I was diagnosed with BPH one year ago. I started Silosidine Silodosine+Dutasteride 9 months ago which clearly improved my symptoms.
Then 6 months ago I started a low dose feminization HRT (estradiol patches, no AA besides Dutasteride).
Everything went well until I had to undergo a minor surgery (phlebectomy) which was performed under general anaesthesia though. That was 7 weeks ago.
In the mean time, 5 weeks ago, my endo has doubled the estradiol dose I take twice a week. Since that time BPH symptoms have recurred. I wonder if it might be due to the increase of estradiol intake. Informations I have found are contradictory. Some tell that exposition to estrogen makes the prostate shrink, others (a lot) tell that it makes the prostate grow.
I have an appointment with my urologist next week. I am scared that he asks me to stop HRT.
If anyone has more information (with scientific references) on this subject, it might help me a lot for the discussion with the doctor (I know he has no or very few experience with trans patients).
Thanks for any advice !

I am not an expert on this but lowering your T levels should cause your prostate to shrink. There is a possibility if you are not on blockers that the estrogen isn't sufficient to reduce you T levels but without blood test results, it's a bit of a guessing game. Your Endo and urologist may need to talk and decide what the best way to shift your chemical balance to bring things under control.

Quote from: Dena on March 16, 2016, 04:33:05 PM
I am not an expert on this but lowering your T levels should cause your prostate to shrink. There is a possibility if you are not on blockers that the estrogen isn't sufficient to reduce you T levels but without blood test results, it's a bit of a guessing game.

Sorry I forgot to give my last results (dated this week):
- 17beta-estradiol: 67 pg/ml
- testosterone: 2.10 ng/ml

QuoteYour Endo and urologist may need to talk and decide what the best way to shift your chemical balance to bring things under control.

I hope they both will accept to cooperate with each other. But even if they do, I would prefer to have enough information and arguments beforehand so that I am able to understand and discuss their decision.

High doses of estrogen have been prescribed for decades to men with prostate cancer. If there was any chance E increased the size of the prostate, I very much doubt this practice would have persisted for so long. Results seem quite positive.

Prostate 1991;18(2):131-7

"Four hundred and seventy-seven prospectively randomized patients with
prostatic carcinoma were treated with a combination of intramuscular
polyestradiol phosphate (PEP) and oral ethinyl estradiol, with
intramuscular PEP alone, or with orchiectomy."

"Age-standardized mortality from cardiovascular diseases was very low in the
PEP group, as compared to other treatment modalities, and the mortality rates
for prostatic cancer were about equal in all three treatment groups.
It is concluded that intramuscular PEP monotherapy is associated with
low cardiovascular mortality and with an all-cause and prostatic
cancer mortality equal to orchiectomy."

Prostate 1989;14(4):389-95

"Oral estrogen therapy for prostatic cancer is clinically effective"

Prostate 1988;13(3):257-61

"Thirty-eight patients with cancer of the prostate were treated with
strict parenteral estrogen"

"Twenty-nine of the 38 patients (76%)
have responded to therapy."

J Urol. 2003 May;169(5):1735-7.

"We report preliminary results of a pilot study
using transdermal estradiol therapy to treat men with advanced
prostate cancer."

"Transdermal estradiol therapy produced an effective
tumor response."

I am post-op, I take high doses of E and have very little T. My PSA is VERY low.

There is the problem and time to have a talk with your Endo. Your T levels are still at the lower end of the male range so a blocker might be appropriate.
http://www.hemingways.org/GIDinfo/hrt_ref.htm

Quote from: Lucie on March 16, 2016, 04:53:00 PM
- 17beta-estradiol: 67 pg/ml
- testosterone: 2.10 ng/ml

Your estradiol is LOW and testosterone levels above female range (210 ng/dl).

Where did you read that estrogen makes the prostate grow? Are these studies? In humans?

I heard that dutasteride may actually increase the risk of aggressive prostate cancer although this risk seems VERY low.

Quote from: Dena on March 16, 2016, 05:00:31 PM
There is the problem and time to have a talk with your Endo. Your T levels are still at the lower end of the male range so a blocker might be appropriate.
http://www.hemingways.org/GIDinfo/hrt_ref.htm

Thanks Dena for the link. I will talk to my endo and to my urologist as well. I expect that they will decide I have to take CPA :-( which is the main AA prescribed for trans women in France where I live.

Quote from: KayXo on March 16, 2016, 05:04:05 PM
Your estradiol is LOW and testosterone levels above female range (210 ng/dl).

Where did you read that estrogen makes the prostate grow? Are these studies? In humans?

"Androgens and estrogens in benign prostatic hyperplasia: past, present and future"
Tristan M. Nicholson and William A. Ricke
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179830

Quote
I heard that dutasteride may actually increase the risk of aggressive prostate cancer although this risk seems VERY low.

