takes time.
Curious, Jenny - what's your reasoning behind that?
Kelsie
Quote from: KelsieJ on November 20, 2013, 11:16:04 PM
Curious, Jenny - what's your reasoning behind that?
Kelsie
When you eat estradiol, it passes through the liver and much of it is converted to estrone- an estrogen that does exist naturally in the body but in very small doses. It is the primary reason people get bad side effects from oral hrt / birth control because the level becomes much higher due to the liver conversion. Estradiol is what you want, it is 10s of times more effective for feminization compared to estrone (by weight) and actually extremely good for you. Estradiol will actually extend your life expectancy if you start it before testosterone related health problems arise. Estrone does not have these natural healthy benefits, and high levels of it in your blood stream is flat out bad for you. Quite the opposite of what we want.
By adding estradiol straight into the bloodstream, it avoids the initial phase of liver conversion- which means lower doses, higher feminization, and vastly lower risk of health complications like bloot clots / weight gain / mood effects.
Our bodies are not designed to EAT hormones. Actually the liver is set up to protect against it, hence why a healthy liver is so drastically important for oral HRT and why eating plant estrogens simply does not work. It puts a lot of load on your body in all the wrong ways. Endocrinologists should do away with all forms of oral completely when treating trans people especially because of the high dose that is needed due to estrone conversion. It is less of a problem for cis females who need a much smaller dose, but it's still not good- just less bad.
I've been on Spiro about four months and was on Androcur and some other AA (and two Es) during my first transition. I've had considerably better breast development and growth this time than I had after 26 months on HRT last time so I'll be interested to hear back from Cindy.
BTW, just what exactly does "breast bud fusing" mean? Sounds very nasty!
Quote from: Jennygirl on November 21, 2013, 01:07:45 AM
When you eat estradiol, it passes through the liver and much of it is converted to estrone- an estrogen that does exist naturally in the body but in very small doses. It is the primary reason people get bad side effects from oral hrt / birth control because the level becomes much higher due to the liver conversion. Estradiol is what you want, it is 10s of times more effective for feminization compared to estrone (by weight) and actually extremely good for you. Estradiol will actually extend your life expectancy if you start it before testosterone related health problems arise. Estrone does not have these natural healthy benefits, and high levels of it in your blood stream is flat out bad for you. Quite the opposite of what we want.
I may be misremembering this, but doesn't spiro help keep estradiol from converting to estrone? Something about blocking receptors of some sort and leaving free estradiol.
Spiro has many medical uses but in the transgender field is used as a AA and very weak Progestin (not the same as Progesterone) to my knowledge. It doesn't actually shut down the production of T like the GnRH injection (Decapeptyl) but prevents cells from utilising the T. I don't think it has any impact on the conversion process Ashey but i could be wrong.
Ms Grace, YES! that term scared the heck out of me!! I assume he meant it's the breast bud under the nipple fuses and prevents further growth/rounding out of the breast.
So does this research essentially recommend switching to Androcure? My endo initially wanted to place me on Andro, but we decided to switch to Spiro for the beginning. I will be seeing her soon, so maybe it is time for little experimenting? And yes, I have experienced slow but steady growth, though I think the progesterone had a lot of saying into that. Apparently, I might probably end with B cup (which should be fine for me), but if I might get stuck with A.. then its not cool (I have A cup, Tanner III/IV at six months of the HRT).
No, from what i recall he didn't recommend Cyprotene Acetate either, i mean if he was just singling out Spiro i probably would have started to consider thinking about Androcur, but ultimately it seems like the hugely expensive Decapeptyl 3 monthly injection is the most effective and safest AA he uses.
Quote from: ♡ Emily ♡ on November 21, 2013, 05:45:55 AM
So does this research essentially recommend switching to Androcure? My endo initially wanted to place me on Andro, but we decided to switch to Spiro for the beginning. I will be seeing her soon, so maybe it is time for little experimenting? And yes, I have experienced slow but steady growth, though I think the progesterone had a lot of saying into that. Apparently, I might probably end with B cup (which should be fine for me), but if I might get stuck with A.. then its not cool (I have A cup, Tanner III/IV at six months of the HRT).
I don't have a copy of the handout with me at the moment, and I haven't managed to get my hand on a copy of the article itself yet, but from what I recall the percentages for the other is even higher. Will have to check to make sure.
