Hello, everyone - long-time lurker who just registered here.  I haven't seen any threads like this, so I'm hoping I didn't just miss one; my apologies if I did.

Basically, I have been up and down about actually transitioning for a long time, largely out of fear of never passing as a man (I am very small and hourglassy - 5'1" and .65) and a while ago I decided I wouldn't let that stand in my way -  I scheduled an appointment with an endo who has helped a lot of people in my city's LGBT community transition.  I had some blood taken a few weeks ago, plus he contacted my general physician.  Today I got the news:

I have an existing hormonal condition in which I produce next to no testosterone (much lower levels than the average ciswoman) and very high estrogen.  I was told that because of this, I could never go on T (at HRT levels - I already take some to stay healthy in my female state) without risking severe health problems, such as liver and kidney damage and possible neurological issues. 

I basically broke down bawling in the doctor's office.  I've been so frightened of taking this step for so long, and now that I've finally set my heart on truly becoming a man, I've been told I can't, and that no doctor would ever write the prescription as it would be too risky.

I felt like walking on air when I finally decided I would go through with it, like this giant weight had been lifted, I had all these fantasies of joining up here in a year or two and posting a crap-ton of manly after pics, of walking around town and having waitstaff call me "sir," of being someone's boyfriend, and now...  I have no clue what to do.

Has anyone else had this happen to them or anyone they know?  I am still considering getting top surgery/mastectomy - would anyone else do a "half transition" like that? 

Hi Tobey, welcome to the site!

I'm so sorry that you are experiencing so much distress right now.  I would highly recommend getting a second opinion.

As for top surgery, there are surgeons that will perform that operation without ever being on hormones.  Most of them would require some type of letter of recommendation though.

There are a lot of hourglassy cisguys out there from what I can tell.

I am not a doctor, and I don't understand how the hormones of your target gender could ever be completely contraindicated. If I were you I would get at least one other opinion before making peace with your current hormonal state. I'm not convinced that healthcare providers always understand the importance of transition.

Aside from that, absolutely you should consider a "half-transition." For some people that's all they need to feel good and be socially recognized as who they want to be. Life is so complicated that a lot of us have done our transition in less-than-ideal circumstances, patching together different details and steps as they became available. If I were unable to get hormones and surgery, I would still bind, change my name, explain my pronouns to people, try to learn all the little habits that cue my gender to others, etc. I think my most important milestones were when I changed my name (not when I did it legally, but socially) and when I started binding. You can probably still be recognized as someone's boyfriend and get called sir eventually no matter what barriers are still in place.

I think the others have given you some really good advice. I don't have anything to add to what they said but I just wanted you to know I was listening. Because that's got to be so freaking hard to get that news. It's not the end though, it's a stumbling block. try to take some breaths and hang in there.

Quote from: King Malachite on June 28, 2014, 12:51:51 AM
  I would highly recommend getting a second opinion.

Definitely this!

Doctors are human and not infallible. 

I don't know, I think your dr. might not be considering all the options. Did he say your condition? There are like 3 or 4 different steps in the process that E production can be blocked and different meds for all of them... You should definitely get a second opinion.

(also, it doesn't really matter how much T you produce, a cis woman only produces a tiny fraction of the amount you would be supplementing anyway)

Personal: I actually had the opposite thing going on, I naturally produced very high levels of T, and have had to take so much E to get my T levels down to even close to the female range, that it's pretty much destroying my health, and I still haven't stopped producing the T. Though I wasn't physically masculine at all, and that makes it that much harder, because I have to ask myself if the mostly marginal changes are really worth all this frustration. Ultimately I decided I'm going to detransition, but I'm stuck again, and don't really know what to do next.

I don't know if that helps... sorry I just know how it feels to be stuck. It's terrible...

Unless there is information that was not given to you, that sounds a bizarre comment. I would definitely go and see an experienced endocrinologist.

I would recommend seeing a different doctor. I'm positive that there is some treatment plan for you. That being said, you can get surgery still and many doctors do not require HRT. Don't let yourself stress too much until you talk to someone else.

Thank you for all the replies.

I am definitely going to seek a second opinion as soon as I can.  If all else fails, I will blow some vacation time and head to see specialists in Chicago.

