Thursday, October 4, 2018, Continued

The Estradiol/Estrone Dilemma...

For my last blood tests, I asked the doctor to order not just the standard estradiol and testosterone levels, but also estrone, estradiol, and total serum estrogen. This was because @SassyCassie had told me about a doctor in Michigan who had done a lot of research on the transgender condition and was becoming well-known for his effective methods. He'd recommended monitoring all those numbers. I didn't know at the time exactly why I was collecting them, but I knew I could figure it out later once I had the data.

The numbers were, well, weird. My estradiol looked good, 274 pg/ml. But estrone was 1574 pg/ml. The expected numbers for ciswomen are in the luteal phase, 16-173 pg/ml. And total serum estrogen was 2582 pg/ml. The highest expected in ciswomen is 590, during the follicular phase. I didn't know what my numbers meant, and neither did my doctor, but I knew they were way out of whack. Doc theorized that there had been a mistake, and we should let it ride until we had another set of numbers at the next 3 month check, to develop some sort of baseline.

In the meantime, two things were going on. Cassie wasn't satisfied with her numbers either, so started researching estradiol valerate - the intramuscular injectable. It has been in very short supply for at least a year, but after a lot of work, she determined that it was once again available. She got her prescription, and I got curious.

Simultaneously, I had been studying the work of the doctor I mentioned above. Dr. Will Powers had put together a PowerPoint presentation about the Care of the Transgender Patient, and I downloaded and studied it. And he spent five slides talking about exactly the kind of numbers I had. He sees that in 1/4 to 1/3 of his patients. The problem? With estrone that high, the estrogen receptors in the body are flooded with estrone instead of estradiol. And estrone is only 4% as efficacious as estradiol. So even with the good estradiol numbers I'm showing, I'm getting only 4% of the benefits. He found that those patients were among those swallowing the estradiol. When he switched them to valerate or topical application, the numbers straightened themselves out, and the increased rate and effectiveness of feminization was readily apparent. In the the nearly 16 months I'd been on HRT, I'd seen some body improvements, but I attributed what few changes I could see in my face to better skin care - and of course breast growth is never enough, is it? I copied the presentation onto a flash drive and made an appointment with my doctor for Thursday.

I do want to point out that though Dr. Powers found a certain number of his patients have this problem, 2/3 to 3/4 of his patients are doing fine on oral estradiol. So YMMV and you need to get properly tested and work with a doctor on this stuff.

My doctor is very open-minded and ready to listen, and he's come to trust my judgement and research on these things. We have a good working relationship, but he's also cautious and wants to take good care of his patients. My expectation for the day was that we'd have a good discussion and he'd agree to study the presentation, and follow up with another consultation before any decisions were made.

Instead, I walked out with a prescription for estradiol valerate. Or should I say, I floated out! The day before I had checked if my local pharmacy could get it, and while it wasn't in stock, it was readily available for ordering. While needles and I have a very uncomfortable relationship, I can't wait to try it. If I can't stick myself, there are a few people around who would be thrilled to stab me!

More to come!


Stephanie

Thursday, October 4, 2018, Continued

No longer making a spectacle of myself

I had been kicking around the idea of making as many changes as possible when I came back from Spain, with the idea that doing something radical would make the people who are still having problems seeing the new me realize that "he" doesn't exist any more. One thing is to really work on my voice and come back using only the new one. Let them think that I'd had some kind of work done to fix it while I was gone. They have no idea that there's no talking for a month, and it takes as much as a year to get the full effects.

I'm not sure if I can pull that off or not, but the other thing that occurred to me was getting rid of the glasses that people have always seen me wearing. That seems like a big enough change, along with the facial redecorating, that it would get their attention. And easy to do, too. I would really like to try Lasik, but I'm not sure I can afford that right now, so I was thinking about contacts until I could save the money for Lasik. I was still on the fence about the idea until I read the post-op instructions for the rhinoplasty. They recommend not wearing glasses for a while until the nose heals. That cemented the idea. On my way to see the doc about my estradiol, I stopped at my eye doctor's office to talk about it.

I waited at the counter behind some other people, and when they left, the lady who I've always worked with there looked around and said, "Yes, ma'am?" She was the one who had heartily congratulated me when I'd gone in earlier this year to get my records changed. This time she hadn't recognized me at first. Yay! We talked about contacts and set up an appointment, and while she was looking at my record on her screen I saw my old picture there. I commented that I had no idea who that was, and we agreed to shoot a new one when I came back next time. Big smiles, and on to my next appointment.

More to come!


Stephanie

Thursday, October 4, 2018, Continued

BUNCO!

Remember the post I'd made a few weeks ago about seeming to be excluded from an all-woman get-together in the neighborhood? It was here, with a followup here.

