Quote from: Cindy on July 15, 2017, 08:04:15 AM
@Maybebaby56, I do not believe that the scientific literature covers transgender females, oestrogen and venous thrombosis risk. There are on occasion posts suggesting that the physiology of transgender females to cis females in regard to oestrogen effect is equivalent but as far as I am aware there has never been a comparative study. For a surgeon to ignore risk for no reason beyond discomfort would be unethical. That said and just to complicate matters, when I had my larynx removed recently, which I think counts as major surgery, no one worried about my oestrogen levels. However all my documents listed my gender as female so when my pre surgery check asked what drugs I was on and I mentioned E that was just taken as normal post-menopausal female HRT management, noted and ignored.
I think the point that surgeons are concerned with E and surgery is risk management, if you can possibly reduce risk you do so.
Sorry for the thread hijack 
Cindy,
I certainly understand your point, especially the part about surgeons wanting to reduce risk (and liability). But risk management is not risk elimination, it is about risk vs benefit (i.e. cost of risk mitigation), and that can be very squishy to quantify.
"Postoperative venous thrombosis does occur in transgender women who undergo elective surgery, including gender affirming surgery [23], leading some authors to suggest holding hormonal therapy for 2 weeks prior to elective surgery and resuming once mobility is regained [18,36].
No prospective data exists to confirm the benefit of this recommendation, although similar recommendations have been suggested for women receiving postmenopausal hormone replacement therapy."
Thrombotic issues in transgender medicine: A reviewAm. J. Hematol. 92:204–208, 2017
Quote from: SadieBlake on July 15, 2017, 08:16:11 AM
Terri, I agree with you on the science and I pushed back on my surgeon but she wouldn't OK me even at my miniscule im dosage.
That creates the problem that they're going to ask (like a dozen times) what meds I'm taking and whether I've stopped E and I'd have to dissimulate or my doc would cancel. The thing is, I'm really unable to be anything but truthful on important stuff (small stuff too) even when the penalty for it is pretty high. Even the more so when I'm completely in love with my surgeon and she's doing such a big thing for me.
Not saying don't go with your plan, I thought about it myself, I just couldn't.
Yup, it's a personal decision. Life is risky. The lowest risk option is not to have the surgery at all. This is not acceptable to me. I am willing to accept the risks. On having hot flashes, insomnia, and irritability on top of pre-op stress well that's a finer line. The risk is very low, but the consequences can be catastrophic. I think stopping sublingual estradiol a week or two before surgery and switching to patches is an acceptable compromise, but that is my decision.
Oral hormones increase the risk of VTE by 160%, from 0.7 per 1000 cases to 1.1 per thousand cases (in women over 50). A lot of transgender women take oral hormones anyway, and would never consider giving them up, even given the data.
But I am derailing this thread. I will stop now. Sorry, Moni!
~Terri
Edit: Sadie PM'd me and made the excellent point that post-op nmenopausal symptoms will be mitigated by pain meds. The real problem for me will be dealing with pre-op stress. Fortunately Moni had a long chat with me, and talked me off the ledge. I think I my real problem is I'm stubborn.
