Quote from: MadelineB on November 21, 2013, 11:25:29 AM
Sounds like the study is using a very odd measure for determining success. Spiro is the drug of choice in a country (the US) that is culturally obsessed with large breasts, where androcur isn't avail, and where people's health coverage won't pay for g blockers except in children. So using BA surgery as the measure makes no sense.
18 months on Spiro, from A to D, fully formed, Tanner IV-V, and still growing. No P.
BA is a question of money and personal taste, which is shaped by culture.

Thanks! I'm still really looking forward to my spiro script -- I feel it's the only thing that can fix my head right now.

Quote from: Keroppi on November 21, 2013, 08:09:08 AM
You need to give some context to those number I'm afraid....

they took records for 165 trans woman how had BA and had a min of 2 years of hormones (avg was like 10) and a min breast development of tanner IV. Then compared that to 165 trans woman who did not have BA but met the same criteria. So basically the assumption is that those who didnt have BA were happy with their size. Lab results of the two groups was basically the same. Actual breast size was not recorded but it did state breast size was on par with adult women but the chest wall differences might result in perceived size differences. There is another chart on side effects/medical problems associated with who took what drug. Average age at the end of the study was around 47 I think.

And I ask again...
Just what exactly does "breast bud fusing" mean?

There was a "maybe" answer but does anyone know for sure?

Quote from: MadelineB on November 21, 2013, 11:25:29 AM
Sounds like the study is using a very odd measure for determining success. Spiro is the drug of choice in a country (the US) that is culturally obsessed with large breasts, where androcur isn't avail, and where people's health coverage won't pay for g blockers except in children. So using BA surgery as the measure makes no sense.
18 months on Spiro, from A to D, fully formed, Tanner IV-V, and still growing. No P.
BA is a question of money and personal taste, which is shaped by culture.

"The study was conducted at a single-center National Health Service tertiary care unit" [in the United Kingdom].

I found the study, fully accessible too!

http://jcem.endojournals.org/content/early/2012/10/08/jc.2012-2030.full.pdf

Quote from: Lady_Oracle on November 21, 2013, 11:38:55 PM
I found the study, fully accessible too!

http://jcem.endojournals.org/content/early/2012/10/08/jc.2012-2030.full.pdf

Thank you Lady!
It does help to know that the sample size who actually took spiro was tiny (4.8%, or 18 out of 370) and may have been comprised largely or completely of self-medicators, who were also the most likely as a group to request mammoplasty.

If I am doing my maths correctly (a big if, so feel free to correct!) the study clearly points out that self-medicators were twice as likely to request mammoplasty vs. physician directed HRT (11.5% vs 6%); and that self-medicators were three times more likely to take spiro vs. physician directed HRT (4.8% vs 1.8%); if you combine those two factors, and the fact that we are talking about a tiny sample (11% of 4.8% of ~370), the conclusion about spiro is completely unsupported. We are talking about 2 out of 370 individuals, which is not enough to draw any conclusions whatsoever. Two self medicators who took spiro requested mammoplasty, out of a total sample of all combinetrics of 370.

Any follow up study aiming to measure effects of anti-androgens should be done in the US or Canada or another country, where anti-androgens are common enough to actually be statistically relevant. As the study says, "Antiandrogens are not routinely used in the clinical protocol".

So any conclusions about anti-androgens from this study are likely to be fallacious.

It would be worth following up in a study that had equal numbers (50/50, instead of 5/95 and 2/98) of spiro vs other androgen control mechanisms.

Even though I would like to encourage ALL serious studies being done on transsexual treatments - can't be too picky about water when you reside in a desert! - this sentence made me cringe and call into question the entire study:

QuoteSpironolactone is more likely than the other, more specific antiandrogens or GnRH analogs to result in the need for breast augmentation.

If it had mentioned a 'possible correlation, I would agree. But a 'result in'? Nothing in this study would indicate causality, or have nearly the numbers needed to make any kind of conclusion that strong.

Interestingly enough, the breast bud fusion conjecture appears to have been misread initially by the doctor quoted in the OP.

The study does not posit that Spiro causes increased breast bud fusion; rather, it posits that self-medication, and any other treatments that result in estrogen levels that are too high, can result in sub-optimal breast growth, projecting from the experience of natal females who are exposed to too rapid introduction of estrogen during puberty. This is stated as a conjecture, not as a result of the study.

How much exactly does GNRH cost in the USA, Approx?  Im Curious what its benifits are over spiro, other than one injection every 3 months.  If it stops T production, is it possible theres unstudied risks/benefits to takeing it?  Someone mentioned that taking spiro blocks T from connecting at certain receptor sites or some such?  Isnt having a bunch of T still floating around in your system, which im sure interacts with more stuff than what spiro blocks, prolly not that good for you?

Thank you Lady.

Quote from: MadelineB on November 22, 2013, 12:24:11 AM
Interestingly enough, the breast bud fusion conjecture appears to have been misread initially by the doctor quoted in the OP.

It's the same person.

Quote
The study does not posit that Spiro causes increased breast bud fusion; rather, it posits that self-medication, and any other treatments that result in estrogen levels that are too high, can result in sub-optimal breast growth, projecting from the experience of natal females who are exposed to too rapid introduction of estrogen during puberty. This is stated as a conjecture, not as a result of the study.

I think that part of the the presentation did indeed mention it being based on / similar to experience etc.

Thanks Madeline!

I agree with your statements and think that 2 people is NOT a sample size!

That being said I'll continue with my meds as my specialist prescribes and report back later .

Anyone else think "alternative energy" when they hear "breast bud fusion?"