The original date had been September 28th, but it had been moved to last Thursday. As soon as I left my late afternoon doctor appointment I went to the party.

OMG

It was amazing. There were only 11 women there, and all but three were from the neighborhood. Of the eight locals, seven know my story for sure, and one I'm not sure about, though I suspect she doesn't know.

There were four to a table (with one empty chair), so I gathered my courage and deliberately joined the table with the three new ladies to push things to the limit.

I was simply Stephanie to them, another lady from our neighborhood.

Part of the attraction of the game is you are continually changing partners. You get to talk with everyone in the room at one time or another, and other than one particular person, who I'll talk about in a minute, there was absolutely no problem. I was "Stephanie," or "she," or "her" all evening. Those who did know, were discreet (with one exception) and those who didn't know - didn't know. We were face-to-face or side-by-side all evening, and I passed with flying colors. I mean that in any sense you like.

As alluded to above, all was not absolutely perfect. When I walked in and saw one particular person there, I knew there would be trouble. Not in a deliberate or mean sense, but in a "just can't remember to be careful" sense. Almost immediately she misgendered me. She caught herself, and for the rest of the game she used my name instead of pronouns. I don't think anyone noticed. Good enough. But when the game was over and we were standing around bantering, she misgendered me twice. And instead of letting it go, she started going on about, "Oh, and I was doing so well all night, too! Yadda yadda yadda." The hostess, who had been so kind in inviting me, caught her attention and shut her up. I suspect nobody else knew what she was talking about. But SHEESH!!

In the end, everyone said fond goodbyes and headed out. I even got a big hug from one of the new ladies because she loved the jalepano-bacon jelly/cream cheese dip I'd made (recipe courtesy of @SassyCassie). I profusely thanked my wonderful friend for inviting me, and headed home with my head spinning.

It was a wonderful rite of passage for this new woman.

More to come!


Stephanie

@Steph2.0
Dear Stephanie:
Great update....  for sure, as you intimated, successfully passing and not being recognized as your "old self" depends so much more that just your body appearance.... but like you stated, getting rid of your eye-glasses, FFS, having your new voice, (hmmm, no talking for a month!!!!!)    etc, etc..........   one step at a time....

Frankly, how you described your latest encounter at your pharmacy is so assuring and confidence building....  you are without a doubt "Stephanie" to all ... right now.

Thank you for updating all of your fans and followers....  I am always eager to check on your thread when I log in to the Forums.

Hugs and hugs and hugs,
Danielle

Thursday, October 4, 2018, Continued

Family...

When I got home from the party and had absorbed what had happened, I sat down to send an email to my Mom and sister to fill them in on my upcoming trip to Spain, what I was having done, and why.

Just as with all of you, they questioned the need, with my sister writing, "you have a beautiful smile - something we weren't accustomed to seeing in quite a while," and my mother saying, "I think you are beautiful the way you are." Their replies were so loving and supporting that the ocular leakage was impossible to contain. I have a wonderful family, and I regret doubting them and their reactions for all these years. I also regret that not everyone has such acceptance from their families. I do recognize how lucky I am.

More to come!

Stephanie

Thursday, October 4, 2018, Continued

Epilogue: Friday, October 5, 2018

I woke up early, with the memories of the preceding day spinning around in my head. And I cried happy tears. While there are still challenges to be met, and painful physical passages to navigate, I feel as if my social transition is completed. I can go anywhere in my day-to-day life, and as long as I take minimal precautions, I am perceived as I wish to be. It's something I despaired would never happen - for half a century I was in despair about it.

I have written this before, but I mean it as strongly as ever: I wish for everyone to eventually reach this point, to know the contentment and joy that living authentically brings. No one who doesn't go through this could ever know how it feels to finally reach this point. We all have our different routes to get here, but the personal growth we experience as we follow our individual paths will serve us the rest of our lives.

Best wishes for all.

Stephanie

Stephanie, congratulations on so many accomplishments!

Quote from: Steph2.0 on October 06, 2018, 08:52:25 AM
>
Instead, I walked out with a prescription for estradiol valerate. Or should I say, I floated out! The day before I had checked if my local pharmacy could get it, and while it wasn't in stock, it was readily available for ordering. While needles and I have a very uncomfortable relationship, I can't wait to try it. If I can't stick myself, there are a few people around who would be thrilled to stab me!

I should make a post on my updated experience with this in the HRT board.  I switched from patches to estradiol valerate self-injection in June and I've found the difference quite noticeable.  Although the dosage is theoretically equivalent to patches my E levels went up sharply (sorry about the jabbing pun) and breast growth bounced up right before a boob job in July... that's one reason I requested a bit less plastic.  There's been a visible increase in feminization although I have several other variables so I don't want to over-credit the switch to injections.  The process of self-injecting is something I would have never wanted to do in the past but the benefits are so awesome I'm fine with it all.  I have learned to do this and make it my Friday treat.  I stab, therefore I am.

