To try and aim for female levels (to compare us to ciswomen) is wrong in three ways.
First reason being that women develop during puberty when growth hormone levels are high. Our growth hormones are much lower.
Second reason being that our androgen "load" is lower. Pre-op, doctors often aim to for testosterone levels in female ranges BUT most of the time, this does not tell the whole story. If we take estradiol orally, SHBG is quite high, higher than that of ciswomen getting estradiol internally because oral estradiol increases SHBG much more. So while our total testosterone might be in the range, our bioavailable (and free) testosterone might be much lower. Also, often, we take an anti-androgen which blocks androgen (and also further increases SHBG!). So, even if do actually measure free or bioavailable testosterone and it matches ciswomens' levels, part of that testosterone measured in the blood (serum) is actually blocked while it is not in ciswomen who take no anti-androgen. So, on the whole, we end up being LESS AFFECTED by androgen than women, having a lower androgen "load" as I like to call it. Lastly, some also take dutasteride/finasteride (an alpha-reductase inhibitor) which reduces conversion of T to DHT. Thus, despite matching levels of T with ciswomen, we have much less DHT in our tissues than them, further reducing androgen effect, and androgen "load". Post-op, transsexual women usually have lower T due to only adrenal production vs adrenal+ovary production in ciswomen AND some may have even less androgen "load" due to finasteride/dutasteride, as explained before. All this having been said, we can pretty much state with 100% confidence, that for the vast majority of us, in whatever phase of our transition we might be, our androgen "load" is less than those ciswomen we compare our estrogen levels with. Given the lower androgen "load", we need something to replace it with, namely, estrogen. More estrogen than ciswomen because we have a lesser androgen "load".
Third reason being and related to the second reason is that if we take estrogen orally, SHBG will be higher in us than in them. So, even if our (total) estradiol levels match, more of our estradiol is bound to SHBG and is unavailable. Free estradiol is rarely measured.
For all these reasons, comparing our estrogen levels (and even testosterone levels) to ciswomen is not useful. We probably need much more due to our lower androgen "load", lower bioavailable estrogen if we take estrogen orally and lower growth hormone levels. Doctors don't realize this unfortunately but they must be made aware of this.
Interesting information. I'll be sure to keep it in mind. Do you have sources for all of this? It does seem to make sense but I'm sure a doctor would want to know where the info is coming from not just, "I read it on a website"
Sure you could be right,your reasoning seems sound to me, but...
Doctors are not going to just take your word for it. In the absence of proper studies, or guidlines from health organizations (IIRC WPATH doesn't really give specific HRT instructions); they are going to go with what either worked for other medical professionals or what makes sense to them.
My point is, even if I am self medding with doctors supervision, generally speaking none of them are going to be comfortable if I take it out of the natural female range. Maybe even they would decide it is too dangerous and stop agreeing to supervise. This wouldn't be helpful.
So if you really believe like this then what you should do is gather your available evidence and ask for a local clinic, doctor, or university to their own study to see if indeed the ranges could benefit from being higher. Most doctors would love to see their name published in a medical journal so I am sure you can find someone with some interest.
All of what I have said is based on fact that no doctor would dispute. So, if you bring these arguments to any doctor, they should agree. It's based on steroid hormone physiology, how different drugs we take work. Just show this to doctors, they will understand. :)
As to levels being measured to ensure that risk is kept to a minimum, this is based on the assumption that the higher the level, the higher the risk. If that were so, then four things contradict this assumption.
First, pregnancy. Pregnant women typically reach levels of 40,000 pg/ml (x 3.671 in pmol/L), up to 75,000 during the third trimester. They do not appear to be dying left and right. The worldwide population is still growing, often in places where hygiene is less than optimal (third world countries). Our species is clearly not on the decline. http://cebp.aacrjournals.org/cgi/content-nw/full/12/5/452/T1
Second, in men who have prostate cancer, who are at an advanced age, high estrogen doses are prescribed, in many times more than what is typically prescribed for us. Yet, studies have found no complications and indeed, an increased protection from thrombosis.
