Hi, Maggie, another good post. You make some good points and I'd have to agree, were I the medical professional, with your decision.

I've just seen, heard, read too many women who have found in many different ways that a 2-5 year span between pubertal onset and post-menopause is not effective for them. I'll add you to that list asw ell.



Nichole

Quote from: Nichole on April 03, 2009, 08:34:13 AM
Changing doctors is most likely to find the exact same worries and SOP.

That is true in my case, Nicole. I live in one of the larger cities and there are only 3 doctors here who are offering services directly to MTFs. This in itself is a good reason to not carelessly dismiss a doctor on -- especially on a controversial issue such as this is.

I could always hunt down someone who would be willing to administer HRT to me but I really don't want to train him or her on how to administer HRT to MTFs (like I had to do in Smalltown, Nebraska.) A major reason for moving to the big city was to get the gender support I couldn not find previously.

-------------------------------------------------

In the interest of full disclosure, although she did not mention my age as a factor in her decision, I am 57 years old which could be a huge reason in wanting me to be on a lower dose. Also, I have been on estrogen for 2 years coming this July.

I haven't made any decisions yet on my dosage yet as I am gathering as many facts and theories as I can before doing so. I am thinking that because of my age, and that I have been on e for 2 years, I do think I should at least halve my dosage. 

Thanks everyone for the great feedback!

Dora

Quote from: Cami on April 02, 2009, 03:51:34 PM
I would love to get an orchi soon though because I am concerned about the long term complications from prolonged use of Spiro and I don't know when or if I will ever be able to get full GCS.

That's an interesting statement to make, Cami. I asked her if it was true if I need to have the SRS or an Orchi within 5 years for safety reasons and she replied, no. She said if there are no other problems (liver function etc.) Spiro has been shown to be safe for long term use.

Dora

Get the T levels down to female norm and adding E at that point should cause the same results regardless of how much or how it is taken.  (given that you take enough that it doesn't just get flushed through the system).  Granted if you were to take enough estrogen to have, lets say 1/4 that of a normal female, versus taking enough to have 1/2 that of a normal female, the 1/4 is going to take longer to change anything.  The reverse of that also seems to be true however, in that getting the E levels to high can cause quicker changes, but the end results tend to not be the same for whatever reason.  Also keep in mind that E can be broken down into T if the body has to much of it.

Quote from: Dora on April 03, 2009, 12:56:41 PM
That's an interesting statement to make, Cami. I asked her if it was true if I need to have the SRS or an Orchi within 5 years for safety reasons and she replied, no. She said if there are no other problems (liver function etc.) Spiro has been shown to be safe for long term use.

Dora

That is true enough.  If A-A's are continuously used for about 18 months, the effect is permanent chemical castration.  The testes will become so atrophied that they would only become minimally functional if the A-A's are discontinued.  Testosterone production would fall to such a low level that only the amount produced by the adrenal gland would have any measurable effect.

Additionally, in the absence of testosterone, the prostate will shrink, which actually is the purpose of spironolactone in the first place.

-Sandy

Quote from: Birdie on April 02, 2009, 03:44:41 PM
My doctor does this for all his patients and has already reduced my E to the minimum amount. There isn't really any way to argue with him either, I don't have any medical knowledge and if I didn't do as instructed I'd probably get kicked out of the gender clinic. It doesn't make any sense to me, because hrt seems to have had very little effect so far, but he's been completely dismissive of taking any path other than the one prescribed to all his patients.

This is called "standards of care."  The doctor protects himself from malpractice by doing what most other doctors do, and the same thing with all patients.

You have to have medical knowledge, and if not accquire it; so you can take charge of your own treatment in order to customize it to what works for you.  Then dealing with the doctor becomes a process of negotiation and compromise.

There is also a thing called "harm-reduction".  Recently the AMA adopted a harm-reduction protocol for transsexuals using black market hormones.  Essentially, it says that a General Practitioner can order and interpret tests for transsexuals who don't want to use Endocrinologists, or who use black market hormones, or purchase without a prescription through the Internet.

So endocrinologists do not have transsexuals by the balls anymore.