This is a wonderful update Stephanie!!! I think we all have that one person that doesn't know when to shut up. I lived with one till I was 18. My mother called him The Horses Ass. No harm done.

I have an appointment with my Endocrinologist next week for my 3 month follow up. I am currently taking a oral generic for Estrace and Spiro. I will request the estradiol valerate self-injection. She offered it to me a few months ago but I'm not sure if it was the same thing. I would have had to go back every month or so for an injection. I told her I had been trained to handle a needle but for some reason, that wasn't possible.

Great news Stephanie. Thanks for the update.
Hugs,
Donica.

Quote from: Donica on October 06, 2018, 12:04:06 PM
I have an appointment with my Endocrinologist next week for my 3 month follow up. I am currently taking a oral generic for Estrace and Spiro. I will request the estradiol valerate self-injection. She offered it to me a few months ago but I'm not sure if it was the same thing. I would have had to go back every month or so for an injection. I told her I had been trained to handle a needle but for some reason, that wasn't possible.

Well, I don't even play a doctor on TV. My request was based on my labs results and research into how to address them. I guess if your endo already offered it, they must be okay with it, but don't take my word that it's right for you. My prescription is for an injection every two weeks, and they will be training me on how to do it.

Thanks for keeping up with my thread!

Stephanie

Quote from: Kendra on October 06, 2018, 11:27:55 AM
Stephanie, congratulations on so many accomplishments!

I should make a post on my updated experience with this in the HRT board.  I switched from patches to estradiol valerate self-injection in June and I've found the difference quite noticeable.  Although the dosage is theoretically equivalent to patches my E levels went up sharply (sorry about the jabbing pun) and breast growth bounced up right before a boob job in July... that's one reason I requested a bit less plastic.  There's been a visible increase in feminization although I have several other variables so I don't want to over-credit the switch to injections.  The process of self-injecting is something I would have never wanted to do in the past but the benefits are so awesome I'm fine with it all.  I have learned to do this and make it my Friday treat.  I stab, therefore I am.

I had always said that I was planning to wait to see what HRT would do for me before I went after anything surgical. I have become impatient for help with the facial features, and the things I'll be addressing probably wouldn't have changed much with HRT anyway. But I remain patient for the breast growth, especially with the possibility of turbocharging it with the valerate. I'll give that another year or so before I make any other moves.

When it comes time for my first injection, I'll sit in my plane and use the horizontal stab-ilizer.

Stephanie

Quote from: Steph2.0 on October 06, 2018, 01:02:07 PM
When it comes time for my first injection, I'll sit in my plane and use the horizontal stab-ilizer.

Stephanie

Just make sure no ones looking. That might look a little funny. Oh and the idea of shooting up in your plane may not go over well either .

Quote from: Donica on October 06, 2018, 01:19:17 PM
Just make sure no ones looking. That might look a little funny. Oh and the idea of shooting up in your plane may not go over well either .

Considering my personal plane is an empty fuselage, I doubt anyone will give me a hard time. In fact, the horizontal stab isn't even installed at the moment. I'll have to use the vertical stab.

Stabby Stephie

Yaw made a fine point.

Quote from: Kendra on October 06, 2018, 02:45:20 PM
Yaw made a fine point.

I thought I'd pitch that out there. I'd just roll with it. It's the thrust of the matter. I hope you don't think it's a drag.

I wander if fly by wire Starbucks Venturi Valerate(tm) injections are available from Seattle ground control.  Gross wait makes me impatient but I'll roll into an endo to avoid getting foiled.  Pusher engines are knot certified to prop up a stablized glide path and risk landing a bad stall.  No yoke.  At least you won't wake the contrail artists unless you gotta jet now.

As long as you don't get in a spin.

Well, I hope I don't create a flap if I congratulate you on your awesome day!

Wow, you all present such a wonderful pitch.

Quote from: Donica on October 06, 2018, 05:28:22 PM
Wow, you all present such a wonderful pitch.

I'd tell yaw to put the speed brakes on but I've flamed out.

Wow Stephanie!  I just checked in and see you've had quite the day.  Wonderful news, Congratulations!

Earlier you said...
"Just as those times when I would doubt my transitioning, I wonder whether I'm making a mistake."  I think we all have some doubt lingering in our heads when making a big decision like this, its normal.   You'll be fine despite your family liking your smile, etc.

The neighbors that misgender you may or may not come around after your appearance is updated.  Be prepared for the worse but plan for the best.
All my best to you.  Keep floating on that cloud!
Judi