I can't seem to find answers to some questions about transdermal estrogen. Maybe someone here knows. My question is does transdermal E go through the liver at all and if so does it stimulate clotting chemicals? If there is a first pass then what is the second pass?
Amy,
Transdermal Estrogen (either patches or gel) does NOT have an initial pass through the liver. For us older girls (meaning me) it is a better bet than oral as it does not have the clotting effect.
Erin
What Erin said. I use the patch exclusively, due to being "older" and the fact that I like the "slap-it-on-and-forget" aspect of patches. I also like the even, consistent delivery of E that they seem to provide. No weird spikes and lulls.
Amy,
I was told it would by my Endocrinologist. As it is I am tested monthly or more for my clotting levels (INR), so keeping an eye on any changes was already part of my life. I have been using the patch since the beginning and I've suffered nothing negative at all. On the last test my blood was a little too thick, but the variation wasn't very great and no panic ensued. As long as your doctor is aware of all medical conditions and able to monitor, you shouldn't have reason not to begin the patch or gel.
And the unclenching of my soul when E hit my system... Amazing. :)
-Claire
Quote from: Claire (formerly Magdalena) on June 11, 2014, 01:34:31 PM
Amy,
I was told it would by my Endocrinologist. As it is I am tested monthly or more for my clotting levels (INR), so keeping an eye on any changes was already part of my life. I have been using the patch since the beginning and I've suffered nothing negative at all. On the last test my blood was a little too thick, but the variation wasn't very great and no panic ensued. As long as your doctor is aware of all medical conditions and able to monitor, you shouldn't have reason not to begin the patch or gel.
And the unclenching of my soul when E hit my system... Amazing. :)
-Claire
So your doctor told you that transdermal E does cause an increase in clotting factors?
That is what she said, yes. Individuals here have said differently. I can't say which one to believe, I just think you should be aware of all sides.
My condition (Lupus Anticoagulant) is so serious that I had a clot blocking 99% of one of my arteries, I was only 40 at the time. I probably should have died, to be honest. My point is that all the warnings about any source E increasing my clotting to the point of danger have all been untrue. That said, YMMV and you should definitely proceed under close medical supervision.
I remember you asking questions along these lines before. What's going on? Do you have clotting issues?
-Claire
Quote from: Claire (formerly Magdalena) on June 11, 2014, 02:38:22 PM
That is what she said, yes. Individuals here have said differently. I can't say which one to believe, I just think you should be aware of all sides.
My condition (Lupus Anticoagulant) is so serious that I had a clot blocking 99% of one of my arteries, I was only 40 at the time. I probably should have died, to be honest. My point is that all the warnings about any source E increasing my clotting to the point of danger have all been untrue. That said, YMMV and you should definitely proceed under close medical supervision.
I remember you asking questions along these lines before. What's going on? Do you have clotting issues?
-Claire
I don't know if it's clotting issues or what but the estrogen make my right upper leg ache. Aspirin reduces the pain to nothing but it come back everyday so I have to keep taking aspirin. It's always the right upper leg. Never anywhere else. It's really strange. Actually though it seems to be mostly in the pelvic joint.
E rarely increases blood clots in people who don't normally have problems, my doctor told me that, too. :) Correlation isn't causation. Just because the timing is coincidental doesn't mean that E is necessarily the cause. Have you seen your doctor about this?
Quote from: Claire (formerly Magdalena) on June 11, 2014, 04:29:17 PM
E rarely increases blood clots in people who don't normally have problems, my doctor told me that, too. :) Correlation isn't causation. Just because the timing is coincidental doesn't mean that E is necessarily the cause. Have you seen your doctor about this?
I'm afraid if I tell him he'll cut me off and then it's back to buying off the internet.
I understand your fear, but you have to tell the doctor. Don't do permanent damage because you're scared to speak up. You have rights under WPATH standards of care. He can't just cut you off and send you packing.
http://www.wpath.org/site_home.cfm
Check it out. You're protected.
Then let me know how it went with the doctor. I'll worry. It's what I do.
with love,
-Claire
Quote from: Claire (formerly Magdalena) on June 11, 2014, 05:33:17 PM
I understand your fear, but you have to tell the doctor. Don't do permanent damage because you're scared to speak up. You have rights under WPATH standards of care. He can't just cut you off and send you packing.
http://www.wpath.org/site_home.cfm
Check it out. You're protected.
Then let me know how it went with the doctor. I'll worry. It's what I do.
with love,
-Claire
I don't think WPATH is legally binding is it?
Quote from: Amy1988 on June 11, 2014, 05:48:55 PMI don't think WPATH is legally binding is it?