When I went to an endo she chopped my E in half and left the anti-T alone.  She was worried about my health and told me I could go to another doctor if I kept self-medicating.  I did not feel as good under her doses so that she prescribed me anti-anxiety drugs.  She is more concerned about keeping the T low. She told me not to expect much more from the HRT.  She continued me on sublingual Oestradiol at the lowered dose.  My body adjusted after a few months.

It is unethical for a doctor to refuse to treat you (or threaten to do so) because you choose self-medication. 

To quote a relevent webpage:
Self-medication is a risky process that is neither encouraged, nor condoned. The information offered here is not intended to enable an individual to self-medicate, but rather, as a guide to help understand what to expect from properly monitored treatment, and as a guide to help understand the risks that are present.

While we do not encourage or condone self medication, we do believe strongly in the principles of least-harm and of harm reduction. We recognize that some people may have no other option, or be pressed into believing they have no other option. We hope that the information we present here will help even those individuals to protect themselves as best possible.

Please note, that if you are already self-medicating, you have an "out" - it is unethical for a medical provider to refuse to help you obtain properly supervised care when the alternative is for you to continue unsupervised treatments. This is enshrined in the medical principle of "first do no harm" and in the medical doctrine of "least-harm". It is also a guideline within the widely-followed HBIGDA standards of care.
[urlhttp://www.tssupport.org/Medication]http://www.tssupport.org/Medication









Link made inoperable. Please allow staff and suthorized posters only to make links. See Rule #1in the TOS --- Nichole

Gina Douglas wrote, "It is unethical for a doctor to refuse to treat you (or threaten to do so) because you choose self-medication. 

To quote a relevent webpage:...some people may have no other option, or be pressed into believing they have no other option... "





Well a doctor can say they do not want to treat you because you represent a liability to them.  They can accept you if you self medicate but can refuse to continue to help you if you do whatever you please.

Actually in my mind I felt I had no other options.

I visited my endo today and she showed me my T was at 26 which she said was fine.  I asked her about my E levels and she said she did not measure them.  She said I had gained nothing from my high doses and I risked hurting myself.  Many friends told me that but it was not easy to go to the doctors for help.  I will keep the doses low and consider other options.  I listened to her for the past month and did what she asked and she helped me today.

T level of 26 ?? 
...... if that's pmol then it seems WAY too high....normal male level!
My GIC at Charing Cross London has told me unequivocally that the target range for T is "under 3".
.... natal females have around 1.4 ...... those who are prone to be a bit hairy have levels of around 1.8

Quote from: Steffi on April 25, 2009, 11:35:56 PM
T level of 26 ?? 
...... if that's pmol then it seems WAY too high....normal male level!
My GIC at Charing Cross London has told me unequivocally that the target range for T is "under 3".
.... natal females have around 1.4 ...... those who are prone to be a bit hairy have levels of around 1.8

The doctors are very cautious.  I got copies of all the test.  She told me under 40 was good.  The results from the sheet are:
23 L  ng/dl with average adult male at 241 to 827.


I was never a hairy male but my features are very male.  My body hair is currently less than many females.  I have about 75% of the beard removed.  I calculated yesterday that I lost 38 pounds of muscle from 4 years of HRT. Actually I wanted the endo to up the anti-T and E but to no avail.

...................
Update:  Kiera gave me a bunch of statistics on her site and I worked out the conversion numbers. 

Stephi 23 ng/dl is equivalent to .79 nmol/L.  If I convert your 1.4 nmol/L for natal females then I get 40 nmol/L.

Thanks for info, corrections etc 
( Wow.... I'm surprised that T in Premenopausal Females can be up to 2.43 nmol/L  )

Quote from: Kristi on April 02, 2009, 11:58:26 AM
I think this is a dangerously simplified statement.  It may be true for you, but blanket statements like this bother me.

Excellent.

I agree partially with the OPs physician.  However that doctor wasn't speaking at a lecture.  He wasn't at a board meeting.  He wasn't speaking to colleagues.  He was speaking to her as an individual, unique patient.  Therefore what he said was for her ears, and not intended to be cited as a medical reference for everyone.