I've been on T for a little over eight months now. I've experienced a good deal of changes--greatly increased muscle mass, tons of body hair, some facial hair, very deepened voice, etc--and, up until recently, have experienced no downsides. I have an endo that's very well-versed in trans-related affairs and is super on top of my blood tests.
Every result is coming back just fine except for my hemoglobin levels (16.9) and my Kb/p (which is currently sitting at 52%). She has recommended that my dose be halved for at least the next three months so that my levels can be re-evaluated at that time.
I know that I have to do this but I'm somewhat panicked; I don't want to start sliding backwards, lose anything I've gained or have any of my 'factory' plumbing reactivate. While I understand that posting dosages here is against the rules, I'd like to say that I wasn't on a low dose by any stretch (my endo has stated that I was started on a dose almost twice what the average FTM she treats is at) but I can't help but feel nervous as hell about going down.
Have any of you ever had to do this? Were the emotional changes rough or was it barely noticeable? I guess I'm just looking for a few different experiences so I can maybe get an idea of what I'm looking at.
If it makes your anxiety that bad maybe you could cut it by 1/4 instead of a 1/2?
I'd personally prefer that but, according to her, she spoke with a couple of her colleagues concerning the matter and all of them unanimously concluded that the dose needed to be drastically reduced. I had been teetering on the edge of being so but now I'm polycythemic.
She did discuss the possibility of finding a midpoint between the two doses if my mental state begins to decline. I've just felt so good for the past several months that I really have no desire to return to any semblance of what I felt before, even if it's just for a brief period.
High hemoglobin puts you at higher risk of a stroke and unhealthy iron levels which are associated with heart disease and dementia. So your doctor is right to be concerned.
Couple of options you could pursue if you want to question the validity of the results or look into other causes for the elevated hemoglobin:
- Were you well-hydrated before your lab work? Dehydration would make your results worse, so if you may have been dehydrated, I would ask to be retested.
- Has your doctor checked your thyroid function? Hyperthyroidism can raise RBC. See if they can test this for you.
- Do you have sleep apnea? Sleep apnea can increase RBC. You could get tested for this.
Options for lowering your RBC if the above don't pan out:
- Give blood regularly.
- Switch delivery methods of T. There is a study that shows topical testosterone gels and creams increase RBC by less than half of what is seen with injections
- Lower your T dose.
Quote from: FTMax on July 08, 2016, 03:22:43 PM
High hemoglobin puts you at higher risk of a stroke and unhealthy iron levels which are associated with heart disease and dementia. So your doctor is right to be concerned.
Couple of options you could pursue if you want to question the validity of the results or look into other causes for the elevated hemoglobin:
- Were you well-hydrated before your lab work? Dehydration would make your results worse, so if you may have been dehydrated, I would ask to be retested.
- Has your doctor checked your thyroid function? Hyperthyroidism can raise RBC. See if they can test this for you.
- Do you have sleep apnea? Sleep apnea can increase RBC. You could get tested for this.
Options for lowering your RBC if the above don't pan out:
- Give blood regularly.
- Switch delivery methods of T. There is a study that shows topical testosterone gels and creams increase RBC by less than half of what is seen with injections
- Lower your T dose.
I was very well hydrated. My hemoglobin levels have been steadily increasing since I was initially put on T. Three months ago, she noted that I was sitting at the high end of 'normal' and that it was something she was anticipating to be an issue. In three months, I went from 16.1-16.9 and 49%-52%. My levels pre-T were 12.6 and 39%.
My thyroid levels have been checked and are normal. I also don't have sleep apnea. I'm completely healthy aside from this particular snag.
I wasn't aware about the different delivery methods being less harsh and I may actually ask to switch even though I was avoiding topicals due to the potential risk of transference to my partner.
I'm really more concerned about how the next three months are going to go.
The only time I had to cut back my dose was after my hysto, and I was glad for it. After the hysto, my T got so high that it was converting to estrogen at a pretty high level. I was fatigued all the time. Couldn't get enough sleep, never wanted to get up. After it was lowered, it was an almost instant fix.
