first post my name is lydia. been meaning to get on here for a long long time..


my hrt dosage so far.

endocrinologist has me on premarin and  finasteride.


is this the best route for me i can say over the last year and a half i have definite breast growth and am still quite tender which the doc says means they are still growing.. am i taking the right medication and doses?

Mode Edit:Dosage

Welcome to Susan's Place. Dosages are not the best way to determine if your levels for HRT are correct. You should receive blood test at the 3 month mark and your E and T levels should be checked you can post those on this site and others will help you interpret the numbers. In the old day we used standard dosages as we didn't have the testing ability we had today. The results were that some of us saw very little development and others responded well. Today with testing, all of us are able to live up to our genetic potential.

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Greetings Lulu!

You're under an endo so that's great. Presuming they know their stuff then you just need to be led by them tbh. Dosages are not permitted for discussion, as you'll have found out, but if you're under an endo then they're likely to be in normal safe range.

Fwiw, I did the same as you for a long time with finasteride + estradiol though I much prefer the normal rather than conjugated oestrogen. About a month back I switched from finasteride to dutasteride. I'm not entirely sure why I did that except that dutasteride is a better T to DHT blocker. I have had what I think are some side effects so I'm coming under an endo out here in Thailand where I now live as well as my UK one.

There are plenty of people on here who will tell you that you need to be on a 'proper' T blocker i.e. one which stops T production rather than just the T to DHT conversion. Personally I don't think you need necessarily take much notice of that. Finasteride or Dutasteride in conjunction with oestrogen will do the job perfectly satisfactorily. Your overall T level, not just DHT, will drop away. I now have no ejaculate at all: I mean literally nothing comes out. My T level recently has dropped through the floor whilst my E level has gone way into female range. That's without using any of the conventional T blockers like spiro or androcur, both of which are nasty nasty drugs imho. The UK NHS will not prescribe spiro for transgender and, as you know, androcur (Cyproterone acetate) is a flippin dangerous drug esp in its form with diane 35 - a banned drug in the US and therefore topic on here. Avoid that one like the plague. I would also personally avoid spiro as it's not intended for the purpose of transitioning and I think it's also a dangerous drug.

The other route to go down is GNrH analogues about which others know way more than me. It's those which the NHS prescribe. My T levels have vanished without any recourse to them but it may be something I consider for the sake of my liver. All these drugs are toxic to our bodies. It's one of the biggest reasons why I'm pulled to go the whole way for SRS.

Good luck and welcome on here!

I believe your endo is incompetent, and I'd try find another, or at least get them to change medications

Premarin is horse estrogen, not human estrogen. They are not the same chemical. Fine if you're a horse, but we're not. There was a time that Premarin was the only thing available, but technology moves on and that's no longer true. In the meantime the company that makes Premarin has billions of dollars in sales and doesn't want to lose it. Of course they will says its good, just like "More Doctors Smoke Camels than Any Other Cigarette".

I've got to agree really: I don't much care for the conjugated variety either. Aside from liver toxicity there's increased DVT risk as well as cancer risks.

Neither ethinyl estradiol (as in the unmentionable D drug) nor conjugate oestrogen (premarin) are naturally occurring in humans and I guess AnonyMs has a good point therefore.

Wonder why the endo didn't prescribe normal oestrogen?

Ok, I will step into the argument. I started my transition in 1977 and Premarin was the safest drug available at the time I remained on it up to about 2006 and didn't suffer any ill effects from it. I have learn that my reasons for discontinuing HRT were invalid and have resumed HRT a month ago on Estradiol and while I haven't much time on the newer medication, it seem like it may be more effective than the Premarin was. In addition, the cost is far less. Estradiol is the primary human sex estrogen and the other estrogens are produced from it. Premarin on the other hand is a mix of hormones with some of it being estradiol the the rest may not be the ideal mix for the human body.

I have a copy of the standards of treatment that I am being treated under and Estradiol is the estrogen of choice while Premarin is the secondary choice.