If you don't trust your physicians, keep them separate.
Talk to your endocrinologist about HRT related things. Talk to your PCP or a specialist about your leg pain. They can't talk with each other without you consenting to it. But in my opinion it's pretty irresponsible of you not to mention the leg pain to your endocrinologist if those symptoms came about when you started HRT. Physicians can't read minds, so if you don't work with them and tell them what you're experiencing they won't be able to help completely. I suppose this is the risk people who self-medicate take.
Also I think patches are meant for birth control uses, not hormone replacement. You'll have to wear multiple patches over your body, they lose contact, etc. There's better methods out there.
Quote from: teeg on June 11, 2014, 05:59:08 PM
If you don't trust your physicians, keep them separate.
Talk to your endocrinologist about HRT related things. Talk to your PCP or a specialist about your leg pain. They can't talk with each other without you consenting to it. But in my opinion it's pretty irresponsible of you not to mention the leg pain to your endocrinologist if those symptoms came about when you started HRT. Physicians can't read minds, so if you don't work with them and tell them what you're experiencing they won't be able to help completely. I suppose this is the risk people who self-medicate take.
Also I think patches are meant for birth control uses, not hormone replacement. You'll have to wear multiple patches over your body, they lose contact, etc. There's better methods out there.
Well actually I use estrogel which I rub on the arm. I guess a worse case would be to keep taking the spironolactone and very low dose estrogen. I couldn't see my doctor having a problem with that. Of course it's 3 months until the next visit so I'll have to keep taking the aspirins until then.
Amy if you keep this up you are going to harm yourself. It does not matter if you suspect "E" or not, but you need to get your problem looked at now. Plenty of people have told you this could be a problem and to seek medical assistance with it. You take too much aspirin and you open another can of worms with NOT being able to clot. A car accident or accidental cut on your body and the bleeding may not be controllable. Even patients on an Aspirin regimen do not exceed a low dose every day. If you are using off the shelf not especially designed for that it is probably high dose Aspirin. See a doctor and disclose what you are doing. You are basically gambling with your life.
What Jess said. She's more knowy about medical stuff than me. Please see your doctor soon. I want you to be around long enough to turn into one of those feisty old ladies that can say whatever they want. ;)
Quote from: Amy1988 on June 11, 2014, 12:06:25 PM
I can't seem to find answers to some questions about transdermal estrogen. Maybe someone here knows. My question is does transdermal E go through the liver at all and if so does it stimulate clotting chemicals? If there is a first pass then what is the second pass?
only estrogen PLUS progesterone rises the risk of thrombosis (formation of clots), estrogen alone by any way does not increase your risk of thrombosis
Fertil Steril. 2010 Mar 1;93(4):1267-72. doi: 10.1016/j.fertnstert.2008.12.017. Epub 2009 Feb 6.
Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy.
Ott J1, Kaufmann U, Bentz EK, Huber JC, Tempfer CB.
Author information
Abstract
OBJECTIVE:
To evaluate the incidence of venous thromboembolism (VTE) in transsexual patients and the value of screening for thrombophilia in this population.
DESIGN:
Retrospective cohort study.
SETTING:
Academic research institution.
PATIENT(S):
Two hundred fifty-one transsexuals (162 male-to-female [MtF] and 89 female-to-male [FtM] transsexuals).
INTERVENTION(S):
Screening for activated protein C (aPC) resistance, antithrombin III, free protein S antigen, and protein C deficiency.
MAIN OUTCOME MEASURE(S):
Incidence of thrombophilic defects and VTE during cross-sex hormone therapy.
RESULT(S):
Activated protein C resistance was detected in 18/251 patients (7.2%), and protein C deficiency was detected in one patient (0.4%). None of the patients developed VTE under cross-sex hormone therapy during a mean of 64.2 +/- 38.0 months. There was no difference in the incidence of thrombophilia comparing MtF and FtM transsexuals (8.0% [13/162] vs. 5.6% [5/89], respectively).
CONCLUSION(S):
VTE during cross-sex hormone therapy is rare. General screening for thrombophilic defects in transsexual patients is not recommended. Cross-sex hormone therapy is feasible in MtF as well as in FtM patients with aPC resistance.
Quote from: peky on June 11, 2014, 07:32:19 PM
only estrogen PLUS progesterone rises the risk of thrombosis (formation of clots), estrogen alone by any way does not increase your risk of thrombosis
Fertil Steril. 2010 Mar 1;93(4):1267-72. doi: 10.1016/j.fertnstert.2008.12.017. Epub 2009 Feb 6.
Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy.
Ott J1, Kaufmann U, Bentz EK, Huber JC, Tempfer CB.