Quote from: Jennygirl on November 20, 2013, 05:21:49 AM
Same with my endo, he never prescribes the stuff and scoffed at me when I asked him about it during my second appointment 10 months ago.
I hit a full B tanner stage III at around 7-8 months of HRT , very little fat despite gaining some weight and nearly all breast tissue. Now at Tanner stage IV and still at a full B even after losing about 15lbs. For sure, all breast tissue.
Spiro is not necessary, and I'm not surprised he was lecturing about it. Estrogen and progestins seem to be the most important from my own experience. I've never put a single tablet of estrogen, progesterone, or spiro into my mouth and I never will (it's all been pellets with a few booster injections). I hope nobody ever puts a pill in their mouth, but I know it takes time.
Come on modern medicine, wise up for us! This isn't the stone ages. You don't treat gender dysphoria with prostate medicine and horse hormones.
Sorry if my rant is a little brash. It frustrates me to know that people aren't getting the care they deserve.
I've always wanted to try injections or implant, but I live in a nanny state and we are only allowed Progynova pills here because that is what "mommy" has decided is right for us :(
Quote from: MariaMx on November 21, 2013, 06:57:12 AM
I've always wanted to try injections or implant, but I live in a nanny state and we are only allowed Progynova pills here because that is what "mommy" has decided is right for us :(
Same story here, except it is not even a nanny state so I can at least choose between Progynova and Estrofem (which is 2 x cheaper than Progynova). But yeah, no injections here... I can only get the stuff which You can buy in pharmacies and which is intended for "normal" people, because nobody knows that transgender people exist here too :(.
Let's see...
Augmentation vs none
Antiandrogen 72 vs 92
Cyproterone acetate 45 vs 39
Finasteride 25 vs 23
Spironolactone 16 vs 6
Dutasteride 5 Vs 3
GnRH 51 vs 40
You need to give some context to those number I'm afraid....
Quote from: Keroppi on November 21, 2013, 08:09:08 AM
You need to give some context to those number I'm afraid....
WOW yes! ;D
So... I'm hearing that those of us in the USA are a bit screwed for options? GnRH costs a fortune... Finasteride isn't recommended as a primary AA... and Spiro is all that's left.
Which means... get that Spiro and forget about the rest... or just have an orchi and be done with it.
Also, the sample size is pretty darn small with those numbers so you couldn't draw any real conclusive conclusions from that tbh.
Thanks for posting them up Mariah! :)
Sample size are always small in trans research, there's not many of us (in terms of % of population). What's important is statistical confidence. Again, access to the article would help here. :(
Quote from: Keroppi on November 21, 2013, 09:23:52 AM
Sample size are always small in trans research, there's not many of us (in terms of % of population). What's important is statistical confidence. Again, access to the article would help here. :(
...but a low sample size gives a low confidence interval unless all samples showed exactly the same results... that rarely happens with anything medical and breast size in MTF transgender patients seems to be all over the board (just as it is with cis women).
I'm no doctor so I can't say what spiro does or does not do. But I do know that after 11 months on hrt I'm pushing a D cup and I was easily a C by 6 months so I don't think it has hurt my development one bit. But as they say your Mileage may vary and I've been very lucky so far that my body has responded so well to hrt. :)
Sounds like the study is using a very odd measure for determining success. Spiro is the drug of choice in a country (the US) that is culturally obsessed with large breasts, where androcur isn't avail, and where people's health coverage won't pay for g blockers except in children. So using BA surgery as the measure makes no sense.
18 months on Spiro, from A to D, fully formed, Tanner IV-V, and still growing. No P.
BA is a question of money and personal taste, which is shaped by culture.
Quote from: MadelineB on November 21, 2013, 11:25:29 AM
Sounds like the study is using a very odd measure for determining success. Spiro is the drug of choice in a country (the US) that is culturally obsessed with large breasts, where androcur isn't avail, and where people's health coverage won't pay for g blockers except in children. So using BA surgery as the measure makes no sense.
18 months on Spiro, from A to D, fully formed, Tanner IV-V, and still growing. No P.
BA is a question of money and personal taste, which is shaped by culture.
:) Thanks! I'm still really looking forward to my spiro script -- I feel it's the only thing that can fix my head right now.
