Susan's Place Transgender Resources

I think it would be educational to get a more definitive picture of this.  Please vote in the poll.

Also different things work for different people, this poll in no way represents what is best for you.  I would appreciate, if posters who want to share their experience with various forms of estrogen therapy, if posters would please also share body type, blood type, activity level, diet type(red meat common, lots of fruit, etc), even stress levels, anything and everything possible that you personally think could contribute to why someone works for you but didn't work for someone else.  Caffiene intake also plays a decent role, or any stimulant usage, I THINK, that caffiene could really screw someone taking estrogen orally over due to speeding up the metabolism between doses.

This isn't a corny attempt to diagnose or provide medical advice, just to see how it plays out and see if there's any consistency between differeny body types and lifestyle factors that make people more receptive to one form of estrogen over another.

EDIT:
DO NOT POST A CLAIM WITHOUT CITING A REFERENCE TO PROVE IT.  THIS THREAD IS BEING TAKEN OVER BY PEOPLE TOTING THEIR, "SUBLINGUAL ABSORPTION IS GOD" STUFF AND YET THERE IS YET TO BE ONE ARTICLE ON IT.

injectables are way in front so it looks like I'm going to have to find an outlet to access them in the U.K

Quote from: Berliegh on January 07, 2008, 08:36:16 AM
injectables are way in front so it looks like I'm going to have to find an outlet to access them in the U.K

HOld up until there at atleast 20 votes!

Yeesh.

I was on oral hormones in my early teens.  My dosages were highly inconsistent between fighting with my rents to stay on it and ending up in mental hospitals all the time and such, but I had begun to see a tid bit of development.  I'm thinking about talking to the doc about patches, or combining patches with oral, or even injectables.

I can't say much about fat redistribution, I wish I had some to redistribute.  My BF% as of now is under 4% which is insane.  I try really hard to not drink caffiene, but school has started back up so it is going to be a necessity for me to pass, atleast during lectures.  My diet is pretty healthy except I have a pretty crazy sweet tooth for cakes and cookies and wafers.  I workout every day pretty vigorously, with some moderately difficult cardio and then weight lifting, mostly leg stuff or powerlifting.  That and I ride my bike a few miles a day as it's my transportation device.  I'm currently on oral right now, but I'm gonna talk to my gender therapist about what she's noticed in general with her clients.  I honestly have just a good feeling about injectables, as far as the effects go, like an intuitive thing.  But, the concept of sticking a needle into myself is rather unnerving.

Please people, bring in some posts, all there are is 3 votes and I don't think I have enough knowledge to participate yet!

I can't say which works best, since I've never been on injections (and don't plan to).

And my doc has me on BOTH orals and patches, so... not sure how to answer this ;)

Aside from my breasts, I pretty happy with my results though... for someone who looks like a maniacal pixie now.

~Kate~

Quote from: Kate on January 07, 2008, 01:01:27 PM
I can't say which works best, since I've never been on injections (and don't plan to).

And my doc has me on BOTH orals and patches, so... not sure how to answer this ;)

Aside from my breasts, I pretty happy with my results though... for someone who looks like a maniacal pixie now.

~Kate~

You're pretty tall and slim, aren't you Kate?

What's your diet, caffiene intake, and activity levels like?

Quote from: kalt on January 07, 2008, 01:11:54 PM
You're pretty tall and slim, aren't you Kate?

At 6'2", I'd say so ;) Although my "pooch" or whatever they call it... the lower tummy thing... is there these days. My wife threatens to have me committed whenever I say that though, so I dunno if it's that bad.

QuoteWhat's your diet, caffiene intake, and activity levels like?

Around 1,500 cals per day. Pasta, rice and chicken mostly. Mix in cereal, some cheese, whole grain breads, eggs, assorted veggies, deli turkey, etc. now and then. Zero fast food. An occasional pizza or chinese. Water, but an occasional soda maybe every few days.

Caffeine from the rare sodas. I don't drink coffee. Tea very rarely.

Activity? LOL... none.

And yet, I'm healthy and happy ;)

~Kate~

Quote from: Kate on January 07, 2008, 01:45:50 PM
Around 1,500 cals per day. Pasta, rice and chicken mostly. Mix in cereal, some cheese, whole grain breads, eggs, assorted veggies, deli turkey, etc. now and then. Zero fast food. An occasional pizza or chinese. Water, but an occasional soda maybe every few days.

That's an admirable diet, it really is.

And your development is coming along just fine... but you were on oral and transdermal?

Quote from: kalt on January 07, 2008, 01:51:44 PM

Quote from: Kate on January 07, 2008, 01:45:50 PM
Around 1,500 cals per day. Pasta, rice and chicken mostly. Mix in cereal, some cheese, whole grain breads, eggs, assorted veggies, deli turkey, etc. now and then. Zero fast food. An occasional pizza or chinese. Water, but an occasional soda maybe every few days.

That's an admirable diet, it really is.

And your development is coming along just fine... but you were on oral and transdermal?

Thanks Kalt! Yea, it's pretty low on fat, but really high on carbs (the pasta and rice)... so I think the carbs all stick to my stomach, lol.

Yes, I've always had the same exact pills/patches regimen consistently throughout the 16 months of my HRT.

~Kate~

Quote from: Kate on January 07, 2008, 01:58:26 PM

Thanks Kalt! Yea, it's pretty low on fat, but really high on carbs (the pasta and rice)... so I think the carbs all stick to my stomach, lol.

Yes, I've always had the same exact pills/patches regimen consistently throughout the 16 months of my HRT.

~Kate~

So many people think carbs are a bad thing, but really carbs are the essence of life.  Photosynthesis produces carbs, carbs are the body's ideal form of energy, etc etc.

Thanks for sharing Kate.  Now if everyone else would quit being so shy and share^_^

I don't think I have a right to share since I haven't been on this HRT long enough :P

Hey,

I've been orals since a teenager and not had any problems and I'm almost a C cup...now mind you...that it does sort of depend on your genetics and you family history in breast size....the same goes for your sensitivity to estrogen in general, but typically the younger you are the more sensitive you most likely will be to estrogen.

I don't think that any of these methods are better or worse then the other for development...the main difference you may also be seeing is age at work...for those over 40 the preference is for injectable since it is easer on the liver...only takes on pass, while orals require two...which is why it's important to have liver function checked at least yearly or twice a year if you show any potential problems with the liver.

Just my 2 cents...

Peace and love,
Isabelle St-Pierre

As one gets older the level of human growth hormone subsides. The action of E and progesterone are both affected by hgh. One's feminization, and other body-changes, tends to be better the more hgh one's body produces. That's been the big draw of hgh for body-builders and professional athletes who abuse both hgh and steroids.

There are ways even an older person can try to increase their naturally occurring levels of hgh w/o resorting to using black-market substitutes.

I do use injectables and swear by them. No negative results. There is a "more than enough' limit with E, as there is with pretty much anything else. The receptors do 'tire' of it above certain levels. Anyone, imo, should discuss these matters with an endo and before doing so should make himself or herself knowledgeable enough to carry on the conversation.

Make sure your doctor stays up-to-date. Lotsa docs know what was considered 'good' when they left residency or ten years ago when they started working with TSes. Docs don't always maintain their reading and study. They should be updated when necessary, but to do that you have to be a well-researched consumer who knows his or her stuff.

There are many reliable TS health info pages available on the internet. Take your time and read and get some knowledge for yourself. Anecdotal evidence like we are giving may not be best for anyone but us. I think that to abdicate any responsibility for knowing about myself and what I am doing is totally irresponsible and downright dangerous.

There are few if any clinical trials done to date using data on TS women. What little is done is mostly being done by the Amsterdam (Holland) Free University. As was mentioned in a different thread yesterday, there IS very little clinical research and cause and effect are often 'qualified' by what has not been ruled out as part of the cause/effect equation.

The poll is kinda neat, Kalt; but I think we will mostly answer with what we use or what we think we should be using and the voting will reflect that fact.

HRT can be wonderful, is in fact. But there are also dangers that entail from it. To rely on hearsay from this forum or any other without doing the research yourself seems to me a very misguided way to make determinations about one's health and regimen.

Do the leg work and work with your doctor in every way you can. Please do not rely on what I or anyone else says is our experience as it is very likely to differ from yours or maybe from anyone's.

Nichole 

Posted on: January 07, 2008, 04:14:37 PM

---

P.S. -- I have worked much with and around doctors. They often get much of their prescribing info from pharmaceutical reps who also buy them nice lunches and dinners and pay for their vacations, conference appearances, etc.

Another good reason to know information yourself. Beware and be safe.

I take E sublingually, and progesterone orally.  I have had great results.
Injectibles are not for everybody.
I have a friends who could not get their testosterone to female levels without injections.

I will say that it is whatever works for you. How much luck one has with hrt is largely dependent on genetics and hgh anyway. 

Nichole, you brought up a very good point with the HGH.  I recall a few other testimonials, that the people who've had the best feminising effects from hormones, even later in life, were those who went to the gym.  working out, specifically total body max efforts(powerlifting, heavy leg work, compound lift maxouts, etc), have been shown to increase testosterone and HUMAN GROWTH HORMONE.  Testosterone isn't a big deal when on an anti androgen, in fact I've never known anyone except cyclists who cycle for hours each day lose their boobs or whatever.  But I have seen some female powerlifters who got a big bigger in the chest area, and they were OLY lifters so it wasn't chest muscle(the clean & press and the jerk don't use the pectoralis major).  So maybe, just maybe, that's that secret to getting hips and distance between legs some people talk about!

A lot of people seem to go by injectables.  The human body naturally has spikes in hormonal levels, I suppose it only makes sense that those people who are on injected and have spikes too benefit.

All in all, we really need to know more.  Like you said Nichole, this is in no way for people to substitute for professional medical advice in any way at all.  It's just something for a bunch of people who've, "been there done that" to talk about it, ya know?

Yep, I do know, Kalt. The thread's quite good, so far.

Sometimes I think we maybe owe it to guests and newly transitioning or 'about to transitioners' a bit more than 'I do this and I look great.' (Yikes, we all say that don't we!!! *giggle*) Anyhow, a word of caution to the untutored was all that was meant to be.

N~

I can't say, since I've never tried patches... though I plan to eventually.

Injectables will technically always give you better results, since they contain a higher ratio of estradiol:estrone than pills.  But, it might not really be that much of a difference in practical terms.

Lia

Hi Nichole I also take inject-ables. Wing Walker and I were both together in DC when we were prescribed the injectables by her Physician. I don't know much about the potency and possible reaction from these different hormones, but we were told the injectable were safer because they bypass the liver and spreads out more evenly through the body. Well I count myself lucky that I got any reactions at all because of my age, but I did. My breasts are pretty well in proportion to my body size  legs are not match sticks anymore, and I do have some hips, but I also got pot that I don't like. I just wish it would go somewhere else. But even then I have had lots of people think I'm younger then I am. I guess that may have a lot to do with the main I have for hair to.

Cindy

Quote from: cindybc on January 07, 2008, 05:08:29 PM
Hi Nichole I also take inject-ables. Wing Walker and I were both together in DC when we were prescribed the injectables by her Physician. I don't know much about the potency and possible reaction from these different hormones, but we were told the injectable were safer because they bypass the liver and spreads out more evenly through the body. Well I count myself lucky that I got any reactions at all because of my age, but I did. My breasts are pretty well in proportion to my body size  legs are not match sticks anymore, and I do have some hips, but I also got pot that I don't like. I just wish it would go somewhere else. But even then I have had lots of people think I'm younger then I am. I guess that may have a lot to do with the main I have for hair to.

Cindy

Yeah, I get the same. We older broads sometimes do better than we were led to expect.

Like Amy said, genetics (I always thank Goddess for my ancestry) and hgh levels (which is probably also genetic) make major differences.

