so i had my blood tests done and i found out that my T levels were within male ranges but just on the very bottom of male ranges, so i was expecting to get a change in my anti androgen medication, so i had my meeting with my endo on monday and he told me that he needed to increase my estrogen levels to decrease my testosterone levels,  i was confused and told him i thought that my anti androgen would be responsible for dropping my testosterone and not the estrogen to which he disagreed, so i just took the new prescription and left but im worried he is just lieing to me for some other reason, like related to how i still haven't presented as female when i have visited him

i have a close trans friend that has told me that she is on double the anti androgen dosage of mine and i was expecting to start taking the same amounts as her

Your endo speaks the truth.  Estrogen alone will shut down testosterone production.

Obviously many people think anti-androgens are necessary, but Spiro has several un-desirable side effects.  Anyone taking estrogen and an anti-androgen will have a bit of difficulty determining which med is responsible for the results.

There are many variables involved and a scientific study would be difficult.  Imagine finding transsexual twins and subbing a placebo for one twin's anti-androgen.


 

A similar experience as I´ve made today. I guess the Endos having a new "policy" applying on hormone levels in Trans Women.... Anyway, she told me that it was sufficient to transitioning for having an Estrogen level ranging above the current T-level in order to "trick" the brain and preventing the body from producing more T. She explained to me that the brain receptors triggering the gonads to produce a certain amount of hormone if needed, i.e. the brain assesses the current hormonal level and steers the production of hormones. So, with an Estrogen level high enough, the brain wouldn´t find anything to do about and therefore not "commanding" the gonads to produce T. After time, the gonads will become in an atrophy state and from then on, there would be no T production possible anymore.

I was really stunned and I asked her if there was no need for anti-androgens anymore (since what she told me stood in contrast to everything I´ve read before) and she admitted that at my current T-levels it would only allow to apply a small dose of anti-androgens...

Honestly, I don´t know how to think about this. I´m going to have more research done I guess.

xoxo

It is true that Estradiol will decrease testosterone, but my doctor has said to me that using blockers to get the T levels down are more important than the Estradiol levels.  I am very privileged to have one of the few doctors who is a GP, but she specializes in transgender care and only has transgender patients.  I have been very happy with the results.

What he is saying is true. My HRT doctor who treats a lot of transgender MtF patients told me the same and my T level lab results at 7 month on HRT were:


                         Result        Male         Female
TESTOSTERONE, TOT.,S      217.2   249.0-836.0       20-85        ng/dL
FREE TESTOSTERONE         2.59   30.00-150.00      0.3-1.9       pg/mL

After increasing my Estrogen for 50% and injectable here were my results 3 months later:

                         Result        Male         Female
TESTOSTERONE, TOT.,S      15.2   249.0-836.0       20-85         ng/dL
SEX HORM.BIND.GLOB.       92     10-57             40-120        nmol/L
FREE TESTOSTERONE         1.32   30.00-150.00      0.3-1.9       pg/mL

That's a very big difference all in the female range now.

My HRT doctor didn't want to increase my Spiro because it's much more taxing on the liver where as Estrogen isn't, especially the injectable kind. She also upped my Finasteride as well. I'm very happy with the results

Quote from: Sydney_NYC on December 17, 2014, 02:15:54 PM
My HRT doctor didn't want to increase my Spiro because it's much more taxing on the liver

I didn't think that was the case since Spiro is sometimes prescribed to individuals with liver cirrhosis. 

When I started HRT my endo put me on a low dose of E only and said that should be enough to knock out my T...and sure enough it was. If you don't trust or believe your endo then see if there's another you can see or get a second opinion from...but it seems to me he knows what he's talking about.

I never once took spiro.  According to my endo it was unnecessary for me.  The biggest concern he had was my DHT level, which is why he put me on dutasteride. 

Things have improved greatly since I went "balls out" though.     

Quote from: KayXo on December 17, 2014, 02:28:00 PM


I didn't think that was the case since Spiro is sometimes prescribed to individuals with liver cirrhosis. 

That is kind of weird, here is a report about it. Also high amounts of Spiro we take can also be taxing on the kidneys as well.

I think generally speaking most endos are pretty confident in what they're doing, and taylor the medication pretty accurately individual to individual. Like a friend of mine who uses the same doctor had a dose much, much, much lower than mine, like I'm on more than 4 times what she's on. We have similar levels in our blood and my risk of clots is very low compared to hers.

Take your endos word for it, their objective is the same as yours and they know the easiest and safest way to achieve them.

Quote from: KayXo on December 17, 2014, 02:28:00 PM


I didn't think that was the case since Spiro is sometimes prescribed to individuals with liver cirrhosis. 

In end stage liver failure, liver contraindications are commonly ignored... I know, I watched someone die.

I'm on estrogen alone - never took an anti-androgen at all - and my T was at female levels within three months. E *does* suppress T to some degree; it depends on the person and the dose how much, but it may be that he thinks it's better to up the dose of the feminizing hormone now.

Spiro is used because some people need a really high dose of E to obtain adequate T suppression. Too much E can cause problems like DVT and increase your cancer risk.

