So, I am 10 months into hormone therapy and I was considering speaking with my endocrinologist about the possibility of adding progesterone. Perhaps 10 months is a bit too early, but I figured it wouldn't hurt to lay some ground work. Not that I am disenchanted with my progress, but curiosity kills... I have a feeling that I have plateaued somewhat.
Would the one year mark be too early? Should I give it another 6 months or year before I enquire?
My endo asked me on my first visit if I wanted to add progesterone. I did. So, I don't think 10 months is too early. The science behind it is conflicting though so I don't think there is a definitive answer.
It is better to be hated for what you are than to be loved for what you are not.
André Gide, Autumn Leaves
If it was me and only taking E and things were progressing fairly nicely, I wouldn't want to change anything. "If it ain't broke, don't fix it". ;) You lose nothing though from discussing it with your doctor.
Right from the start my hrt doctor suggested that we would probably add Progesterone at some point. At five months in I asked about it and she provided the prescription without hesitation. I have to add that I started taking it combined with e and Spiro at a time when all kinds of emotional stuff was piling up and I spiraled into depression. I stopped P for a while and the emotional situations have diminished a bit and my spirits are back in a good space. I do plan to begin again but only when the holiday season is past and life stabilizes a bit. I can not say how much of a role the P added to the emotional crash but I do plan to experiment with reintroducing it in a very controlled emotional environment.
Anne
Quote from: KayXo on December 04, 2016, 10:23:23 AM
If it was me and only taking E and things were progressing fairly nicely, I wouldn't want to change anything. "If it ain't broke, don't fix it". ;) You lose nothing though from discussing it with your doctor.
I feel that I may have plateau'd. My measurements have not progressed in 6 months, which in the grand scheme of things is the blink of an eye. So I have been considering it for a while without acting upon it. However, there have been so many differing opinions and very few real studies done in the pubmed arena that it's been a curiosity of mine. My Endocrinologist has already confronted me about waiting so long before suggesting that something may be "off". I'm of the mind that I better be sure of something before talking with my doctor. It usually takes me a couple months of believing that something needs tweaking before I bring it up... that upset her greatly that I am slow to speak up.
The article from Dana Beven on the TG Forum ref Progesterone is probably one of the better reads I've found for making some compelling arguments for and against.
Quote from: Anne Blake on December 04, 2016, 11:29:16 AM
Right from the start my hrt doctor suggested that we would probably add Progesterone at some point. At five months in I asked about it and she provided the prescription without hesitation. I have to add that I started taking it combined with e and Spiro at a time when all kinds of emotional stuff was piling up and I spiraled into depression. I stopped P for a while and the emotional situations have diminished a bit and my spirits are back in a good space. I do plan to begin again but only when the holiday season is past and life stabilizes a bit. I can not say how much of a role the P added to the emotional crash but I do plan to experiment with reintroducing it in a very controlled emotional environment.
Anne
I do hope that the craziness of life has subsided for you Anne. I am in a fairly good place as I've already taken what I feel is "my fair share" of lumps from life. I consider myself fairly resilient.
Harley, it sounds like you are planning to go for Progesterone. I think that is probably a good idea, I am looking forward to getting back on in next month. Would you please let us know how P is working for you as you begin to notice changes, both physically as well as mentally/emotionally. Good luck. Anne
I will definitely be posting "IF" I do start (and probably if I don't). I haven't really met my current Endocrinologist. We've spoken on the phone briefly to adjust my medications a few months ago, but Friday will be my first face to face. Going to have to feel her out as to what she's comfortable with. They're all "fellows" after all. ::)
Now the real question is how I should present for the formal introductions... lol... I am thinking just shirt and tie... perhaps slacks. That way she can give me the "hmmm... you don't look very feminine" stare and maybe she'll feel bad for me and give me whatever I want. Or maybe I should dress gender appropriate and wow her with my feminine wiles, so she knows I mean business... full speed ahead. Decisions Decisions....
Is it bad that I treat ever encounter with my doctors like a game of chess?
