Hi all,

I am terrified of DVTs....

I just got off the phone with my Endo. Since I am traveling to Vegas the 20th on a 6 hr flight. I asked her if it would be ok to stop Hormones until I get back.

She told me Yes.

2 weeks Prior which means that tomorrow will start my 3-4 weeks without Hormones.

I am Pre-OP (My GCS is this Nov)...That's another HRT Stoppage Story lol.

Are there any side effects for stopping for about 3-4 weeks that anyone has ever noticed or experienced?
Should I worry?

At least I can drink while in Vegas and I rarely drink.

Thank you.

Jess

Some people take a low dose of aspirin for a week before flying to reduced the chance of dvt. I don't know if it actually makes any difference.

I just get up and walk around every do often. I don't fly 6 hours though - do that from Sydney and you'll be swimming.

Quote from: Jessika on July 05, 2017, 02:39:30 PM
Hi all,

I am terrified of DVTs....

I just got off the phone with my Endo. Since I am traveling to Vegas the 20th on a 6 hr flight. I asked her if it would be ok to stop Hormones until I get back.

So what do ciswomen do? Their bodies naturally produce estrogen. What you fail to realize is that when you take the exact same hormones ciswomen produce and when, that hormone is delivered directly into your blood, exactly like in ciswomen, then you are just like them and shouldn't worry about such issues as several studies have shown that, even in older folks (sometimes with cancer and an increased risk of getting DVT), the risk is negligible on quite high doses of estradiol given non-orally. Many fear hormones without understanding that birth control pills and that sometimes HRT for menopausal women consist of estrogens and progestogens not naturally produced by the human body and that can wreck havoc on the body. If you are taking bio-identical estradiol, then you should be fine. Unless your doctor instructs otherwise, of course. 

I've been on 6-7 hour flights and my levels of estradiol range anywhere from 1,000-4,000 pg/ml. There was no reason for me to stop the hormones and if I do, I would feel lousy, hot flashes, irritable, low energy, etc.

Low does Aspirin and compression socks was the recommendation of my PCP for a 22 hour flight in August... I'll try, usually Aspirin messes up my digestive system pretty badly but it still beats DVT.

Drinking a lot and walking around the plane regularly also helps. Not having any other risk factors like smoking would also be beneficial to prevent DVT.

Quote from: AnonyMs on July 05, 2017, 02:57:24 PM
Some people take a low dose of aspirin for a week before flying to reduced the chance of dvt. I don't know if it actually makes any difference.

I just get up and walk around every do often. I don't fly 6 hours though - do that from Sydney and you'll be swimming.

I would be interested in actually reading studies where aspirin was shown to be effective in reducing the risk of DVT in people with no priors.

I believe that Aspirin has none or nearly none effect on the risk of having dvt. It has some effect on the risk of getting a stroke or myocardial infarction.

Skickat från min LG-H815 via Tapatalk

Quote from: KayXo on July 06, 2017, 06:51:22 AM
So what do ciswomen do? Their bodies naturally produce estrogen. What you fail to realize is that when you take the exact same hormones ciswomen produce and when, that hormone is delivered directly into your blood, exactly like in ciswomen, then you are just like them and shouldn't worry about such issues as several studies have shown that, even in older folks (sometimes with cancer and an increased risk of getting DVT), the risk is negligible on quite high doses of estradiol given non-orally. Many fear hormones without understanding that birth control pills and that sometimes HRT for menopausal women consist of estrogens and progestogens not naturally produced by the human body and that can wreck havoc on the body. If you are taking bio-identical estradiol, then you should be fine. Unless your doctor instructs otherwise, of course. 

I've been on 6-7 hour flights and my levels of estradiol range anywhere from 1,000-4,000 pg/ml. There was no reason for me to stop the hormones and if I do, I would feel lousy, hot flashes, irritable, low energy, etc.

You fail to realize that Ciswoman don't have testicles as Pre-op Transwoman do.

I think you added one too many zeros there also. I think those levels would kill someone. Looks like a typo....

ESTRADIOL: Adult Female Reference Ranges for Estradiol, ESTRADIOL: Ultrasensitive, LC/MS/MS: ESTRADIOL: ESTRADIOL: Follicular Phase: 39-375 pg/mL ESTRADIOL: Luteal Phase: 48-440 pg/mL ESTRADIOL: Postmenopausal Phase: < or = 10 pg/mL ESTRADIOL: ESTRADIOL: ESTRADIOL: Pediatric Female Reference Ranges for Estradiol, ESTRADIOL: Ultrasensitive, LC/MS/MS: ESTRADIOL: ESTRADIOL: Prepubertal ESTRADIOL: (1-9 years): < or = 16 pg/mL ESTRADIOL: 10-11 years: < or = 65 pg/mL ESTRADIOL: 12-14 years: < or = 142 pg/mL ESTRADIOL: 15-17 years: < or = 283 pg/mL

Mine is at an 86 pg/ML.

You can't compare Cis-Gender Woman to Pre-Op Transwoman. With testicles still producing testosterone it COULD have a different effect going off of Hormones.