Quote from: Keroppi on November 21, 2013, 08:09:08 AM
You need to give some context to those number I'm afraid....
they took records for 165 trans woman how had BA and had a min of 2 years of hormones (avg was like 10) and a min breast development of tanner IV. Then compared that to 165 trans woman who did not have BA but met the same criteria. So basically the assumption is that those who didnt have BA were happy with their size. Lab results of the two groups was basically the same. Actual breast size was not recorded but it did state breast size was on par with adult women but the chest wall differences might result in perceived size differences. There is another chart on side effects/medical problems associated with who took what drug. Average age at the end of the study was around 47 I think.
And I ask again...
Just what exactly does "breast bud fusing" mean?
There was a "maybe" answer but does anyone know for sure?
Quote from: MadelineB on November 21, 2013, 11:25:29 AM
Sounds like the study is using a very odd measure for determining success. Spiro is the drug of choice in a country (the US) that is culturally obsessed with large breasts, where androcur isn't avail, and where people's health coverage won't pay for g blockers except in children. So using BA surgery as the measure makes no sense.
18 months on Spiro, from A to D, fully formed, Tanner IV-V, and still growing. No P.
BA is a question of money and personal taste, which is shaped by culture.
"The study was conducted at a single-center National Health Service tertiary care unit" [in the United Kingdom].
I found the study, fully accessible too!
http://jcem.endojournals.org/content/early/2012/10/08/jc.2012-2030.full.pdf
Quote from: Lady_Oracle on November 21, 2013, 11:38:55 PM
I found the study, fully accessible too!
http://jcem.endojournals.org/content/early/2012/10/08/jc.2012-2030.full.pdf
Thank you Lady!
It does help to know that the sample size who actually took spiro was tiny (4.8%, or 18 out of 370) and may have been comprised largely or completely of self-medicators, who were also the most likely as a group to request mammoplasty.
If I am doing my maths correctly (a big if, so feel free to correct!) the study clearly points out that self-medicators were twice as likely to request mammoplasty vs. physician directed HRT (11.5% vs 6%); and that self-medicators were three times more likely to take spiro vs. physician directed HRT (4.8% vs 1.8%); if you combine those two factors, and the fact that we are talking about a tiny sample (11% of 4.8% of ~370), the conclusion about spiro is completely unsupported. We are talking about 2 out of 370 individuals, which is not enough to draw any conclusions whatsoever. Two self medicators who took spiro requested mammoplasty, out of a total sample of all combinetrics of 370.
Any follow up study aiming to measure effects of anti-androgens should be done in the US or Canada or another country, where anti-androgens are common enough to actually be statistically relevant. As the study says, "Antiandrogens are not routinely used in the clinical protocol".
So any conclusions about anti-androgens from this study are likely to be fallacious.
It would be worth following up in a study that had equal numbers (50/50, instead of 5/95 and 2/98) of spiro vs other androgen control mechanisms.
Even though I would like to encourage ALL serious studies being done on transsexual treatments - can't be too picky about water when you reside in a desert! - this sentence made me cringe and call into question the entire study:
QuoteSpironolactone is more likely than the other, more specific antiandrogens or GnRH analogs to result in the need for breast augmentation.
If it had mentioned a 'possible correlation, I would agree. But a 'result in'? Nothing in this study would indicate causality, or have nearly the numbers needed to make any kind of conclusion that strong.
Interestingly enough, the breast bud fusion conjecture appears to have been misread initially by the doctor quoted in the OP.
The study does not posit that Spiro causes increased breast bud fusion; rather, it posits that self-medication, and any other treatments that result in estrogen levels that are too high, can result in sub-optimal breast growth, projecting from the experience of natal females who are exposed to too rapid introduction of estrogen during puberty. This is stated as a conjecture, not as a result of the study.
How much exactly does GNRH cost in the USA, Approx? Im Curious what its benifits are over spiro, other than one injection every 3 months. If it stops T production, is it possible theres unstudied risks/benefits to takeing it? Someone mentioned that taking spiro blocks T from connecting at certain receptor sites or some such? Isnt having a bunch of T still floating around in your system, which im sure interacts with more stuff than what spiro blocks, prolly not that good for you?
Thank you Lady.
Quote from: MadelineB on November 22, 2013, 12:24:11 AM
Interestingly enough, the breast bud fusion conjecture appears to have been misread initially by the doctor quoted in the OP.
It's the same person.
