I do not actually know where to start talking about this. I may have already mentioned which HRT warped my normal mind way of working to a degree at the first months, some of you saw it; but looking back, I see it actually changed me considerably. Now I am more stable, but I still feel some of it. I am not sure if it is because of Androcur, which was banned in USA because it could do that, but espironolactona did me no good. Yet in fact, estrogen would physically affect your mind anyway the further you use them. It does for many of us at different degrees.
I got more easily angered, with some irrational thinking among other things, and sometimes I did not even noticed, at others I made a conscious effort to control them. It was embarassing. On the other side, I became more daring, and that opened more doors to me. Sometimes I felt quite peaceful as too mentioned before. What also surprised me, was which I lost some ability at some things, such as arts; but improved at other areas. Other point is which I started to write in a "cuter", more emotional way to an extent. My gestures became more feminine too, but they already were so to a lesser extent as a child.
That was quite beyond what I anticipated, but I accept it all because I would not refuse my transition for nothing in this world. Know this if you will start a transition or is at its very beginning, to know if you really want to pass through such experiences, or to prepare for them.
Dearly,
Tsukiyoarts
Differences in mental issues are common on HRT and are a side effect that the prescribing physician should warn about.
Androcur has a well documented side effect of inducing or triggering depressive episodes in some people and they can be quite sudden. Spiro can also do this but the effect is less common.
The brain has a high level of androgen receptors and is one reason that TG people feel dysphoric when they are on the wrong androgen.
Good night Cindy,
I think it was worse just at the first months, I am more stable now, but not fully. Yet I have not faced any really difficult situation to know how I would deal with it now I am on HRT. Surely I will have to warn my endocrinologist if things get too uncomfortable for me (and for others). I did get some positive traits too, or perhaps I was just putting to good use new negative traits.
Tsukiyoarts
It's pretty common to have any number of reactions to changing someone as biologically cored as hormones. The levels you were at before hormones plus your body's ability to process them all make it a unique experience for each one of us. The important thing, and you're already doing it, is acknowledging the changes and ensuring it's normal.
Good for you, and keep the faith!
Im about 6 weeks in on low doses of spiro and estradiol and I feel way off. It's so much more effort for me to focus and do simplest tasks. I may be going through a lot of stress in my life in general but I think the meds have some impact. They must be
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Hello dist123,
Actually, I know what you mean. That was one of the reasons for me to jump boat to Androcur in Brazil. Here we only have those two choices as far as I know. It is more expensive though. There usually is this disruption of your body and mind in the beginning at any choice, sometimes it goes away with time, sometimes not. I was already in the danger zone of spironolactona, my nails were getting quite purple sometimes, I was losing too much weight, and going too much to bathroom.
Tsukiyoarts
I think your brain re-wires sort of and then you learn to adapt to the new configuration. It definitely changes things though there is no doubt out. For myself along with the massive reduction in depression and anxiety, the positive sex drive changes etc came challenges like attention span differences, sleep differences etc.
Quote from: tsukiyoarts on November 21, 2017, 08:26:01 PM
I was already in the danger zone of spironolactona, my nails were getting quite purple sometimes, I was losing too much weight, and going too much to bathroom.
Tsukiyoarts
I had a similar experience! And when my endo took over my HRT she noticed my blood pressure was dangerously low due to the spiro. I had to get right off it and that's when I started androcur. The lesser of two evils for me. I'm just too slim, the drop in blood pressure is too severe. Otherwise I'd stay on spiro because I really liked the body hair reduction I experienced on it.
Quote from: tsukiyoarts on November 19, 2017, 03:09:07 PM
I am not sure if it is because of Androcur, which was banned in USA because it could do that, but espironolactona did me no good.
Just a quick correction here, Androcur wasn't banned in the US, the FDA simply never approved it due to apparent liver toxicity - which is not an issue with proper monitoring.
As for the changes you describe, I can't say I really experienced any of them to any serious degree, if at all, which is probably related to the fact that individuals do seem to react to HRT in similar, but individual, ways.
I think Androcur (Cyproterone Acetate) is a dangerous drug. It certainly made me feel very off, mentally as well as physically.
It does take time for the brain to settle to new hormones. They are powerful things.
I think professional help is always advisable. A good, gender specialist, endocrinologist is a must. If you feel that you cannot live in your natal genital state, and you also find anti-androgens to be debilitating, then you may wish to discuss surgery with them. Removal of testicles removes any need for these medications, after all. You can simply take a low(ish) dose of estrogen.
Quote from: Mandy M on November 22, 2017, 04:20:04 AM
I think Androcur (Cyproterone Acetate) is a dangerous drug. It certainly made me feel very off, mentally as well as physically.
Mental health issues are a known side effect - beyond the commonly known depression. This is in all the product literature. It's also something your therapist and endo/gyno should have discussed with you. At transition doses, it's likely as safe as spiro, if you have proper monitoring.
QuoteIt does take time for the brain to settle to new hormones. They are powerful things.