The rule-of-thumb I have always seen, and that mostly works out pretty well, is that you can expect in most cases about a 10 year difference in age-look on hrt. A lot of that will also have to do w/ genetics and how much damage you may have done to skin, etc before beginning.

Hell, it's a crap-shoot often enough. No one really knows until it happens.

BTW, your hair is gorgeous. Lucky girl!

Nichole

Quote from: genovais on January 07, 2008, 04:51:39 PM
I can't say, since I've never tried patches... though I plan to eventually.

Injectables will technically always give you better results, since they contain a higher ratio of estradiol:estrone than pills.  But, it might not really be that much of a difference in practical terms.

Lia

How do you figure that, and have you got any literature to share supporting it?

Hi Nichole
Ancestry hmmmm one side, on my mom's side is Iroquois and the on my dads side was French.
How does one find out about their genetic makeup?

Cindy

If the pills go through the digestive tract, there the output does contain more of the weaker
estrogen. It has nothing with the pills themselves, more to do with their metabolism.
Some of this can be countered by higher dosages.

If you take them sublingually, you don't have this problem.

Sometimes, people remember information, but its trucated.

Quote from: Keira on January 07, 2008, 07:18:01 PM

If the pills go through the digestive tract, there the output does contain more of the weaker
estrogen. It has nothing with the pills themselves, more to do with their metabolism.
Some of this can be countered by higher dosages.

So in other words, the faster your metabolism, the better a candidate you are for transdermal/injectables?

QuoteIf you take them sublingually, you don't have this problem.

I've never seen any literature published by medical professionals stating that sublingual absortion was superior when taking estrogen pills, over just taking the pills themselves.  In theory and all it might work, but surely considering the big fuss about it, if it worked, then doctors would prescribe to take it that way.  the directions indicate to swallow the pills, not stick them in your mouth for an hour, that's all I'm saying.  If you have anything to shut me up, I'm easily humbled.

No I meant, going through the stomach is a different metabolism than direct injection in the blood of estradiol valerate. You got stomach acids, all sort of enzymes, etc. When you do it sublingually, its the same as injecting if your able to not swallow. There are actually studies, but I'm too lazy to get them .

Pills are also made to be used sublingually, if not they would be hard coated and the powder inside wouldn't micronised. Its just more convenient to swallow the pill instead of keeping the pill 10 minutes under your tongue.

Quote from: Keira on January 07, 2008, 07:30:49 PM

No I meant, going through the stomach is a different metabolism than direct injection in the blood of estradiol valerate. You got stomach acids, all sort of enzymes, etc. When you do it sublingually, its the same as injecting if your able to not swallow. There are actually studies, but I'm too lazy to get them .

Pills are also made to be used sublingually, if not they would be hard coated and the powder inside wouldn't micronised. Its just more convenient to swallow the pill instead of keeping the pill 10 minutes under your tongue.

I would appreciate it, and others would too I'm sure, if you'd find time sometime in the near future to find those studies:-)

Estrace when taken sub lingually essentially goes into the bloodstream directly. its the best method to take it as it does not get mucked up by the digestive track. 

Generally speaking nearly everybody I know on injections is on injections because pills did not work.  Injectibles did not work much better.  Why?  Because they were not as receptive to estrogen.  Plain and simple.  So as much as people think one works better then the other its really factors out of your control and it gets down to personal prefrence.  The only reason injections may have to be used is to get T to female range.  I was there very quickly with a low dosage of pills.  I know a few others on this board where that was also the case.   

Ya I am curious enough to want to know. I also wanted to inform you all of the price for injectables.

Wing Walker pays $135 for 20 ml of *prescribed,*  compounded injectables.  I will give you an idea of the costs for one person:

Dose = 1 ml every two weeks = 40 week supply = $135 USD or CAD.  = $135/40 wk = $3.38/wk.

The last time I bought the little blue estradiol pill here in Canada it cost me $75 for not even a full month because it was not on the Ontario formulary.  Prior to that I had been taking conjugated estrogens and I heard that they were pretty tough on a person, so I asked my doc to give me the blue pill.

Wing Walker did the rest.  BTW, a box of syringes and needles is also by prescription only and it varies between $6 and $12 for 100 each.

Cindy

Quote from: Amy T. on January 08, 2008, 03:10:11 AM
Estrace when taken sub lingually essentially goes into the bloodstream directly. its the best method to take it as it does not get mucked up by the digestive track. 

Generally speaking nearly everybody I know on injections is on injections because pills did not work.  Injectibles did not work much better.  Why?  Because they were not as receptive to estrogen.  Plain and simple.  So as much as people think one works better then the other its really factors out of your control and it gets down to personal prefrence.  The only reason injections may have to be used is to get T to female range.  I was there very quickly with a low dosage of pills.  I know a few others on this board where that was also the case.  

O, puh-leez!!  ???

That was quite a "loading of language." "Because they weren't as receptive to estrogen...." What's unspoken there is ...? (That is sorta an 'I'm better than you' doncha think, Amy?)

Please! MY doctor had reasons for beginning and continuing on IM that had nothing to do with anything like that, Amy. When someone begins prescribing a drug they NEVER know before-hand that " they were not as receptive to estrogen." That becomes an ad hominem argument from the git-go. But, you're a smart girl and knew that, didn't you?

Where is this alleged test that your doctor did to determine 'estrogen-receptivity' prior to any hrt at all? Please cite references for such tests being available and used within the profession. Most docs start with a mix of oral, skin-absorbed and IM unless there are other physical (medical) reasons that might interfere: i.e. liver-damage possibly most-frequent.

Certainly there is no "estrogen-receptivity" test!!!  :D :D

That is just wishful-thinking and speaks not at all to what the thread is discussing. It may be good for 'ego-points' but certainly doesn't have any viable chemistry or medicine behind it. We're back to "this is what I use so it must be the best."

Cindy is correct on costs and cost-efficiency. $44.56 for 10cc 40mg/ml solution of estradiol valerate w/ syringes mailed by a compounding pharmacy. There is at least one that is about $5 less than that.

N~

I'm starting to get upset at all these unsupported, dogmatic claims.

Please people on these forums, discontinue talking about how sublingual absorption of estrogen, "goes directly to your bloodstream" and all that until there is literature by a medical professional posted on these forums and studies to support such a claim.

I edited the poll, making distinctions now between oral and sublingual, since it's becoming a pretty big issue.

Right now I'm on Estradiol Valerate injections plus progesterone been on it for 4 months it seems to work. I only been on premarin sporadically so I can't really make a call on whats best. I read some where that injectable give you faster results in the beginning than pills but things even out after a time period. Tonight I'll look for that article and really don't know much about sublingually.

Later,
Anna

Kalt, that's what sublingual does and means, going into the bloodstream, how on earth do you think the estrogen gets into the body there!! That does not need a study, that's the mode of action of sublingual, micronised estradiol valerate gets absorbed there because there because the area is so vascularized and the blood vessels are so close to the surface of the skin. There are few areas like that, the lower intestinal tract is another one, and that's why its used for suppositories. The medication of suppositories is not digested, its absorbed into the bloodstream directly. That's why progeterone capsule are more efficient as suppositories than swallowed. Its the swallowed thing that's less effective.

If you're so upset about it, go get the info yourself.

I'm upset by the fact that you do not distinguish things that need full scientific
scrutiny from things that do not.

Things that would need a study is finding out how much people swallow when using sublinguals.
That's now known specifically, but its higher than 0%;.

This gives a little summary of each method. For women who had a hysterectomy but information is still good.
http://menopausehysterectomy.com/methods.htm

Later,
Anna

Quote from: Keira on January 08, 2008, 09:32:53 AM

Things that would need a study is finding out how much people swallow when using sublinguals.
That's now known specifically, but its higher than 0%;.

That's exactly what I've wondered. 

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fganjataz.com%2F01smileys%2Fimages%2Fsmileys%2FloopyBlonde-blinking.gif&hash=4545ddf8251cf9c32ae6074d56e48bc34a755857)Kristi

Quote from: Nichole W. on January 08, 2008, 05:14:49 AM

Quote from: Amy T. on January 08, 2008, 03:10:11 AM
Estrace when taken sub lingually essentially goes into the bloodstream directly. its the best method to take it as it does not get mucked up by the digestive track. 

Generally speaking nearly everybody I know on injections is on injections because pills did not work.  Injectibles did not work much better.  Why?  Because they were not as receptive to estrogen.  Plain and simple. So as much as people think one works better then the other its really factors out of your control and it gets down to personal prefrence.  The only reason injections may have to be used is to get T to female range.  I was there very quickly with a low dosage of pills. I know a few others on this board where that was also the case.   

O, puh-leez!!  ???

That was quite a "loading of language." "Because they weren't as receptive to estrogen...." What's unspoken there is ...? (That is sorta an 'I'm better than you' doncha think, Amy?)

Please! MY doctor had reasons for beginning and continuing on IM that had nothing to do with anything like that, Amy. When someone begins prescribing a drug they NEVER know before-hand that " they were not as receptive to estrogen." That becomes an ad hominem argument from the git-go. But, you're a smart girl and knew that, didn't you?

Where is this alleged test that your doctor did to determine 'estrogen-receptivity' prior to any hrt at all? Please cite references for such tests being available and used within the profession. Most docs start with a mix of oral, skin-absorbed and IM unless there are other physical (medical) reasons that might interfere: i.e. liver-damage possibly most-frequent.

Certainly there is no "estrogen-receptivity" test!!!  :D :D

That is just wishful-thinking and speaks not at all to what the thread is discussing. It may be good for 'ego-points' but certainly doesn't have any viable chemistry or medicine behind it. We're back to "this is what I use so it must be the best."

Cindy is correct on costs and cost-efficiency. $44.56 for 10cc 40mg/ml solution of estradiol valerate w/ syringes mailed by a compounding pharmacy. There is at least one that is about $5 less than that.

N~

Like I said, this is not from the people I know who started out on Injections, this is from women who started out on orals and who had to go to injections. 

This is from people I know.

I know there are doctors out there who only do injections and start you on them, I also know there are doctors out there who will start on orals and will only switch to injections if it is necessary. 

Generally speaking, pretty much every women I know personally on injections with regards to how receptive their bodies are to estrogen.  If your body is more receptive, it just is.  Plain and simple.  You probably would not know if you would have done just as well on orals, which may have acted a little bit slower, but still probably would have worked just as well.

By the way most doctors do not start out on a mix of methods.  They all seem to have their own crazy idea as to what works. 

This is not a "I'm better then you" scenario.  It is something that I have experienced with people I know in real life.  I know about half a dozen women on injections...in which nothing happened.  Whether you like to admit it or not some peoples bodies are more receptive to certain types of hormones.  This is common knowledge with regards to HRT.  Thats why some people like Gothique do great with low doses of orals, while others like my friends who go on injections have absolutely no breast development after a year.  Its hormone receptivity, which is by in large...genetic. 

Quote from: Amy T. on January 08, 2008, 11:53:21 AM
By the way most doctors do not start out on a mix of methods.  They all seem to have their own crazy idea as to what works. 

A personal theory of mine from what I've seen... and yes, pure IMHO and speculation... is that dosage changes are what cause bursts in development. Someone goes to their doc and complains nothing is happening anymore, the doc switches them from pills to shots, they start developing again, and HEY! INJECTIONS ARE BETTER! When in fact it's not the method, but rather the dosage change that "shocks" the body back into motion.

And vice-versa, from injections to patches or pills.

Pure speculation though.

~Kate~

I think you're on the right track there Kate.

Its very rare when people switch from pills to injections that the serum level will
be exactly the same, so saying one is better than the other is like comparing
apples and oranges.

Doctors tend to rarely prescribe high enough dosages
of pills because of the misguided notion (in my opinion) that its hard on the liver.
They seem to confound non-bio identical estrogens like premarin and ethinilestradiol,
with those that are bio identical.

They seem to also totally forget that they can be used sublingually.