J Urol. 2005 Aug;174(2):527-33; discussion 532-3.
Transdermal estradiol therapy for prostate cancer reduces
thrombophilic activation and protects against thromboembolism.
"These results suggest that transdermal estradiol reduces thrombophilic activation in men with advanced prostate cancer, and protects against the risk of thrombosis."
Third, from this study is stated
Am J Obstet Gynecol. 1993 Dec;169(6):1549-53.
Fibrinolytic parameters in women undergoing ovulation induction.
"Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event."
Lastly, despite very high doses of estrogen prescribed in the past to transsexual women and prostate cancer patients, from the 1960's to the 1990's, very few breast cancer incidences have been noted either by urologists, Harry Benjamin himself and Gooren's team in Holland, international recognized. Also, no liver complications were noted by Harry Benjamin.
Further to my post, I would like to add other reasons...
Our levels are only taken at one moment in time, where if we took more blood tests, we would perhaps find out that our levels sometimes go below range or above range due to fluctuation in levels, especially in the case of sublingual and injectables.
Also, levels fluctuate so much during a woman's menstrual cycle that the range is pretty wide and makes aiming for that range pretty much useless. Where do we do we decide is a good level for us, how do we narrow it down to a smaller range? Take an average? And have we actually determined that on average, ciswomen or transsexual women feel best within that chosen, average range? Perhaps they feel best at a higher level and perhaps it even varies among women such that some feel good at lower levels while others not so good and feel better at higher levels? What about sensitivity and individual variation? There is surely no way we can measure that.
Finally, on average, we are heavier, weigh more than bio females (as was brought to my attention by a very observant girl) thus probably requiring higher levels for the same effect.
All these things taken together, we have a pretty good case, I think, in persuading our doctors that we probably need higher levels than ciswomen, if the case may be (and not suggesting that you increase your dose if you are doing well at the moment) and that taking our levels isn't very useful.
You can bring this to your doctor's attention. As always, consult your doctor with any change you make. Let me know what your doctor thinks, if you do. ;)
I think you are trying to push the more is better idea.
This has been brought up so many times in the past. What has been found is that NORMAL is a SAFE range.
Many always think more is better and things will be faster, does not work that way post-puberty.
Now if you are pre-puberty and start HRT you will have a way better response to cross hormone therapy.
Relax, stop over thinking all of this and stay safe.
Isabell
Kay, I think you decided that more is better and sought out evidence, primarily from your own thought processes, to back up that decision.
Why do you think there is any benefit from increased doses of estrogen? There are only a finite number of estrogen receptors in the body. Once they are all activated by the estrogen molecule, there is nothing remaining to be done. The extra estradiol will convert to the weaker estrone and SHBG will bind up the rest.
Randi
Quote from: mind is quiet now on February 10, 2014, 01:23:00 PM
I think you are trying to push the more is better idea.
Isabell
I'm just stating that first and foremost, there is no such thing as a normal female level since in genetic females, levels vary so (too) much during a menstrual cycle. Secondly, that comparing our levels to theirs is like comparing oranges and apples because of our unique situation and different growth hormone levels. Third, that because of several variables, our needs may be different and as such, it is possible but not absolutely imperative that we need higher levels. I'm not overthinking this. I'm stating what seems to be quite obvious to me, and what came to my attention after I personally experienced less than optimal results on lower doses which seems to be the case in quite a number of other girls but certainly not all.
It's important to make this known to not only other girls but to doctors as well so that all of us can get the treatment we truly need without compromising our well-being or safety. So that we don't base ourselves on numbers that don't seem to mean much if we take everything that I have stated above in consideration.
Quote from: Randi on February 10, 2014, 02:19:07 PMThere are only a finite number of estrogen receptors in the body. Once they are all activated by the estrogen molecule, there is nothing remaining to be done. The extras estradiol will convert to the weaker estrone and SHBG will bind up the rest
Is there any science behind your statement? Has it been shown?