Quote
The study does not posit that Spiro causes increased breast bud fusion; rather, it posits that self-medication, and any other treatments that result in estrogen levels that are too high, can result in sub-optimal breast growth, projecting from the experience of natal females who are exposed to too rapid introduction of estrogen during puberty. This is stated as a conjecture, not as a result of the study.
I think that part of the the presentation did indeed mention it being based on / similar to experience etc.
Thanks Madeline!
I agree with your statements and think that 2 people is NOT a sample size!
That being said I'll continue with my meds as my specialist prescribes and report back later :).
Anyone else think "alternative energy" when they hear "breast bud fusion?"
:angel:
Quote from: Jennygirl on November 21, 2013, 01:07:45 AM
When you eat estradiol, it passes through the liver and much of it is converted to estrone- an estrogen that does exist naturally in the body but in very small doses. It is the primary reason people get bad side effects from oral hrt / birth control because the level becomes much higher due to the liver conversion. Estradiol is what you want, it is 10s of times more effective for feminization compared to estrone (by weight) and actually extremely good for you. Estradiol will actually extend your life expectancy if you start it before testosterone related health problems arise. Estrone does not have these natural healthy benefits, and high levels of it in your blood stream is flat out bad for you. Quite the opposite of what we want.
By adding estradiol straight into the bloodstream, it avoids the initial phase of liver conversion- which means lower doses, higher feminization, and vastly lower risk of health complications like bloot clots / weight gain / mood effects.
Our bodies are not designed to EAT hormones. Actually the liver is set up to protect against it, hence why a healthy liver is so drastically important for oral HRT and why eating plant estrogens simply does not work. It puts a lot of load on your body in all the wrong ways. Endocrinologists should do away with all forms of oral completely when treating trans people especially because of the high dose that is needed due to estrone conversion. It is less of a problem for cis females who need a much smaller dose, but it's still not good- just less bad.
Thanks for this, Jennygirl. My doc said I should go injectable when I first discussed it. but only said that the reason was that 'some people say it works better for them'. I'm not happy with my development on pills right now - everything started with a *bam* ad fizzled out couple of months in. There haven't been any changes I've noticed in about 2 months now.
Quote from: kabit on November 22, 2013, 06:25:44 AM
Anyone else think "alternative energy" when they hear "breast bud fusion?"
:angel:
YES!!! You made me laugh for the day :)
"The use of spironolactone as an antiandrogen seemed also to be associated with an increased incidence of breast augmentation in transwomen. The other, more specific antiandrogens and GnRH analogs were not. Spironolactone is a mineralocoricoid receptor partial antagonist as well as an estrogen receptor agonist. As such, in addition to blocking the androgen receptor (which is its primary purpose in this situation), it also has a significant estrogenic action at the doses used in transwomen. One can postulate that this could lead to an excessive estrogenic action and consequent poorer breast outcome by the same mechanism as that seen when patients self-medicate with estrogens. It is interesting that the other antiandrogens, cyproterone acetate and finasteride, do not appear to be used more frequently in those requiring breast augmentation compared with controls, suggesting that this is not a class effect of antiandrogens"
I have flashbacks of doing my school papers and trying to make observations and connections from even the smallest of correlations.
Thanks for finding this Lady Oracle!!
Quote from: kabit on November 22, 2013, 06:25:44 AM
Anyone else think "alternative energy" when they hear "breast bud fusion?"
:angel:
Perhaps it could make you the female equivalent of
Iron Man if it gives you a hyper-efficient reactor in your chest? Or better two?? :D
If, as Madeline suggests it appears that the conclusions in the paper are based on conjecture, what then was the real intent of the author? Many studies/papers, not just medical, are produced with the goal of 'proving' a predetermined belief or ideology, to sell a specific product, or simply to get attention for the author. I'd be wary of judging conjecture-based 'facts' but there must be some tidbits or local context that can give us some insight into the motives of the author. To quote the author, "One can postulate", but this is a dangerous game. As Bardoux may have inferred, such penmanship in school would lead to very 'critical attention' by the reviewing teacher/professor - but there I am postulating...
I would gather it's another slice of evidence to be used in their case for why patients should be funnelled through the GIC's and all their glorious inadequacies when it comes to gender therapy. Ironically one of the endo's named on that paper also operates a private practice (still operating to the GIC guidelines, just willing to shorten the queue times for money) whilst continuing his role as a consultant, and yet here the rest of them are trying to shut down the informed consent model operating outside the allotted guidelines... it seems like you do it their way or put up with papers like this.