There is a correspondence table between pills and injections,but this is an
area which has not been studied at all and I don't even know where those
tables come from!

So, when they prescribe injections which are more liver friendly, they might
boost the doses. But, since we're not comparing actual numbers here I can't say
for sure what doctors prescribe here, just what I know from TS acquaintances on
my side.

And yes, everything has a baseline genetic sensitivity to E.
This sensitivity even varies with the amount of T and P and the level of E in the body,
plus a few other feedback mechanisms. How much tissue growth or fat transfer
you get from this sensitivity is influenced by multiple metabolic factors (insulin and human growth hormone
levels for example).

So, it is impossible at first hand to know how sensitive you are and what results you'll get
from this sensitivity, though its possible to guess
from familly genetics and your own body.

If you're at a normal weight and
you've got very little fat in the gynoid areas, thigh and legs,  prior to HRT, your response
to estrogen is likely lower (not zero, so nobody jumps on me)
than someone who's got a good cover of fat there even if skinny.

I've seen both versions at a party this summer, there were some with years of HRT
who had muscles well defined on their legs with little fat on them (and they were not that athletic or skinny) and others with no visible muscle definition because of fat coverage who were athletic (one was an university athlete).

The patches work better with a hot iron.

LO

Quote from: lisagurl on January 08, 2008, 01:48:02 PM
The patches work better with a hot iron.

LOL, I'm sure that they do, Lisa!!! Did you get those patches on your jeans when you were a kid too!!!?

Sweetie, I think these patches are meant to come off sooner than those were. LOL!!

Yes, I know that there are levels of receptivity -- some do better, some worse, some not much visibly at all except maybe skin softening. And lotsa women are fooling themselves to think that pills, patches, sublingual or swallowed or IM will affect that.

Keira & Kate are definitely right about dosages changing and I suspect Keira is also correct that most endos are way too conservative -- although we should be aware that E, like some vitamins and minerals, will simply be flushed outta the system when the level reached is higher than the receptivity level at any particular time. So there is a level beyond which some one is wasting her money. However, that old saw about E 'turning' into T is not true. It just gets evacuated.

Low doses are particularly problematic, imo, for post-ops who are taken to post-menopausal levels. They often complain of feeling tired, generally crappy, etc. I imagine that there's a perfectly good reason for that: too little E. Of course, finding physicians stats on THAT is impossible -- there are none.

N~

Hi I never said or suggest anyone take this or that over this and that I only listed what worked for me. I started on conjugated estrogen  then I went to estradiol pill then went to injectables and I found that (for me) the injectables worked best. A 62 year old with the body of a fourty year old woman's body, I say that's darn satisfying results for me. Well except the pot needs to go. I can only say I have nothing to complain about.

Ya'll have a wonderful day.  :laugh:

Cindy

Cindy, it goes back to my argument. Injections were better, but
where you in fact getting the same dose. Very doubtful since you
went from something that's known bad for DVT and the liver, to
something with a very slight impact.

Its probable the doctor
pushed the dosage when you went through this change.
Did you swallow the pills or use them sublingually? (this would have
a major impact on effectiveness)

Well I agree with you that the dosage wouldn't be consistent with all. I am smaller then the average woman so I would be taking less then anyone bigger the me I suppose. Ya I swallowed the pills, tried the under the tongue thing but there never seemed to be sufficient time where I wasn't talking to someone and it doesn't work to well talking. I like talking to people out there as well as my friends in here.

Cindy 

Quote from: Kate on January 08, 2008, 12:12:54 PM

Quote from: Amy T. on January 08, 2008, 11:53:21 AM
By the way most doctors do not start out on a mix of methods.  They all seem to have their own crazy idea as to what works. 

A personal theory of mine from what I've seen... and yes, pure IMHO and speculation... is that dosage changes are what cause bursts in development. Someone goes to their doc and complains nothing is happening anymore, the doc switches them from pills to shots, they start developing again, and HEY! INJECTIONS ARE BETTER! When in fact it's not the method, but rather the dosage change that "shocks" the body back into motion.

And vice-versa, from injections to patches or pills.

Pure speculation though.

~Kate~

Normal puberty has its peaks and vallieys of development as well.  Its the same argument for waiting to get a boob job, just becuase you think your body has stopped developing, doesn't mean it has.  It may just be a latent period.

Ask any teenage girl...

Quote from: Keira on January 08, 2008, 09:32:53 AM
Kalt, that's what sublingual does and means, going into the bloodstream, how on earth do you think the estrogen gets into the body there!! That does not need a study, that's the mode of action of sublingual, micronised estradiol valerate gets absorbed there because there because the area is so vascularized and the blood vessels are so close to the surface of the skin. There are few areas like that, the lower intestinal tract is another one, and that's why its used for suppositories. The medication of suppositories is not digested, its absorbed into the bloodstream directly. That's why progeterone capsule are more efficient as suppositories than swallowed. Its the swallowed thing that's less effective.

If you're so upset about it, go get the info yourself.

I'm upset by the fact that you do not distinguish things that need full scientific
scrutiny from things that do not.

Things that would need a study is finding out how much people swallow when using sublinguals.
That's now known specifically, but its higher than 0%;.

Actually, you're wrong on this.  Just because something sounds good in theory doesn't mean it actually works.

There really are studies needed on this to support it, surely if it worked so well then there would be!

As is, even in my profession in a pharmacy, I don't see any distinction between the two.

Posted on: January 08, 2008, 09:14:02 PM

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Quote from: Kate on January 08, 2008, 12:12:54 PM

Quote from: Amy T. on January 08, 2008, 11:53:21 AM
By the way most doctors do not start out on a mix of methods.  They all seem to have their own crazy idea as to what works. 

A personal theory of mine from what I've seen... and yes, pure IMHO and speculation... is that dosage changes are what cause bursts in development. Someone goes to their doc and complains nothing is happening anymore, the doc switches them from pills to shots, they start developing again, and HEY! INJECTIONS ARE BETTER! When in fact it's not the method, but rather the dosage change that "shocks" the body back into motion.

And vice-versa, from injections to patches or pills.

Pure speculation though.

~Kate~

It makes a lot of sense though.  The body develops tolerances in all sorts of areas.  I know this to be ESPECIALLY true with weight lifting, muscle and strength development.  The human body is naturally adaptive, can't help it.

Posted on: January 08, 2008, 09:17:46 PM

---

Quote from: Keira on January 08, 2008, 03:28:16 PM

Did you swallow the pills or use them sublingually? (this would have
a major impact on effectiveness)

Once again, I'm opposing this and demanding evidence if it's going to be stated as fact.

The simple fact is that if sublingual drastically changed the effectiveness of the medication or increased the potency then doctors would be very careful about the method being taken, and so would pharmacies, not only out of concern for proper dosage but also to cover their asses against a lawsuit.  It doesn't fit that the top minds in the medical industry and pharmaceutical facilities would ignore such a severe danger, of someone taking 10MG of ambien and sticking it under their tongue and ODing on it or something.

And while we're on topic, let's get into it a bit further.

Are the little yellow spironolactone pills better absorbed sublingually or orally?  Because lemme tell you, that mint taste is both overpowering and yet amazingly bitter.  What about estradiol, or provera?  Since you're trying to get it into the blood stream, wouldn't putting a drop or two of a strong alcohol like scotch help increase the blood flow through the tongue, making it more effective?  What about the skin under the tongue thickening due to regular chemical exposure?

It's a lot to think about.

You are aggravating Kalt!!!!

Table 3-5 answer all your answers. Took me 10 minutes to find it with google.

Everything I said was TRUE. So THERE.


http://books.google.com/books?id=6vUUW6ymVFEC&pg=PA76&lpg=PA76&dq=sublingual+versus+stomach+absorbtion+medecine&source=web&ots=aO_ScxoRpW&sig=WMJOrBOSPrkcuSYO44n7kCB8bGE
(http://books.google.com/books?id=6vUUW6ymVFEC&pg=PA76&lpg=PA76&dq=sublingual+versus+stomach+absorbtion+medecine&source=web&ots=aO_ScxoRpW&sig=WMJOrBOSPrkcuSYO44n7kCB8bGE)

Next time, do the job yourself. Because now, I AM UPSET!!!

Quote from: Keira on January 08, 2008, 08:49:13 PM

You are aggravating Kalt!!!!

Table 3-5 answer all your answers. Took me 10 minutes to find it with google.

Everything I said was TRUE. So THERE.


http://books.google.com/books?id=6vUUW6ymVFEC&pg=PA76&lpg=PA76&dq=sublingual+versus+stomach+absorbtion+medecine&source=web&ots=aO_ScxoRpW&sig=WMJOrBOSPrkcuSYO44n7kCB8bGE
(http://books.google.com/books?id=6vUUW6ymVFEC&pg=PA76&lpg=PA76&dq=sublingual+versus+stomach+absorbtion+medecine&source=web&ots=aO_ScxoRpW&sig=WMJOrBOSPrkcuSYO44n7kCB8bGE)

Next time, do the job yourself. Because now, I AM UPSET!!!

I'm sorry you're upset that I asked you to support your claims.  But, YOU were the one who was making them, not me.

I have looked and looked, and this thing is pretty vague on sublingual absortion except when it gets to about page 108, when it shows through context that there are medicines DESIGNED to be taken sublingually, such as buccal tabs or droplets, oral sprays and chewing gums.  It doesn't mention anything about putting a pill, intended for ingestion, into the oral cavity and hoping it gets absorbed into the blood stream.

I'll continue looking Kiera, because not only do I want to know but because I respect you.  But as it stands, there still isn't much of an argument for sublingual absorption of estrogen.

But, on the other side, it mentions intranasal absorption in a pretty positive light, lol.

Shhhhh.  ::)  ::)

TABLE 3-5 talks about just that. I told you where to look!!!!!

It talks about direct absorbtion when used sublingually. That's what I said.
It says, for pills, length of time in intestinal tract and amount of food changes absorbtion and
that it goes through hepatic treatment (not absorbed directly).

Cool it down folks.

Steph

Here ya go.

Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17 beta-estradiol:

http://acogjnl.highwire.org/cgi/content/abstract/89/3/340

Lia

Thanks Genovais, now I can rest in peace  ;)

BTW, you look great! Probably already know it HAHA

Thanks, Keira.

Not to hijack the thread, but the way the flash hits my brow bone in pictures kills me.  It's not so bad in person, just pics.  Any ideas for diminishing the effect?  Foundation doesn't seem to help, as far as I can tell.

Lia

Quote from: genovais on January 08, 2008, 11:32:31 PM
Thanks, Keira.

Not to hijack the thread, but the way the flash hits my brow bone in pictures kills me.  It's not so bad in person, just pics.  Any ideas for diminishing the effect?  Foundation doesn't seem to help, as far as I can tell.

Lia

Please don't - Start a new thread - lets sty on topic folks :)

Steph

Estrace type pills were formulated to be taken sublingually.  The very fact people swallow them is the problem.

Spiro for example was designed to be taken orally, so are micronized progesterone pills.  But those little blue or blue-green pills were formulated to be taken sublingually.  Thats why they dissolve so fast. 

Quote from: genovais on January 08, 2008, 11:21:19 PM
Here ya go.

Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17 beta-estradiol:

http://acogjnl.highwire.org/cgi/content/abstract/89/3/340

Lia

Way cool, thank you.

And thank you Kierra!  This place was getting to be a sauna and I LOVE saunas!

The um, article posted by Gen was inspecific about the form of dosage, just that it was micronized estrogen.  I apologise for the splitting hairs, but if they WEREN'T using the little blue pills, but some kind of droplet or spray formula specifically designed to be taken sublingually, then it makes all the difference.

Concerning the comment that the pills are MEANT to be taken sublingually, I work in a pharmacy and hand precriptions out to menopausal women every day.  I have never seen an order to take a prescription sublingually, as a doctor would indicate on the prescription or even the bottle of the medication would indicate.

