I'm 57, 147 pounds 5'10, I exercise daily, I have my entire life I believe generated a lot of T naturally. and I work out hard 7 days a week, 40-45 minutes at gym and I do additional walking/hiking to add steps to my workouts most days.

So....I started HRT, and doctor (zoom call) gave me optiopns and I chose injections.  20mg/ml, 5ml injection estridol val.

The doctor didn't want to give me blockers or anything for 10 weeks till first Blood test. which I thought a little odd.. but researching I think thats normal for starting maybe...

so... I would take my injection and feel good(but weak) for a day or two, third day I would wake up severely depressed(and weak), sad, dealing with emotions..by End of week I'd start feeling good again and ready to do nextr dose. This went on for 5 weeks and then I was done. I couldn't do it any longer. 

I think things just weren't right. I mean I want my body to transition so I want the hormones to be impactful. My theory is that lack of blockers was really messing me up.


Thoughts? anyone see this? know about this?

Quote from: mickib on May 28, 2025, 11:59:28 AMThe doctor didn't want to give me blockers or anything for 10 weeks till first Blood test. which I thought a little odd.. but researching I think thats normal for starting maybe...

They were probably checking to see if the Estradiol would provide suppression of T so they could determine what blocker and how much you might need. Most providers start with E plus spironolactone or finasteride as blockers. The problem I encountered was that these blockers work by affecting the 5α-reductase enzyme. For some people, this works well. It did not work for me.

Before figuring out that I am a fast metabolizer, my healthcare team was puzzled about why they could not get my hormones dialed in. The senior endocrinologist noted that the 5α-reductase enzyme affects ALL hormones, including T, E, progesterone, and others. So they would make one adjustment that would throw everything else off.

The decision was then to go a different route. Currently, I receive a 3-month injection (pellet) of Eligard (leuprolide), which blocks testosterone production at the source. It is expensive, but as a disabled veteran, I do pay for my meds. Just be aware that it is expensive. The body needs testosterone for other things, so you can't shut it off completely. The body will convert T into DHT, which is the most potent form (which causes facial hair and male-pattern baldness). To offset that, they prescribed Casodex (bicalutamide) tablets. These block the androgen receptors but do not affect hormone levels. This means that any T that is circulating will have no effect.
 
As you can see, it is important for your physician to monitor your hormone levels every 30 days for the first six months or so, to get everything dialed in. After that, they can space the labs out to 90 days and even six months or a year, just to make sure everything is behaving.

I do agree dialing in is what I need help with. I need more personal, in person care. my challenge now is finding it. I haven't been lucky in my area, search continues. Thanks again for your thoughts and time

I started HRT in late 2013 and was on blockers  for a month to get T levels down first before even starting E... I was very allergic to Spironolactone after a couple weeks so was switched to Finasteride as my blocker until I had bottom surgery 17 months later... Hormones out of wack can cause a lot of problems including deep depression out of nowhere... my levels got quite high trying to dial in my post surgery dosage... and I can attest to the emotional effects! Planned Parenthood offers gender services if there is one in your area!

Onward!

Ashley 💕

Mickib, there are a couple of odd things about your introduction to HRT. Doctors will usually like to see you in person before starting you on a regime which will change so much physically. And they should get baseline blood samples to guide their hormone decisions. Estradiol Valerate has a half life of 3-4 days, so weekly injections will expose you to highs and lows, usually causing emotional issues and not feeling good.

There are doctors, and there are doctors, and changing hormone in your body is serious stuff, so it requires a doctor who has experience in this field, and who will tailor treatment to your needs. Most doctors usually start with low dose oral or patches, as these can be changed quickly to suit how you feel. There are no formal courses for doctors to learn about Trans Medicine so, unfortunately, many base their treatments around old texts based on different medicines.

Based on blood levels, mono therapy, or bioidentical estradiol only, is seen as less risky than blockers and estradiol, so this method is gaining popularity. At the correct dose, Estradiol will suppress testosterone sufficiently for feminisation in most people, but there are some with persistent testosterone who will need the assistance of blockers. This is why early and frequent blood draws are helpful to guide treatment.

Honestly, I would canvas other trans people in your area to look for another doctor!

Hugs,

Allie

Quote from: Allie Jayne on May 28, 2025, 05:57:30 PMMickib, there are a couple of odd things about your introduction to HRT. Doctors will usually like to see you in person before starting you on a regime which will change so much physically. And they should get baseline blood samples to guide their hormone decisions. Estradiol Valerate has a half life of 3-4 days, so weekly injections will expose you to highs and lows, usually causing emotional issues and not feeling good.