I think your endo is giving you good advise.

I am on a low dose AA and a high dose E and my T varies between 20-36 ng/dl.

My endo started me on estrogen but we could never get the levels to settle down just with estrogen. I kept yo-yoing between about 60 ng/dl and about 190 ng/dl and it wouldn't settle down.

I honestly would have preferred an estrogen only solution, but alas, in my case it was not to be.

Quote from: Ms Grace on December 17, 2014, 02:33:43 PM
When I started HRT my endo put me on a low dose of E only and said that should be enough to knock out my T...and sure enough it was. If you don't trust or believe your endo then see if there's another you can see or get a second opinion from...but it seems to me he knows what he's talking about.

That's very interesting, as I'm the opposite, and I think we have the same endo.

I was on low dose for years and my T was between male and female. That part wasn't by the endo. The endo then put me on estrogen implant and spiro, and I've had another implant since - its definitely not low dose anymore. My T is now below female, although he says that could be measurement error. I questioned him about needing spiro since I'm not too keen on taking it "... but it seems to me he knows what he's talking about."

I'm not sure why I'm surprised, but I guess this particular endo really does tailor HRT to the individual. I must be getting overly cynical. Having said that, I do trust him, which is very unusual for me.

I really like the overall effect so far, but I might drop the spiro sometime and see what happens. I'll be pretty impressed if my T gets out of control.

Quote from: Madison (kiara jamie) on December 17, 2014, 01:23:47 PM
so i had my blood tests done and i found out that my T levels were within male ranges but just on the very bottom of male ranges, so i was expecting to get a change in my anti androgen medication, so i had my meeting with my endo on monday and he told me that he needed to increase my estrogen levels to decrease my testosterone levels,  i was confused and told him i thought that my anti androgen would be responsible for dropping my testosterone and not the estrogen to which he disagreed, so i just took the new prescription and left but im worried he is just lieing to me for some other reason, like related to how i still haven't presented as female when i have visited him

i have a close trans friend that has told me that she is on double the anti androgen dosage of mine and i was expecting to start taking the same amounts as her

Don't worry too much. All that matters is results.

If you want to get technical with your blood tests watch your SHBG levels. Too low means you may increase E (thus accelerating feminization) and too high means your body is getting rid of excessive E. Antiandrogens are much more likely to cause undesirable side affects than estrogens so it's easy to assume the reason for that prescription.

Quote from: Sydney_NYC on December 17, 2014, 03:14:41 PM
That is kind of weird, here is a report about it. Also high amounts of Spiro we take can also be taxing on the kidneys as well.

As the report states, this RARELY occurs, just a few cases, and it is mild. So, really, it is quite UNLIKELY; otherwise, it would not be prescribed/indicated for people who have liver cirrhosis.

Quote from: ImagineKate on December 17, 2014, 07:37:19 PM
Spiro is used because some people need a really high dose of E to obtain adequate T suppression. Too much E can cause problems like DVT and increase your cancer risk.

This was more the case in the old days when non bio-identical estrogens were used, in regards to DVT. Today, bio-identical estrogen is mostly prescribed and has a much less negative impact on coagulation factors especially if taken non-orally, where risk is minimal. I personally don't think high levels are linked to cancer because otherwise, why would pregnant levels who experience such high levels have a lesser risk and why does risk increase over the age of 40 (and especially 50), when E starts to drop significantly. Food for thought...

Quote from: Indoctrinated on December 18, 2014, 05:34:26 AM
If you want to get technical with your blood tests watch your SHBG levels. Too low means you may increase E (thus accelerating feminization) and too high means your body is getting rid of excessive E.

SHBG increases as more E circulates through the liver so has nothing to do with reacting to excessive levels of E.

He is telling you the truth. The numbers below really do show how little to no spiro is needed to get the job done.
Here were my numbers before ordered by my primary care doctor.
06/11/2014   10:00 AM   ESTRADIOL   49.3   pg/mL
06/11/2014   10:00 AM   ESTRIOL,UNCONJUGAT   0.1   ng/mL   
06/11/2014   10:00 AM   ESTRONE   126   pg/mL   
06/11/2014   10:00 AM   FREE TESTOSTERONE   14.6   pg/mL
06/11/2014   10:00 AM   PROGESTERONE   1.76   ng/mL   
06/11/2014   10:00 AM   TESTOSTERONE   885   ng/dL
HRT started 9/20/2014
first numbers ordered by the endo who only checks the testosterone and Estradiol numbers with only low dose Estradiol patches.
10/27/2014   8:07 AM   ESTRADIOL   60.9   PG/ML
10/27/2014     8:07 AM    TESTOSTERONE 551   ng/dL
Shortly after that I was switched to self injections again low dose with a little bit of Spiro
12/02/2014   8:54 AM   TESTOSTERONE LCMSM   28   ng/dL
12/02/2014   8:54 AM   ESTRADIOL   244.8   PG/ML

He thought the Estradiol level was high, but since we had changed when the injection was at the beginning of that cycle I talked him into one more number he tries to lower what is already low.
12/17/2014   8:35 AM   ESTRADIOL   254.6   PG/ML