Quote from: Brenda E on October 23, 2014, 08:50:50 AM
I looked that study up, and while interesting, it's a study of a specific group of women (post-menopausal), being given a specific drug combination and dose (premarin and medroxyprogesterone), for a specific purpose (prevention of cardiovascular disease). To draw conclusions about the safety of medroxyprogesterone in an entirely different group of people (MtF), using vastly different drug combinations and dosages (countless), and for entirely different purposes (feminization) is misinterpreting the study and drawing conclusions that simply cannot be drawn. Inferences could be made perhaps, but nothing more.
WHI 2002 was a large-scale clinical trial which (going on its wikipedia page) looks to have involved around 200,000 women in total, of whom around 26,000 were given the hormone therapy. Its end results show that none of the treatments made a jot of difference except the hormone therapy, which caused considerably increased mortality. There were only two hormone therapies tested in the trial: Premarin + progestin (MPA), or premarin on its own. Both had increased mortality from several different causes. Although they didn't trial MPA on its own, you can just subtract the premarin results from the premarin+MPA to work out the increased mortality from MPA, which shows an increased risk of heart disease, blood clots, breast cancer and dementia.
The results of that study tie in with experience with other synthetic hormones, for instance birth control pills (which also use synthetic estrogen+progestin), likewise carry an increased risk of blood clots. There's another synthetic hormone, called methyltestosterone, that was at one time used for HRT in men, but was dropped in favour of bioidentical testosterone because it was killing so many of the patients given it.
Over the short term synthetic hormones are generally fine, but they all appear to cause harmful side effects with higher dose and longer term use. From our point of view, that makes them a poor choice for HRT, especially since the proper bioidentical hormones have been shown to be safe for long term use (as long as their blood levels are kept in the normal physiological range). There's also the fact that there are millions of healthy young people with high levels of bioidentical hormones flowing through their veins, without it appearing to have any adverse effects on their health!
The reason doctors like synthetic hormones is, I think, a mixture of convenience, inertia (it's only recently become apparent how harmful synthetics can be over the long term), plus they're probably steered in that direction by pharmaceutical company marketing campaigns too.
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Which, I think, highlights the difference between actual medical advice and one's own internet research. A good endocrinologist - one who has been practicing for a decade or two and has guided dozens, if not hundreds of transwomen to their goals in relative medical safety - is without question a trusted, important source of information.
I beg to differ. My own experience of doctors is that their knowledge of male hormonal problems is abysmal. Neither of the GPs I've seen appears to know the difference between primary and secondary hypogonadism, or how to interpret the blood work. Judging by what I've seen other people in a similar situation saying on the hypogonadism forums I subscribe to, this is a near-universal problem (although particularly bad in the UK). While I didn't manage to get as far as an endocrinologist referral myself, from what I've seen other people saying, all you get with most endocrinologists is an extra serving of arrogance on top of the ignorance. Doctors do a great job of making out that they know exactly what they're talking about, but the reality is that most of them don't have the first clue when it comes to hormones.
I don't know whether you've seen some of the stuff I've posted on here about DES, but between 1940 and about 1980, millions of pregnant women all over the world were given high doses of a powerful chemical castration agent called DES, in a misguided attempt to prevent miscarriages. One of the earliest case controlled studies carried out in medicine showed that DES was completely ineffective at preventing miscarriages, and actually increased the likelihood of them occurring. Nonetheless, the pharmaceutical companies continued to promote the stuff and doctors to prescribe it for a further 20 years. Even worse, for at least the last decade or so it was being used for miscarriage treatment, it must have been obvious to everyone dispensing it that the doses being used were insanely high. DES is an extremely powerful estrogen and towards the end, for most other purposes, was being dispensed in 0.1mg tablets. For miscarriage treatment, they were dispensing 25mg tablets - a 250x higher dose! The whole disaster was largely covered up, so that not many people today are even aware that it happened. If you look at some of the posts I've made on here in the past, I think DES is the underlying cause of many if not most cases of MTF gender variance in those of us who were born in that era (along with other intersex-related problems including hypogonadism, infertility and genital abnormalities).
Not long after DES was discovered, the first progestins were developed, which (although they're supposed to mimic a female hormone), were actually derivatives of testosterone. These drugs were likewise prescribed to large numbers of women (probably in the millions), until they were eventually discovered to cause male development in female fetuses. That disaster's been even more completely erased from history than the DES one, but I think could well explain most cases of FTM transsexuality from that period.
So doctors and the medical/pharmaceutical industry can and do make colossal mistakes that end up harming or killing large numbers of people. However, the way the system is set up, those mistakes rarely come to light.
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Anyone discounting the value of experienced medical practitioners in the transition process is advocating for removing an important safety net from the transition process. The docs might not get it right first time, every time, but they get it right the vast majority of the time and they know what to do when they get it wrong.
I do appreciate the opinions about the effects of the medication in transition, but when the posts start to wander into crazyland where experienced doctors are portrayed as clueless idiots, I think the value of the conversation becomes not just worthless, but actually harmful. God forbid anyone read some of this and decide to completely forego having an endocrinologist involved in their transition and instead self-medicate.
While I agree that it's important for anyone taking hormones to have their blood work monitored and, if at all possible, to get everything done under the supervision of a competent doctor, I think you need to take off your rose tinted glasses. There's an online e-book about the DES disaster (written by one of the mothers who trusted her physician and was given the drug), which is available as a free download here:
http://www.lulu.com/shop/pat-cody/des-voices-995/ebook/product-17522743.htmlIt's more focused on the problems experienced by the daughters, however it does mention some of the problems experienced by "sons" (many of whom are now daughters!) as well.
I'm not sure whether this is viewable outside the UK, but here's an article about another medical hormone disaster from that era in which several million people were exposed, that was likewise covered up:
http://www.telegraph.co.uk/health/10819186/Is-this-the-forgotten-thalidomide.html