For some people this is quite true, others seem to have little issue.
QuoteI think professional help is always advisable. A good, gender specialist, endocrinologist is a must. If you feel that you cannot live in your natal genital state, and you also find anti-androgens to be debilitating, then you may wish to discuss surgery with them. Removal of testicles removes any need for these medications, after all. You can simply take a low(ish) dose of estrogen.
Yep, good medical professionals are very handy, but this is no excuse to not also educate yourself on the matter. And there's a far simpler alternative to surgery if your E levels are reasonably stable and sufficient, don't take an antiandrogen at all. This doesn't require terribly high levels or doses for most.
Quote from: kelly_aus on November 22, 2017, 05:11:49 AM
And there's a far simpler alternative to surgery if your E levels are reasonably stable and sufficient, don't take an antiandrogen at all. This doesn't require terribly high levels or doses for most.
It depends whether you want to be empirical or simply go by what you feel: which is fine for some people. Empirically, if you have testicles then estrogen alone will simply not suppress testosterone levels sufficient for most MtF's. That's an empirical fact. Alas.
p.s. hormones are powerful for everyone on the planet. They deserve some respect and professional direction.
Quote from: Mandy M on November 22, 2017, 05:31:25 AM
It depends whether you want to be empirical or simply go by what you feel: which is fine for some people. Empirically, if you have testicles then estrogen alone will simply not suppress testosterone levels sufficient for most MtF's. That's an empirical fact. Alas.
p.s. hormones are powerful for everyone on the planet. They deserve some respect and professional direction.
Really? I haven't taken an AA in 8 months and still have testicles. My T level is low/mid female range and has stayed at that level, excepting an initial minor blip upwards when I discontinued using cypro. Neither my dose or E level is high. This is not uncommon and certainly not unknown, as the research I did quelled my initial skepticism. I'd recommend some further research - I'd suggest looking at some of the Oncology journals in addition to Endo and Gyno journals. (Androgen Deprivation Therapy is a place to start.)
A growing number of trans women are transitioning on a E only regimen like mine or a combo of E and P. My medical team has no issues with such a regimen, and I've found it nothing but a positive.
I have done plenty of research and none of it gives any scientific backing for your assertion that E is sufficient for pre-operative transgender patients to lower their T levels to natal female levels.
Whilst, one case alone is an insufficient data sample can we at least have from you some hard science please: levels before and after switching to E only, ensuring like for like tests. Clearly, if you have been on anti-androgens prior to this E-only regime then your T level will have been lowered. It doesn't automatically switch back on again afterwards so it may be possible to have an AA + E regime for a time and then switch to E only.
Estrogen on its own is not a WPATH recommended regime for transgender patients transitioning from male to female.
Quote from: Mandy M on November 22, 2017, 12:08:27 PMEstrogen on its own is not a WPATH recommended regime for transgender patients transitioning from male to female.
Because it is believed that higher doses of estrogen are needed to effectively suppress testosterone production from testicles and that those higher doses are more likely to cause problems such as DVT, stroke, etc. BUT...
this fear comes from a time when non bio-identical estrogens were prescribed to transsexual women and did have an exaggerated impact on the liver and its production of several proteins and factors leading to increased health risks. If one takes the time to read the studies that have been published in the last 20-30 years, one will eventually realize those risks are significantly minimized/diminished on bio-identical estrogen, ESPECIALLY if taken non-orally and that the high doses/levels *sometimes* needed to suppress T to castrate/female levels are generally quite safe so that anti-androgens aren't needed and when the risks of anti-androgens are weighed against the risks of higher levels of bio-identical estradiol, one may realize it may be worthwhile to go with E alone (at the doctor's discretion of course).
Estrogen in men does suppress T effectively.
J Clin Endocrinol Metab. 1991 Sep;73(3):621-8."These results provide direct evidence that E2 inhibits gonadotropin secretion at the pituitary level in men"
Gonadotropins signal testes to produce T and direct spermatogenesis.
J Urol. 2003 May;169(5):1735-7."transdermal estradiol (...) patches were applied weekly for 8 weeks and then the number of patches was reduced
to maintain castrate levels of testosterone."
"Median follow-up is 15 months (range 12 to 20).
The patches were well tolerated by all patients. Estradiol levels greater than 1,000 pmol/l. were maintained using (...) patches and higher levels were achieved by increasing the number of patches."
"One patient had fluid retention and was withdrawn from study at 10 months but no other cardiovascular toxicity occurred. None of the coagulation activators, inhibitors or fibrinolytic factors was induced by transdermal estradiol therapy, and increased levels of prothrombin, fibrinogen and D-dimer at baseline were decreased (p 0.001, p 0.001, p 0.049, respectively). Arterial inflow was increased (p 0.004), while venous outflow was unaffected and arterial compliance improved (p 0.17)."
