Hello everone!

I had my exciting, long-awaited initial visit with my Endocrinologist today and I was very surprised to find that she is starting me off with Estradiol and no anti-androgen. I didn't expect to hear that from her as it seems everywhere I read it is commonly given as part of the therapy treatment. She gave an explanation, which is a unclear now, unfortunately,  but i recall she said she has other TS patients on Estradiol only and they are getting good results without adding an anti-androgen.

Can you girls help me with some feedback on hrt without an anti-androgen? Should I insist at my next appointment to be prescribed one? My next appt is in two months.

I'm guessing that it may be that she doesnt want to start me off with too many changes and wants to see how I react to the initial dose. I did have my initial bloodwork done while there today, so those results were not available for todays appt. She did not use either of those reasons, however, for not giving me an anti-androgen.

I'm a little confused and somewhat disheartened that I might not have the typical or standard treatment therapy. Any input would be appreciated.

Thanks,

Valerie

normally, the doctor will start you on a low dose of a medicine to try to make sure you don't have any adverse side effects.  It's easy to pinpoint when it's the only medication your taking and you have side effects.

Introductory doses are usually really low.  Insist on spiro later on though, an anti-androgen is essential. 

A high estrogen dose *may* be enough without an AA for some patients.

But unless there are other factors in play increasing E higher will probably have more health risks than just using an AA. I think it would make sense to use an AA while pre-op unless you have some special circumstances.

My Endro said the same thing when I saw him. He said spiro is just good for stopping hair, and that my Estrogen is what has made my T levels almost zilch.

My family doctor has me on a low dose of Spiro and an average of Estrogen (which is actually kind a high for me, according to my blood levels, but then they seem to be okay with the levels).

*shurgs*

Posted on: September 26, 2007, 04:14:48 AM

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One interesting thing to note: I have a friend that had high T levels even on Spiro and Estrogen, and so she just took a bunch more Spiro to make it go down. She then saw the Endro I was seeing (her T levels weren't going down that well) and he said she was fooling her self, put her on a typical dose and upped her Estrogen levels. Her T levels dropped on the estrace.

So, maybe there is something going on. Then again, the spiro would be good and I don't know anyone who isn't on spiro.

First some generic endocrinologic facts overly simplified in a biological male body. Note that this ignores lots of things:
* GnRH pulses increase LH and FSH
* LH (and FSH) increase production of T
* Both T and E downregulate GnRH, FSH and LH
* E is produced from androgens via P450-aromatase (e.g. FSH regulates this)
* SHBG determines what portion of T (and to a lesser extent E) is biologically active (higher SHBG -> less active)
* T downregulates SHBG
* E upregulates SHBG
* DHT is a more potent form of T produced from androgens including but not limited to T

Now we add estrogen:
* Downregulates GnRH
* E and GnRH Downregulates FSH, LH
* LH (and FSH) downregulate T
* SHBG is increased (thus makes T less bio-active)
* DHT is somewhat decreased but much less than T

Then we add spiro, things are different with different AAs:
* blocks bio-active testo and DHT at the receptor level, i.e. they are precent in the cells but spiro stops them from affecting things. This blocks androgenic effects.
* if male-pattern-baldness is a problem then adding finasteride/dutasteride makes sense.

I take spiro, estradiol and dutasteride.
I had very low levels of free testosterone. 

I have been VERY reactive.

I would like to note taking a DHT blocker increases estrogen and testosterone levels if taken alone, however combined with the other part of HRT the T really does not increase. 

Gothique, I think we are on the same dosages.  But we will not discuss numbers here. 

I had to wait a year before I was given anything besides the estradiol. My doc wanted baselines all the way through the HRT journey. It has worked out extremely well for me.

Spiro didnt do much if anything for me cept make me lethargic and grumpy... oh and generaly dehydrated due to long hours in the sun and such....

We tried it on a trial period and then removed it as it didnt have any noticable positive effect on me.  my T level before HRT was in the 80s and its now abit lower than that..

Im only takeing EV injections and prgestrone, also in injectable form and getting fair results off the two 

Sometimes the AA isnt necicary, it seems to be likeeverything else case by case <even if AAs are the standard> according to the person.

Quote from: Amy T. on September 26, 2007, 01:37:39 PM
I take spiro, estradiol and dutasteride.
I had very low levels of free testosterone. 

I have been VERY reactive.

I would like to note taking a DHT blocker increases estrogen and testosterone levels if taken alone, however combined with the other part of HRT the T really does not increase. 

Gothique, I think we are on the same dosages.  But we will not discuss numbers here. 

Um, maybe. I'm on Spiro, Estrace, and Prometrium. My endro really doesn't believe in Prometrium, but my family doctor put me on it. My levels are good, so he's not going to mess with what my family doctor put me on. He also thinks that I don't need Spiro at all, and it's not really doing much, but since I'm still getting laser and electro (just touch up ones now) he's going to keep me on Spiro for a little while longer. I'm not supposed to see my Endro until after my GRS, and then he'll adjust things.

--natalie

My initial reaction was that after finally making the commitment to transition and then taking the steps to get my HRT letter, that I was unlucky to find a Dr. who had different ideas about treatment than is typical. I'm going to try to be patient and trust the endo.

I'll continue to talk to her about anti androgens in the appointments ahead as we monitor my blood test results. I am 49 and have experienced hair loss, which could worsen without blocking the t?

So far, after 4 days I feel a few effects from how I felt before. I have had this continual butterfly like feeling in my stomach (which may be an increase in heartrate?). I have felt a little more tired (with that feeling behind the eyes that comes when you need sleep) and a feeling of contentment. I am very happy to be on this next step of my life adventure and look forward to the changes to come.

Thanks everyone for replying and helping me with your experiences and knowledege.

Valerie