I would say for you to question your doctor about the decision to use Premarin because the results may be as good or better and the cost could be much less.

Quote from: Dena on March 29, 2016, 12:58:27 AM
Estradiol is the primary human sex estrogen and the other estrogens are produced from it. Premarin on the other hand is a mix of hormones with some of it being estradiol the the rest may not be the ideal mix for the human body.

I'm pretty sure Estradiol in humans and Estradiol in horses is not the same chemical, even if it is spelled the same in English. I'm not sure of the terminology, but I believe they belong to a general class of estrogens, but are chemically different. This is where the bioidentical term comes in, and premarin is not bioidentical with human estrogen.

Some people have an ethical issue with Premarin as well.

 

The argument is over.

See a competent endocrinologist. Please.

As in any medical treatment if you have doubts seek a second opinion.

..

Cindy,

I am just posting the following for informational purposes so people can be better informed when they go see their doctors. This will allow them to best decide if the doctor who is treating them is indeed competent, it's a safeguard against possible malpractice or incompetency. Doctors are human after all and some may not always make the best decisions. I urge others to also do their own research, talk to as many experts as possible, and remain critical at all times of all information they are exposed to, including in HERE and my information. I believe the following is useful and important though as it can serve to initiate a positive discussion with the doctor who is prescribing these medications and encourage the person to seek the opinions of other experts as well.

Thank you. and best of luck!

Quote from: PrincessLulu on March 28, 2016, 07:42:36 PM
my hrt dosage so far.

endocrinologist has me on premarin and  finasteride.

Premarin is an estrogen which increases health risks to a greater degree than bio-identical estrogen while both estrogens are just as effective for feminization and breast growth. It makes no sense to take Premarin as you are unnecessarily increasing harm to your body.

Finasteride has been associated with bouts of depression/anxiety in some people even after discontinuation and reduces very important neurosteroids that affect learning, memory and mood.

I would have a talk with your doctor and ask to perhaps be switched to bio-identical estrogen (17-beta estradiol or estradiol valerate) and perhaps drop finasteride and take another potent anti-androgen if estrogen alone is not enough for decent feminization. In the end, they decide and as Cindy stated, if you feel they aren't right, get a second opinion.

Quote from: Dena on March 28, 2016, 08:28:39 PM
Dosages are not the best way to determine if your levels for HRT are correct. You should receive blood test at the 3 month mark and your E and T levels should be checked

I disagree, especially on Premarin as it contains horse (equine) estrogens that affect the body and cannot be measured by tests. There is no ideal level of E for everyone and besides, levels fluctuate over time so tests only reveal one given point in time. Same with T, some need less, some are ok with a little more. In my opinion, solely relying on how your body is responding to HRT is enough to tell you if it's working as planned. In the end, your doctor decides based on their own protocols.

Quote from: Richenda on March 28, 2016, 11:59:13 PM
Finasteride or Dutasteride in conjunction with oestrogen will do the job perfectly satisfactorily.

It DEPENDS on many things. Not always.

QuoteI would also personally avoid spiro as it's not intended for the purpose of transitioning and I think it's also a dangerous drug.

If you take the necessary precautions, drinking enough water and eating enough salt, you should normally be fine. Also limit high potassium stuff.

QuoteThe other route to go down is GNrH analogues about which others know way more than me. It's those which the NHS prescribe. My T levels have vanished without any recourse to them but it may be something I consider for the sake of my liver.

There have been no studies showing bio-identical estradiol to cause liver problems. Premarin and other non-bio-identical estrogens may however cause problems in high doses or even perhaps, lower doses.

QuoteAll these drugs are toxic to our bodies.

Toxic is a strong word. It depends. Estradiol and progesterone are the same hormones half the world population produce for decades, sometimes in very high amounts during pregnancy so I wouldn't call these drugs toxic. Spironolactone seems quite safe. Some other drugs and non bio-identical estrogens pose higher risks, but toxic is a strong word!