"In our study the physiological ratios of estrone-to-estradiol, sex hormone binding globulin, low density lipoprotein-to-high density lipoprotein, and factor VII and factor XII were maintained, (data not shown), and increased levels of prothrombin, fibrinogen and D-dimer were decreased. As a result,
transdermal estradiol therapy reversed the hypercoagulable state"
"Moreover,
transdermal estradiol therapy improved the vascular flow and increased arterial compliance, changes suggestive of a cardiovascular benefit.10"
So, not only did non-oral estradiol reduce T to castrate levels but it
reduced coagulation and
improved cardiovascular markers in old men with advanced prostate cancer.
Other similar studies have been undertaken with similar results. :) If studies show parenteral (non-oral) bio-identical estradiol to be safe (even beneficial) and effective at suppressing T in this population at greater risk of health problems, then why not in transwomen? Doctors treating us should look into this, I think. ;)
Quote from: Mandy M on November 22, 2017, 12:08:27 PM
I have done plenty of research and none of it gives any scientific backing for your assertion that E is sufficient for pre-operative transgender patients to lower their T levels to natal female levels.
Well, sadly, I suspect you've been looking in the wrong places or are being way too specific. The info is out there and it's not new. Unlike Kay, I don't drop links as I find it preferable that people find the info themselves - I did give you some hints though.
Quote from: Mandy M on November 22, 2017, 12:08:27 PMWhilst, one case alone is an insufficient data sample can we at least have from you some hard science please: levels before and after switching to E only, ensuring like for like tests. Clearly, if you have been on anti-androgens prior to this E-only regime then your T level will have been lowered. It doesn't automatically switch back on again afterwards so it may be possible to have an AA + E regime for a time and then switch to E only.
So the data is wrong? Multiple studies by endocrinologists, oncologists and other researchers are wrong? Somehow, having read the studies, I doubt it. You also make assumptions about my regimen that are incorrect - I stopped E entirely prior to discontinuing my AA.. I then recommenced taking E without an AA - my E levels dropped and my T rose until my E level was reestablished at a sufficient level.
Quote from: Mandy M on November 22, 2017, 12:08:27 PM
Estrogen on its own is not a WPATH recommended regime for transgender patients transitioning from male to female.
Synthetic estrogens, such as ethinyl estradiol used to be on WPATH's recommended regimen for tans patients, which shows they can and do change when needed. This is an area where I can see change happening.
I don't post this E only idea in an effort to get people to change their own regimen, I post this info so that people can be informed and educated about their care and make informed decisions on their ongoing care in consultation with their doctors. My doctor(s) have no issue with an E only regimen using modern, bio identical estrogens via a non-oral delivery method, as their own research suggested better E1:E2 ratios when the oral route was avoided.
I am about 6 weeks into HRT and I feel mentally better than i ever have in my life. No 'weird' behavior or side effects. I keep worrying that this will end or go away and that it's temporary. I've not felt so good in so long
One of the more deleterious features of this site, and others like it, is that a small number of non-medics with their own subjective experiences promote guidance. If something appears to work for them, which is to be welcomed, it is promoted as if this is a universal truth. Sometimes, perhaps even often, this flies in the face of current established and scientifically backed protocols. Of course, personal opinions and experiences are a valuable resource, and may feed into scientific understanding, but they do not substitute for empirical peer-reviewed research. It is also important that we monitor latest scientific research. In this regard, it is perhaps regrettable that KayXo has referred to research conducted as long ago as 1991 and 2003. Many more recent studies have moved along the scientific understanding of transgender treatment.
Both the World Professional Association for Transgender Health (WPATH) and the Endocrine Society have created transgender-specific guidelines to help serve as a framework for providers caring for gender minority patients. These guidelines are mostly based on clinical experience from experts in the field. Guidelines for hormone therapy in transgender men are mostly extrapolations from recommendations that currently exist for the treatment of hypogonadal natal men and estrogen therapy for transgender women is loosely based on treatments used for postmenopausal women. It is important to note that, in many cases, MtF patients are reliant on non-specific treatment studies.
Therefore, let's be clear about this. Current WPATH and scientific papers do, indeed, suggest that Estrogen, through a feedback loop, does suppress testosterone. However:
"Hormone therapy for transgender women is intended to feminize patients by changing fat distribution, inducing breast formation, and reducing male pattern hair growth Estrogens are the mainstay therapy for trans female patients. Through a negative feedback loop, exogenous therapy suppresses gonadotropin secretion from the pituitary gland, leading to a reduction in androgen production. Estrogen alone is often not enough to achieve desirable androgen suppression, and adjunctive anti-androgenic therapy is also usually necessary. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/
This backed by a scientific study and presented to the Endocrine Society in their Chicago conference 2014.