If that were in fact the case, then why do increased estradiol levels in pregnant women, well beyond the levels we ever reach, up to 75,000 pg/ml, occur and why do they result in increased breast growth, increased scalp hair growth, thickness, and have several other effects? If indeed, there were a finite number of estrogen receptors, then we should not expect such high levels of estradiol during pregnancy, we should expect it was a waste and wonder why nature would make such a mistake. We should expect much higher estrone levels relative to estradiol, which isn't the case and we should expect no more effects than before, which again we don't. We see increased effects from increased levels.
One could argue that women are different than us. But, one just needs to point out those studies in prostate cancer patients, males at an advanced age who are prescribed estrogen doses well beyond what we take in most cases. Such high doses are prescribed because lower doses aren't as effective and just go to show that in males, as well, higher level do make a difference and there is no such thing as finite receptors, otherwise, higher doses wouldn't be prescribed.
Receptors aren't a constant either. They have a limited lifetime, are constantly renewed and synthesized. So, at any given time, you might have more or less, depending on hormonal "milieu", environment.
Furthermore, based on the previous explanations, I'm prone to thinking that oral administration of estrogen, even if bio-identical and considerably less risky is not optimal for us.
Oral estrogen tends to increase SHBG. SHBG binds to androgen more strongly to estrogen. With this increase in SHBG, you are further reducing androgen which increases your need for estrogen.
Can the levels gotten from oral estrogen meet those needs for higher estrogen? Perhaps not, because firstly, since SHBG is increased, more estrogen will be bound and not available and more importantly, you will mostly get from oral, estrone as opposed to estradiol which is less potent in terms of estrogen receptor activity. Hence, for these reasons, your needs for higher estrogen might not be met.
Non-orally, SHBG is much less pronounced and elevated. Estradiol levels are also higher relative to estrone. Hence, you affect androgen much less and get more for your buck in terms of estrogen.
I think you are trying to push a snowball up hill in the middle of summer.
Cross hormones have been used for many, many years now. There are know medications that work and others are just the old placebo effect.
I truly wish you luck and hope you can find a doctor that will help you get where you wish you can get.
Isabell
By no means am I advocating that anyone self-medicate or increase their doses if things are going well for them at the moment or do anything without first consulting with their doctor. I've been careful with my statements and take everyone's health into strong consideration. I'm treated by a doctor who works together with me and who trusts my judgment when it comes to hormones. I've been under his care since 2005. He's our family doctor. :) He takes the time to listen and I consider myself very lucky to have him in my life. I am planning to see other doctors in my area to discuss with them HRT for transsexual women after discussion with a psychiatrist who treats transgendered girls. He suggested I do this and agreed that my reasoning behind much of what I said was sound.
There is much to be learned in this very narrow area of endocrinology, not taught at medical school, where guidelines in TS hormone treatment are still quite vague. I have spent years educating myself with scientific studies, I have been on hormones for almost 10 years, and I have spoken to hundreds of girls worldwide so I am aware of their concerns, the problems, and various treatment protocols in the world. So, I think my knowledge can benefit others like me who are less informed, doctors who don't have the time to educate themselves as much because they have so much to read, so many patients to treat. This is why I share this information with you. Not so you can follow my guidelines, ignore your doctors and do as you wish. But, so you can start to ask yourselves questions, become more informed, share with your doctors and optimize your treatment and that of other girls under his care.
I'm not advocating high doses, I'm advocating optimal doses for each and everyone of us and stating current weaknesses with today's TS hormone protocols in an attempt to improve treatment. :)
This is simply for information purposes to advance knowledge in this area for the betterment of our treatment. Read, question, share with your doctor. That's all I hope for. Nothing more. I strongly discourage doing things on your own. I'm also saying that perhaps, if you don't have good results at lower levels, there could be an explanation and you could share this with your doctor.
My word is not gospel. Take with a grain of salt, question it and discuss with doctors. ;)
Orals less risky? Where did you get that? Non-orals, injections, gel or patches are much less risky than orals. The first pass effect in the liver when processing oral estrogen is well known. In addition conversion of oral estrogen to the weaker estrone is well established.
I agree that non-oral estrogen is safer and more effective.