I have four college lectures literally ALL DAY today.  But, I intend to do some searching for this myself tonight if I'm not brain fried.  I really am trying to tear this up and get in deep, even if what I've implied proves to be completely incorrect.  People put so much stock into this sublingual method and preach it so much that we need a compilation of professional medical information and then it needs to be stickied.  Whether it's for self medication or not, people WILL perform the practice of sublingual taking of meds and that will shoot the potency up a lot more if what's been implied is true.  It's our obligation as a support community and as representatives of our culture to post this kind of information, in such a way that we're doing nothing more than redirecting to a professional's advice, for everyone this effects.

Posted on: January 09, 2008, 06:58:16 AM

---

UPDATE!
On micronized 17 beta estradiol, as mentioned in several studies:
Micronized 17 beta estradiol is otherwise known as estrace.  All patches use micronized 17 beta estradiol.

www.nhlbi.nih.gov/health/women/pht_facts.pdf


So blaaaaaah.  I hate being wrong>.>  Lol, but now we are getting a clearer picture, right?

Kiera, you forgot about suppository admin for Progesterone caps.
Which works pretty well. There are studies out there. But, I'm not going to look for them ;-).

Absortion in the mouth of P is really not good (and it wasn't made to be used that way) as you stated, and in the stomach, you also
lose quite a bit of efficiency.

Suppository Yeeeeeeeks!

Just tugin your socks hon. But jokes aside I never heard about Progesterone caps????

I guess one can expect that from an old bush girl.  ;D

Progesterone is suspended in an oil. So it needs some kind of capsule to hold the liquid.

This has nothing to do with the topic but I went to comment a very great Charactersitic of Kalt.

She doesn't form opinions WITHOUT definite facts, studies, results and adequate scientific proof for the topic.

Notice how she doesn't accept any ideas or theories of sublingually taking meds WITHOUT definite facts.

This is a very great habit as it prevents you from forming opinions without it's justification.

You have a very great talent to extract knowledge from other people.

Quote from: Kiera on January 09, 2008, 03:56:15 PM

Quote from: Keira on January 09, 2008, 03:38:57 PM

Progesterone is suspended in an oil. So it needs some kind of capsule to hold the liquid.

Ahhh! Peanut oil! Hummm . . . knew might of been a "stupid q"  :embarrassed:

Could get messy eh? . . . >:(

I share your sentiments cindybc & thx dr. K! :icon_bunch:

Quote from: Tanya1 on January 09, 2008, 03:47:19 PMYou have a very great talent to extract knowledge from other people.

LOL I'd call it a "very annoying talent!"

You never did tell me how much "da bus" was Kalt!

yea she was getting annoying...LOL

Quote from: Keira on January 09, 2008, 03:38:57 PM

Progesterone is suspended in an oil. So it needs some kind of capsule to hold the liquid.

Provera is not in capsule form, but in hard powder form.

Are there any other methods of taking progesterone other than orally?  I haven't ever seen any.

Kierra, I have noted to myself recently that there are quite a few transdermal estrogen creams, like Estrogel or whatever.  I haven't ever really heard of anyone using them.  Testosterone creams, however, seem to be very popular.

I remember reading on Bodybuilding.com aobut how to isolate estrogen.  I didn't really look into it too much.  But, a lot of these bodybuilders have chemistry majors and know their ->-bleeped-<- when it comes to hormones and steroids, and a lot of bodybuilders actually use estradiol to balance our their regimens or whatever, I'm not sure.  Maybe for Kierra's sake, I could look into how to isolate the estradiol to be made into a cream.  I really think, however, that way too much would be lost.  I mean, we're talking about a medicine that's maximum pill dosage is 2mg, which would be very easily lost in some kind of freakish medical experiment that is in no way endorsed by a doctor.  Actually, writing this out has made my decision.

DO NOT TRY TO FORMULATE YOUR OWN MEDICATIONS.  Period.  There are specialty pharmacies in every city with DOCTORS to specialize creams and mix up medications for you, so you don't end up blowing yourself up or poisoning yourself.

As of yet, noone has addressed whether adding a drop or two of a liquor would help sublingual absorption.  What I mean is, crushing up the pill to powder, dropping it under the tongue, and then dropping just a tid bit of alcohol on there to increase blood flow drastically to that area.  I've been doing it and it hurts:-(

Oh and a very sincere gestuer involving one of my digits to Kiera(the one who isn't an architect) and Tanya, lol.  I am proud of be a nuisance and always will be.  Or rather, a PIONEER FOR TRUTH!

Quote from: kalt on January 09, 2008, 07:11:39 PM

Quote from: Keira on January 09, 2008, 03:38:57 PM

Progesterone is suspended in an oil. So it needs some kind of capsule to hold the liquid.

Provera is not in capsule form, but in hard powder form.

Provera isn't progesterone, but a progestin.  Progesterone, in bio-identical forms like Prometrium, is the same thing as the body produces.  Progestins are not and carry the risk of mental disturbance (depression).

Lia

Hi Kiera

Well I don't argue with anyone don't like arguing, but I do formulate and evaluate the situation and learn something from each individual expounding on their differing ideas on the subject at hand. But there is always something to learn from a good debate.   ;D

Cindy

Kalt,
I don't know where you get your info.
They all can be taken
in non oral form, progestin AND progesterone!!!!!

Natural Progesterone
(progesterone is a more fragile molecule than estrogen, that's why its not in powder form, which
  makes it not ideal for sublingual use since the liquid will not stay there    :D )
- Capsule form (Promethium, Microgest, etc)
    - Can be taken orally
           (but absorbtion in stomach is not that good (food, etc)
                 and the progesterone is fragile and can be destroyed by the stomach environment )
    - Can be taken as a suppository (its in the leaflet in the box I had)
             (good absortion since that area is highly vascular and the environment is much more benign)
- Gel Form, Crinone
- Cream Form (less concentrated than the gel, people just use more)
   - The progesterone creams; I believe it can be bought anywhere over the counter in the US.


Provera is a progestin, has some of progesterone's effects but has many other possible side effects.
Provera exists in Depot form. Depot-Provera. Under the skin. Lasts a while. Used for birth control.

Duphaston is the progestin with the best side effect profile.
Duphaston exists in Depot form, proluton depot. Again, non oral.

There is a host of other progestins that used to be used, and some still are in
birth control pills, but they have bad side effect profiles (worse than provera).
They are particularly androgenic.



The reason people like pills rather than sublingual or swallowing a capsule rather
than using it as a suppository is ease. The doctors allow it because what they want
most is compliance in meds taking. The most important thing about a medication, is actually taking it.

There is a greater chance that people will actually take their medication at a specific time a specific
day if its no bother. So, even though pills like estrace can be taken sublingually, its
less bother just swallowing it even if the effects will be slightly more random, same
thing with a suppository; what do you prefer sticking a capsule up your butt or swallowing it!
Well, most people will swallow it, even taking higher oral doses to compensate for the
loss in effectiveness rather than going the other route. Even in pill form, many people
forget to take their meds all the time; its a big problem.

So, thus far this thread has basically come up to:

The poll favors injectable hormones.  What kind, we can't know, since the voters didn't post.

The posters seem to be all for sublingual methods.  Sublingual method seems to be valid, but I still am wary of the, "little blue pill" being the same 17 beta estradiol used in the studies.

It's pretty much agreed that the body can plateau on certain dosages, and that even minor dosage adjustments and times taken can restimulate receptivity to the treatment.

Kiera(who's been amazing in this thread), pointed out that she's noticed certain body types to be more receptive to estrogen.  Specifically people with little muscle mass, while their counter parts(those with lean muscle mass) seem to not take it up so well.  This could indicate that metabolism, caused by more lean muscle mass in the body, has something to do with estrogen reception.  Something that should be dug into is whether or not injectable or transdermal prescriptions are better absorbed in these individuals.  I'd also like anyone who was physically fit and capable when starting HRT and has been on it for a lengthy period of time to speak up!

Sublingual absorption has just about been ripped apart, but we're still not doing too well on transdermal methods, whether it be by cream or by gel.

So, battle isn't over yet folks!

^ I defiently agree that the receptivity of estro is less the more muscle mass one has.

Other factors include obesity.

Sure- fat will help taking in estrogen BUT remember- if you have fat on your waist and start HRT that isn't good!


For example- someone like Shaquel O'Neal is not very likely to do well because he has very little fats and too much muslce mass.

I suggest you should have very little muscle mass and "some" fat but NOT obese.- this is the perfect body- cardio is excellent as circulation I believe will improve receptivity.- like 3-4 times a week- not too much.


Kalt I really don't suggest you do wieght training as even natal females get T up from it sometimes.

I suggest cardio and yoga for you not lifting wieghts. Just a suggestion, do more research...

I wasn't talking about muscles and E sensibility being related.
Was talking that muscles are more VISIBLE pre HRT, even at nornal weight
and with normal size muscles
if you've got a low E sensibility.

Inside the abdominal cavity fat, visceral, disrupts fat metabolism and
distribution in the body; estrogen cannot steer most fats to the
thighs, legs and buttocks, part get stored in the middle.

Normally estrogen will keep fats away
from the middle, but if you don't exercise fat will start accumulating
behind the stomach muscles even in thin women,
which creates the characteristic bulging out
from the sternum to the waist. Look at non active thin women,
this area bulges out even if you can't pinch anything on them.

I've been considering this:

Would it not be possible to use Prometrium vaginal suppositories anally? This would greatly reduce the dosage needed per the same efficacy if what I've been reading is correct. Both orifaces are warm, wet and lined with mucous membranes.

Yeah you can Cire. That's what I do. Look in the leaflet for your meds.
It should be be one of the proposed administration mode. Though,
even if its not, it should work anyway. Sometimes, the leeflet
doesn't mention it simply because the company didn't want
to have to test this mode and have it FDA approves (or
whoever approves the one you have) because it costs money.

Uck, body fat?  On me?  You've got to be joking.  Some people, like me, simply have a high metabolism and nothing stops it.  In fact, right now I'm eating a big slice of pound cake.  I have gone weeks eating nothing but ice cream, pizza, eggs and sausage and drinking soda and haven't gained a pound.

And what's this with sticking medicine up your butt?  Prometrium?

Never heard of a suppository? Plenty of medecine in capsule form have
this mode of administration. Its more efficient than swallowing the capsule.

QuoteSome people, like me, simply have a high metabolism and nothing stops it.

Enjoy it while you are young. ;)

Most of the difference in metabolism with age can be explained by
  1) Declining E and T levels, both are linked to metabolism
  2) Decreasing muscle mass
  3) Increasing visceral fats, which has a inpact on insulin levels (which regulate appetite
           and metabolism) and fat storage in the body.

Its possible to supplement 1), continued or increasing exercise helps (2 and 3) when coupled with 1)

I started on the patches in combination w/ a small amt of oral like 1mg/day.  This worked quite well initially, breast development kicked in quickly as they were very sore, and my moods were very level. 

However, a few months into it my skin (very sensitive) developed a sensitivity to the adhesive in the patches.  It would be on for a day and the skin under it got very red and started itching so bad I couldn't handle it.  I had to pull it off.

After that I was changed to purely oral/sublingual with spiro.  To be specific Estrofem allowed to dissolve under the tongue.  My T levels are within female range.  My breast development has been adequate (A cup in a year).  But I know alot of this is controlled by genetics.

As far as muslce mass etc.  I was very lean and muscular as I have a very physically demanding job.  The hormones have really cut down on my muscle mass and definition.  Instead of a six pack I have a little tummy bulge, not bad but I am trying to watch what I eat now.  Before I could eat whatever I wanted, but I think it is starting to catch up with me.  I also have a layer of subcutaneous fat over my body, which is good as i am softening up.