A Cis Woman usually takes Estrogen to help due to the lack the body is producing to stay within the recommended ranges of her specific situation.

A Transwoman takes Estrogen to enhance the Female Hormones that are already present and Spironolactone (Or other) to suppress the Testosterone production and/or effects.

When a Transwoman stops all Hormones, Estradiol Levels drop and Testosterone once again takes over if Pre-Op.

Taking a pause on Estradiol as a safety precaution for travel will not materially affect your transition.  But you ought to continue taking Spironolactone or other antiandrogen.  Two weeks is a bit much really and your current trough measurement of 86 pg/ml is not very high at all.  I'm having minor surgery in a couple of weeks and they would like me to discontinue Estradiol a week in advance.  A call to your doc might be an idea to confirm the rather hyper conservative direction of a month off HRT.  Particularly since you're going be a bit moody as your system adjusts.  Most of all have a wonderful trip and be safe always.  T-girls, booze and nightclubs can be a bit worrisome.  Please be careful.

Hugs,
Julie

Quote from: Jessika on July 06, 2017, 08:45:24 AM
You fail to realize that Ciswoman don't have testicles as Pre-op Transwoman do.

OMG this quote had me ROTFL.

I doubt that anyone on this forum fails to realize that Ciswomen don't have testicles. [emoji846]

The previous poster MAY have failed to take that fact into account however. 

I'm not sure it means anything much, but I've done a fair number of 20+ hour flights and my levels are often 400pg/ml+. That's a guess, it could be a lot more. I don't test levels at their peak, but 13 months after my last implant I was around 250pg/ml.

Quote from: Jessika on July 06, 2017, 08:45:24 AM
You fail to realize that Ciswoman don't have testicles as Pre-op Transwoman do.

That has no bearing on the risk of DVT whatsoever. Studies in men with testicles (with advanced cancer) treated with estradiol, with high levels, through patches, showed that the risk of DVT did not increase and actually decreased.

QuoteI think you added one too many zeros there also. I think those levels would kill someone. Looks like a typo...

No, it wasn't a typo. My estradiol levels are 1,000-4,000 pg/ml since 2014. I'm under the supervision of 4 doctors. My blood test results come back normal. I'm healthy. My blood pressure measured this morning was 120/77.

Pregnant women have levels between 1,000-40,000, sometimes up to 75,000 pg/ml. The risk of DVT during pregnancy is 0.1%, of pulmonary embolism, 0.01%.

http://www.ilexmedical.com/files/PDF/Estradiol_ARC.pdf

"Normal estradiol levels are lowest at menses and into the early follicular phase (25-75 pg/mL) and then rise in the late follicular phase to a peak of 200-600 pg/mL just before the LH surge, which is normally followed immediately by ovulation. As LH peaks, estradiol begins to decrease before rising again during the luteal phase (100-300 pg/mL)."

"If conception occurs, estradiol levels continue to rise, reaching levels of 1,000-5,000 pg/mL during the first trimester, 5,000-15,000 pg/mL during second trimester, and 10,000-40,000 pg/mL during third trimester. 6-8"

https://www.ncbi.nlm.nih.gov/pubmed/24776841

In this study, in late pregnancy, levels as high as 75,000 pg/ml.

See this study also in ciswomen
https://www.ncbi.nlm.nih.gov/pubmed/7835827

"Estradiol increased from 34.8 +/- 7.5 pg/ml to 3226 +/- 393 pg/ml after 3 months and to 2552 +/- 254 pg/ml after 6 months, respectively, in group A. Bone density increased by 15.3 +/- 3.6% within the first 3 months to a total of 18.8 +/- 3.9% after 6 months, respectively. Two patients we have controlled for two years, maintained this increase. In group B estradiol increased from 27.8 +/- 6.5 pg/ml to 3028 +/- 728 after 3 and to 2491 +/- 684 pg/ml after 6 months. Bone density in this group increased by 11.8 +/- 1.9% within 3 and to a total of 18.2 +/- 2.8% after 6 months."

Authors of this study reported minimal side-effects and good tolerability.

QuoteESTRADIOL: Adult Female Reference Ranges for Estradiol, ESTRADIOL: Ultrasensitive, LC/MS/MS: ESTRADIOL: ESTRADIOL: Follicular Phase: 39-375 pg/mL ESTRADIOL: Luteal Phase: 48-440 pg/mL ESTRADIOL: Postmenopausal Phase: < or = 10 pg/mL ESTRADIOL: ESTRADIOL: ESTRADIOL: Pediatric Female Reference Ranges for Estradiol, ESTRADIOL: Ultrasensitive, LC/MS/MS: ESTRADIOL: ESTRADIOL: Prepubertal ESTRADIOL: (1-9 years): < or = 16 pg/mL ESTRADIOL: 10-11 years: < or = 65 pg/mL ESTRADIOL: 12-14 years: < or = 142 pg/mL ESTRADIOL: 15-17 years: < or = 283 pg/mL

Lab ranges vary.