There are doctors, and there are doctors, and changing hormone in your body is serious stuff, so it requires a doctor who has experience in this field, and who will tailor treatment to your needs. Most doctors usually start with low dose oral or patches, as these can be changed quickly to suit how you feel. There are no formal courses for doctors to learn about Trans Medicine so, unfortunately, many base their treatments around old texts based on different medicines.

Based on blood levels, mono therapy, or bioidentical estradiol only, is seen as less risky than blockers and estradiol, so this method is gaining popularity. At the correct dose, Estradiol will suppress testosterone sufficiently for feminisation in most people, but there are some with persistent testosterone who will need the assistance of blockers. This is why early and frequent blood draws are helpful to guide treatment.

Honestly, I would canvas other trans people in your area to look for another doctor!

Hugs,

Allie

thanks for replying in both my threads. This is what I need to hear... I KNEW that something wasn't right, 3/4 days 1/2 life that would make sense why beginning the curve I'm fine...end of the curve I'm feeling fine, middle my hormones were a warzone I think. I have left a message with OHSU and Legacy, I'm really hoping Legacy returns my call, they literally said on message it might take 3 weeks. this is how bad support is where I'm at. on web site I checked for endo doctors.. legacy listed 3, all of them NOT taking new patients. :|. OHSU same way in the past. so frustrating. I'll keep persisting...till I get a local appointment. I thought about planned parenthood but would be a trek across town, and I don't think I'd get the kind of endo support I need. anyway.. Thank you, and everyone in this community, I know I hit this site like a storm today. I apologize... I'm just feeling on the edge and a bit hopeless lately.

Quote from: mickib on May 28, 2025, 07:34:36 PMThank you, and everyone in this community, I know I hit this site like a storm today. I apologize... I'm just feeling on the edge and a bit hopeless lately.

It's not a problem, really. That is why we are here. If we can help, we will. Even if you just need to vent, we are here to listen. Good luck in your efforts, and please let us know how things work out for you.

@mickib everything written above. Really sound, sensible, advice.

I'll just add that when I began HRT nearly 15 yrs ago after a month it also made me feel off colour. I had a lot of struggles and like @tgirlamg I also had a very bad reaction to spironolactone. It does seem quite odd not to start you on a T blocker at the same time as the estrogen.

It's a major thing to reset your body's hormones and it takes time and persistence. You definitely need to be under a physician who knows what they're doing and who monitors you properly and regularly. @Lori Dee 's advice is really important about this.

And as you've hinted, estrogen doesn't only change you physically. It definitely also changes one emotionally, especially in the early days whilst the big ship's course is altered. I can remember sobbing uncontrollably for no apparent reason one day!

This place is a great resource which I first discovered right back when I began transitioning. Stick around. We're not allowed to discuss dosage but pretty much everything else is okay, including blood levels. I hope you can find the right path for you.

I wanted to share with you all. Yesterday I discovered and was able to reach and schedule HRT with a LOCAL HRT provider. I feel like after so much gray/rain/badluck/misfortune, a ray of sunshine hit me.  I filled out the paper work and they said next step after review they will call me to schedule an appointment.

above I mentioned my troubles with HRT, hoping when I see them they will listen to my experience, run some blood tests and we can dial this in properly.

Quote from: mickib on June 03, 2025, 07:31:45 AMI wanted to share with you all. Yesterday I discovered and was able to reach and schedule HRT with a LOCAL HRT provider. I feel like after so much gray/rain/badluck/misfortune, a ray of sunshine hit me.  I filled out the paper work and they said next step after review they will call me to schedule an appointment.

above I mentioned my troubles with HRT, hoping when I see them they will listen to my experience, run some blood tests and we can dial this in properly.

That sounds like a plan!  Thank you for sharing out.  I hope it all works out well for you too.

Chrissy

Quote from: mickib on June 03, 2025, 07:31:45 AMI wanted to share with you all. Yesterday I discovered and was able to reach and schedule HRT with a LOCAL HRT provider. I feel like after so much gray/rain/badluck/misfortune, a ray of sunshine hit me.  I filled out the paper work and they said next step after review they will call me to schedule an appointment.

above I mentioned my troubles with HRT, hoping when I see them they will listen to my experience, run some blood tests and we can dial this in properly.

Congrats Sister! You can go far in life with a little bit of sunshine working for you! 💕🌞💕 Well Done Girl 😀👍

Hugs!!!

Ashley 💕

Quote from: mickib on June 03, 2025, 07:31:45 AMI wanted to share with you all. Yesterday I discovered and was able to reach and schedule HRT with a LOCAL HRT provider. I feel like after so much gray/rain/badluck/misfortune, a ray of sunshine hit me.  I filled out the paper work and they said next step after review they will call me to schedule an appointment.

above I mentioned my troubles with HRT, hoping when I see them they will listen to my experience, run some blood tests and we can dial this in properly.

This is wonderful news. It's always nice to hear this positive news from members.