Quote from: Harley Quinn on December 04, 2016, 07:08:14 AM
So, I am 10 months into hormone therapy and I was considering speaking with my endocrinologist about the possibility of adding progesterone. Perhaps 10 months is a bit too early, but I figured it wouldn't hurt to lay some ground work. Not that I am disenchanted with my progress, but curiosity kills... I have a feeling that I have plateaued somewhat.
Would the one year mark be too early? Should I give it another 6 months or year before I enquire?
If I were you, I'd certainly pose the question. I don't think it's too early; it wouldn't be too early even on the initial visit. Personally, I'm interested in any qualified opinion on the difference between medroxyprogesterone, Provera and micronized progesterone, Prometrium. I understand the latter is a bio-identical hormone and the former isn't. I could be wrong, though.
My clinic seems to favor Provera, though the cost is low, I'm a little reluctant. Prometrium seems to have some advantages and the cost is much higher, but what do I know...
All the best,
--AshleyP
(https://tickers.tickerfactory.com/ezt/d/4;4;6/st/20161123/e/Ashley+began+HRT/dt/-6/k/d6aa/event.png)
(https://www.tickerfactory.com/)
Quote from: AshleyP on December 05, 2016, 11:54:38 PM
If I were you, I'd certainly pose the question. I don't think it's too early; it wouldn't be too early even on the initial visit. Personally, I'm interested in any qualified opinion on the difference between medroxyprogesterone, Provera and micronized progesterone, Prometrium. I understand the latter is a bio-identical hormone and the former isn't. I could be wrong, though.
My clinic seems to favor Provera, though the cost is low, I'm a little reluctant. Prometrium seems to have some advantages and the cost is much higher, but what do I know...
All the best,
--AshleyP
(https://tickers.tickerfactory.com/ezt/d/4;4;6/st/20161123/e/Ashley+began+HRT/dt/-6/k/d6aa/event.png)
(https://www.tickerfactory.com/)
I have researched and found the same. Provera, and its like, seem to have worse side effects than the micronized progesterone. I would be more apt to try the Progesterone rather than the Progestin. And they do have several generics of the Promentium on the market now, so the prices may come down.
In the large WHI study, Provera use was associated with an increase in clots, stroke, cardiovascular incidents and breast cancer. Progesterone use, in another study, was not associated with an increase in breast cancer.
Just a few studies:
Nat Med. 1997 Mar;3(3):324-7.
"Cardiovascular disease, the major cause of death in post-menopausal women, can be reduced by replacement of ovarian steroid hormones. To compare medroxyprogesterone with progesterone as the progestin in hormone replacement therapy from the standpoint of coronary artery vasospasm, we treated ovariectomized rhesus monkeys with physiological levels of estradiol-17 beta in combination with medroxyprogesterone or progesterone for four weeks. Coronary vasospasm in response to pathophysiological stimulation without injury showed that progesterone plus estradiol protected but medroxyprogesterone plus estradiol failed to protect, allowing vasospasm. We conclude that medroxyprogesterone in contrast to progesterone increases the risk of coronary vasospasm."
International Journal of ->-bleeped-<-, 13:165–232, 2011
"Progestins (especially medroxyprogesterone) are also suspected to increase breast cancer risk and cardiovascular risk in women (Rossouw et al., 2002). Micronized progesterone may be better tolerated and have a more favorable impact on the lipid profile than medroxyprogesterone does (de Lignieres, 1999; Fitzpatrick, Pace, & Wiita, 2000)."
Endocrine Reviews, April 2013, 34(2):171–208
"Recent results suggest that MPA, acting via
transactivation of the GR on target genes such as the fatty
acid synthase gene, may promote tumorigenesis in normal
cells and cancer progression in cancer cells, unlike progesterone
(195). »
MPA = medroxyprogesterone acetate (Provera)
Journal of the Gay and Lesbian Medical Association, Vol. 4, No. 4, 2000
"Micronized progesterone (Prometrium) is advantageous because it has a more favorable side effect profile (anxiety and irritability) than medroxyprogesterone."
Horm Behav. 2013 Feb; 63(2): 284–290.