http://www.specialtylabs.com/clients/outreach/web/site/details.asp?tid=44312&cid=301&keyword=
Normals for Males: 11 - 44 pg/mL
Female normal by day of the week relative to LH peak:
Follicular: 21 - 251 pg/mL
Mid Cycle: 38 - 649 pg/mL
Luteal: 21 - 312 pg/mL
Post menopausal (HRT): 0 - 144 pg/mL
Post menopausal (non-HRT): 0 - 28 pg/mL

http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=36169
Estradiol       
Female       
  Follicular Stage   39-375   pg/mL
  Mid-Cycle Stage   94-762   pg/mL
  Luteal Stage   48-440   pg/mL
  Postmenopausal   ≤10   pg/mL

QuoteYou can't compare Cis-Gender Woman to Pre-Op Transwoman. With testicles still producing testosterone it COULD have a different effect going off of Hormones.

Studies in cismen with testicles, as noted above, have shown that the impact on coagulation (i.e. negligible) of high levels of estradiol (mean levels 500-600 pg/ml, up to around 1,000 pg/ml) to be similar to ciswomen, when bio-identical estradiol is taken non-orally. There are studies in transwomen too that show that despite high doses of bio-identical estradiol, taken by patches or injections, there were barely any thromboembolic complications (occurrence less than 1%).

I'm addressing the issue of stopping HRT due to the risk of DVT, not the effect that stopping hormones will have on DVT. I think you misunderstood my point.

QuoteWhen a Transwoman stops all Hormones, Estradiol Levels drop and Testosterone once again takes over if Pre-Op.

What I'm saying is that it doesn't appear necessary to stop bio-identical estradiol, especially if taken non-orally, in doses typically prescribed to us, due to risk of DVT. There is no evidence supporting it. Please note that I AM NOT A DOCTOR. Consult with your doctors and share these studies with them if you wish. I'm stating my own opinion based on the data I have thus far come across. Some doctors may agree, some may disagree. As always, follow your doctor's advice.

I did not stop estrogen prior to gallbladder surgery or any of my flights.

Andrologia. 2014 Sep;46(7):791-5.

"it may be prudent to discontinue hormone treatment at least 2 weeks before sex reassignment surgery (SRS) or other elective surgery, although this is not supported by evidence. After surgery the VTE risk decreases slowly over weeks (Sweetland et al., 2009), and resuming hormone treatment postoperatively after 3–4 weeks seems a reasonable approach although, again, not supported by evidence"

I can share more studies/links by private message. I will not post more studies or links here.

I don't get the preoccupation with chasing levels instead of actual feminization results.  Especially since most transgender women today are taking bio-identical estrogen.

. . . in a medical establishment that is obsessed with cya.

@KayXo...You are covering a whole new Topic. All I'm trying to do is find out if Pre-Op Transwoman noticed effects of stopping HRT for 3-4 weeks for whatever reason and then started back up.

I should have made it more clear.

I didn't intend for you to write an Off-Topic novel, but still great info nonetheless.

As for those measurements.....To each their own.

Thanks.

So far I have not had any issue with 3+ hour flights. I just drink plenty of water, and stretch as much as possible.

Jessica, yes you'll notice the difference, you could see it as a trial run to know what to expect when you have to stop hrt before your vaginoplasty. I agree with continuing your antiandrogen.

The DVT risk stems principally if you're taking your dose as tablets. Estrogen puts a fairly high stress on the liver which I believe in turn is what's making that elevated risk.

You do also want to take the basic precautions for flying including getting up to walk some and staying well hydrated.

Hugs, have a great time.

What did I notice? Nothing good.. Mood wings.. Hot flashes.. Depression.. Reduction in breast size that has not recovered.. Oily skin.. Acne.. And by the end, raging libido..

Quote from: Jessika on July 06, 2017, 03:11:24 PM
@KayXo...You are covering a whole new Topic. All I'm trying to do is find out if Pre-Op Transwoman noticed effects of stopping HRT for 3-4 weeks for whatever reason and then started back up.

I think Kay was simply pointing out that there is little, if any, risk of DVT - which seemed to be the primary reason you are stopping. I just don't see why you would stop.

Thank you all.

@KayXo..I didn't mean to sound rude or harsh. I apologize.

It's always good to gain more information and you have provided that.

Thank you!

I had to quit 3 weeks before and 1 week after GCS. Noticed a mild change in mood and body hair growing faster.
I travel frequently both domestic and international on flights anywhere from 2 - 14 hours. I've been doing this for the entire time I've been on HRT (2+ years) with E levels at 400 - 600 pg/mL. On the long flights I sleep, read and walk around once in a while, but on a 3-4 hour flight I just sit. Never had a problem and I don't worry about it. I'm on injections.

I really appreciate all the responses. I use the Pill version btw.

I have decided, starting this morning to only take half my daily dose for the first week and then stop it entirely at the one week before flight (Thursday).
This way I will only be off of hormones completely for 13-14 days. That should not be too bad.

Better safe than Sorry is my thinking.

I will have to do this again in November for my GCS when I will be off of Hormones for 7 weeks. At least Spiro will be done forever.