Quote from: KayXo on February 10, 2014, 02:43:22 PM
Furthermore, based on the previous explanations, I'm prone to thinking that oral administration of estrogen, even if bio-identical and considerably less risky is not optimal for us.
My endo doesn't even bother testing E levels, and I'm comfortable with that; she says she doesn't want to chase lab values at the expense of the patient. She tests free T and monitors the other major lab values which are indicators of health. However, she also tries for the minimum effective dose, which is my personal preference after my scary experience.
I started off on a dose, via patches, that is much lower than is usually recommended... and within 2 months was showing signs of liver damage that abated once I was taken off HRT. (I was eventually able to resume at half the initial dose, which has worked beautifully for me so far.) So I have no question whatsoever that for *some* women, there are definitely risks to increasing the dose, and there's no real way to find out if you're in the group who's sensitive enough without taking the chance. I myself will NEVER suggest that more = better results. Once you've gotten enough E to achieve your goals, more changes nothing except the risk profile.
I meant to say that oral bio-identical estrogen is less risky than oral Premarin or especially oral ethinyl estradiol. I should have elaborated. My fault!
Since bio-identical estradiol is native to the body and is quickly eliminated from the body, its effects on the liver and especially on coagulation factors is much less. This is why I personally consider oral bio-estradiol quite safe, especially compared to other forms of estrogen.
The effects of ethinyl estradiol have been established to be about 500-2000x times those of bio-identical estradiol on liver. If you translate this in terms of how much is prescribed to women worldwide when birth control pills are taken, you get alot!
I agree that non-oral is safer for the reasons you mentioned but when it comes down to bio-identical estradiol, the increased safety is not that much at least at the doses we typically take.
Quote from: Jenna Marie on February 10, 2014, 03:58:17 PMI started off on a dose, via patches, that is much lower than is usually recommended... and within 2 months was showing signs of liver damage that abated once I was taken off HRT.
What signs?
Quote
I started off on a dose, via patches, that is much lower than is usually recommended... and within 2 months was showing signs of liver damage that abated once I was taken off HRT.
I assume you're referring to an 'unusual' blood test for liver function? If so, I doubt a low dose estrogen patch caused any liver damage. The liver is an amazing organ, mine appears to have super human strength. It hates me I know that much. ;)
I find this topic very helpful.
Yes, it was a severely abnormal liver function test, after which I had an ultrasound that showed "transient liver damage." I dunno, I'm inclined to trust the experts who said it was the high HRT causing it, particularly since thereafter the liver recovered once the dose was first removed and then lowered. (I'd had a baseline panel done beforehand, too, and there were no other apparent causes; she ran some other tests to check on other possibilities but it was years ago and I don't recall what she did, only that it came back negative for any other possible issues.)
The final conclusion is that I'm just very, very responsive to estrogen, because in addition to the "overdose" signs, I've been on a dose solidly within the range of what's provided to cis menopausal women and I've had fantastic results.
I doubt it was due to the patch for two reasons. First, that very little estrogen taken transdermally makes it to the liver and secondly, that you were taking a low dose so that very, very little would make it to your liver. Pregnant women have very high levels for 9 months and don't have liver damage from it. Even in prostate cancer patients who are on a high dose transdermal treatment of estrogen, much older than you and sick, no liver complications arise. And I could cite many other examples.
Must have been something else or an error or something. I've never heard of any transsexual woman having liver problems from transdermals, ever. I believe what you are saying, don't doubt you for a second but something is off.
I do also know that your situation is quite unique in that your baseline T levels were quite low to begin with and that you developed DD breasts on a low dose of estrogen, lower than what is typically prescribed as you seem to state in your posts. Maybe you have a genetic condition, aren't XY, something? Don't know...
Quote from: KayXo on February 10, 2014, 06:21:48 PM
I doubt it was due to the patch for two reasons. First, that very little estrogen taken transdermally makes it to the liver and secondly, that you were taking a low dose so that very, very little would make it to your liver. Pregnant women have very high levels for 9 months and don't have liver damage from it. Even in prostate cancer patients who are on a high dose transdermal treatment of estrogen, much older than you and sick, no liver complications arise. And I could cite many other examples.