Quote from: Richenda on March 29, 2016, 12:43:35 AM
Aside from liver toxicity there's increased DVT risk as well as cancer risks.

To be fair, in the large WHI study of 2003, Premarin was actually associated with a decrease in breast cancer incidence. Also a decrease in colon cancer. The addition of another hormone was associated with cancer.

Quote from: AnonyMs on March 29, 2016, 03:15:00 AM
I'm pretty sure Estradiol in humans and Estradiol in horses is not the same chemical

Premarin is a mix of hormones from horse estrogen (equilin) to estrone (predominant one), similar to what is found in humans so that you have naturally occurring estrogens in humans and others which only occur in horses.

Thanks everyone ive been doing my own reasearch also i have agreed that premarin is defintally questionable, i did a clinical trial and i didnt really like menest and i cant remember im sure it was estrodiol ( i was incarcerated at the time and had to take what they gave me.) and i was in such a rush to get back to the premarin because i knew i was having good results from it. But from fact that im getting deeper into my transition investing to move on to the next step. I wanted to know if others had different experinces i plan to call one to talk soon at least.

You might ask at lgbt centers for a referral to an endocrinologist.
Some plannedparenthood do also hrt.

You might ask for bioidentical micronized estrogen, one example is estrace or a generic.
It can be taken sublingually which is supposed to be less straining on the liver and avoiding clotting.

Some people had good effects with injections.
With injections it is possible to keep the levels well in the female range which all by itself drives down t and no antiandrogen might be necessary. This can be safely done only with hormone implants or injections.
With injections a weekly schedule can avoid a seesaw pattern with high and low levels which may be possible with a biweekly schedule.

You might look for an endo versed in transgender treatment, and talk to them.


*hugs*

Quote from: PrincessLulu on March 29, 2016, 12:13:23 PMi didnt really like menest and i cant remember im sure it was estrodiol

Still contains some horse estrogens such as equilin which is difficult for the human body to metabolize and as a result, remains in the body longer and thus triggers change in clotting to a greater degree. The predominant hormone in Menest is estrone (in its inactive form), also found in the human body which converts to estradiol, the most potent of the three forms found in the human body.

Overall, I think it contains less equine (horse) estrogens than Premarin so is safer.

So everyones recommendation is estradiol?

I would recommend talking to your doctor about it. There may be a reason why you were prescribed the medication you were given and the decisions on your HRT should be made jointly between you and your doctor.

Quote from: Dena on March 31, 2016, 09:04:26 PM
I would recommend talking to your doctor about it. There may be a reason why you were prescribed the medication you were given and the decisions on your HRT should be made jointly between you and your doctor.

I disagree that Premarin may have been prescribed for a reason. I see absolutely no good reason to ever prescribe it as it  is as effective as estradiol for our purposes but riskier. Studies have shown this quite unequivocally.

But, I agree this should be discussed with your doctor and together you should come to an agreement about what is most effective and safest for you.

I think it is important we have a forum like this where we can share information that may prove useful for the person, after discussion with the doctors. Doctors aren't infallible, they are human beings, they don't always know everything, can make mistakes. So double checking is always good.

Quote from: PrincessLulu on March 31, 2016, 08:25:22 PM
So everyones recommendation is estradiol?

bioidentical estrogen
Patches (Estradot, Vivelle-Dot),
Gels (Sandrena, Divigel, Estrogel),
Injectable estradiol valerate and generics. 
bioidentical estrogen pellet implants

Bio-identical progesterone (Prometrium, Utrogestan, Cyclogest)

talk with your endo about it.


hugs

Thanks everyone im stopping by my endo's office today to have her give me a call when she can about switching to a bioidentical medication for the estrogen.

Quote from: PrincessLulu on April 01, 2016, 07:58:23 AM
Thanks everyone im stopping by my endo's office today to have her give me a call when she can about switching to a bioidentical medication for the estrogen.

It should also be in her interest. Long term there are supposed to be less side effects.


*hugs*