Author information
Abstract
OBJECTIVE:
To evaluate the incidence of venous thromboembolism (VTE) in transsexual patients and the value of screening for thrombophilia in this population.
DESIGN:
Retrospective cohort study.
SETTING:
Academic research institution.
PATIENT(S):
Two hundred fifty-one transsexuals (162 male-to-female [MtF] and 89 female-to-male [FtM] transsexuals).
INTERVENTION(S):
Screening for activated protein C (aPC) resistance, antithrombin III, free protein S antigen, and protein C deficiency.
MAIN OUTCOME MEASURE(S):
Incidence of thrombophilic defects and VTE during cross-sex hormone therapy.
RESULT(S):
Activated protein C resistance was detected in 18/251 patients (7.2%), and protein C deficiency was detected in one patient (0.4%). None of the patients developed VTE under cross-sex hormone therapy during a mean of 64.2 +/- 38.0 months. There was no difference in the incidence of thrombophilia comparing MtF and FtM transsexuals (8.0% [13/162] vs. 5.6% [5/89], respectively).
CONCLUSION(S):
VTE during cross-sex hormone therapy is rare. General screening for thrombophilic defects in transsexual patients is not recommended. Cross-sex hormone therapy is feasible in MtF as well as in FtM patients with aPC resistance.
There is so much conflicting information out there I honestly don't think anyone really knows.
Your doctor does know, but you have to be honest with him with what you are taking.
Quote from: Jessica Merriman on June 11, 2014, 06:55:43 PM
Amy if you keep this up you are going to harm yourself. It does not matter if you suspect "E" or not, but you need to get your problem looked at now. Plenty of people have told you this could be a problem and to seek medical assistance with it. You take too much aspirin and you open another can of worms with NOT being able to clot. A car accident or accidental cut on your body and the bleeding may not be controllable. Even patients on an Aspirin regimen do not exceed a low dose every day. If you are using off the shelf not especially designed for that it is probably high dose Aspirin. See a doctor and disclose what you are doing. You are basically gambling with your life.
It'll be ok. I'll just cycle on and off the E while taking the spiro.
ARGH! :eusa_wall: :icon_headache:
Is the doctor expensive? Or do you just not like doctors?
Quote from: Amy1988 on June 11, 2014, 12:06:25 PM
I can't seem to find answers to some questions about transdermal estrogen. Maybe someone here knows. My question is does transdermal E go through the liver at all and if so does it stimulate clotting chemicals? If there is a first pass then what is the second pass?
Transdermal estradiol goes directly to the blood instead of first (first pass) going through the gut and liver before reaching the blood like oral estradiol does. This results in much less estradiol going through the liver and affecting clotting proteins/enzymes. Studies have shown that transdermal estradiol in prostate cancer patients and in genetic women (and even transsexual women) does not increase clotting risks and even appears to protect against it!
Quote from: teeg on June 11, 2014, 05:59:08 PM
Also I think patches are meant for birth control uses, not hormone replacement.
It's actually the opposite. Patches only contain estrogen and are meant for hormone replacement therapy in menopausal women. That's why they deliver small amounts. I think a patch containing ethinyl estradiol and perhaps a progestin was used years ago as birth control but it fell out of favor...since the risks did not seem to lessen.
Quote from: Amy1988 on June 11, 2014, 06:12:56 PM
Well actually I use estrogel which I rub on the arm. I guess a worse case would be to keep taking the spironolactone and very low dose estrogen. I couldn't see my doctor having a problem with that. Of course it's 3 months until the next visit so I'll have to keep taking the aspirins until then.
Taking Aspirin so often might not be a good idea as it irritates the stomach and could cause an ulcer. You might be asking for even more problems in the long run. You need to advise your doctor. Perhaps, blood circulation is just bad and this could be due to either a lack of estrogen since it tends to dilate blood vessels or stress caused by all the changes going on in your life (?). You need to absolutely let the doctor know so they can really figure out what's going on. These are just ideas I'm throwing at you but in the end, the doctor should know. Don't take Aspirin lightly. Too much can also make the blood too thin and cause internal hemorrhage which, in some cases, can be fatal.
Quote from: peky on June 11, 2014, 07:32:19 PM
only estrogen PLUS progesterone rises the risk of thrombosis (formation of clots), estrogen alone by any way does not increase your risk of thrombosis
That is not true. Estrogen alone can cause clots, more so if taken orally and especially if non bio-identical estrogen is taken such as ethinyl estradiol. Bio-identical progesterone does not appear to affect coagulation at all, according to several studies while some progestins do like medroxyprogesterone acetate and cyproterone acetate.