"Here, we review the evidence that supports the neuroprotective effects of progesterone and discuss the various mechanisms that are thought to mediate these protective effects. We also discuss the receptor pharmacology of progesterone's neuroprotective effects and present a conceptual model of progesterone action that supports the complementary effects of membrane-associated and classical intracellular progesterone receptors. In addition, we discuss fundamental differences in the neurobiology of progesterone and the clinically used, synthetic progestin, medroxyprogesterone acetate that may offer an explanation for the negative findings of the combined estrogen/progestin arm of the Women's Health Initiative-Memory Study (WHIMS) and suggest that the type of progestin used may dictate the outcome of either pre-clinical or clinical studies that addresses brain function."
Maturitas. 2015 Mar 9.
"In a cross-sectional study of 176 women who had previously switched from HT containing MPA to HT containing micronized progesterone, 71% had switched because of the better side effect profile, 35% because they believed the long-term risks would be fewer, and 23% because of intolerance to MPA [21]. When evaluated at 1 to 6 months after switching, the women experienced significantly better quality of life, including less depression and anxiety, than with MPA (both P < 0.001) [21]. Patient satisfaction questionnaires also indicated that women preferred micronized progesterone over their previous regimen for better symptom control and fewer adverse effects (P < 0.001) [21]."
"Sleep was significantly improved after 6 months of CEE plus micronized progesterone but not with CEE plus MPA in a randomized study of 21 postmenopausal women tested in a sleep laboratory [22]."
CEE = conjugated equine estrogens (Premarin)
HT = hormone therapy
"Progesterone stimulated nitric oxide synthesis and inhibited adhesion of platelets to endothelial cells in rat endothelial cell cultures, whereas MPA inhibited nitric oxide synthesis and increased platelet adhesion [48]. »
Trends in Endocrinology and Metabolism
Volume 11, Issue 2, 1 March 2000, Pages 69–71
"Curiously, addition of the synthetic progestin, medroxyprogesterone, blocked the modulating effects of oestrogen on serotonin activity, while natural progesterone did not."
Climacteric. 2013 Aug;16 Suppl 1:44-53.
"Estrogen probably adds some cardioprotection, that can, however, be obscured by progestogens, especially medroxyprogesterone acetate (MPA)"
"Natural, 'body-identical' progesterone, devoid of any androgenic as well as glucocorticoid activities but being slightly hypotensive due to its antimineralocorticoid activity, appears to be the optimal progestogen in terms of cardiovascular effects, blood pressure, VTE, probably stroke and even breast cancer »
Etc.
For me it caused enlargement of lymphnodes in dangerous spots which led to a 3 week stay in the hospital and 2 months of recovery before I was back to normal. A rare possibility from it apparently but happened to me so it's worth mentioning.
Since then I've stuck to a noogleberry pump to stimulate growth, which I think has been helpful. I still have all the symptoms of growth so I'm firmly in the "if it isn't broke" category.
Are you still experiencing any tenderness or itching at all? If so I'd wait if not I'd ask
Quote from: LShipley on December 06, 2016, 12:41:23 PM
For me it caused enlargement of lymphnodes in dangerous spots which led to a 3 week stay in the hospital and 2 months of recovery before I was back to normal. A rare possibility from it apparently but happened to me so it's worth mentioning.
Since then I've stuck to a noogleberry pump to stimulate growth, which I think has been helpful. I still have all the symptoms of growth so I'm firmly in the "if it isn't broke" category.
Are you still experiencing any tenderness or itching at all? If so I'd wait if not I'd ask
I'm sorry to hear that. I will definitely keep it in mind... I haven't had anything in about 6 months. So meh, worth a shot.
The doctor I saw put me on Progesterone, estradiol and suprafact the first day i saw him. It was only about 2 months ago but I hope it works well.
I am also on progesterone since day 1. Doctor pointed out that research is divided about effectiveness. I take it the first half of every month. One effect I notice is that I develop a "cycle" - as soon as I have taken my 14 pills, I get cravings, bloating and a bunch of other cycle related issues. Still continue with it since it is supposed to help with reshaping my body