The same is for finasteride.
This is the reason why my urologist prescribed dutasteride at 1/3 dose.
But as you say the risk seems very low. The "Long-Term Survival of Participants in the Prostate Cancer
Prevention Trial" study (https://swog.org/Visitors/PCPT/NEJM2013.pdf) has shown that ten-year survival rates were higher in the Finasteride group than in the placebo group...

Quote from: Lucie on March 16, 2016, 05:20:32 PM
I expect that they will decide I have to take CPA :-( which is the main AA prescribed for trans women in France where I live.

Just beware of depression, irritability, extreme fatigue on it. Happens to some. Vitamin B12 levels may drop. CPA is also known to increase prolactin levels and has been implicated in some cases of prolactinoma in transsexual women (only 8 cases reported in the literature) so watch out for that as well AND galactorrhea, especially. It may increase water retention, dull libido and affect adrenal activity, being a glucocorticoid agonist. Finally, it may adversely affect coagulation, slightly increasing it. High doses have the potential to cause hepatotoxicity, more so long-term. Many have done quite well with low doses, including me.

Another anti-androgen available is bicalutamide.

Quote from: KayXo on March 16, 2016, 05:34:08 PM
Just beware of depression, irritability, extreme fatigue on it. Happens to some. Vitamin B12 levels may drop. CPA is also known to increase prolactin levels and has been implicated in some cases of prolactinoma in transsexual women (only 8 cases reported in the literature) so watch out for that as well AND galactorrhea, especially. It may increase water retention, dull libido and affect adrenal activity, being a glucocorticoid agonist. Finally, it may adversely affect coagulation, slightly increasing it. High doses have the potential to cause hepatotoxicity, more so long-term.

This is what I fear.
Until recently I was hoping that estrogens would be sufficient for the level of feminization I aim, without the need of any AA...

QuoteMany have done quite well with low doses, including me.

If the doctors conclude towards CPA I'll ask a low dosage, as for estradiol.

QuoteAnother anti-androgen available is bicalutamide.

Thanks Kay for the details. I will discuss the bicalutamide option with both doctors.

There is one other way to control the T levels that isn't normally considered but might be a solution for you and thats having a Orchiectomy. I am not sure how it's handled in your country so it might be out of the question.

Quote from: Lucie on March 16, 2016, 05:28:33 PM
Androgens and estrogens in benign prostatic hyperplasia: past, present and future
Tristan M. Nicholson and William A. Ricke

And yet, we only have 4 reported cases of prostate cancer as of 2013 in transsexual women, despite sometimes, very aggressives doses of estrogen prescribed to transsexual women for several decades.

Can Urol Assoc J. 2013 Jul-Aug; 7(7-8): E544–E546.

"The development of prostate adenocarcinoma in feminized transgender women is extremely rare. It has been assumed that castration in early life protects against prostate cancer. There are a few case series on castrated Ottoman court eunuchs, who, after 44 years, have small or non-palpable prostates on digital rectal examination, with evidence of atrophy on histological examination.1 It might suggest that the development and the viability of the gland throughout life require the continued presence of androgens. After 8 months of anti-androgen or estrogen therapy, the histological appearance of the prostate reveals low content of malignant epithelial cells, which are only detectible by immunohisto-chemical staining."

I have not fully read the study you provided, but from what I gather so far, the idea that estrogen can cause prostate to grow comes from animal studies (findings not necessarily applicable to us) and the fact that it occurs in men when estrogen to androgen ratio increases BUT as far as I know, estrogen levels stay more or less the same with age (non significant increase) whereas androgens decrease significantly with age, so perhaps high levels of androgens were protective? I always wondered about this...Perhaps, one or the other sex hormone needs to be there, enough of either to prevent cancer to occur?

Quote from: Lucie on March 16, 2016, 05:48:29 PM
Until recently I was hoping that estrogens would be sufficient for the level of feminization I aim, without the need of any AA...

At one patch, T levels are already quite low, but not low enough so perhaps 2 (or 3 patches) will do the trick without having to resort to any AA? One can also, with the consent of doctors, add gel and combine this with patch.

Lucie,

Did you have your PSA levels tested? Perhaps you should. And a digital rectal exam, just to be sure as PSA is not always reliable. See what your doctor thinks... (I speak French, btw).

Quote from: Dena on March 16, 2016, 06:11:09 PM
There is one other way to control the T levels that isn't normally considered but might be a solution for you and thats having a Orchiectomy. I am not sure how it's handled in your country so it might be out of the question.