"Simply giving estrogen to male-to-female transgender patients won't completely suppress testosterone levels, researchers reported here." This study by Dr Leiniung is, however, a single study and presents conflicting advice, so we need to be wary until further research has been conducted."
https://www.medpagetoday.com/meetingcoverage/endo/46497
WPATH and the Endocrine Society guidelines are quite clear about the protocols regarding anti androgens. Most importantly of all, anti androgens permit lower doses of estrogen, which is beneficial for health reasons:
"Suppression of testosterone production and blocking of its effects contributes to the suppression / minimization of male secondary sexual characteristics. Unfortunately many of these characteristics are permanent upon completion of natal puberty and are irreversible. Androgen blockers allow the use of lower estradiol dosing, in contrast to the supraphysiologic estrogen levels (and associated risks) previously used to affect pituitary gonadotropin suppression."
http://transhealth.ucsf.edu/trans?page=guidelines-feminizing-therapy
The bottom line here to everyone who sees this is please go and seek professional medical help. Do not self-prescribe. Have your blood levels regularly checked and be very wary about something diverging from current WPATH guidelines. At the least, ensure you discuss this thoroughly with a properly trained medical professional.
See also:
Giltay EJ, Gooren LJ. Effects of sex steroid deprivation/administration on hair growth and skin sebum production in transsexual males and females. J Clin Endocrinol Metab 2000;85:2913-21. 10.1210/jcem.85.8.6710
Dittrich R, Binder H, Cupisti S, et al. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist. Exp Clin Endocrinol Diabetes 2005;113:586-92. 10.1055/s-2005-865900
Quote from: Mandy M on November 23, 2017, 03:09:23 AM
One of the more deleterious features of this site, and others like it, is that a small number of non-medics with their own subjective experiences promote guidance. If something appears to work for them, which is to be welcomed, it is promoted as if this is a universal truth. Sometimes, perhaps even often, this flies in the face of current established and scientifically backed protocols. Of course, personal opinions and experiences are a valuable resource, and may feed into scientific understanding, but they do not substitute for empirical peer-reviewed research. It is also important that we monitor latest scientific research. In this regard, it is perhaps regrettable that KayXo has referred to research conducted as long ago as 1991 and 2003. Many more recent studies have moved along the scientific understanding of transgender treatment.
This isn't personal opinion - it is the opinion of my medical team, which is supported by the science. More recent studies?
QuoteBoth the World Professional Association for Transgender Health (WPATH) and the Endocrine Society have created transgender-specific guidelines to help serve as a framework for providers caring for gender minority patients. These guidelines are mostly based on clinical experience from experts in the field. Guidelines for hormone therapy in transgender men are mostly extrapolations from recommendations that currently exist for the treatment of hypogonadal natal men and estrogen therapy for transgender women is loosely based on treatments used for postmenopausal women. It is important to note that, in many cases, MtF patients are reliant on non-specific treatment studies.
WPATH and the Endocrine Society both in the past recommended drugs like Premarin and ethinyl estradiol and yet no longer do, mostly due to research and advancements that were not trans specific - or are the work of medics working directly with trans people, which often goes unpublished.
QuoteTherefore, let's be clear about this. Current WPATH and scientific papers do, indeed, suggest that Estrogen, through a feedback loop, does suppress testosterone. However:
"Hormone therapy for transgender women is intended to feminize patients by changing fat distribution, inducing breast formation, and reducing male pattern hair growth Estrogens are the mainstay therapy for trans female patients. Through a negative feedback loop, exogenous therapy suppresses gonadotropin secretion from the pituitary gland, leading to a reduction in androgen production. Estrogen alone is often not enough to achieve desirable androgen suppression, and adjunctive anti-androgenic therapy is also usually necessary. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/
This backed by a scientific study and presented to the Endocrine Society in their Chicago conference 2014.
"Simply giving estrogen to male-to-female transgender patients won't completely suppress testosterone levels, researchers reported here." This study by Dr Leiniung is, however, a single study and presents conflicting advice, so we need to be wary until further research has been conducted."
https://www.medpagetoday.com/meetingcoverage/endo/46497
WPATH and the Endocrine Society guidelines are quite clear about the protocols regarding anti androgens. Most importantly of all, anti androgens permit lower doses of estrogen, which is beneficial for health reasons:
"Suppression of testosterone production and blocking of its effects contributes to the suppression / minimization of male secondary sexual characteristics. Unfortunately many of these characteristics are permanent upon completion of natal puberty and are irreversible. Androgen blockers allow the use of lower estradiol dosing, in contrast to the supraphysiologic estrogen levels (and associated risks) previously used to affect pituitary gonadotropin suppression."
http://transhealth.ucsf.edu/trans?page=guidelines-feminizing-therapy
The bottom line here to everyone who sees this is please go and seek professional medical help. Do not self-prescribe. Have your blood levels regularly checked and be very wary about something diverging from current WPATH guidelines. At the least, ensure you discuss this thoroughly with a properly trained medical professional.
At no point did I suggest self-prescribing. I've presented it as an option for discussion with your medical professionals. And that 2nd link doesn't state what you've quoted quite as emphatically as you've put it. The study is also limited in the delivery methods used.
Will it work for everyone? Probably not. Should it work for many? Yes. Anti-androgens are not, for the most part, friendly drugs, they all have side effects we can do without. Why take a drug that's not needed?