Quotelive for the rest of my life extremely depressed, trapped in an alien body

That is definitely what it's felt like for a long time for me   

QuoteI would still bind, change my name, explain my pronouns to people, try to learn all the little habits that cue my gender to others, etc

I do bind, although it doesn't do me much good - even after getting down to 17% BF, they're still horrible and huge   The name is at least easy for me - my parents gave me a typically male name at birth (and actually asked if that was to blame when I first brought up wanting to be a guy to them years ago).  Short hair, no shaving, boys' clothes, bound as tightly as I can, and I still get "miss" everywhere I go.  I do need to work on gaining the confidence to tell them not to do that, though.  Usually I just take it in silence.

QuoteDid he say your condition?

I'm fairly certain he did, but I didn't catch it as I was too busy flipping out.  My GP just refers to it as "estrogen dominance syndrome," and my google-fu has been failing me on that one for the past two hours - apparently, it's not a specific diagnosis.  I will have to contact the endo's office on Monday to actually get the figures and have any documentation sent to me before I start shopping around for that second opinion (or third, or fourth...)

QuoteAs for top surgery, there are surgeons that will perform that operation without ever being on hormones.  Most of them would require some type of letter of recommendation though.

Thanks very much for that - I will check around and see about getting recommendations from my therapist and/or GP.  I'm pretty sold on the idea of this - I've really and truly hated them for such a long time.

Thanks to everyone for responding - and I'm really sorry that I only joined and posted when I had such crappy news.  I will try to get into some happier threads this weekend, and contact the endo and several others on Monday.  And bring up all this with my therapist during my weekly on Wednesday.  For now, I'm off to try and slam as much of my freaking out as I can into my heavy bag before crawling into bed. 

Seriously, thank you all so much.  I probably would have spent weeks feeling totally lost and beaten down before coming to the conclusion that I should see another doctor on my own.

Even if it turns out you absolutely can't do HRT, if your chest causes dysphoria, top surgery can help with that. I had top surgery before starting HRT and that alone made a huge difference psychologically (not to mention being safer/healthier than binding indefinitely). Some surgeons don't require a therapist letter, much less HRT, for top surgery (Dr. Gary Lawton, Dr. Mangubat, and Dr. Steinwald to name a few).

I had issues similar to Samantha. I was told by my endocrinologist that there was no way for me to take E without life threatening clots, that even if I were somehow approved for the smallest bit of E she'd never approve me for any surgeries because I'd clot and die. According to her I was just a clot waiting to happen. I got the impression that if I was in the presence of too many women I'd clot and so forth. Life was to become an E minefield for me. I cried, it was horrible.

I tried to explain that any risk, up to and including death, was worth it because the alternative was a life of misery. (And early death.)

She recommended another local doctor more familiar with trans patients. He carefully refuted all points and put me on E right away. Oh, the happy. My levels are still below optimal and he's considering proscribing shots because the patch isn't getting it done. Not only am I happy (which is a new and fun experience) but I'm healthier than I've been maybe ever.

Definitely get that second opinion. Doctors do make mistakes and rarely understand just how important transition is. Good luck, Tobey.

PS If you do head to the Chicagoland area, Dr Fredric Ettner is the one to see. He's great.

I'm so curious about this business of producing too much estrogen or producing too much testosterone.  Just where in the body is all this unwanted hormone production taking place?  If we're talking about the gonads (testicles or ovaries) then why not simply remove them?  Yeah, I know, there's nothing simple about removing the reproductive organs, but if that's all that stands in the way of whether one is medically permitted to transition or not, well then the solution is daunting  but clear.

Of course, I'm no medical professional... the above question just popped into my head as I was reading this thread.

"Estrogen dominance syndrome?" Really??!

"Estrogen dominance" is quackery; there's no actual scientific support for its existence as a medical condition. It's a popular "theory" among the alternative medicine crowd -- you know, the ones who believe that vaccines cause autism, aluminum causes Alzheimer's, and SSRIs are the root of all evil.

Tobey, if you fell into the hands of a doc who believes in this BS, that's just a shame. Unless I'm missing something here, you should have no trouble finding a doctor who is more knowledgeable than this, who will give you the hormone therapy you need.

I hope you can find such a doctor soon -- it sucks that this happened to you.

Those are excellent questions, Mirahu Barbie -- and they sure point out how fishy this is.