Audrey

Quote from: Keira on January 11, 2008, 01:45:53 PM

I wasn't talking about muscles and E sensibility being related.
Was talking that muscles are more VISIBLE pre HRT, even at nornal weight
and with normal size muscles
if you've got a low E sensibility.

Inside the abdominal cavity fat, visceral, disrupts fat metabolism and
distribution in the body; estrogen cannot steer most fats to the
thighs, legs and buttocks, part get stored in the middle.

Normally estrogen will keep fats away
from the middle, but if you don't exercise fat will start accumulating
behind the stomach muscles even in thin women,
which creates the characteristic bulging out
from the sternum to the waist. Look at non active thin women,
this area bulges out even if you can't pinch anything on them.

Ohhh so you meant that the "tone" of the muscles lightens and becomes less prominent. Excersice is good as it helps fat distrubution while on HRT faster and prevents the belly like you said- but I think you can get away from excersicing if you avoid junk food, fast food, trans food and stick to a very healthy diet.

No, even on a healthy diet, without exercise, any caloric imbalance will make fat got behind the stomach wall. That's what I said, even thin women who eat right will have it. Its due to inactivity and metabolic imbalance caused by it.

When I'm talking exercise, I don't mean anything heavy, a 30 minutes of walking at a decent speed is enough to keep this away or remove it if its not too extreme. If its extreme, it will take more exercise. This fat, responds almost not at all to dieting; it only responds to moderate intensity exercise. High intensity exercise will have a tendency to burn carbs, so its not the best for this.

So Keira, is a strong metabolism a good or a bad thing now?  Visible muscle is due to a low bodyfat, which is due to a high metabolism.  Moderate intensity exercise... Surely spironolactone would block any testosterone released from weight lifting.  However, heavy lifting also releases miniscule amounts of HGH, but it's conceivable that in certain individuals it could be enough to effect things like widening of the hips, is it not?  Simply put, everyone has benefits to gain from weight lifting.  One will burn about 200 calories an hour running, but 800 calories an hour weight lifting, according to Men's Health studies.  Testosterone is the culprit for putting on muscle, not weight lifting.  I know girls that look like cheerleaders who are powerlifters and can outlift most men in most gyms.  The only difference between them and any other hot chick is their backsides are MUCH more aesthetically pleasing!
As far as losing weight goes, putting the body in a catabolic state is a must for trans women, especially those new to HRT.  That means putting a large physical demand on your body for over 45 minutes, till your body begins using protein for energy.  This can be done by doing half an hour of cardio before a moderately intense weightlifting session, or doing half an hour of one cardio and then a bit of another.
I still think that putting on muscle is a must, even if it's only on the thighs and butt.  We haven't got hips, so using everything possible to put some extra mass there is needed.
Besides, what's wrong with muscualr chicks?  I'm not talking about the roid heads, but models like Jamie Eason are absolutely BEAUTIFUL.  And for any transwoman that's not a hard thing to do, work thighs all the time and just do an upper body workout once a month or so, and you've got an athletic figure which allows much more forgiveness for broader shoulders or lack of hips or a poor waist-hip ratio.
As far as muscle behind the stomach goes, what about crunches?  I mean, I'm kind of avoiding all ab exercises in attempt to lose muscle mass off the waist, but high rep crunches can only do so much for putting on muscle, and even that will be negated by lack of testosterone for the large part of it.  A lot of fitness experts say that "spot reduction" is completely false, but I've seen some anecdotal evidence to the contrary.  I also know that an active torso DOES make it harder for the internal organs to put on fat, and it massages the internal organs and shakes up the veins and stuff a bit, helping blood flow.

I guess I'm still trying to figure out of exercise messes up receptivity to estrogen.


And Kiera, I'm looking very much forward to our meeting^_^  In fact, I'm thinking of cooking you something special that you can share with the family that night!  Do you like oriental or cajun or italian better?  I'm young and I'm proud, so shove off:-p  when I first got onto HRT years ago I was an anorexic, and within a week I was cleaning out the fridge.  The crazy appetite subsided eventually.  Even now, I'm TRYING to cut my calorie count down to lose muscle, but it's difficult.  I get this crazy sweet tooth I never had before and I practically DRULE when I see things like dark chocolate and expensive chocolates and such.  I mean, I was literally ringing someone up at the pharmacy and they had one for me to ring up and I moaned, I didn't know it until I got a bunch of weird looks...
I fail to see, however, the connection between estrogen and losing weight.  Losing muscle mass would actually CONTRIBUTE to weight gain, as far as I know and have been drilled into from personal training certifications and health education.  It's all very confusing, if anyone could explain the weight loss from HRT, please do!

Audrey, how muscular were you?  You said a physically demanding job and a 6 pack.  I mean, could you take your shirt off and have the ladies oooh and aaaaah?  I know that at any given point in time right now I could walk on a teen body building stage and place in the top 3.  It's gonna take forever to lose all of this, but hey, it's worth it.  As far as sensetive skin goes, blaaah.  But your doc had you taking estadriol sublingually?  How long did you hold it under your tongue?  Lol, this might be the close of this friggin sublingual thing that's like, never ending!


And one more thing concerning estrogen receptivity, to have a list to discuss with the doc.  Would it be better for oral medications, to take them twice a day, morning and night, or try and split it up so that there's a lunchtime dosage as well?  I'm asking because that would require requesting a different dosage so it could be done, but hopefully it could be done, ya know?  And what about food intake, is it better to take prescriptions on an empty stomach, or before/after a meal?  Any literature to support whatever the answer is?

I looked at the drug label for prometrium today, I didn't see anything about vaginal or anal absorption, but I did see peanut oil.  I'll be collecting labels from all the hormone types from now on and educating myself on it!

About the Prometrium:

Is there any kind of study/knowledge about the different absorbtion percentages of Prometrium with suppository vs oral? I'm not finding efficacy rates to get any dosage information to derive.

Example: is 100mg of Prometrium the same as 200mg oral? 300? 400?

There are studies, but you'll have to look for them. Could be quick or not and
I don't have time. Oral is less efficient than using it as suppository for sure.
Not sure about the dosage question, you'll get more if you use more and
there is no way you can get to the highest physiological levels through
any means. In pregnancy, P levels shoot through the roof. There is a posiitive
effect on the breast devellopment, but just how serum levels relate to effect has never
been studied and is not likely to be studied any time soon. One of the reason is the
difficulty of isolating Progesterone's effects from Estrogen's effects and the
fact that people have a different sensitivity to it. So, the ideal dosage for TS
is certainly not likely to be known or knowable. The more usefull, ideal E dosage is
also not known and knowable.

Quote from: Keira on January 11, 2008, 07:39:41 PM

No, even on a healthy diet, without exercise, any caloric imbalance will make fat got behind the stomach wall. That's what I said, even thin women who eat right will have it. Its due to inactivity and metabolic imbalance caused by it.

When I'm talking exercise, I don't mean anything heavy, a 30 minutes of walking at a decent speed is enough to keep this away or remove it if its not too extreme. If its extreme, it will take more exercise. This fat, responds almost not at all to dieting; it only responds to moderate intensity exercise. High intensity exercise will have a tendency to burn carbs, so its not the best for this.

Okay, I'll do just that! thanks

Quote from: Keira on January 11, 2008, 01:45:53 PM

I wasn't talking about muscles and E sensibility being related.
Was talking that muscles are more VISIBLE pre HRT, even at nornal weight
and with normal size muscles
if you've got a low E sensibility.

Inside the abdominal cavity fat, visceral, disrupts fat metabolism and
distribution in the body; estrogen cannot steer most fats to the
thighs, legs and buttocks, part get stored in the middle.

Normally estrogen will keep fats away
from the middle, but if you don't exercise fat will start accumulating
behind the stomach muscles even in thin women,
which creates the characteristic bulging out
from the sternum to the waist. Look at non active thin women,
this area bulges out even if you can't pinch anything on them.

Hello, Keira,

Thank you for mentioning the fat behind the stomach muscles. 

I heard of this only once before in a talk about gender-based medicine delivered by Dr. Pamela Peake, a physician and nutritionist who was at the time associated with the University of Maryland, College Park Campus.  I never gave it any thought until I read your posting  and looked at myself.

In my case I have a goodly amount of padding on me.  My breasts are C-cup.  I have fat on my tummy, thighs, hips, and bum.  I also have way too much that I gather is behind my tummy.  Did I read correctly that this fat will eventually go from behind my stomach to other places on my body provided I exercise sufficiently?

I've been using the weather as an excuse for not walking but I believe that it's time that Cindy and I went to a large, local shopping mall and walk briskly for a half-hour and work our way up to an hour.  When the weather gets better we will be walking up the hills in the neighborhood.

I am anxious to see the results.  I don't want to lose from anyplace besides the area from my sternum to my pubic bone.

Thank you for the info and the help.  BTW, can you point me towards a diagram of the abdominal cavity of the female that shows the visceral fat?  It would explain a lot for me.

Sincerely,

Wing Walker

I'm afraid you'll lose fat from the breasts also. Its better to lose it now, before the breasts support and skin gets deformed from the weight and you get saggy breast when you lose weight later.

Besides, if you have less fat in the middle, smaller breasts stand out a lot more, so its not all bad. I went from 38B to 34B+ that's much smaller (though a good part of this loss is not fat but muscle) (in between B and C, though I wear B's because I hate bras with loose space in them).

In most men (and we live with that legacy), most of the fat is behind the stomach wall (there is some over it of course, the big bulging out is caused by intra-abdominal fats). The good thing, with moderate exercise, its also the first fat to go and you get very quick result on your waistline.

Quote from: Keira on January 12, 2008, 01:26:13 AM
I'm afraid you'll lose fat from the breasts also. Its better to lose it now, before the breasts support and skin gets deformed from the weight and you get saggy breast when you lose weight later.

Besides, if you have less fat in the middle, smaller breasts stand out a lot more, so its not all bad. I went from 38B to 34B+ that's much smaller (though a good part of this loss is not fat but muscle) (in between B and C, though I wear B's because I hate bras with loose space in them).

In most men (and we live with that legacy), most of the fat is behind the stomach wall (there is some over it of course, the big bulging out is caused by intra-abdominal fats). The good thing, with moderate exercise, its also the first fat to go and you get very quick result on your waistline.

Thank you for your confirming reply.

My breasts are made of very dense tissue.  It took more than one image to get a baseline mammogram for me.  There is fat on me up there but it's not much.  My chest was always around 42 to 44 inches around.  Since I have been on HRT since 2002 I believe that whatever muscle was to be lost, has been lost.

When I drop weight it's usually my face that shows it first.  It will be a nice change to see the abdominal fat go first.

Again, thank you for sharing that knowledge, Keira.

Sincerely,

Wing Walker

Even if breasts are very dense (which I don't doubt), I'm pretty sure you'll lose some (maybe not much then) often its on the side and top that there's more fat that's why the band size gets affected too, though its more probable that you'll lose band size too, so in fact you'd wind up still a C but at a smaller band.

Quote from: Keira on January 12, 2008, 02:11:08 AM

Even if breasts are very dense (which I don't doubt), I'm pretty sure you'll lose some (maybe not much then) often its on the side and top that there's more fat that's why the band size gets affected too, though its more probable that you'll lose band size too, so in fact you'd wind up still a C but at a smaller band.

When my weight was where it belonged my band size was 44, cup was C.  There is fat visible inside the curve of my cleavage so I can see where I will have a loss.

I still have my old brassieres.  Now all I need is the figure that I once had.  It is attainable.

Thanks again, Keira. 

I saw my GP yesterday and I asked for Injectable hormones. She flatly refused and said that she cannot consider anything like that until my blood pressure goes down. But all my family on my mothers side suffer from blood pressure both male and female members. My GP blames my high blood pressure on HRT but I have always had high blood pressure long before HRT.

How can I ever access Injectable hormones?