If anything, this thread has gotten me to see the need to discuss with my doctor what my other options are next time I go to see her, in about a month. Just starting on HRT, 2 weeks ago, she prescribed estradiol and spiro in pill form. I didn't really press her on what method to use because I was so happy just to be starting and figured she knew best, but maybe there's a better way (injections, progesterone?) for me and I have to get her to see that. :police:
I dunno... I'm only two weeks in but I want to see the best results possible, not get down the road a few months and realize there was a better way all along
Quote from: FinallyMe84 on November 22, 2013, 10:53:42 AM
If anything, this thread has gotten me to see the need to discuss with my doctor what my other options are next time I go to see her, in about a month. Just starting on HRT, 2 weeks ago, she prescribed estradiol and spiro in pill form. I didn't really press her on what method to use because I was so happy just to be starting and figured she knew best, but maybe there's a better way (injections, progesterone?) for me and I have to get her to see that. :police:
I dunno... I'm only two weeks in but I want to see the best results possible, not get down the road a few months and realize there was a better way all along
i completely agree! I highly, highly recommend you get off estradiol in pill form.
What's wrong with taking the pill version if its sublingual?
Pills as in swallowing yea I can see that being a problem.
Quote from: Kayla86 on November 22, 2013, 09:02:40 PM
What's wrong with taking the pill version if its sublingual?
Pills as in swallowing yea I can see that being a problem.
I have used estrodiol sub-lingualy it works fine, good lab number on modest dose. Medroxyprogesterone works sub-lingualy too.
There is nothing "wrong" with medications appropriately prescribed for you as an individual, including oral and sublingual routes. We assume your provider factored in your age and other considerations from your personal history.
There is a "first pass" effect of medications taken orally. That term describes the amount of an oral dose that is taken up by the liver as the medication travels the digestive tract. transdermal patches or pellets are prescribed in a much lower dose and may have far less interaction with the liver and may have less cardiovascular complications associated with long term use for old geeks like me. ;)
I'm off of Spironolactone due to plantar neuropathy problems. My Dr. thinks that the flushing effects did aggravate the neuropathy problems. Spiro did in effect with the E flush out the lead in my hands. I can identify things in my pocket and objects in a small box out of view now. My boobs has shrank though. About of month off of spiro now. We'll see.
Joelene
Does anyone know if there is a significant difference in what and how much makes it to your bloodstream when taking Estrace sublingually instead of swallowing the tablet? I decided to try sublingual yesterday just for the hell of it since I'm on the lowest dose at the moment. It barely tasted like anything and it dissolved away quite quickly. I can't say I noticed any difference. At eleven days in I'm not sure I've noticed any effect at all since it was added to my prescription. At least I can say thankfully there's been nothing negative.
Quote from: Violet Bloom on November 23, 2013, 11:41:29 PM
Does anyone know if there is a significant difference in what and how much makes it to your bloodstream when taking Estrace sublingually instead of swallowing the tablet? I decided to try sublingual yesterday just for the hell of it since I'm on the lowest dose at the moment. It barely tasted like anything and it dissolved away quite quickly. I can't say I noticed any difference. At eleven days in I'm not sure I've noticed any effect at all since it was added to my prescription. At least I can say thankfully there's been nothing negative.
I don't think there is enough data in any one study out there to substantiate an accurate description of the difference in dosages if any to achieve the same serum level. I surmise that sublingual works fine based off my good lab numbers on a robust HT regimen( including Estradiol, Progesterone, Spironolactone, and Finasteride. All scripts, all generic and all filled through my work-mail-order-pharmacy or Sam's Club.)
My Endo has 70 TS patients, and I literally trust him with my life. He swears by Cyproterone Acetate (Androcur). I've brought up the high cost of it with him, and he offered to switch me to much cheaper spiro, but says it's nowhere near as good. We just downsized to a maintenance dose, so the financial aspect became easier.
Strangely, we also doubled my E dose, and within one week I developed breast buds. I asked if the extra E could have that fast an effect. I love his response. 'I've been a Dr. for over 30 years, and all I can say- Boobs are unpredictable'.