Quote from: Amy1988 on June 11, 2014, 08:02:09 PM
It'll be ok. I'll just cycle on and off the E while taking the spiro.
This is also not a good idea as this might cause ups and downs in moods, too much instability which is not good for either the body or mind. You need to contact the doctor instead of taking it upon yourself to do this or that without truly understanding the implications of what you're doing and what is really going on.
Quote from: KayXo on June 11, 2014, 10:03:29 PM
Taking Aspirin so often might not be a good idea as it irritates the stomach and could cause an ulcer. You might be asking for even more problems in the long run. You need to advise your doctor. Perhaps, blood circulation is just bad and this could be due to either a lack of estrogen since it tends to dilate blood vessels or stress caused by all the changes going on in your life (?). You need to absolutely let the doctor know so they can really figure out what's going on. These are just ideas I'm throwing at you but in the end, the doctor should know. Don't take Aspirin lightly. Too much can also make the blood too thin and cause internal hemorrhage which, in some cases, can be fatal.
I go back to the doctor in September so I guess I'll let him know then and see what he wants to do.
Amy,
You have asked us for an answer and now you're ignoring what we've said. I understand that you don't want to see a doctor. Is it because you've self-medicated? Doctors are not police, and they can't just call the police because you self-medicated. There are laws in place that prevent them from reporting you for something like that, believe it or not. The doctor also has obligations under the WPATH standards of care and can't just arbitrarily cut you off from E. In short, there is no downside to seeing a doctor right now with the possible exception of the expense.
You have something wrong that you've decided was caused by E. What we're trying to say is that there's every chance it's completely unrelated. Still, you have something wrong. It might be serious. If it is, you may to irreversible damage to yourself if you wait until September.
Asprin isn't the answer. Not only can it cause ulcers (excruciating pain), it also thins the blood. Little known fact: that's how many poisons work. Thinning your blood too much will kill you, this is not a case of maybe.
If we assume for a moment that you are correct in your assumptions and it is a clot. Then it's already there. Thinning your blood will not get rid of it. Mine took six hours of surgery. It will not simply become smaller and disappear. If it is there and it comes loose to be carried in the blood stream it will lodge somewhere else, it still won't become smaller or disappear. If it goes to your lungs, heart, or brain, it can be fatal, and what are the chances blood will go through your heart?
You absolutely, 100%, no getting out of it, need to see your doctor. Jessica has years of medical experience as an EMT. Her knowledge is far greater than yours (or mine). If she says you need to do this, you need to do it.
"There is so much conflicting information out there I honestly don't think anyone really knows." There is a bit of truth here that's applicable. If no one really knows, then you can't know either. Your doctor does know, however. That's one person whose expertise is greater than the internet.
I don't know if I'm being entirely clear to let me restate my point. Make an appointment with your doctor today. Don't wait. Don't give excuses. Call. Now.
Oh, and almost forgot to mention, see your doctor.
I'm only being a pain about it because I care enough to want you to be healthy.
with love,
-Claire
Quote from: Claire (formerly Magdalena) on June 12, 2014, 09:22:08 AM
Amy,
You have asked us for an answer and now you're ignoring what we've said. I understand that you don't want to see a doctor. Is it because you've self-medicated? Doctors are not police, and they can't just call the police because you self-medicated. There are laws in place that prevent them from reporting you for something like that, believe it or not. The doctor also has obligations under the WPATH standards of care and can't just arbitrarily cut you off from E. In short, there is no downside to seeing a doctor right now with the possible exception of the expense.
You have something wrong that you've decided was caused by E. What we're trying to say is that there's every chance it's completely unrelated. Still, you have something wrong. It might be serious. If it is, you may to irreversible damage to yourself if you wait until September.
Asprin isn't the answer. Not only can it cause ulcers (excruciating pain), it also thins the blood. Little known fact: that's how many poisons work. Thinning your blood too much will kill you, this is not a case of maybe.
If we assume for a moment that you are correct in your assumptions and it is a clot. Then it's already there. Thinning your blood will not get rid of it. Mine took six hours of surgery. It will not simply become smaller and disappear. If it is there and it comes loose to be carried in the blood stream it will lodge somewhere else, it still won't become smaller or disappear. If it goes to your lungs, heart, or brain, it can be fatal, and what are the chances blood will go through your heart?
You absolutely, 100%, no getting out of it, need to see your doctor. Jessica has years of medical experience as an EMT. Her knowledge is far greater than yours (or mine). If she says you need to do this, you need to do it.
"There is so much conflicting information out there I honestly don't think anyone really knows." There is a bit of truth here that's applicable. If no one really knows, then you can't know either. Your doctor does know, however. That's one person whose expertise is greater than the internet.
