Hi Everyone,
So I finally got the nerve to let my GP (family doctor) prescribe me low dose E.  He said one thing I've never heard before.  He said that older men and women have less hormone receptors and cannot handle the same dosage as younger people.  He still prescribe me the low dose E but at a lower dose than expected?
Has anyone heard this before? 
Thanks,
Paige

First I've heard of it. I'm not exactly young anymore and I'm on a far higher level than most people get, prescribed by an endo with 3500 trans patients.

Quote from: Paige on July 07, 2016, 01:22:07 PM
So I finally got the nerve to let my GP (family doctor) prescribe me low dose E.  He said one thing I've never heard before.  He said that older men and women have less hormone receptors and cannot handle the same dosage as younger people.  He still prescribe me the low dose E but at a lower dose than expected?

There is something wrong with this reasoning: If we have less E receptors then we need more estrogens for achieving the same effect, not less.

Hi,

I am 54 and have been on HRT for over 3 years. I am on a high dose of E through injection (highest dose my doctor will permit). My primary care has 8 practioners that see almost exclusively trans. Excess E is metabolized.

Congrats Paige!  Might be a low dose...but it's a huge step!  [emoji274]


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Quote from: Paige on July 07, 2016, 01:22:07 PM
So I finally got the nerve to let my GP (family doctor) prescribe me low dose E.  He said one thing I've never heard before.  He said that older men and women have less hormone receptors and cannot handle the same dosage as younger people.  He still prescribe me the low dose E but at a lower dose than expected?

Quote from: Lucie on July 07, 2016, 03:20:03 PM
There is something wrong with this reasoning: If we have less E receptors then we need more estrogens for achieving the same effect, not less.

You might show this to your doctor:

Endocrinology An Integrated Approach, Stephen Nussey and Saffron Whitehead
Oxford, UK : Bios, 2001
(http://www.ncbi.nlm.nih.gov/books/NBK20/#_A33_)

"Usually less than 5% of hormone receptors are occupied at any one time and maximum biological responses are achieved when only a fraction of the total number of receptors are occupied. Thus, it might be questioned why a small reduction in receptor number or a change in hormone concentration should make much difference to the overall biological response. This is governed by the law of mass action. If receptor numbers are reduced then the chances of a hormone binding to a receptor are decreased. Thus, a higher concentration of hormone is required to achieve a similar receptor occupancy. A similar argument may be applied when hormone concentrations are reduced."

I think individual variation must be huge. I'm 60 (I kinda hate typing that #) and started at the normal IM injection amount of estradiol valerate which resulted in a very high estrogen level, 700pg/ml. Still high after cutting the dose in half and now halving it again, which raises the difficulty of accurately administering 1/16 cc (note for mods, this isn't a dosage, merely injection volume which depends on concentration).

My experience suggests at least some older women have a strong response to HRT.

OP, oral administration *can* be a problem for older people, as first-pass metabolism via the liver eliminates most of the effect of the dosage. Patches, injection and sublingual administration are all workable alternatives that bypass the first pass effect.

Thank you all for the responses.  I think I'll have to discuss this with him again at our next meeting.  To be fair to my doctor, he has only one other trans patient and the patient is FTM, so he admits that he's learning as we go.  He seems very receptive to suggestions so I don't think it will be a problem.  I think with the first E prescription he just wanted to be cautious.

We'll figure this out.  Thanks again.
Paige