Quote from: Berliegh on January 12, 2008, 05:53:58 AM
I saw my GP yesterday and I asked for Injectable hormones. She flatly refused and said that she cannot consider anything like that until my blood pressure goes down. But all my family on my mothers side suffer from blood pressure both male and female members. My GP blames my high blood pressure on HRT but I have always had high blood pressure long before HRT.

How can I ever access Injectable hormones?

move to US or a country where they supply it. Get therapy so you can legally obtain HRT in that country- tell the endo about your "story" and how other meds DON'T work a bit- so you think injections should be tested- if you say that you've been on every estro form except injection they most likely will let you try it.

Quote from: Wing Walker on January 12, 2008, 12:57:21 AM
Hello, Keira,

Thank you for mentioning the fat behind the stomach muscles. 

I heard of this only once before in a talk about gender-based medicine delivered by Dr. Pamela Peake, a physician and nutritionist who was at the time associated with the University of Maryland, College Park Campus.  I never gave it any thought until I read your posting  and looked at myself.

In my case I have a goodly amount of padding on me.  My breasts are C-cup.  I have fat on my tummy, thighs, hips, and bum.  I also have way too much that I gather is behind my tummy.  Did I read correctly that this fat will eventually go from behind my stomach to other places on my body provided I exercise sufficiently?

I've been using the weather as an excuse for not walking but I believe that it's time that Cindy and I went to a large, local shopping mall and walk briskly for a half-hour and work our way up to an hour.  When the weather gets better we will be walking up the hills in the neighborhood.

I am anxious to see the results.  I don't want to lose from anyplace besides the area from my sternum to my pubic bone.

Thank you for the info and the help.  BTW, can you point me towards a diagram of the abdominal cavity of the female that shows the visceral fat?  It would explain a lot for me.

Sincerely,

Wing Walker

Wing Walker, brief exercise is enough to keep fat off.  When it's already on there, however, the hardest place to lose it is the stomach.  A brisk walk might do it, dependong on how well your body responds to exercise.  I've never been a fan of walking or running for cardio due to the impact it places on the knees.  Biking, or purchasing a stationary eliptical bike(http://www.overstock.com/Sports-Toys/Health-Trainer-440-Recumbent-Exercise-Bike/2767753/product.html (http://www.overstock.com/Sports-Toys/Health-Trainer-440-Recumbent-Exercise-Bike/2767753/product.html)), would probably be the best option of an excellent method to stay in shape.  I work with senior and middle aged clients every week.  Walking contributes to or aggravates hip disorders, and running is simply out of the question when the heartrate can be gotten up without the wear and tear on the knees and spine.
What I would suggest is what I'd suggest for anyone, a little bit of resistance training along with consistent cardio.  Whether it's squats and crunches, 3 times a week with cardio every day or you get a full out gym membership, it's your place to decide and not mine.

Everyone's body works differently, but quite frankly if everyone could lose weight by just going for a walk then I'd be out of a job and so would millions of other fitness experts across the country.  There is no such thing as 6 minute abs or 4 minutes a day cardio, I'm sorry:-(

If you'd like some in detail articles on how you can lose weight, I'd suggest you look over these few:
A guide to proper nutrition:
http://forum.bodybuilding.com/showthread.php?t=3720211
A thread discussing artificial sweeteners.  I find it highly biased, but if you scroll through a few pages then you'll find other people agreeing with me, but still excellent literature from both sides.
http://forum.bodybuilding.com/showthread.php?t=291569
And all you need to know about cardio:
http://www.bodytrends.com/articles/cardio/everythingaerobic.htm

EXCELLENT answer for losing weight:
"Firstly, a combination of a good weightlifting schedule and cardio is better than just cardio alone. I found that out when I took a college women's strength class in Fall 2002 at age 50 and being 245lbs back then for over 30 years of marriage and raising my own children. After a year of classes, I dropped several inches and a few pant sizes. Worked out at home for the next year and a half and dropped abit more. Went from wearing size 48 for 18 years to wearing size 36/16.

Now, at 53, I am 170lbs at 5'6"/largeboned. Was about this weight when I married m husband 33 years ago. I was never skinny as a kid and my exercise as a teen in college was riding a 10sp all over San Diego.

There are many excellent threads in these board to help you. But one especially with great advice for the beginner about diet and exercise is "BuffedWildCat's Advice to Newbies". You cant go far wrong with this one.

As for diet. It is not necessary to go to an Atkins or South Beach if you have been eating properly in the first place. Basically, it is upping the protein intake, lower any refined carbs/sugars and eat in moderation. Have 5-6 small meals a day instead of three big ones to help keep the metabolism up. When I started out, I barely ate as it was and only when I was hungry. Then ate the wrong things when I did. The combination put my body into "starvation mode". When I first started lifting, I was letting my stored fat burn as energy while lifting but you can only go so far with that. Later that first semester, I found this site and learned ALOT about the Female Myths of dieting and lifting. I was determined to make both lifting and proper diet a lifestyle to stay with. Why I gave myself four full semesters of classes while relearning to eat. This way it "stuck" for good and it had.

For myself, I was just plain sick and tired being...."sick and tired". Low energy, inflexible, back and shoulders hurting from some osteo and out of sorts in general. At 50, I looked around at all the older hobbling, injury ridden, overweight snowbirds in my local town ...and quite afew women my age.....to realize I was headed the same direction. Uh uh....no way!

My classes were small and made up of women older and abit younger than me. Each semester had it's share of newbies and carryovers like myself. My first semester instructor was a local wrestling coach and bodybuilder (his wife was one too) who had a simple but effective program used for years. At the beginning of the second, a new female instructor took over with a slightly different program. The gym had a combination of freeweights and Universal machines.

Both instructors started everyone out with low weights (5 pounds)...depending on the person's general strength. In my first class, a couple did use 3 pound weights as they were older than I was and had shoulder problems. But some were younger and had office jobs.

However, as I found out....those lower weights were too light for me and, eventually, worked out with 10 pounds for curls/flies and 20 pounds for the bentover DBL rows. Living a rural lifestyle and raising animals, I was stronger than the others who led more sedantary lives. So depending on how active your mother is normally, she just maybe stronger than first thought too.

We started out with 3-4 sets of 10 to 12 reps using a combination of freeweights (dumbbells) and Universal machines. Did this as an evening class, three days a week on a split schedule for a hour to 90 minutes. After the first semester, I just continued where I left off and was soon lifting more than any one else. I found I liked lifting and the new feeling of self confidence and self esteem it gave. Just took the class premise and ran with it.

"Form" is most important to prevent any possible injury and to get the most out of the workout. Be sure she stretches before starting. Especially since she has never lifted before and may not have the flexibility. Before lifting, I was finding it harder to get out my car. Pushing myself out of a chair or getting up off the ground after playing with the dogs. I had always been fairly strong anyway, but was losing flexibility over the years. Bummer.


But "Losing fat" is only one reason for doing this as there are others to consider too. During the succeeding semesters, there were some women taking this for after gastric bypass surgery therapy to help them drop the fat and gain more strength. A drastic step that even I had thought about at one time years before when I was over 260 for a while. They told me if I could drop the fat and improve my health this way.....it was best. They took this step after seriously trying all other avenues but could not get the weight down.

I knew one 72 year old woman who had serious osteoarthritis in her shoulders and knees who took the class to help with joint bloodflow and improve her flexibility. Lifting moderatley heavy weights is a good way to build bone mass before and after menopause to keep osteoporosis at bay. There was another who was Type 2 diabetic taking this to help control it by dropping the weight/improve health. So there are many factors why combining both lifting and cardio is the best way to go.


You have to give yourself time and patience when starting out. However long it has been being overweight, it will take awhile to get it off. Give yourself at least four months to really see the changes. Put away the scale for the first few weeks, as this can be misleading, confusing and disheartening at first. Better that you use your wardrobe as an indicator of progress. For various reasons, the scale might not show much change at first. But finding your pants are getting looser as the inches go is far more encouraging. This as your body goes through some subtle adjustments while getting used to the routine. Also while exercising diet, the body is shifting the fat too.

There is no such thing as "spot reducing" and we all have our trouble spots. With me, I carry my fat in my back, shoulders, stomach and do not have large thighs/hips. Just not built that way. Where you deposited the fat first, this will be the last to go. Why you may see more changes in your face and arms first. It depends.

After the first few weeks, you will begin seeing and feeling the difference. After the first two months, depending on how often and the intensity, you will REALLY see the difference and feel more energized. It depends as each person is different. Even if you can only set aside 45 minutes three days a week, it will all add up. Two days or even one day. All of this will help build stronger bones (hold back any osteo) and strengthen muscles. I do have some lower back arthritis and my back muscles were not the best. I could not do reverse ab crunches because of this. However by working the other exercises, my lower back muscles were strengthened considerably.

Like I said, you will have to be patient and just keep at it. So easy to want immediate results, just take your time and be consistant."

Kalt, there has been recent studies on visceral fat and it does respond well to moderate exercise 30 minute a day walk (I'm not talking leisurely walk, get you heart at 120 at least) and healthy eating. Those fats are next to the liver and are easier to convert than those around the body, so they'll be used if intensity goes high enough that normally the body would switch away from using fats, but in this case, since they are easily accessible, it continues using them instead of switching to mainly carbs. Of course, not eating more than before is important. Most people walk at much lower rythm than this rendering the exercise a bit futile.

The reason this fat responds best to moderate exercise is because higher intensity of resistance, endurance, weight training demands too much energy too quickly for fats to be used carbs are used in preference. IF you continue at a high intensity past a certain point, you'll end up eating up muscles for fuel. Another good reason for short intense training sessions twice a day rather than long ones if you want to build muscles strength and overall capacity. If you have too low intensity it will take it from carbs, never expend of them to go for the fats, the remaining carbs or then stored as fats and you keep on piling the pound around the middle.

Quote from: Keira on January 12, 2008, 12:38:05 PM

Kalt, there has been recent studies on visceral fat and it does respond well to moderate exercise 30 minute a day walk (I'm not talking leisurely walk, get you heart at 120 at least) and healthy eating. Not eating more than before. Please find them. Most people walk at much lower rythm than this rendering the exercise a bit futile.

The reason this fat responds best to moderate exercise is because higher intensity of resistance, endurance, weight training demands too much energy too quickly for fats to be used carbs are used in preference. If you have too low intensity it will take it from carbs, never expend of them to go for the fats, the remaining carbs or then stored as fats and you keep on piling the pound around the middle.

No offense Keira, but I've seen the studies and I call complete bull->-bleeped-<- on the whole thing.  Calories are calories, be it carbohydrates or fat.  Being a complete sissy about the whole thing and trying to target just fat burning isn't even going to yield half the results that proper training would.
This is the myth that just about every honest fitness professional has been battling for years now, along with things like, "upper/lower abs" and "spot reduction," and all.  Thousands of articles from doctors and educated trainers who've made a name for themselves in the field because they know what they're talking about from years of college education negate this, but all it takes is a few people who don't know what they're talking about to make it sound good and get people's wishful thinking up again.
But ANYTHING is better than nothing, and it helps blood flow, which in turn would help estrogen receptivity.

How can a study be a myth!! I call bull myself.
If you've got something against the studies methology,
find it and point me the faults. This is a blanket attack
coming from your own empirical observations, which
I don't agree on.

Besides, you surely haven't read it by the way you react to it.


BTW, I've trained at a national level (Canada) for close to 9 years
in High Jumping, so I trained twice or even 3 times a day for years,
from 1983 to 1991. I know what training is about.

Losing weight is a long term deal. Walking 30 minutes a day while
watching what you eat can make you lose 1 pound a week very easily.
At the end of the year, that' 50 pound. For most women, that takes
them close to their ideal weight. I really don't get the sissy thing
in there. Where no talking about going into the marine's here. For
most people, even this moderate exercise is way more than they're
doing now and will make a big difference in their lives.