Must have been something else or an error or something. I've never heard of any transsexual woman having liver problems from transdermals, ever. I believe what you are saying, don't doubt you for a second but something is off.
I do also know that your situation is quite unique in that your baseline T levels were quite low to begin with and that you developed DD breasts on a low dose of estrogen, lower than what is typically prescribed as you seem to state in your posts. Maybe you have a genetic condition, aren't XY, something? Don't know...
Why do you doubt it was due to estrogen when this was a conclusion reached by doctors who were actually monitoring her and doing tests?
Thank you, Thylacin. I'd bowed out of this conversation because I don't see much point to continuing with someone who dismisses all counter-evidence; there's not much I could say beyond the fact that I trusted the 2 doctors overseeing my care. I'm a librarian by training, and I've researched this quite a bit and find the studies etc. on exogenous estrogen and potential strain on the liver quite convincing - but Kay clearly does not, and as neither of us are doctors, I wouldn't presume to debate her on layperson's terms. Heck, we could both be wrong. :)
(Oh, and I have in fact been karyotyped, b/c they wondered the same thing. Normal 46,XY. Oh well.)
Quote from: Jenna Marie on February 17, 2014, 05:48:29 PM
I've researched this quite a bit and find the studies etc. on exogenous estrogen and potential strain on the liver quite convincing
Can you cite a few of these studies? Are these studies on bio-identical estradiol and was the estradiol taken transdermally or non-orally? What about doses? Were they similar or higher than yours? Did they actually find liver damage from exogenous estrogen intake? What matters is actual facts, not speculation, not ideas, not theories.
I can cite you several studies with exogenous estrogen intake, bio-identical, non oral or oral, in genetic women, genetic men and transsexual women with no liver complications noted.
Even Harry Benjamin remarked himself in the The TRANSSEXUAL PHENOMENON
Harry Benjamin, M.D. , 1966
""The liver is the organ that metabolizes ("digests") the estrogen and it is conceivable (
although not actually shown) that it may be unfavorably affected by long-continued medication. A hazard may possibly exist if there is a history of hepatitis."
Notice the underlined part. Consider that back then, estrogen was mostly high doses of ethinyl estradiol, sometimes Premarin or high doses of injectable estradiol valerate. Today, we are taking a safer form of estrogen and usually much lower doses.
This is why I question what your doctors said. Doctors are human, they can make errors. There is nothing wrong in questioning professionals and seeking facts, finding out what is true from what is not. I don't care to argue or be right. I care about facts, about what everyone can agree on and if we don't know, then let's not invent facts, do some more research and find out as much as we can. The truth cannot always be sought but we can work towards it and in the meantime, present what to this day, seems pretty strong convincing evidence. :)
As I said, I don't want to debate you about it. I sincerely doubt you'll be convinced, since you dismiss what I consider to be solid facts, and I find your facts and studies equally unconvincing.
What facts did I dismiss? And why do you find the facts and studies that I presented unconvincing? What do you question? We can discuss it, there is no harm in discussing about it. This is about finding out the truth, not about being right or wrong. :) Putting pride, ego aside and seeking facts.
Hi Kay,
Interesting topic you've contributed. I've 3 observations and 1 questions to ask if you don't mind.
Firstly I agree on your statement regarding the lack of TS hormone understanding/teaching in the medical faculty.
Secondly, my own personal experience with respects to HT levels. In the initial HT regime (oral progesterone, Spiro & patch E) I struggled to make post menopausal levels and development was slow. Six months into the programme the regime changed to micronised bio identical P & E implants. (Similar if not identical to what College Pharmacy provide). "Feminisation" development increased quickly as did the levels. (E = 2,500 pmol/L). Endo held no concerns at all.
Thirdly. There is a perceived subconscious theme running through this thread that pays little deference to the effect of HT on brain "alteration." Depending on the period the brain has been "marinated" in HT and the associated effects of enriching, atrophied E receptors and atrophying T receptors together with all associated "roll-on" effects, (dopamine's, proteins, enzymes etc) which probably have not been research. Leaves a substantial gap in understanding the total "system" effects, HT imposes.