I don't know if I'm being entirely clear to let me restate my point. Make an appointment with your doctor today. Don't wait. Don't give excuses. Call. Now.
Oh, and almost forgot to mention, see your doctor.
I'm only being a pain about it because I care enough to want you to be healthy.
with love,
-Claire
Claire I am under a doctors care. That's how I'm getting my estrogel and spironolactone prescriptions and I'll tell him about my leg next visit. I no longer self medicate. As for clotting I doubt if it's clot related since the leg pain goes away with aspirin. 325mg a day. I don't think aspirin would reduce pain from a clot and the symptoms would be much worse by now. Not just pain but also swelling and pain while walking. The pain actually gets better when I walk. I think it's something else estrogen is doing to me. What ever it is I want to find out.
Quote from: Amy1988 on June 12, 2014, 11:06:40 AM325mg a day.
I thought people used baby aspirin to help with potential clotting, etc.? That's 81mg per tablet, why take so much? I could be wrong here.
Quote from: Amy1988 on June 12, 2014, 11:06:40 AMI don't think aspirin would reduce pain from a clot and the symptoms would be much worse by now.
You're not a doctor.
Quote from: Amy1988 on June 12, 2014, 11:06:40 AMWhat ever it is I want to find out.
Most hospitals offer 'free care' (depending on income) which can cover 100% of your costs for almost anything. Or you could go to an emergency room today and find out what's wrong. You don't
have to wait until your appointment in September, you're choosing to. If it were me I'd have been checked out yesterday, but that's me and my opinion I guess.
Aspirin protects against ARTERIAL clotting not VENOUS clotting. Taking Apsirin will not do anything about clots caused by Estrogen as they are not arterial.
Quote from: Amy1988 on June 12, 2014, 11:06:40 AM
.... the leg pain goes away with aspirin. 325mg a day.
Duh! You do realise that aspirin is a pain killer? Of course it makes the pain go away, that is what it is for. Aspirin will not make you better.
Go see a doctor.
Whatever it is, I want you to find out as well. Please don't wait.
Quote from: yvvrvt on June 12, 2014, 12:22:31 PM
Aspirin protects against ARTERIAL clotting not VENOUS clotting. Taking Apsirin will not do anything about clots caused by Estrogen as they are not arterial.
Duh! You do realise that aspirin is a pain killer? Of course it makes the pain go away, that is what it is for. Aspirin will not make you better.
Go see a doctor.
I can't see how one 325mg aspirin would get rid of the pain of a blood clot. Maybe reduce it some for a short time.
You are playing Russian roulette with your life dear. If you continue to ignore people's advice on this including medical professionals you may find yourself to be changing your username to Amy the one legged girl. Is this extreme, yes it is, but then so is a clot. The fact is you have no idea what is going on in your body right now. The fact is it is bothering you enough to seek assistance in the form of advice. The fact is it could or could not be, but clots are a harm to life and limb so it should be checked immediately. The fact is you are on a medication known to form clots. The fact is it has persisted too long now to be a random ache or pain. The fact is 325Mg of Aspirin every day unless ordered by a Doctor can and will cause other issues such as Ulcers, coagulation issue's and could lead to internal bleeding. The fact is regular Aspirin regimen users only use 81-84 Mg of Aspirin a day WHILE being monitored for complications. The fact is also more than likely you have not told your parents about your leg issue. I know if one of my kids was on a medication known to cause clotting and had your issue they would have been in the Emergency Room last week. Don't worry, this is the last time I try to help or provide guidance or advice on this. Good luck. :)
Quote from: Amy1988 on June 12, 2014, 01:36:25 PM
I can't see how one 325mg aspirin would get rid of the pain of a blood clot. Maybe reduce it some for a short time.
What the hell is wrong with you? You sit around debating with people over words and definitions whilst you have a persistent medical problem that is not getting better. Go get
professional help.
Forget about the clot in your leg. Start worrying about the clot you see in the mirror!
Quote from: Amy1988 on June 12, 2014, 01:36:25 PM
I can't see how one 325mg aspirin would get rid of the pain of a blood clot. Maybe reduce it some for a short time.
If you already know everything about what your leg pain is not, why are you making a post asking what you should do?
Everybody's telling you to see your doctor. If you want to continue to argue out of it or make excuses, why did you post in the first place?
Go to an urgent care facility if you don't want your original doctor to know immediately.
Coming from someone who's had duodenum inflammation, your stomach is not somewhere that you want an ulcer. Some of the most crippling pain I've experienced, and aspirin every day can give you one.
Topic has run it's course.
Topic locked.