I used to be on the 4 weekly ones but after 3 months moved up to the 12 weekly ones :) they're free here in the UK
Quote from: Violet Bloom on November 23, 2013, 11:41:29 PM
Does anyone know if there is a significant difference in what and how much makes it to your bloodstream when taking Estrace sublingually instead of swallowing the tablet? I decided to try sublingual yesterday just for the hell of it since I'm on the lowest dose at the moment. It barely tasted like anything and it dissolved away quite quickly. I can't say I noticed any difference. At eleven days in I'm not sure I've noticed any effect at all since it was added to my prescription. At least I can say thankfully there's been nothing negative.
I take my E sublingually, not for the effect on the bloodstream but to help bypass the first pass through the liver which it can have quite an effect on.
I think it does lead to increased levels because it is bypassing the stomach and liver. I don't have any evidence to hand, but I forgot to not take my meds before my last blood test and my E levels were through the roof, like 6000+ (looking back I'm a little upset that they weren't over 9000! ;) )
Quote from: Kaylee on November 29, 2013, 08:42:56 AM
I take my E sublingually, not for the effect on the bloodstream but to help bypass the first pass through the liver which it can have quite an effect on.
I think it does lead to increased levels because it is bypassing the stomach and liver. I don't have any evidence to hand, but I forgot to not take my meds before my last blood test and my E levels were through the roof, like 6000+ (looking back I'm a little upset that they weren't over 9000! ;) )
OK.... Not trying to derail an important thread, but here is a post with lots of info/links for sublingually.....
"
I've been reading a little about how 17beta-estradiol (E2) works, from injestion and metabolism to gene transcription.
A few things:
1) E2 is more potent than its metabolite etrone (E1) and has greater affinity with the ERalpha and ERbeta receptors. E1 and E2 compete for the same receptors which would mean less estrogenic action if there is less E2
2) Swallowing estradiol leads to first pass in the liver and conversion to estrone. Sublingual or buccal estradiol leads to a rapid spike in free 17beta-estradiol and a greater E2/E1 ratio (which is desirable for the reason above).
A comparison of the pharmacokinetic parameters of oral and sublingual
administration of micronized estradiol to post menopausal women revealed
that the time to the maximal concentration of estradiol was significantly
different by the two routes of administration, being 1 hr or less for sublingual
administration and 6.5-7.6 hr for oral administration. The maximal plasma
concentration, terminal half life, area under the curve for the integral of the
serum concentration over time (area under the curve) and oral clearance
were also different with the two routes of administration. For example, after
sublingual administration of 1 mg micronized estradiol, the maximal plasma
estradiol concentration was 451 pg/mL, the terminal half life was 18 hr, the
area under the curve was 2109 pg/mL per hr and the oral clearance was 7.6
L/hr per kg bw; after oral administration, these values were 34 pg/mL, 20.1 h,
823 pg/mL per hr and 27.2 L/hr per kg bw, respectively. The concentrations
of estrone were not dependent on route of administration. Sublingual
administration resulted in a significantly lower ratio of estrone to estradiol
than oral administration during the 24 hr period.[IARC. Monographs on the
Evaluation of the Carcinogenic Risk of Chemicals to Man. Geneva: World
Health Organization, International Agency for Research on Cancer, 1972-
PRESENT. (Multivolume work). Available at:
http://monographs.iarc.fr/index.php, p. V72 476 (1999)] **PEER
REVIEWED**
3) Free estrone can and is converted back to E2 when needed but is then metabolized by the liver again (second pass...). This circular process is repeated until the estrogen metabolite is evacuated from the body. Estrone can be thought of estrogen storage in this respect and it is the reason that oral estrogen can feminize.
Oral mucosal administration of estradiol
Sublingual and buccal treatment is a non-invasive
and simple route of administration. Owing to the
high vascularization of the oral mucosa, estradiol
is rapidly absorbed and enters directly the
circulation. Although the oral mucosa contains
degrading enzymes, the inactivation is much less
than after enteral administration, and the avoid-
ance of the gastrointestinal metabolism and the
first-pass effect in the liver results in serum levels
of estradiol 10-fold higher than after oral inges-
tion, and the bioavailability is about five times
higher 123,124.
Pharmacokinetics
The sublingual administra-
tion of a tablet with 0.25 mg micronized
estradiol caused a rise in the level of estradiol up
to a maximum of about 300 pg/ml and of estrone
of 60 pg/ml within 1 h. The application of 1 mg
estradiol led to a serum maximum of 450 pg/ml
estradiol and 165 pg/ml estrone. Thereafter, the
estradiol level decreased rapidly to 85 pg/ml
within 3 h, while that of estrone declined much
slower, reaching a value of 80 pg/ml after 18 h
123.