Quote from: kelly_aus on November 23, 2017, 03:32:15 AM
Anti-androgens are not, for the most part, friendly drugs, they all have side effects we can do without. Why take a drug that's not needed?
If you wish to suppress testosterone effectively then, yes, WPATH guidelines are clear that estrogen alone is unlikely to be sufficient or, more seriously, you may need dangerously high levels of estrogen.
However, I do completely agree with you about anti-androgens. If someone has followed WPATH protocols, including the correct amount of time, and has the support of two medical letters, then surgery is a preferable option. It is, of course, more or less irreversible and not without its own complications.
Quote from: Mandy M on November 23, 2017, 04:01:22 AM
If you wish to suppress testosterone effectively then, yes, WPATH guidelines are clear that estrogen alone is unlikely to be sufficient or, more seriously, you may need dangerously high levels of estrogen.
However, I do completely agree with you about anti-androgens. If someone has followed WPATH protocols, including the correct amount of time, and has the support of two medical letters, then surgery is a preferable option. It is, of course, more or less irreversible and not without its own complications.
Funny how there are at least 250 trans women out there, that I know of, who are not on AA's, not on high E doses and have no issues - and they are all over the world. Strange that my medical team have no issue with it.
I guess it must be some kind of weird accident.
Anecdote alert ^^^ ;) Even if these 250 genuinely existed, we know nothing about them, their backgrounds, their drug regimes, their blood levels. We would need a proper scientific study. We would need to know, for instance, whether prior to going onto an estrogen-only regime they had previously taken anti-androgens. There is some evidence that once the testosterone loop is interrupted, then estrogen alone may be sufficient, though again generally this requires inadvisably high levels of estrogen.
This should all be about hard science, which is why books like Thomas Bevan's Psychobiology of Trans is so helpful. It's also why anyone reading this thread would be well advised to seek professional medical help.
Quote from: Mandy M on November 23, 2017, 06:23:18 AM
Anecdote alert ^^^ ;) Even if these 250 genuinely existed, we know nothing about them, their backgrounds, their drug regimes, their blood levels. We would need a proper scientific study. We would need to know, for instance, whether prior to going onto an estrogen-only regime they had previously taken anti-androgens. There is some evidence that once the testosterone loop is interrupted, then estrogen alone may be sufficient, though again generally this requires inadvisably high levels of estrogen.
This should all be about hard science, which is why books like Thomas Bevan's Psychobiology of Trans is so helpful. It's also why anyone reading this thread would be well advised to seek professional medical help.
I'm done. The science is out there.
You've made up your mind that this is all some kind of delusion or fallacy.. That's fine. I'll continue taking the standard WPATH/Endocrine Society dose of estrogen as advised by my doctor and continue to receive the benefits of not taking an AA I don't need.
Quote from: kelly_aus on November 23, 2017, 06:39:34 AM
'The science is out there.'
If you are making assertions which run contrary to current WPATH guidelines then you should back it up, rather than state that you are happy to leave others to find it 'out there'. Not everyone has access to online academic papers in the way that I do.
So, in the absence of any back up for your assertions I will, I'm afraid, sadly remain sceptical. If you feel it works for you then that's truly great. I don't underestimate the power of the mind to help regulate hormone levels on an epigenetic level. But it's not to be applied to others because 1. there is insufficient scientific backup and 2. it's contrary to WPATH guidelines.
To everyone else: seek professional medical guidance please rather than be steered by non-medics, however well-meaning and earnest they appear.
"Androgen deprivation therapy complications.", Allan CA, Endocr Relat Cancer. 2014 Aug;21(4):T119-29
"Drug-induced diseases: prevention, detection, and management", Tisdale J, American Society of Health-System Pharmacists, 2005.
"Anxiety and mood disorders associated with gonadotropin-releasing hormone agonist therapy." Warnock JK, Psychopharmacol Bull. 1997;33(2):311-6.
"Transdermal estradiol therapy for advanced prostate cancer--forward to the past?", Ockrim JL, J Urol. 2003 May;169(5):1735-7.
"An example of a reasonable accommodation is the use of injectable cross-sex hormones, if not medically contraindicated... There is some evidence that parenteral estrogen treatments may be safer than oral preparations especially in people over 35 years of age. "https://www.researchgate.net/publication/247510691_Recommended_Revisions_to_the_World_Professional_Association_for_Transgender_Health%27s_Standards_of_Care_Section_on_Medical_Care_for_Incarcerated_Persons_with_Gender_Identity_Disorder
"Parenteral estrogen versus combined androgen deprivation in the treatment of metastatic prostatic cancer: part 2. Final evaluation of the Scandinavian Prostatic Cancer Group (SPCG) Study No. 5.", Hedlund PO, Scand J Urol Nephrol. 2008;42(3):220-9.
"The Haunting of Medical Journals: How Ghostwriting Sold 'HRT'", PLoS Med. 2010 Sep; 7(9): e1000335, Published online 2010 Sep 7. doi: 10.1371/journal.pmed.1000335, PMCID: PMC2935455.
