My doc has me on Avodart and a high dosage of spiro in addition to prometrium and IM EV injections...

Ive been on HRT for 13 months now and my T has been under 10 ng/dl for at least 9 months now....

What Id like to do is drop the Avodart and spiro and try a GNRH agonist for the next 6-9 months before I have SRS and just use bio identical E and P from here on out....

While I seem to tolerate both Spiro and Dutas pretty well I also think Id probably feel a lot better without them and just using E and P... I do like the idea of just a few of shots carrying me through to the other side and possibly feeling better and even seeing better feminization with a much simpler regiment.... Cost is not an issue even if my insurance wont pick up some of it...

I like the idea a lot and Ive been doing some research but most of it related to TG care is for delaying puberty, not a concern here... Im sure there are side effects that might not warrant using them but again I cant find much info... Im sure my OB/GYN doc probably is clueless as well but he has expressed concerns about both the Spiro and the Avodart... Id like some info to give him for MTF HRT, he's real keen on the Endo Society "guidelines" and the do mention GRNH for an AA in MTF HRT....

Im in the US but I do know in Europe they are a popular choice for an AA so hopefully someone can give me some first hand feedback on them, Thanks

Hi Eva,

I'm on the GNRH agonist Gosserelin (Zoladex) .

I get it through an injection in my tummy where the implant will sit while slowly being absorbed. It's a big needle of course, big enough to be able to get the small pellet through. I got a prescription for EMLA (anesthetic cream) to put on the area a few hours before to help with the pain the first time I had the injection. Ask your physician about that if you can. She forgot to put a band aid on the site and I didn't know wether I would need it. But by the time I got to reception on my way out my top was full of blood so watch out for stuff like that, these aren't too common so even experienced practicioners might overlook a thing or 2.

I was adviced to stay on my previous AA for 2 weeks after receiving my first injection/implant due to the way GNRH agonists work... Goserelin acetate stimulates the production of the hormones testosterone and estrogen in a non-pulsatile (non-physiological) manner. This causes the disruption of the endogenous hormonal feedback systems, resulting in the down-regulation of testosterone and estrogen production. Meaning it puts your hormones in overdrive which causes an on purpose crash in your system halting production of T completely. But those 2 weeks are a chaos hormonally so hence the need to keep on your previous AA, I mention all of this cause I did substantially feel it. Even with my old AA I felt bursts of depression and bursts of happiness, that I immediately realized were hormonally dependent. So do watch out for those. I tried to find comfort in the fact that I knew the implant was starting to work and it would only be a short period of time.  Right around the 2 week timeline things seem to get back to normal if not more calm and at ease than ever before. There is a feeling like there's not a struggle between your hormonal intake and your body trying to do what it was originally designed to do. Maybe it's just that I feel so well .

Your physician will want to do a trial period to make sure you're not having any rare reactions to it, so you will get 1 or 2 of the 1 monthly implants and then, if all is well, move onto the 3 monthly ones. My situation is very much like your intention of being on them up to getting to the finish line with GRS .

I feel great and they seem to do a better job than anything else. The specialist and my Dr likened to a full orchiectomy for all effects and purposes.

I hope this helps

Thanks

Id think Id have to feel better even if if it was partly psychological just knowing that T was shut down and not taking all that spiro and the dutas

Honestly the dosage of E Im on probably does more than the spiro to shut things down but I refuse to go off AA's until I have SRS...

Can I ask what AA you were using when you first started??? Since potentially both E and P could rise naturally during the surge were you advised to lower or go off E??? 

I can show medical necessity for SRS so Id think my insurance would have to cover some of the cost... What does it cost you???

Thanks again that was very helpful

I know there are others like Lupron Depot and another that intrigues me is Suprefact thats taken nasally...

Ok I wrote a big long post and I deleted it by mistake when I was about to finish Arghhh! So here go again.

I was put on a slightly lower dose of E, and it was simplified to sublingual/oral only. This change is expected to be for a while now, they simply expected I would need a lower amount of E with Zoladex, the lasts test verified that, I am now just waiting for more tests just to make sure that it is now stable and will not fluctuate.