A friend of mine who did not want vaginoplasty has chosen orchiectomy for getting rid of AA (this surgery is practised by some surgeons in my country). She is quite satisfied of her choice. So yes, orchiectomy might be the right answer for me. I just have to accept the idea that I'll have to keep my male genitals until the end of my life...

Quote from: KayXo on March 16, 2016, 06:12:19 PM
And yet, we only have 4 reported cases of prostate cancer as of 2013 in transsexual women, despite sometimes, very aggressives doses of estrogen prescribed to transsexual women for several decades.

Can Urol Assoc J. 2013 Jul-Aug; 7(7-8): E544–E546.

"The development of prostate adenocarcinoma in feminized transgender women is extremely rare. It has been assumed that castration in early life protects against prostate cancer. There are a few case series on castrated Ottoman court eunuchs, who, after 44 years, have small or non-palpable prostates on digital rectal examination, with evidence of atrophy on histological examination.1 It might suggest that the development and the viability of the gland throughout life require the continued presence of androgens. After 8 months of anti-androgen or estrogen therapy, the histological appearance of the prostate reveals low content of malignant epithelial cells, which are only detectible by immunohisto-chemical staining."

I am no longer in my early life. I started HRT at 64...
Besides that I wonder if BPH and prostate cancer respond in the same way to sex hormones (?).

QuoteI have not fully read the study you provided, but from what I gather so far, the idea that estrogen can cause prostate to grow comes from animal studies (findings not necessarily applicable to us) and the fact that it occurs in men when estrogen to androgen ratio increases BUT as far as I know, estrogen levels stay more or less the same with age (non significant increase) whereas androgens decrease significantly with age, so perhaps high levels of androgens were protective? I always wondered about this...Perhaps, one or the other sex hormone needs to be there, enough of either to prevent cancer to occur?

I agree with you that animal models are not necessarily applicable to humans.
In the study I mentionned the authors state that estrogen levels raise with age due to aromatase. But they also say that "the precise role of endogenous and exogenous estrogens in directly affecting prostate growth and differentiation in the context of BPH is an understudied area".
You are probably right when you tell that BPH (and/or prostate cancer) result from insufficient overall sex hormones level (in the same way that it causes menopause deseases for cis women). At least, I hope so...

Quote from: KayXo on March 16, 2016, 06:15:12 PM
At one patch, T levels are already quite low, but not low enough so perhaps 2 (or 3 patches) will do the trick without having to resort to any AA? One can also, with the consent of doctors, add gel and combine this with patch.

I will wait until I have seen my urologist next week and then I'll ask my endo if I should increase the estradiol dose at once (it was already doubled one month ago).

Quote from: KayXo on March 16, 2016, 07:00:22 PM
Lucie,

Did you have your PSA levels tested? Perhaps you should. And a digital rectal exam, just to be sure as PSA is not always reliable. See what your doctor thinks... (I speak French, btw).

I assume that the urologist will prescribe a PSA dosage. As for the digital rectal exam, I don't like that at all but if it's necessary I will submit to his finger. 

Thanks a lot Kay and Dena for all your advices and suggestions.
Hugs to all of you.

Quote from: Lucie on March 17, 2016, 04:23:33 AM
I am no longer in my early life. I started HRT at 64...

In theory, you starting HRT now should still reduce your risk of getting prostate cancer. Consider the low incidence of this cancer amongst eunuchs and transsexual women relative to men.

QuoteI wonder if BPH and prostate cancer respond in the same way to sex hormones (?).

BPH usually resolves upon starting anti-androgens and/or estrogens. Prostate cancer appears to also respond positively to the treatment of estrogen or anti-androgens (and/or orchiectomy).

QuoteIn the study I mentionned the authors state that estrogen levels raise with age due to aromatase.

I doubt the increase is significant.

QuoteBut they also say that "the precise role of endogenous and exogenous estrogens in directly affecting prostate growth and differentiation in the context of BPH is an understudied area".

If indeed estrogens could induce growth, we would observe many more incidences of BPH and prostate cancer in transsexual women (6 reported cases, after more thorough investigation), some of whom were treated with quite high doses of estrogen over the years. The opposite seems to actually be true.

QuoteYou are probably right when you tell that BPH (and/or prostate cancer) result from insufficient overall sex hormones level (in the same way that it causes menopause deseases for cis women).

Or perhaps, it is just a result of weakened body defenses (immune system), dysregulation of proliferation, body not working as well, which naturally occurs due to ageing. This seems the most likely to me, after thinking it through.

Quote from: KayXo on March 17, 2016, 08:41:58 AM
Or perhaps, it is just a result of weakened body defenses (immune system), dysregulation of proliferation, body not working as well, which naturally occurs due to ageing. This seems the most likely to me, after thinking it through.

Kay, are you saying that I am too old for engaging in HRT ?