" Direct inhibition of Leydig cell function by estradiol.", Jones TM, J Clin Endocrinol Metab. 1978 Dec;47(6):1368-73.
" The effect of oestrogen administration on plasma testosterone, FSH and LH levels in patients with Klinefelter's syndrome and normal men." Smals AG, Acta Endocrinol (Copenh). 1974 Dec;77(4):765-83.
"In men, peripheral estradiol levels directly reflect the action of estrogens at the hypothalamo-pituitary level to inhibit gonadotropin secretion.", Raven G, J Clin Endocrinol Metab. 2006 Sep;91(9):3324-8. Epub 2006 Jun 20.
"Sex steroid control of gonadotropin secretion in the human male. II. Effects of estradiol administration in normal and gonadotropin-releasing hormone-deficient men.", Finkelstein JS, J Clin Endocrinol Metab. 1991 Sep;73(3):621-8.
Is that sufficient back up?
And please show where I advised anything other than discussing this with your medical professionals?
Kelly you're being slightly naughty.
1. Androgen deprivation therapy complications.", Allan CA, Endocr Relat Cancer. 2014 Aug;21(4):T119-29
Is about prostate cancer therapy and has nothing to do with estrogen-only studies in MtF patients . In fact, it's an attack on anti-androgens which really rather gives away your own agenda here. You're not making a scientific case for oestrogen-only MtF therapy. You are taking a pop at anti-androgens: about which, by the way, I have considerable sympathy.
2. https://www.amazon.co.uk/Drug-Induced-Diseases-Prevention-Detection-Management/dp/1585282057
Is an attack on drugs that cause diseases and has nothing to do with estrogen-only studies in MtF patients See no. 1 above
3. Anxiety and mood disorders associated with GnRH gonadotropin-releasing hormone agonist therapy." Warnock
Is about the depressive side-effects of anti-androgens and has nothing to do with estrogen-only studies in MtF patients See no. 1 above
4. Transdermal estradiol therapy for advanced prostate cancer--forward to the past?", Ockrim
Is a study of tumour response in cancer treatment. It is not research of estrogen-only studies in MtF patients See no. 1 above
5. https://www.researchgate.net/publication/247510691_Recommended_Revisions_to_the_World_Professional_Association_for_Transgender_Health%27s_Standards_of_Care_Section_on_Medical_Care_for_Incarcerated_Persons_with_Gender_Identity_Disorder
Brown's 2009 paper on trans prisoners makes not a single mention of anti-androgens and only mentions estrogen once. It is a paper on the practicalities of how to administer HRT to trans prisoners and has nothing to do with estrogen-only studies in MtF patients See no. 1 above
6. 'Parenteral estrogen versus combined androgen deprivation in the treatment of metastatic prostatic cancer'
This is a study into the adverse effects of cancer treatments and has nothing whatsoever do with oestrogen only studies of MtF patients.
7. 'The Haunting of Medical Journals: How Ghostwriting Sold 'HR
Is not about estrogen-only HR treatment, but about litigation cases across all HRT.
8. 'Direct inhibition of Leydig cell function by estradiol'
This is a study of leading cells. It is not a comparison of estrogen-only v WPATH anti-androgen combined estrogen treatment. Nor is it a study of MtF patients.
9. 'The effect of oestrogen administration on plasma testosterone, FSH and LH levels in patients with Klinefelter's syndrome and normal men'
This is a small-scale study of 6 patients with Klinefelter's syndrome. It does show reduction in testosterone with estrogen adminstration, but this is denied by no-one (at least not by me).
10. 'In men, peripheral estradiol levels directly reflect the action of estrogens at the hypothalamo-pituitary level to inhibit gonadotropin secretion.'
This merely says that oestrogen is an important component in testosterone reduction, which no-one (certainly not me) denies. It is not a comparison of estrogen only v WPATH guideline AA + oestrogen therapy and it is not a study of estrogen-only MtF patients.
11. 'Sex steroid control of gonadotropin secretion in the human male. II. Effects of estradiol administration in normal and gonadotropin-releasing hormone-deficient men.'
This is a study of gonadotrophin secretion in hormone deficient men. It is not a study of MtF transgender patients and their medication regimes
There's not a single article there that runs counter to current WPATH guidelines. Whilst no-one denies the importance of estrogen, in fact the opposite, current guidelines are that testosterone blocking agents are usually used in order to minimise the dosage of estradiol neede (Bevan 2015).
One of my principal concerns about your advice is that 1. it runs counter to current WPATh guidelines, 2. it may encourage those who self-medicate to take higher than recommended doses of estrogen.
Both the World Professional Association for Transgender Health (WPATH) and the Endocrine Society have created transgender-specific guidelines to help serve as a framework for providers caring for gender minority patients. These guidelines are mostly based on clinical experience from experts in the field. Guidelines for hormone therapy in transgender men are mostly extrapolations from recommendations that currently exist for the treatment of hypogonadal natal men and estrogen therapy for transgender women is loosely based on treatments used for postmenopausal women.