Similar to investigating a plane crash based purely on what the electrical system was doing during the pre crash phase. Without taking into consideration what the other systems (mechanical, hydraulic, IT, structural, physics etc) contributed to the event.
This is not a criticism, it purely an observation as no doubt such research has not been undertaken.
My question is: are you able to make a comment based on your finding to date, how the results/effects would change, if at all, based on the use of micronised, bio-identical Oestrogen and Progesterone implants? I'm uncertain as to the actual composition of the products bio-identical nature, but would assume it similar to the College Pharmacy product. In fact one of my doses was supplied by them until my Endo sourced a local compounding chemist.
Appreciate your comments
Huggs
Catherine
There is a huge range of estradiol...
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.elkeinland.com%2Fimg%2Fdecemberlabs.gif&hash=26fc0919a8d1406b3d5ad5d7108ae1e9044505f7)
One could read a "good" number at between 20 and 500 on there. There is a known risk at higher doses, not to be dismissed.
Quote from: Catherine Sarah on February 17, 2014, 10:24:14 PMMy question is: are you able to make a comment based on your finding to date, how the results/effects would change, if at all, based on the use of micronised, bio-identical Oestrogen and Progesterone implants?
Are you asking how using pellets would differ in terms of its effects on the body and brain vs other routes like oral or injectables? Or how using bio-identicals would differ from other forms of estrogens/progestogens? Or just a general question about how hormone therapy would change us neurologically?
Quote from: Missy~rmdlm on February 18, 2014, 01:14:49 AMThere is a huge range of estradiol...
Yes. And ranges vary from one lab to another so that even ranges are not the same everywhere.
Quote from: Missy~rmdlm on February 18, 2014, 01:14:49 AMThere is a known risk at higher doses, not to be dismissed.
What are the risks? Pregnant women have extremely high levels (up to 75,000 pg/ml). http://cebp.aacrjournals.org/cgi/content-nw/full/12/5/452/T1. Some women experience pregnancy several times during their lives. Our species is still alive and growing! Prostate cancer patients are prescribed very high doses of transdermal/injectable estradiol. None appear to have suffered increased complications from this. In fact, one study noted this
J Urol. 2005 Aug;174(2):527-33; discussion 532-3.
Transdermal estradiol therapy for prostate cancer reduces
thrombophilic activation and protects against thromboembolism "These results suggest that transdermal estradiol reduces thrombophilic activation in men with advanced prostate cancer, and protects against the risk of thrombosis."
This study also states...
Am J Obstet Gynecol. 1993 Dec;169(6):1549-53.
Fibrinolytic parameters in women undergoing ovulation induction. "Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that
elevated circulating estradiol alone does not predispose to a thromboembolic event." In this study, maximum mean estradiol was 739.8 pg/ml.
Breast cancer risk is also quite rare in transsexual women, despite decades of aggressive hormonal (non bio-identical) treatment. None were noted in prostate cancer patients.
J Sex Med. 2013 Dec;10(12):3129-34. doi: 10.1111/jsm.12319. Epub 2013 Sep 9.
Breast cancer development in transsexual subjects receiving cross-sex hormone treatment."We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure)"
"Among MtF individuals one case was encountered, as well as a probable but not proven second case."
"The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development."
Am J Surg Pathol. 2000 Jan;24(1):74-80.
Short-term and long-term histologic effects of castration and estrogen treatment on breast tissue of 14 male-to-female transsexuals in comparison with two chemically castrated men."so far, only four cases of breast cancer in male-to-female transsexuals have been documented."