While I agree weight training is good since it builds metabolism.
I'm talking the minimum people can do to keep in shape. Most people
don't have the time or inclination to do so.

First off Keira, if you're going to be the one citing studies, then you'd damned well better be the one providing them instead of shirking off the load.  When you make a claim, the burden of proof lays with you, and shifting it is a fallacy.

You don't think I'm not qualified?  I've set a national record for my age and bodyweight on squat.  At 3.3% bodyfat, when my usual is 10-12%, I'm pretty sure I know how to lose weight for myself.  Not only that, I'm certified and get paid to get other people to lose weight.  I acknowledge that you've done a lot of advanced training too, but the fitness industry is a big place and there's plenty of room for bs to go around until someone with an education stops it.

"Myths Under The Microscope: The Low Intensity Fat Burning Zone & Fasted Cardio

By Alan Aragon


INTRODUCTION

Why do natural bodybuilding contests for the most part look like swim meets minus the pool?

The obvious answer is the relative absence of anabolic and androgenic drugs that enable "enhanced" athletes to hold on to considerably more muscle under prolonged metabolic stress than natural pre-contest trainees. The other part of the answer is that naturals as a group tend to undermine their efforts by copying the training and nutritional practices of their pharmacologically advantaged brethren.

I wrote this review in the hopes of slowly but surely prying open some minds (including my own) by bringing the facts to light. Sometimes concepts can't be sufficiently conveyed through cyber debates, where emotionally-driven flexing and posturing for the public take priority over honest, objective, and thorough examination of the evidence. I'll take a look at the hard data, as well as the theoretical extrapolations involved with this highly misunderstood topic.

Warning: This is gonna be lengthy, so save this reading for when you can really sit down and buckle up. I highly encourage you to tread slowly and carefully through the material. For you skimmers out there, I provided summaries of the key research points.


THE "FAT BURNING ZONE" ON TRIAL

Substrate Utilization 101: Origin of the myth

Dietary variables aside, the body's proportional use of fat for fuel during exercise is dependent upon training intensity. The lower the intensity, the greater the proportion of stored fat is used for fuel. The higher the intensity, the greater proportional use of glycogen and/or the phosphagen system. But this is where the misunderstanding begins. Common sense should make it obvious that although I'm burning a greater proportion of stored fat typing this sentence, Getting up and sprinting would have a greater impact on fat reduction despite its lesser proportional use of fat to power the increased intensity. Alas, sufficient investigation of the intensity threshold of maximal net fat oxidation has been done. In what's perhaps the best designed trial of its kind, Achten & Jeukendrup found peak fat oxidation to occur during exercise at 63% VO2 max. This peak level got progressively less beyond that point, and was minimal at 82% VO2 max, near the lactate threshold of 87% [1].

Misunderstanding is perpetuated in fitness circles

It has been widely misconstrued that a greater net amount of fat is burned through lower to moderate intensity work, regardless of study duration and endpoints assessed. In addition the confusion of net fat oxidation with proportional fat oxidation, the postexercise period is critically overlooked. No distinction is ever made between during-exercise fat oxidation, recovery period fat oxidation, total fat oxidation by the end of a 24-hr period, and most importantly, a longer term of several weeks.. Thus, the superiority of lower intensity cardio continues to be touted over the more rigorous stuff that takes half the time to do. Fortunately, we have enough research data to gain a clear understanding. Let's dig in.


DISSECTING THE RESEARCH

Mixed study protocols + mixed results = plenty of mixed-up bodybuilders

As with all research involving applied physiology, the highly mixed set of results is due to a wide variation of study designs in terms subject profile, dietary manipulation, energetic balance, and actual intensities used. Nevertheless, the body of exercise-induced fat oxidation research can be easily deciphered by stratifying it into 3 subgroups: Acute effect (during exercise & immediately after), 24-hr effect, & chronic effect (results over several weeks).

Acute effects spawn ideas for further research

In addition to measuring fat oxidation during exercise, most acute effect trials look at fat oxidation at the 3 to 6 hr mark postexercise [2]. Fat oxidation during exercise tends to be higher in low-intensity treatments, but postexercise fat oxidation tends to be higher in high-intensity treatments. For example, Phelain's team compared fat oxidation in at 3hrs postexercise of 75% VO2 max versus the same kcals burned at 50% [3]. Fat oxidation was insignificantly higher during exercise for the 50% group, but was significantly higher for the 75% group 3 hours postexercise. Lee's team compared, in college males, the thermogenic and lipolytic effects of exercise pre-fueled with milk + glucose on high versus low-intensity training [4]. Predictably, pre-exercise intake of the milk/glucose solution increased excess postexercise oxygen consumption (EPOC, aka residual thermogenesis) significantly more than the fasted control group in both cases. The high-intensity treatment had more fat oxidation during the recovery period than the low intensity treatment. This implicates pre-fueled high-intensity training's potential role in optimizing fat reduction while simultaneously setting the stage for quicker recovery.

24-hr effects come closer to reality

You can call it Murphy's Law, but the promise of greater fat oxidation seen during and in the early postexercise periods of lower intensity cardio disappears when the effects are measured over 24 hours. Melanson's research team was perhaps the first to break the redundancy of studies that only compared effects within a few hours postexercise [5]. In a design involving an even mix of lean, healthy men & women aged 20-45, identical caloric expenditures of 40% VO2 max was compared with 70% VO2 max. Result? No difference in net fat oxidation between the low & high-intensity groups at the 24 hr mark.

Saris & Schrauwen conducted a similar study on obese males using a high-intensity interval protocol versus a low-intensity linear one [6]. There was no difference in fat oxidation between high & low intensity treatments at 24 hrs. In addition, the high-intensity group actually maintained a lower respiratory quotient in postexercise. This means that their fat oxidation was higher than the low-intensity group the rest of the day following the training bout, thus the evening out the end results at 24 hrs.

Chronic effects come even closer

Long-term/Chronic effect studies are the true tests of whatever hints and clues we might get from acute studies. The results of trials carried out over several weeks have obvious validity advantages over shorter ones. They also afford the opportunity to measure changes in body composition, versus mere substrate use proximal to exercise. The common thread running through these trials is that when caloric expenditure during exercise is matched, negligible fat loss differences are seen. The fact relevant to bodybuilding is that high-intensity groups either gain or maintain LBM, whereas the low-intensity groups tend to lose lean mass, hence the high intensity groups experience less net losses in weight [7-9].

The body of research strongly favors high-intensity interval training (HIIT) for both fat loss and lean mass gain/maintenance, even across a broad range of study populations [9-12]. A memorable example of this is work by Tremblay's team, observing the effect of 20 weeks of HIIT versus endurance training (ET) on young adults [9]. When energy expenditure between groups was corrected, HIIT group showed a whopping 9 times the fat loss as the ET group. In the HIIT group, biopsies showed an increase of glycolytic enzymes, as well as an increase of 3-hydroxyacyl coenzyme A dehydrogenase (HADH) activity, a marker of fat oxidation. Researchers concluded that the metabolic adaptations in muscle in response to HIIT favor the process of fat oxidation. The mechanisms for these results are still under investigation, but they're centered around residual thermic and lipolytic effects mediated by enzymatic, morphologic, and beta-adrenergic adaptations in muscle. Linear/steady state comparisons of the 2 types tends to find no difference, except for better cardiovascular fitness gains in the high-intensity groups [13].

Summing up the research findings

• In acute trials, fat oxidation during exercise tends to be higher in low-intensity treatments, but postexercise fat oxidation and/or energy expenditure tends to be higher in high-intensity treatments.
• Fed subjects consistently experience a greater thermic effect postexercise in both intensity ranges.
• In 24-hr trials, there is no difference in fat oxidation between the 2 types, pointing to a delayed rise in fat oxidation in the high-intensity groups which evens out the field.
• In long-term studies, both linear high-intensity and HIIT training is superior to lower intensities on the whole for maintaining and/or increasing cardiovascular fitness & lean mass, and are at least as effective, and according to some research, far better at reducing bodyfat."

"FALSE HOPES FOR FASTED CARDIO

The bandwagon is lead by blind horses

Many trainees pigeonhole weight training as an activity exclusively for building muscle, and cardio exclusively for burning fat. On the contrary, weight training can yield very similar results to cardio of similar intensity when 24-hr energy expenditure and macronutrient oxidation is measured [14]. The obvious advantage of weight training is the higher potential for lean mass and strength gains. In the bodybuilding context, cardio should be viewed as merely an adjunctive training mode to further energy expenditure and cross-complement the adaptations specific to weight training. As far as cardio being absolutely necessary for cardiovascular health, well, that depends upon the overall volume and magnitude of your weight training - another topic for another time.

Chaos theory strikes again

On the surface, it seems logical to separate carbs from cardio if you want a maximal degree of fat oxidation to occur during training. But, there's the underlying mistake - focusing on stored fuel usage during training instead of focusing on optimally partitioning exogenous fuel for maximal lipolytic effect around the clock. Put another way, it's a better objective to coincide your carb intake with your day's thermic peaks, where insulin sensitivity & lean tissue reception to carbs is highest. For some reason, this logic is not easily accepted, nor understood. As we know, human physiology doesn't always cooperate with logic or popular opinion, so let's scrutinize the science behind the claims.


LET THE RESEARCH SPEAK

Carbohydrate ingestion during low-intensity exercise reduces fat oxidation

As far as 3 decades back, Ahlborg's team observed that carb ingestion during low-intensity exercise (25-45% VO2 max) reduced fat oxidation compared to fasted levels [15]. More recently, De Glisezinski's team observed similar results in trained men at 50% VO2 max [16]. Efforts to determine the mechanism behind this phenomenon have been made. Coyle's team observed that at 50% VO2 max, carbohydrate availability can directly regulate fat oxidation by coordinating hyperinsulinemia to inhibit long-chain fatty acid transport into mitochondria [17].

Carbohydrate's effect on fat oxidation during moderate-intensity exercise depends on conditioning level

Civitarese's team found glucose ingestion during exercise to blunt lipolysis via decreasing the gene expression involved in fat oxidation in untrained men [18]. Wallis' team saw suppressed fat oxidation in moderately trained men & women when glucose was ingested during exercise [19].

In contrast to the above trials on beginning and intermediate trainees, Coyle's team repeatedly showed that carb ingestion during moderate-intensity (65-75% VO2 max) does not reduce fat oxidation during the first 120 min of exercise in trained men [20,21]. Interestingly, the intensity margin proximal to where fat oxidation is highest was unaffected by carb ingestion, and remained so for the first 2 hours of exercise.

Horowitz' team examined the effect of a during-training solution of high-glycemic carbs on moderately trained men undergoing either low intensity exercise (25% VO2 max) or high-moderate intensity (68% VO2 max) [22]. Similar results to Coyle's work were seen. Subjects completed a 2-hr cycling bout, and ingested the carb solution at 30, 60, and 90 minutes in. In the low-intensity treatment, fat oxidation was not reduced below fasted-state control group's levels until 80-90 min of exercise. In the 68% group, no difference in fat oxidation was seen whether subjects were fasted or fed throughout the trial.

Further supporting the evidence in favor of fed cardio in trained men, Febbraio's team investigated the effects of carb ingestion pre & during training in easily one of the best-designed trials on this topic [23]. Subjects exercised for 2 hrs at an intensity level of 63% VO2 max, which is now known as the point of maximal fat oxidation during exercise [1]. Result? Pre & during-training carbs increased performance - and there was no difference in total fat oxidation between the fasted and fed subjects. Despite the elevated insulin levels in the carb-fueled groups, there was no difference in fat availability or fat utilization.