Hormone therapy for transgender women is intended to feminize patients by changing fat distribution, inducing breast formation, and reducing male pattern hair growth. Estrogens are the mainstay therapy for trans female patients. Through a negative feedback loop, exogenous therapy suppresses gonadotropin secretion from the pituitary gland, leading to a reduction in androgen production. Estrogen alone is often not enough to achieve desirable androgen suppression, and adjunctive anti-androgenic therapy is also usually necessary. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/
As it happens, on an anecdotal level, I am not that keen on anti-androgens. For this reason I would be supportive of those who seek surgical options, which has the added benefit of permitting lower doses of oestrogen. However, such guidance should only be in the context of professional medical and psychiatric assessment and the completion of all WPATH protocols.
Quote from: Mandy M on November 23, 2017, 03:09:23 AM
One of the more deleterious features of this site, and others like it, is that a small number of non-medics with their own subjective experiences promote guidance.
Not necessarily only subjective but based on actual science (i.e. peer-reviewed studies). We don't promote guidance, we provide information that may be useful to the reader and that they may, if they wish to, bring up with their doctors.
QuoteIf something appears to work for them, which is to be welcomed, it is promoted as if this is a universal truth.
Your assertion that E isn't effective for suppressing T enough in transwomen is absolutism and leaves no room for considering that it may be. You condemn promoting a universal truth and yet, that's exactly what you are doing.
In the past, E alone was used to suppress T in transwomen but this was dropped in favor of anti-androgens not because it was more effective but because it was safer due to the fact that E was not bio-identical and increased significantly the risk of clots.
QuoteSometimes, perhaps even often, this flies in the face of current established and scientifically backed protocols.
Based on my review, it would appear that established protocols for transwomen are actually often not scientifically backed (guesswork, arbitrary) or sometimes backed by poor evidence, outdated or even irrelevant. I encourage readers to go through those guidelines and actually read the references. You will see for yourself. It is especially unfortunate to note the many references missing from their papers that could help establish better, more up-to-date protocols like those studies in ciswomen and in men showing high levels of estradiol being safe, even at an advanced age or studies showing the significant differences between progesterone and other progestogens. IMO, there isn't much effort put into establishing those guidelines because if there was, there would be a more substantial list of references from which to draw better and more rational conclusions.
To promote blind adherence to guidelines and stifle critical/free thinking is, in my opinion, not in the best interest of the reader and unhealthy practice.
QuoteIt is also important that we monitor latest scientific research.
QuoteIn this regard, it is perhaps regrettable that KayXo has referred to research conducted as long ago as 1991 and 2003. Many more recent studies have moved along the scientific understanding of transgender treatment.
These studies even if old, remain important and relevant as findings in men in 1991 and 2003 should not be any different now. Men remain men, humans remain humans. However, you can find below a more recent paper with similar findings.
Interestingly, the established guidelines for transgender women discourage use of only estrogen based on much older studies in transwomen employing high doses of non bio-identical estrogens. Those findings clearly no longer remain relevant as these days, only or almost exclusively bio-identical estrogen is prescribed and hundreds of studies have shown that bio-identical E differs in significant ways as far as health risks go, especially if taken non-orally. You criticize me for providing old studies and yet you omit to mention that those protocols you like to abide by are based on even older studies that are no longer pertinent.
Lancet Oncol. 2013 Apr;14(4):306-16. (In men with advanced prostate cancer)
"Initially, patients in the oestrogen-patch group received (...) patches (...) to be self-administered and changed twice weekly for 4 weeks. The number of patches was reduced (...) if castrate testosterone concentrations in serum of 1ยท7 nmol/L or lower were achieved (regimen one)."
"The regimen was changed, therefore, to (...) patches to be changed twice weekly for 4 weeks, followed by use of (...) patches twice weekly when the target castrate testosterone concentration in serum was reached (regimen two).19 Patients with testosterone concentrations higher than castrate levels at 4 weeks remained on the induction regimen and had testosterone checked every 2 weeks."
QuoteCurrent WPATH and scientific papers do, indeed, suggest that Estrogen, through a feedback loop, does suppress testosterone. However:
"Estrogen alone is often not enough to achieve desirable androgen suppression, and adjunctive anti-androgenic therapy is also usually necessary. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/
This backed by a scientific study and presented to the Endocrine Society in their Chicago conference 2014.
"Simply giving estrogen to male-to-female transgender patients won't completely suppress testosterone levels, researchers reported here." This study by Dr Leiniung is, however, a single study and presents conflicting advice, so we need to be wary until further research has been conducted."
https://www.medpagetoday.com/meetingcoverage/endo/46497
These conclusions are based on one study alone employing ORAL ESTRADIOL at certain doses. Had they prescribed higher doses which, according to studies in ciswomen with breast cancer, seem to still be quite safe or estradiol in the form of patches, gels, pellets or IM injection, testosterone levels could well have been suppressed. Also, estradiol when taken orally, tends to increase SHBG significantly such that free or bio-available T, if measured (they weren't for some odd reason), could have been well into the female range or even below, who knows? Total T doesn't tell the whole story and I find it surprising that they didn't consider this. Perhaps, desirable T suppression was achieved and they just didn't know it because free and bio-available T wasn't measured.