I feel like this foctor maybe isn't specialized for transgender people and you should try a another doctor! I'm sorry for your situation, I hope everything works out

Quote from: Miharu Barbie on June 28, 2014, 09:58:37 AM
I'm so curious about this business of producing too much estrogen or producing too much testosterone.  Just where in the body is all this unwanted hormone production taking place?  If we're talking about the gonads (testicles or ovaries) then why not simply remove them?  Yeah, I know, there's nothing simple about removing the reproductive organs, but if that's all that stands in the way of whether one is medically permitted to transition or not, well then the solution is daunting  but clear.

Of course, I'm no medical professional... the above question just popped into my head as I was reading this thread.

It can be hard to tell. I had too much T production and it's not really obvious where it is happening. only that my T level simply doesn't drop to a female range no matter how much E I take. The thing is adrenal hormones can cause all kinds of problems. Some people also have hormone secreting tumors, or increased activity of some enzyme. Estrogen is stranger because all E starts its life as T. It is converted mainly in the ovaries (by aromatase) but aromatase is present in all kinds of body tissues including fat. And higher E levels actually apparently increase aromatase expression which means yeah, less T and more E. But there is always a way to medicate that, like an aromatase inhibitor. Poor OP getting dishonest treatment :c

QuoteTobey, if you fell into the hands of a doc who believes in this BS, that's just a shame. Unless I'm missing something here, you should have no trouble finding a doctor who is more knowledgeable than this, who will give you the hormone therapy you need.

I'm hoping so.  Monday morning I'm getting all of the records he has and sending them off with requests for appointments at two other endos in town.  If all else fails, I'll go out of town. 

Quote from: Claire (formerly Magdalena) on June 28, 2014, 09:46:29 AM
I had issues similar to Samantha. I was told by my endocrinologist that there was no way for me to take E without life threatening clots, that even if I were somehow approved for the smallest bit of E she'd never approve me for any surgeries because I'd clot and die. According to her I was just a clot waiting to happen. I got the impression that if I was in the presence of too many women I'd clot and so forth. Life was to become an E minefield for me. I cried, it was horrible.

I tried to explain that any risk, up to and including death, was worth it because the alternative was a life of misery. (And early death.)

She recommended another local doctor more familiar with trans patients. He carefully refuted all points and put me on E right away. Oh, the happy. My levels are still below optimal and he's considering proscribing shots because the patch isn't getting it done. Not only am I happy (which is a new and fun experience) but I'm healthier than I've been maybe ever.

Definitely get that second opinion. Doctors do make mistakes and rarely understand just how important transition is. Good luck, Tobey.

PS If you do head to the Chicagoland area, Dr Fredric Ettner is the one to see. He's great.

Oh okay, thank goodness for your post because this situation got me thinking...
This whole thread made me feel like there's a good chance I can't be prescribed for hormones.
In any case, I would really get a second opinion on this which you're already planning to do, which is great.

Good luck!

Let me join the chorus: This doctor is a quack or at least seriously misguided/prejudiced.

See someone else, preferably someone with experience treating trans people.
.

I want to add that there are some otherwise competent professionals who get scared or make stuff up when confronted with trans issues. I think you should (aggressively) give your doctor a chance to explain before moving on to another provider, and be able to put this crap behind you if they are willing to rise above any prejudice and treat you as the human you are. Even if you do somehow have a life-threatening hormonal condition that precludes physical transition, your regular physician should be aware of (and should ask you about) the dangers of living in a body that isn't right for you.

Please think and carefully consider the ramifications if you do decide to out your doctor as anti-trans. It would be much better for all of us if you can get them to change. If they are some kind of die-hard social conservative, then by all means make their life hell, but most people are just uninformed.

I am very slight and 5'1". I *had* a very hour glass figure pre-t, though now that I am on T, this is much less true. I am read as male something like 98% of the time. (I've been on T for a year.)

I don't know why high estrogen levels would make you less able to transition. I'm sure guys have all sorts of estrogen levels pre-T. Estrogen dominance syndrome doesn't appear to be a real thing, so that's worth googling actually. You might take MORE T, but the range of T doses is pretty great anyway.

I think you need a second opinion. The idea of not transitioning because you will never pass is a very odd idea and would mean that the point of transition is to "pass". I don't think that is correct in the slightest, but it also is not necessarily true either.

Chicago has the Howard Brown clinic which is informed consent.

--Jay