Summing up the research findings

• At low intensities (25-50% VO2 max), carbs during exercise reduce fat oxidation compared to fasted trainees.
• At moderate intensities (63-68% VO2 max) carbs during exercise may reduce fat oxidation in untrained subjects, but do not reduce fat oxidation in trained subjects for at least the first 80-120 minutes of exercise.
• Carbohydrate during exercise spares liver glycogen, which is among the most critical factors for anticatabolism during hypocaloric & other conditions of metabolic stress. This protective hepatic effect is absent in fasted cardio.
• At the established intensity level of peak fat oxidation (~63% VO2 max), carbohydrate increases performance without any suppression of fat oxidation in trained subjects."

"REFERENCES

1. Achten J, Jeukendrup AE. Relation between plasma lactate concentration and fat oxidation rates over a wide range of exercise intensities. Int J Sports Med. 2004 Jan;25(1):32-7.
2. Thompson DL, et al. Substrate use during and following moderate- and low-intensity exercise: implications for weight control. Eur J Appl Physiol Occup Physiol. 1998 Jun;78(1):43-9.
3. Phelain JF, et al. Postexercise energy expenditure and substrate oxidation in young women resulting from exercise bouts of different intensity.J Am Coll Nutr. 1997 Apr;16(2):140-6.
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Allan Aragon

Very cool. Except the study I mentioned was more recent and its not mentioned in the sources
I think late 2006 or early 2007.
I will try to find it. Not this weekend.
I'm not talking about fats in general BTW. ONLY Visceral fats which have a metabolic effect.
They are by far the worse for health and their full bad effect has only started to be
discovered and investigated in the last few years.
These fats are even worse than believed at first.
Haven't time to read fully the doc up there, but there doesn't seem to be a differentiation
in the fats.
If we're talking at cross purpose, of course we won't agree.

And to add to the post above: focusing on burning total calories instead of carbs are what bodybuilders and powerlifters do to ensure the least amount of muscle is lost.  This goal is very similiar for any transwoman, not wanting to lose her curves and humps.  The effect of long term moderate intensity cardio will have greater impact on the recuction of breast size than higher intensity interval training and weight lifting to burn calories.  This is why biker chicks have flat chests, but female figure competitors are pretty busty, and natural too(some of them).

Posted on: January 12, 2008, 02:07:42 PM

---

I'm sorry if it seems like I've been arguing with you Keira.  Please let me see that stuff on visceral fat or whatever, I'm pretty interested in it.
And this study, and the studies it's quoting, were all post 05.
And since we're on the topic and you ARE very knowledgable, what's probably the best estrogen intake method for a highly active individual?  My gut instinct says patches.  I asked my doc about it and he didn't really have an answer.

Best way to not burn muscles is not to do only high intesity cardio.
Most women to to much
high intensity cardio, deplete their carbs, fat metabolism can't keep up with and
they end up eating their muscles!! Low carb diets will also eat up muscles if you
exercise at any intensity, or in the morning, since again fats won't be able to
be accessed. So, no wonder many women who train so much get so little out of it.

That's why I'm not espousing more than 30 minutes at moderate intensity, because
then there would be a chance that carbs would be expended and muscles used
for fuel.

BTW, the body will eat up the muscles it uses less first on low protein diet;
some people with liver problems (even failing) have problems processing proteins and must
use those diets.  Because of a study showing this, they now have load bearing exercise
on specific muscles, more than before. I think its a survival
mechanism, the body shrinks its metabolism to suit its nutrition and thus needs
to decrease the muscles it uses least first (most often its the upper body). In
Nazi camps, the people would not be able to walk if they're lower body muscle mass
was as bad as their upper body muscle mass (those photos or film are hard to look at).

Quote from: Renate on January 12, 2008, 01:36:42 PM
Hi Keira & Kalt:

You two are way over our heads and out of our leagues.
(Shouldn't this be another topic anyway?)

So, a simple question:  For MTF's who could care less about upper body strength,
but want to reduce the waistline to something more female, in one sentence, what
is the advice that you two can agree on?

Renate

I'll say what I'll always say, and that is a decent cardio routine(as Keira mentioned), or something more advanced as people become more advanced(as I mentioned), along with weightlifting for the legs(as I've always advocated), such as BW squats, lunges, and holding dumbells as one progesses.
Progession is a very real thing in both cardio and exercise, meaning that someone can't get the same results out of the same setting on a treadmill, same pace on a run, or same weights on a lift forever.  The  body adapts, the heart gets stronger and so do the muscles.  Gradually increasing the resistance of whatever you're doing is CRUCIAL for continued gains.

So pretty much what anyone could do is go for a walk a few times a week.  I think that everyone on this site would do well to do 10 bodyweight squats tonight, then 11 tomorrow night, and 12 the night after, increasing one each day.  Once 100 reps are reached, purchase two 10Lb dumbells and start over.

You don't have to lift weights and junk to be healthy, but it makes it a lot easier to achieve the goal, like catching a plane instead of walking 500 miles.

Keira is going on about visceral belly fat, which probably isn't a big deal for anyone who lives a healthy, moderately active lifestyle to start with, right Keira?

QuoteThousands of articles from doctors and educated trainers who've made a name for themselves in the field because they know what they're talking about from years of college education negate this, but all it takes is a few people who don't know what they're talking about to make it sound good and get people's wishful thinking up again.

The FDA, and drug companies, as well as marketing, and the communication industry have all got their hands into what information is promoted. The truth is hard to find and even harder to verify.

Hi Berliegh hon
From what I have been reading, my impression of the folks that handle HRT over there in UK way are very incredibly stupid if you ask me. I wouldn't live there if I had all the money in the world. I would consider moving to planet Mars first.

As for Keira, what she writes I have no difficulty understanding and it makes sense, common sense.

As for Kult I have no Idea where his head is at, trying to understand what he writes you would need a doctorate's degree in medicine to understand it, and I consider myself a fairly smart individual.

Yawll have a wonderful day

Cindy

At the steady state say 1-2 year in a healthy eating and exercising program,
I'd agree Kalt. But most don't start with this steady state. But, any exercise
at a decent clip is better than no exercise and it will get rid of this visceral fat;
of course, exercising more, will also work :-).
To get rid of the other fats may take more efforts and a higher metabolism built
through weight training.

In my opinion, low carb and low protein
diets used long terms are just crazy if you have an active lifestyle (and in general). Eating
a healthy and balanced is the much better than any crazy restriction diet.

Although from a TS former linebacker's point of view (not my point of view HAHA),
the low protein, low carb diet with high intensity
cardio for a substantial amount of time coupled with weight training on lower body muscles,
will make you shed upper body muscles
like there is no tomorrow (and less on the lower body). But, that's just a temp option
if you don't want your metabolism to be in the dumps so you gain weight just thinking
of donuts.


 

On diet, studies have found that cutting calories had very little to do with loss of muscle.  However, when putting students in a leg cast for 3 weeks, pounds were lost.  This supports that inactivity is what loses muscle mass, not calories.  Calories are just needed to put it on!  Eat healthy and eat a lot, you guys worry so much that your brains gotta need some serious energy!

http://nutritionhelp.blogspot.com/2007/08/losing-muscle-mass.html

Something I've noticed among natal females on birth control that might have some significance: I have personally observed that between athletic and healthy females on BC and druggy smoker females on BC, it seems as if it's the druggy smoker ones that end up pregnant more.  Could activity level be linked to hormonal sensetivity?

Cindy, I really don't appreciate the useless comments and the personal putdowns.  If you don't have anything to say that contributes to the topic then perhaps people could benefit from your advice in other threads.

Low calories with a balanced diet, I agree Kalt. But most time, they cut almost all carbs, proteins
or whatever's in fashion!!!
Hopefully, you don't have to do any thing remotely intense (like running accross the street (sic))
or think too much when you do
that because you'll eat your muscles in the first case and have very poor cognitive abilities in
the second case.

Cutting proteins is plain dumb!! no matter how you look at it, unless to lose muscles or
for medical reasons (liver failure). IF you don't like red meat, switch to vegetable proteins
or fish (I adore salmon and eat a lot of it).

I'm looking for studies relating activity to estrogen sensitivity or lackthereof.

If you mean in general in the body, I don't think they exist. If your thinking
of breast tissues, they exist, but are very contreversial since
even though there are hundreds, none seemingly agree.
There are studies on particular effects of estrogens in particular cases,
say on fat distribution, but
mostly we have to extrapolate this to our case since the
study patients and their environment (which for the study must be controled)
and us rarely match
exactly match. That's why studies reported in the media always turn
out to be wrong; they somehow omit the caveat.

well, I guess this thing has pretty much dried up then.  Hopefully with time the poll will work out better.

I think asking personal opinion of what worked better doesn't really produce
usefull information since we can't discuss dosages, administration mode,
person's weight, nutrition, etc. We've also don't have access to the patient's medical records
and don't have access to labs to sample various blood components at various times, or someone measuring in a systematic ways results. Not to mention the notion of proper sampling is such a diverse community.

There's a reason why medication studies take up to 10 years
and hundreds of million, and we are talking about one med administered in one mode,
under very controlled circumstances.

Another thing, "results" depends on so many factors that I'm not even sure its possible
to create a study that produces meaningful results.

Anyway, the chance there will be a conclusive study on our medications is because its simple, there is not enough cash in it.

 I wanted to ask about HRT patches. I've been on them a while and find they are better than the tablets which I've been on for 10 years. I'm not allowed to go on injections because I have high blood pressure and my GP won't allow it. With patches where is the best place to put them to miximise their effect? I have been putting them on my upper inside leg.

Quote from: Berliegh on January 15, 2008, 01:20:22 PM
With patches where is the best place to put them to miximise their effect? I have been putting them on my upper inside leg.

Each manufacturer has their own recommendation (specified in the instructions), although your doctor may have his own opinion.

~Kate~

Per prometrium absorbtion percentages:

Oral loses 80-95% of dosage.

Cream is almost 100% absorbed.

Suppository seems to lose 70% of dosage.

Data collected per internet.

Quote from: Kate on January 15, 2008, 01:29:59 PM

Quote from: Berliegh on January 15, 2008, 01:20:22 PM
With patches where is the best place to put them to maximise their effect? I have been putting them on my upper inside leg.

Each manufacturer has their own recommendation (specified in the instructions), although your doctor may have his own opinion.

~Kate~

Come on Kate? I doubt my doctor would have a clue and any guidelines on the packet would be for a genetic female. I wanted to know if people could tell me from their own experiences what would be the best place to put the patches to maximise their effect.

I was told that the upper part of the buttock or the abdomen were the best.
Audrey

Quote from: Audrey on January 16, 2008, 09:44:09 AM
I was told that the upper part of the buttock or the abdomen were the best.
Audrey

Thanks Audrey, that is where I've been putting them.

and Renate......your comment wasn't in the slightest bit funny...

I think Renate was just kidding.  Lighten up, no one is trying to victimize you.

Lia

Quote from: genovais on January 16, 2008, 06:14:16 PM
I think Renate was just kidding.  Lighten up, no one is trying to victimize you.

Lia

I know it was a joke and light hearted fun but I was seeking a serious answer to a question which was very important to me. Maybe I take transition too seriously?

Yeah, I think they go on the top of the buttocks, but I'm not really sure.  Surely the package insert should say.

Lia

I am on oral medication.  I eat very healthy meals of every kind cept for junk food.  I have never smoked, I haven't had any caffiene in about 9 months not even chocolate or teas or coffee.  I have never had any alcohol other than mouthwash when I was little.  I am not a fan of vitamin supplements especially since I'm on the AA that happens to not mesh well with vitamin supplements.  I run a mile every other day in less than 15 minutes and usually run it out for another 5 minutes, I do situps, crunches, and pushups daily.  Up until HRT started pretty much, I played arena soccer 2 nights a week but I stopped for a winter break and I've got um.....development now so shorts and tanktop wont cut it anymore.  I also have a very very strong fear of needles and sight of my own blood so oral is my only option right now patches do interest me but I have no issue with my current setup and I would rather the endo do what he wants to do than what I want to do since hes the expert in cross sex HRT.