For all the reasons noted above, it is premature to arrive at such a conclusion based on this single somewhat incomplete study, ESPECIALLY considering there are SEVERAL other studies in men with prostate cancer where estrogen is given in the form of patches or even IM injections and where this effectively suppresses T, down to castrate levels. For some reason, these studies are not mentioned. ??? ::)
QuoteWPATH and the Endocrine Society guidelines are quite clear about the protocols regarding anti androgens. Most importantly of all, anti androgens permit lower doses of estrogen, which is beneficial for health reasons:
"Suppression of testosterone production and blocking of its effects contributes to the suppression / minimization of male secondary sexual characteristics. Unfortunately many of these characteristics are permanent upon completion of natal puberty and are irreversible. Androgen blockers allow the use of lower estradiol dosing, in contrast to the supraphysiologic estrogen levels (and associated risks) previously used to affect pituitary gonadotropin suppression."
Those assertions that there are risks with supraphysiologic estrogen levels are based on OLD studies (before 1990) that you like to dismiss and criticize, where non bio-identical estrogens were used in high doses. Check the references and you will see for yourself. In contrast:
Br J Obstet Gynaecol. 1990 Oct;97(10):917-21."There is some anxiety about the possible harmful sequelae of supraphysiological estradiol levels but no data are currently available to show any deleterious effects of these levels on coagulation factors, blood pressure, glucose tolerance or the occurrences of endometrial or breast cancer (Hammond et al. 1974; Thom et id. 1978; Studd B Thom 1981; Armstrong 1988)."
"Supraphysiological oestradiol levels are an uncommon consequence of oestradiol implants occurring most frequently in women with a history of depression or surgical castration.
These high serum oestradiol levels were not associated with any deleterious effects and may be necessary for the control of symptoms in specific women"
Hum Reprod. 2002 Mar;17(3):825-9."We examined metabolic parameters in cohorts of women with and without subcutaneous estrogen therapy with concomitant supra-normal concentrations of estradiol (SE)."
"Women with SE have similar triglyceride and HDL cholesterol levels but lower LDL cholesterol concentrations compared with post-menopausal women not taking ERT. The observations that the SE group showed reduced fasting insulin and WHR suggest that
supra-normal circulating concentrations of estradiol, delivered subcutaneously, may beneficially influence insulin metabolism."
Horm Metab Res. 1994 Sep;26(9):428-31."Thirteen osteopenic women received (...) estradiol valerate (...) by intramuscular injections once a week for 6 months (so called "pseudopregnancy")."
"Six patients were peri- or postmenopausal (49.5 +/- 4.8 years of age, group A)"
"The duration of the therapy was 6, and in 4 patients 9 months"
"Estradiol increased from 34.8 +/- 7.5 pg/ml to 3226 +/- 393 pg/ml after 3 months and to 2552 +/- 254 pg/ml after 6 months, respectively, in group A."
"The treatment was well tolerated. No adverse effects were seen, the patients expressed a feeling of particular well being, 3 of them wanted to have the injections repeated and none of them wanted to stop treatment because of troubles or side effects."
"Investigations of lipids, liver enzymes and haemostasiology to be published later will show the absence of unwanted metabolic effects of this regimen."
"The increase of bone density in our patients with gonadal dysgenesis was associated with an impressive secondary sexual development, especially of the breasts."
"In conclusion, our data show, that the treatment (...) by means of high parenteral estrogen-progestogen depot injections is effective. Virtually no side effects occurred. The therapy is well accepted by the patients."
"In addition, pseudopregnancy may be useful and effective in osteopenia and lacking secondary sexual development due to gonadal dysgenesis like in Ullrich-Turner syndrome (after completion of growth), where substitution doses of ovarian hormones may be not sufficient enough to guarantee satisfactory response.
There are several other similar studies in men too and even in transwomen taking *bio-identical estradiol* that show identical findings with high (supraphysiologic) levels/doses.
I think Kay, Kelly vs Myself have had plenty of say on this thread and it is now up to others either to heed my warnings or follow their thoughts.
In general I would caution anyone from departing from WPATH guidelines. Medical guidance and supervision, which should include regular blood testing, is always essential.
Whilst discussion of dosage is not permitted on Susan's forum, some people sail close to the wind with advice which flies in the face of WPATH guidelines and which could be extremely dangerous and life threatening. The more so when it comes from non-medical amateurs who like to give the impression that they are scientifically trained, when they are not at all. They have their own reasons for this, both conscious and sub-conscious.
The bottom line is: always go and seek professional help.