From
The TRANSSEXUAL PHENOMENON
Harry Benjamin, M.D. , 1966"In my own clinical material of 152 male transsexuals, 141 of whom were treated with medium to fairly large doses of estrogen, some over several years, no incident of breast or any other cancer was observed. One may argue that these are mostly young men, less apt to develop a malignancy. The experiences of urologists, however, who treated elderly and old men with even much larger doses of estrogen for cancer of the prostate, must then be recalled. With the exception of one disputed case of breast cancer (it may have been a metastasis of the prostatic cancer) reported in the medical literature, no such incident was observed in hundreds if not thousands of cases. In a personal communication from Dr. Elmer Belt, one of the outstanding and most experienced urologists in the country, he said:
In regard to the taking of Stilbestrol as a cause for cancer of the breast, we have placed several hundred men on this material (I imagine if we were to search our records we would find the number to be in excess of two thousand) and in all of these cases we have not seen a single occurrence of cancer of the breast, although the dosages we used were of a very high level. "
Also, one acnedotal report from a transwoman
""Well, I went down yesterday and had blood drawn using privatemdlabs.com and today I already have the results:
Estradiol: 1079.0 pg/mL
Prolactin: 55.3 ng/ML
I also had a full CBC and Metabolic panel done and EVERYTHING was in the "normal" zone. Even those things that were out of balance on my last blood test before starting E and P!
Even the liver tests, which were a tad on the high side before HRT were now in the middle of the normal zone."
Hi Kay,
Quote from: KayXo on February 18, 2014, 07:30:53 AM
Are you asking how using pellets would differ in terms of its effects on the body and brain vs other routes like oral or injectables? Or how using bio-identicals would differ from other forms of estrogens/progestogens? Or just a general question about how hormone therapy would change us neurologically?
Essentially I'm asking how using pellets would differ in terms of its effect on the body vs other routes. Let keep the neurological aspect out of this conversation. That's a minefield all of its own.
Huggs
Catherine
From this study, Pharmacology of estrogens and progestogens: influence of different routes of administration, CLIMACTERIC 2005;8(Suppl 1):3–63
Subcutaneous implants (pellets) yield a ratio close to the natural ratio (2:1) of premenopausal genetic females, a 1.5:1 ratio of estradiol:estrone ratio.
Levels tend to slowly rise the first 4 months, reaching a peak around 4 months, then slowly decline to low levels around 9 months. (Dusterberg and Nishino, 1982)
"In contrast to the transdermal treatment with estradiol which showed large intra- and interindividual variations, the administration of estradiol pellets was associated with relatively small fluctuations during the 6 months after implantation"
"Implants of estradiol showed only minor effects on lipid metabolism with a slight decrease in LDL cholesterol and a slight increase in HDL cholesterol" compared to the oral route, as expected since it is non-oral. "LDL cholesterol, total cholesterol and triglycerides did not change", according to another study.
"In women with supraphysiological estradiol levels during treatment with implants, no adverse effects on lipid metabolism, but a reduction in LDL cholesterol and fasting insulin were observed." and yet another indication that high levels of estradiol don't necessarily equate to higher risk! and actually improve health markers. :)
Basically, with pellets, you get a more constant level vs other methods often used. Which may be good for mood but may over time desensitize estrogen receptors from too constant levels, I'm not sure. It's debatable. You avoid the first-pass liver effect and all the exaggerated hepatic effects seen with oral estrogens, especially non-bio-identical.
That's pretty much it. The important thing in the end is how you feel on them and your development. Cost must also be taken account for results obtained vs other routes that might be cheaper and as effective/as safe.
Hope this helps, :)
Thank you very much Kay,
A very informative reply. Just for the record, I'm getting roughly 15 months out of my E and 8 months out of my P, implants. Based on Aussie prices for pharmaceuticals that is about 25% cheaper to go this way. Apart from the fact I don't have to remember to take or stick something to myself every day.
Doesn't affect the mood situation much. I'd be taking home gold in the Olympics if they had a lacrimal sac races. I still gauge a movie by the tissues used. Half a box for watching Philomena today. Tears ran when I both laughed and cried. Just comes with territory.
It was interesting to note the close ratio to premenopausal women. Not surprised to see the large variation using transdermal patch. Electrolytes, body temperature, skin conductivity, Ph conditions etc fluctuate by the hour, which would have to have a major effect in this form of delivery.
Thank you once again
Huggs
Catherine