I was originally on Spiro back in Cali, and have been on cypro for a couple of years here in the UK, until this year that I got started on Goserelin. Although the wonderful National Health Service pays for it, the specialist told me the 3 monthly implant is priced somewhere around £500 (6-700 usd) back home in Cali , I used to work for a health service provider, I was very much involved wih health insurance companies, checking patients coverage, out of pocket payments, etc. as you know, it really all depends on what your insurance will cover. In this case, I'm assuming your insurance covers Grs which is a good sign. It might be that they are at least willing to cover what it would cost you to be on the treatment you are now and you make the difference out of pocket. Unless you can manage to get your physician on their case as well, who knows then,maybe they'll cover more?

I am not very aware of the other GNRH Agonists, I only know of a girl who goes to a different Gender Identity Clinic and she gets the shots in her butt cheek as like with every other injection. And it is definitely not the same brand I'm taking. I am almost certain it's Lupron, that you mentioned there.

Ok so there!

Quote from: Eva on May 09, 2015, 12:29:02 PM
My doc has me on Avodart and a high dosage of spiro in addition to prometrium and IM EV injections...

Ive been on HRT for 13 months now and my T has been under 10 ng/dl for at least 9 months now....

What Id like to do is drop the Avodart and spiro and try a GNRH agonist for the next 6-9 months before I have SRS and just use bio identical E and P from here on out....

No sense in taking a GnRh agonist because IM EV alone (as opposed to sublingual/oral) is probably suppressing gonadal production of androgens completely and that is what a GnRh agonist does exclusively. The agonist would, at the very least, contribute so little in the event that IM EV is not able to fully suppress gonadal production that, in my opinion, this would be a huge waste of money. Also, there is the risk of scarring while the benefit is so small, it doesn't justify the risks and costs. As always, please verify this with your doctor.

Quote from: KayXo on May 09, 2015, 02:59:36 PM
No sense in taking a GnRh agonist because IM EV alone (as opposed to sublingual/oral) is probably suppressing gonadal production of androgens completely and that is what a GnRh agonist does exclusively. The agonist would, at the very least, contribute so little in the event that IM EV is not able to fully suppress gonadal production that, in my opinion, this would be a huge waste of money. Also, there is the risk of scarring while the benefit is so small, it doesn't justify the risks and costs. As always, please verify this with your doctor.

Well The thought of greatly reducing or even going completely off my E for reassignment surgery is not very appealing but at least once I started on a GNRH I wouldn't have to worry about T coming back ever Im sure my doc would want labs after it kicked in too and he would likely want to reduce my E dosage

What Im looking for is first hand experience and some good info on the risks involved VS the benefits for TS HRT.... Yes T is completely shut down for now but spiro and dutas and even higher dosage EV shots do have their own drawbacks and risks as well and Im sure some sort of discomfort going off of them...  Id rather go through the no doubt uncomfortable changes from going off the spiro and dutas and possibly even lowering my E dosage now rather than after SRS when dealing with recovery will be bad enough on its own...

Thanks for your educated opinion though

Quote from: calicarly on May 09, 2015, 02:45:30 PM
Ok I wrote a big long post and I deleted it by mistake when I was about to finish Arghhh! So here go again.

I was put on a slightly lower dose of E, and it was simplified to sublingual/oral only. This change is expected to be for a while now, they simply expected I would need a lower amount of E with Zoladex, the lasts test verified that, I am now just waiting for more tests just to make sure that it is now stable and will not fluctuate.

I was originally on Spiro back in Cali, and have been on cypro for a couple of years here in the UK, until this year that I got started on Goserelin. Although the wonderful National Health Service pays for it, the specialist told me the 3 monthly implant is priced somewhere around £500 (6-700 usd) back home in Cali , I used to work for a health service provider, I was very much involved wih health insurance companies, checking patients coverage, out of pocket payments, etc. as you know, it really all depends on what your insurance will cover. In this case, I'm assuming your insurance covers Grs which is a good sign. It might be that they are at least willing to cover what it would cost you to be on the treatment you are now and you make the difference out of pocket. Unless you can manage to get your physician on their case as well, who knows then,maybe they'll cover more?

I am not very aware of the other GNRH Agonists, I only know of a girl who goes to a different Gender Identity Clinic and she gets the shots in her butt cheek as like with every other injection. And it is definitely not the same brand I'm taking. I am almost certain it's Lupron, that you mentioned there.