Obviously my concerns being post-hysto were a little different than yours. There are non-hormonal birth control shots you can take that will keep shark week from returning. I would tell your doctor if she insists on dropping your dose, that you would like to start those shots at the same time.
I'm really curious about why your initial dose was almost double what most people are at. I would imagine that is likely what contributed to the situation you're in now. Was it a necessary move based on how your body was responding to the T based on lab work? Have you been getting E tested along with T?
With the decrease in dose, at least initially what you will experience is likely going to be very similar to what you experienced when you first started T - some temperature fluctuations, fatigue, etc. This should only last for a little while as your body acclimates to the lower T levels.
As long as you are getting T, you shouldn't back slide. My only worry for you would be shark week or spotting, so I would ask about Depo Provera when you go in next. I would also (if you can afford it or you have insurance that will cover it) see if you can be a little more frequent about getting labs done to see how the changes are affecting your T and E levels as well as the hemoglobin. I'd also start giving blood to see if you can positively affect it that way.
My dose has been altered many times and I'm now on half the dose I was to start with. I honestly feel fine. Like FTMax said, you'll have some side effects; I felt a bit tired the first week, slight appetite decrease and in general I felt like I might have been coming down with a mild cold. Spotting would be my only concern. I personally never had spotting but I know some guys have spotting when their doses change.
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Quote from: FTMax on July 08, 2016, 06:34:56 PM
The only time I had to cut back my dose was after my hysto, and I was glad for it. After the hysto, my T got so high that it was converting to estrogen at a pretty high level. I was fatigued all the time. Couldn't get enough sleep, never wanted to get up. After it was lowered, it was an almost instant fix.
Obviously my concerns being post-hysto were a little different than yours. There are non-hormonal birth control shots you can take that will keep shark week from returning. I would tell your doctor if she insists on dropping your dose, that you would like to start those shots at the same time.
I'm really curious about why your initial dose was almost double what most people are at. I would imagine that is likely what contributed to the situation you're in now. Was it a necessary move based on how your body was responding to the T based on lab work? Have you been getting E tested along with T?
With the decrease in dose, at least initially what you will experience is likely going to be very similar to what you experienced when you first started T - some temperature fluctuations, fatigue, etc. This should only last for a little while as your body acclimates to the lower T levels.
As long as you are getting T, you shouldn't back slide. My only worry for you would be shark week or spotting, so I would ask about Depo Provera when you go in next. I would also (if you can afford it or you have insurance that will cover it) see if you can be a little more frequent about getting labs done to see how the changes are affecting your T and E levels as well as the hemoglobin. I'd also start giving blood to see if you can positively affect it that way.
I mentally can't do the birth control thing. Before all of this, I had very light/short shark weeks--three days, maybe--that would stop entirely if I worked out hard enough. Despite being so lame and minor, they were a tremendous source of mental anguish and, as stupid as it sounds, taking birth control of any form would really mess with my head. That's why I never did it before.
Anyway, the double dose thing was an accident. They started me out at their 'standard' dose... but only once every two weeks. I was set to move up to every week after a month. During this time, I got different sized syringes and inadvertently ended up double dosing myself after they set me up for weekly shots. When I went back in two months for blood work, the discrepancy was noted. I wasn't experiencing any ill side effects at the time and was emotionally happy; she told me to remain at the dose since it seemed to be working. The original plumbing stopped working after two shots and hasn't been back in any form since then.
My current T count is 840 and my E is at 21.
Quote from: Ayden on July 09, 2016, 03:12:47 PM
My dose has been altered many times and I'm now on half the dose I was to start with. I honestly feel fine. Like FTMax said, you'll have some side effects; I felt a bit tired the first week, slight appetite decrease and in general I felt like I might have been coming down with a mild cold. Spotting would be my only concern. I personally never had spotting but I know some guys have spotting when their doses change.
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That's actually very reassuring to hear. I keep picturing the worst case scenarios (because that's how I roll) so I'll attempt to remind myself that it probably won't end up being as miserable as I'm anticipating.