Quote from: Jennygirl on November 21, 2013, 01:07:45 AM
When you eat estradiol, it passes through the liver and much of it is converted to estrone- an estrogen that does exist naturally in the body but in very small doses. It is the primary reason people get bad side effects from oral hrt / birth control because the level becomes much higher due to the liver conversion. Estradiol is what you want, it is 10s of times more effective for feminization compared to estrone (by weight) and actually extremely good for you. Estradiol will actually extend your life expectancy if you start it before testosterone related health problems arise. Estrone does not have these natural healthy benefits, and high levels of it in your blood stream is flat out bad for you. Quite the opposite of what we want.

By adding estradiol straight into the bloodstream, it avoids the initial phase of liver conversion- which means lower doses, higher feminization, and vastly lower risk of health complications like bloot clots / weight gain / mood effects.

Our bodies are not designed to EAT hormones. Actually the liver is set up to protect against it, hence why a healthy liver is so drastically important for oral HRT and why eating plant estrogens simply does not work. It puts a lot of load on your body in all the wrong ways. Endocrinologists should do away with all forms of oral completely when treating trans people especially because of the high dose that is needed due to estrone conversion. It is less of a problem for cis females who need a much smaller dose, but it's still not good- just less bad.

Thanks for this, Jennygirl. My doc said I should go injectable when I first discussed it. but only said that the reason was that 'some people say it works better for them'. I'm not happy with my development on pills right now - everything started with a *bam* ad fizzled out couple of months in. There haven't been any changes I've noticed in about 2 months now.

Quote from: kabit on November 22, 2013, 06:25:44 AM
Anyone else think "alternative energy" when they hear "breast bud fusion?"

YES!!! You made me laugh for the day

"The use of spironolactone as an antiandrogen seemed also to be associated with an increased incidence of breast augmentation in transwomen. The other, more specific antiandrogens and GnRH analogs were not. Spironolactone is a mineralocoricoid receptor partial antagonist as well as an estrogen receptor agonist. As such, in addition to blocking the androgen receptor (which is its primary purpose in this situation), it also has a significant estrogenic action at the doses used in transwomen. One can postulate that this could lead to an excessive estrogenic action and consequent poorer breast outcome by the same mechanism as that seen when patients self-medicate with estrogens. It is interesting that the other antiandrogens, cyproterone acetate and finasteride, do not appear to be used more frequently in those requiring breast augmentation compared with controls, suggesting that this is not a class effect of antiandrogens"

I have flashbacks of doing my school papers and trying to make observations and connections from even the smallest of correlations.

Thanks for finding this Lady Oracle!!

Quote from: kabit on November 22, 2013, 06:25:44 AM
Anyone else think "alternative energy" when they hear "breast bud fusion?"

  Perhaps it could make you the female equivalent of Iron Man if it gives you a hyper-efficient reactor in your chest?  Or better two??

If, as Madeline suggests it appears that the conclusions in the paper are based on conjecture, what then was the real intent of the author?  Many studies/papers, not just medical, are produced with the goal of 'proving' a predetermined belief or ideology, to sell a specific product, or simply to get attention for the author.  I'd be wary of judging conjecture-based 'facts' but there must be some tidbits or local context that can give us some insight into the motives of the author.  To quote the author, "One can postulate", but this is a dangerous game.  As Bardoux may have inferred, such penmanship in school would lead to very 'critical attention' by the reviewing teacher/professor - but there I am postulating...

I would gather it's another slice of evidence to be used in their case for why patients should be funnelled through the GIC's and all their glorious inadequacies when it comes to gender therapy. Ironically one of the endo's named on that paper also operates a private practice (still operating to the GIC guidelines, just willing to shorten the queue times for money) whilst continuing his role as a consultant, and yet here the rest of them are trying to shut down the informed consent model operating outside the allotted guidelines... it seems like you do it their way or put up with papers like this.

If anything, this thread has gotten me to see the need to discuss with my doctor what my other options are next time I go to see her, in about a month. Just starting on HRT, 2 weeks ago, she prescribed estradiol and spiro in pill form. I didn't really press her on what method to use because I was so happy just to be starting and figured she knew best, but maybe there's a better way (injections, progesterone?) for me and I have to get her to see that. 

I dunno... I'm only two weeks in but I want to see the best results possible, not get down the road a few months and realize there was a better way all along

Quote from: FinallyMe84 on November 22, 2013, 10:53:42 AM
If anything, this thread has gotten me to see the need to discuss with my doctor what my other options are next time I go to see her, in about a month. Just starting on HRT, 2 weeks ago, she prescribed estradiol and spiro in pill form. I didn't really press her on what method to use because I was so happy just to be starting and figured she knew best, but maybe there's a better way (injections, progesterone?) for me and I have to get her to see that. 

I dunno... I'm only two weeks in but I want to see the best results possible, not get down the road a few months and realize there was a better way all along

i completely agree! I highly, highly recommend you get off estradiol in pill form.

What's wrong with taking the pill version if its sublingual?

Pills as in swallowing yea I can see that being a problem.

Quote from: Kayla86 on November 22, 2013, 09:02:40 PM
What's wrong with taking the pill version if its sublingual?

Pills as in swallowing yea I can see that being a problem.

I have used estrodiol sub-lingualy it works fine, good lab number on modest dose. Medroxyprogesterone works sub-lingualy too.

There is nothing "wrong" with medications appropriately prescribed for you as an individual, including oral and sublingual routes.  We assume your provider factored in your age and other considerations from your personal history.

There is a "first pass" effect of medications taken orally.  That term describes the amount of an oral dose that is taken up by the liver as the medication travels the digestive tract.  transdermal patches or pellets are prescribed in a much lower dose and may have far less interaction with the liver and may have less cardiovascular complications associated with long term use for old geeks like me.