I know the drill of stopping Estrogen a couple weeks before GCS, however I am curious to know if this requirement applies across the board or if there is certain criteria that determines this necessity.

I am considering a tummy tuck as I've lost about 100 lbs (yay!) and am at a point where surgery looks like the only option.

Any advice is appreciated,
Thanks!
Brooke

In general yes. It is to prevent excessive bleeding and most surgeons will stop E if they can do so. Obviously they cannot in cisfemales but if they could they would!

My congratulations young lady that is a remarkable effort and you should be very proud!

Two weeks seems to be the standard but it could differ with various surgeons and procedures

It was two weeks when I had my shoulder worked on

Congrats on your progress!!!

Hugs

I'd think the rationale behind the practice is not to stop excessive bleeding, but to reduce DVT.  Estrogen increases clotting (which is why it skyrockets not just in pregnant women, but in all kinds of pregnant mammals, so that giving birth can be survived).

I had some minor surgery a few years ago and the surgeon knew nothing about the risks of HRT. I decided to follow the GCS protocol just to be safe.

If you use implants there's no need to stop.

Quote from: Sophia Sage on November 03, 2016, 07:56:02 AM
I'd think the rationale behind the practice is not to stop excessive bleeding, but to reduce DVT.  Estrogen increases clotting (which is why it skyrockets not just in pregnant women, but in all kinds of pregnant mammals, so that giving birth can be survived).

Skyrockets? Exaggeration.

Curr Opin Obstet Gynecol. 2014 Dec;26(6):469-75.

« Venous thromboembolism is, in the developed world, a major cause of maternal morbidity and mortality during pregnancy or early after delivery, with a reported incidence ranging from 0.49 to 2.0 events per 1000 deliveries."

In other words, ABSOLUTE risk is 0.05-0.2%. Despite estradiol levels being as high as 75,000 pg/ml (http://cebp.aacrjournals.org/cgi/content-nw/full/12/5/452/T1 ).

Add to this that,

Ann Intern Med. 2005 Nov 15;143(10):697-706.

« The relative risk (standardized incidence ratio) for venous thromboembolism among pregnant or postpartum women was 4.29 (95% CI, 3.49 to 5.22;P < 0.001), and the overall incidence of venous thromboembolism (absolute risk) was 199.7 per 100,000 woman-years. The annual incidence was 5 times higher among postpartum women than pregnant women (511.2 vs. 95.8 per 100,000), and the incidence of deep venous thrombosis was 3 times higher than that of pulmonary embolism (151.8 vs. 47.9 per 100,000). Pulmonary embolism was relatively uncommon during pregnancy versus the postpartum period (10.6 vs. 159.7 per 100,000). "

"Among pregnant women, the highest risk period for venous thromboembolism and pulmonary embolism in particular is during the postpartum period."

Risk of thromboembolism during pregnancy is therefore 0.1%, with risk of pulmonary embolism being 0.01%. Very very low incidence despite VERY high levels of E2.

I am on injectable bio-identical estradiol and I don't need to stop regardless of the surgical intervention as my clotting times remain normal. My E2 levels range anywhere from 1,000 - 4,000 pg/ml. The route of administration and type of estrogen (bio-identical) appear to play a crucial role in the effects on coagulation.

Prostate 1989;14(4):389-95
Estrogen therapy and liver function--metabolic effects of oral and parenteral
administration.

"The impact of exogenous estrogens on the liver is dependent on the route
of administration and the type and dose of estrogen. Oral
administration of synthetic estrogens has profound effects on
liver-derived plasma proteins, coagulation factors, lipoproteins, and
triglycerides, whereas parenteral administration of native estradiol
has very little influence on these aspects of liver function."


I didn't stop taking estrogen (was bio-identical, sublingual) before my SRS or gallbladder removal surgery. Some doctors like Dr. Marci Bowers don't require you stop estrogen. Some anti-androgens need to be stopped, however. This needs to be discussed with a doctor who has an extensive knowledge of these matters.

I had back surgery just 2 weeks ago. With my surgeon knowing every medicine I take, the only thing I was asked to discontinue was the fish oil pills I use to control my cholesterol. When the hospital called, they concurred with what my surgeon said.

It might be that I had my orchiectomy so long ago, and discontinuing HRT would cause menopause. They do have devices to use in order to prevent DVT, or clotting in the legs. Walking down the halls, accompanied by staff, is also a healthy idea.

Lots of good information here, thanks! Sounds like it depends on several variables. Delivery method, type, personal reaction in terms of clotting, and surgeon preference.

Definitely feel like I have enough information to have an informed conversation with the surgeon at this point.

One thing I have learned is most doctors just have no knowledge or experience when it comes to trans HRT protocols and risks. Best to be informed so we can advocate (and possibly pass along some knowledge).

Thanks for the congrats on weight loss as well! Things are definitely coming along. I'm actually surprised that I continued to lose weight after starting HRT, as I was expecting at best to just maintain and at worse gain a ton back.

Suppose that just goes to show each person reacts differently. So fascinating!


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