After the buccal administration of 0.25 mg
estradiol in postmenopausal women, a steep rise
in the serum concentration of estradiol occurred,
reaching a maximum of 500 pg/ml within 1 h.
Thereafter, the estradiol level declined rapidly to
70 pg/ml after 4 h. Treatment for 2 weeks with
0.25 mg estradiol each twice a day resulted in
peak levels at steady state of 620 pg/ml 125.
Pharmacodynamics
The method was well toler-
ated, and no taste or other sensation was reported.
In postmenopausal women with coronary artery
disease, a single sublingual administration of 1 or
2 mg estradiol caused vasodilation, improved
ischemia and augmented blood flow. The clinical
effect occurred some minutes after dosing and
suggested a rapid non-genomic effect of estradiol
on the arterial wall
126. In patients with severe postnatal depression,
daily sublingual treatment with 1 mg estradiol 3–8
times daily resulted in a rapid improvement of
depression symptoms with-in 1 week 127.
After 4 weeks of buccal treatment of postmeno-
pausal women with daily 400mg estradiol, hot
flushes had significantly decreased by 80% (from
0.8 to 0.15 hot flushes per hour) and the vaginal
epithelium (maturation index) was normalized.
There were no unusual or severe adverse effects,
and mastodynia was reported by only one out of
18 women 128
4) Estrone is carcinogenic (women on HRT are given progesterone to avoid cancers involving ERalpha receptors).
5) Even when E2 enters the blood directly (eg., buccal administration), most of it is bound to SHGB and only 1-2% is free to exert its estrogenic effect in the relevant cells.
6) Androgens do not bind to E receptors and estrogens do not bind to AR androgen receptors. However, both estrogens and androgens do bind to SHBG sex hormon binding globulin.
7) Reducing SHBG should mean more free estrogen (and more androgens, which is also why they should be suppressed when on estrogen).
8) SHBG drops when insulin is increased. That is, taking E2 (sublingual/buccal/transdermal ...but not orally) immediately after a meal should mean more E2 molecules reaching E receptors as less of it is bound. (Incidentally, a similar reasoning is established in the bodybuilding comunity for testosterone...)
9) Some testosterone is necessary for estrogen to properly exert its estrogenic effect at the E receptors (for poorly understood reasons).
10) While M2Fs take estrogen once or twice in the day, which rapidly falls as it is processed out of the body, females secrete estrogen (converted from testosterone in the ovaries) continually with diurnal and monthly rythms.
...I welcome your thoughts. I have included the papers and references below. They are really worth reading.
Technical papers
http://actor.epa.gov/actor/GenericChemi ... rn=50-28-2
http://www.ncbi.nlm.nih.gov/pubmed/9052581
http://www.cenegenicsfoundation.org/lib ... ration.pdf
http://faculty.washington.edu/andchien/ ... trogen.pdf
http://www.ijbmb.org/files/IJBMB1104006.pdf
Good introductory site
http://www.news-medical.net/health/Estrogen-Types.aspx
Interesting info
http://www.sciencedaily.com/releases/20 ... 161246.htm
http://psychcentral.com/news/2011/10/22 ... 30629.html
"
I have the sense that this post is incredibly important for me to understand... and I need to know a lot more about how E works in the body to understand it.
Where's the best place to learn that? (Aside from endocrinology classes at the local medical college ;))
@AlexisB or anyone else on GnRH what is your hormonal plan in the future? And what meds are you using? I'm in the US and my health insurance covers Lupron Depot injections so I only pay $15 per injection. I also take Elestrin gel daily and Avodart every other day. My endo said that after my first 3 month injection we were going to test my blood at the end of the 3rd month to see if I needed another injection and if I didn't I would just stay on estrogen and avodart with no other anti androgen. he made it seem to me that I would basically have had an orchiectomy without surgery. I'm confused on how this would work and won't be seeing him until January so if anyone can explain this to me I would appreciate it. I also wanted to add that I've read that you cannot get more than 6 Injections in a lifetime without having serious medical issues so if you are just plannin on getting them forever or until surgery I would ask about that as well.
Re. GnRH, it's until surgery.