Ok so there!

Thanks   Im not completely sure yet on my insurance covering SRS but I don't see it excluded in my policy either and I have seen a document from them mentioning coverage if all the SOC have been met  Thats a whole different subject concerning in or out of network though and Im going to Brassard so they might not pay for it on those grounds...  Id think they would pay for some of the cost of a GNRH but probably with a high copay as a "third tier drug" like they do now with my Dutas....

Of course it would be a short term deal anyway and in the grand scheme of all this not terribly expensive for me

I wouldn't want to worry about too much experimentation finding an effective dosage though

Well, in my case, estrogen prescription was only reduced ever slightly and simplified. As I was taking a combination of gel and oral. My oral dose was increased but not enough to match the combination dose. My tests show the  E levels are what was expected, there really isn't much to it, the specialist wants another test just to make sure that things are stable 3 months from last test.  The 1 month injection is about £150. If that helps your case in any way...

EV was great while I took it (years) but I got tired of being all anxi to have my next shot for the last day or 2 before it . I did see tons of breast development on that particularly, but I've been on HRT for a while, I've tried and tested everything, I'm no longer waiting for effects and running that race. My physician and I made sure I tried everything just to see what suited me best in every way.... But I do feel this has me just much more settled, less emotional, just serene and happy and my levels are stable and in great ranges. Thats all that matters to me at this point. And my future grs of course. But like I said, that's just me. I'm sticking to this until my GRS anyway.

Good luck Eva !

Quote from: calicarly on May 09, 2015, 06:14:49 PM
I got tired of being all anxi to have my next shot for the last day or 2 before it .

Then, all you had to do is increase frequency of injections. I take mine every 5 days.

Quotemy levels are stable and in great ranges.

Too stable levels may desensitize cells as with anything else. Ideal or great range varies from one doctor to another and some don't even care so really there is no consensus among doctors on what is a great range. Sensitivity varies from one individual to another so that a great range/level for one person may not be for the other. Levels fluctuate in time so test is inaccurate. Levels fluctuate greatly in ciswomen so that there is no set level in them either. The range is extremely wide, from less than 100 pg/ml to up to 650 pg/ml during a menstrual cycle.

Quote from: Eva on May 09, 2015, 03:48:20 PM
Well The thought of greatly reducing or even going completely off my E for reassignment surgery is not very appealing

Non-oral bio-identical estradiol has not been shown to increase clotting to a significant degree so I personally don't understand why it would have to be stopped or reduced prior to SRS. Ciswomen have estradiol circulating in their bodies and are not denied operations, including pregnant women, for instance, who have Cesarean. Their estradiol is the same estradiol you are taking. In both cases, estradiol is directly delivered to the blood. So, why should you need to reduce/cease E if ciswomen are allowed be operated on? Something just doesn't seem to fit, in my opinion. Perhaps discuss this with your doctor and see what they think?

Quoteeven higher dosage EV shots do have their own drawbacks and risks

What are these risks and drawbacks and how significant are they? So far, I've come across several studies in prostate cancer men, some as old as 91 in whom risk of clotting significantly increases, who were given high doses of transdermal/injectable estradiol, with levels up to 700 pg/ml and yet no cardiovascular or clotting complications were observed. In one study, the researchers even noted there was a protective effect toward thrombosis. Pregnant women, human beings like us, have extremely high levels, far higher than yours, and yet absolute risk of DVT remains at 0.02-0.5%.

I didn't create this post to argue for or against the effects of E as an AA and Im sure you know I agree with most of your points on feminization and levels of E, from my own experience I like more rather than less

Im not a doctor though.... Im sure with all the patients Brassard has seen and will see including you and me he's heard it all by now many times and in many ways...  Last I heard he does 2-3 a day and multiple days every week for how long now???  Whether I agree or not his opinion and judgement outweighs mine or anyone else's because he's the one doing the cutting...

But, remember, he's a surgeon, not an endocrinologist and you can't only go on assumptions and his title. Ask him to provide arguments, facts for why E must be stopped or any other medications/hormones. Recommendations must be based on facts. The point is to understand why do you what you do instead of just blindly following, asking the doctor is by no means a crime. Doctors are there to answer our questions. Dr. Brassard is cool guy, he should be able to answer your queries.