that is what everybody keeps repeating...but where is the evidence? How many documented deaths of TS exists? BeA long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones


NOTE THELAST SENTENCE IN THE ARTICLE BELOW, THEN SEE MY NEXT POST

Henk Asscheman1,
Erik J Giltay3,
Jos A J Megens2,
W (Pim) de Ronde1,
Michael A A van Trotsenburg2 and
Louis J G Gooren1

+ Author Affiliations

1Endocrine Unit, Department of Internal Medicine
2Center of Expertise on Gender Dysphoria, VU University Medical Center, PO Box 7057, NL-1007 MB Amsterdam, The Netherlands
3Department of Psychiatry, Leiden University Medical Center, NL-2300 RC Leiden, The Netherlands

(Correspondence should be addressed to H Asscheman who is now at HAJAP, Valeriusstraat 4hs, 1071 MH Amsterdam, The Netherlands; Email: h.ajap@worldonline.nl)


Abstract


Objective Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones.


Design A cohort study with a median follow-up of 18.5 years at a university gender clinic.


Methods Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses.


Results In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population.


Conclusions The increased mortality in hormone-treated MtF transsexuals was mainly due to non-hormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death.

In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.
fore somebody get her panties in a wad, let me emphazie that I am in no way advbocating self medication.

NOTE THE CONCLUSION AT THE BOTTOM OF THE ARTICLE BELOW

Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses
Mohamed B. Elamin1, Magaly Zumaeta Garcia1, Mohammad Hassan Murad1,2, Patricia J. Erwin1,3, Victor M. Montori1,4Article first published online: 16 MAY 2009

Clinical Endocrinology
Volume 72, Issue 1, pages 1–10, January 2010
DOI: 10.1111/j.1365-2265.2009.03632.x

© 2010 Blackwell Publishing Ltd
Issue


Summary

Objective  To summarize the available evidence on the cardiovascular effects of cross-sex steroid use in transsexuals.

Methods  We searched relevant electronic databases and sought additional references from experts. Eligible studies reported on cardiovascular events, venous thromboembolism, blood pressure and fasting serum lipids. Data were extracted in duplicate. We used the random-effects model to estimate the pooled weighted mean difference (WMD) and 95% confidence intervals (CIs).

Results  We found 16 eligible studies, mostly uncontrolled cohorts of varied follow-up durations (1471 male-to-female (MF) and 651 female-to-male (FM) individuals). In the MF individuals, cross-sex hormone use was associated with a statistically significant increase in fasting serum triglycerides without changes in the other parameters (WMD = 23·39 mg/dl; 95% CI = 4·82–41·95). In the FM individuals, there was a similar increase of triglycerides (WMD = 31·35 mg/dl; 95% CI = 7·53–55·17) and a reduction of high density lipoprotein (HDL)-cholesterol (WMD = −6·09 mg/dl; 95% CI = −11·44 to −0·73). There was a statistically significant but clinically trivial increase in systolic blood pressure (WMD = 1·74 mmHg; 95% CI = 0·21–3·27). Analyses were associated with significant heterogeneity across studies. There were very few reported cardiovascular events (deaths, strokes, myocardial infarctions or venous thromboembolism), more commonly among MF individuals.

Conclusions  Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM. Data about patient important outcomes are sparse and inconclusive.

These studies only cover those who have their HRT monitored by medical professionals.. I'd be interested to see the morbidity rate of those who DIY.. I suspect those might be a little different..

Long-Term Estrogen Therapy Improves Vascular Function in Male to Female Transsexuals ☆
Gishel New, MBBSA,
Katrina L Timmins, BSc(Hons)A,
Stephen J Duffy, MBBSA,
Binh T Tran, BSc(Hons)A,
Richard C O'Brien, MBBS, PhDA,
Richard W Harper, MBBS, FACCA,
Ian T Meredith, MBBS, PhD, FACCA, ,
A Cardiovascular Centre, Cardiology Unit, Monash Medical Centre and Department of Medicine, Monash University, Melbourne, Australia.

Journal of the American College of Cardiology

Volume 29, Issue 7, June 1997, Pages 1437–1444
bstract

Objectives. This study sought to examine the effects of long-term estrogen therapy on vascular function in male to female transsexuals and to compare the findings with those observed in men and premenopausal women.

Background. Gender differences in coronary artery disease have largely been attributed to the beneficial effects of estrogen on vascular function and plasma lipids in women. However, the effects of estrogen on the male vasculature have not been widely studied.

Methods. We compared the effects of estrogen on vascular function in 14 male to female transsexuals, 14 age-matched men and 15 premenopausal women. Flow-mediated vasodilation and response to nitroglycerin were assessed in the brachial artery using noninvasive ultrasound.

Results. Flow-mediated vasodilation was similar in transsexuals and women but greater than that in men ([mean ± SE] 11.5 ± 1.3% and 9.4 ± 1.1% vs. 5.2 ± 1.0% respectively, p < 0.005). Responses to nitroglycerin were also greater in transsexuals and women than in men (21.6 ± 1.7% and 21.0 ± 0.9% vs. 14.5 ± 1.2%, respectively, p = 0.0005). These differences persisted even after adjusting for vessel size. Despite similar total cholesterol levels, transsexuals had high density lipoprotein cholesterol levels similar to those in women and greater than those observed in men (1.76 ± 0.12 and 1.82 ± 0.11 mmol/liter vs. 1.35 ± 0.07 mmol/liter, respectively, p < 0.005). Moreover, triglyceride levels were greater in transsexuals than in men and women, and low density lipoprotein cholesterol (LDL-C) particle size was smaller (25.7 ± 0.2 nm vs. 26.2 ± 0.1 and 26.6 ± 0.1 nm, respectively, p = 0.0001). Serum testosterone (an index of estrogen therapy in transsexuals) was markedly suppressed in transsexuals and similar to that in women. Univariate analysis revealed that there was a strong inverse correlation between serum testosterone and flow-mediated vasodilation (rs = −0.48, p < 0.005). Multivariate analysis revealed that the best combination of predictors of flow-mediated vasodilation was serum testosterone, vessel size and LDL-C (R2 = 0.3, p < 0.005).

Conclusions. Long-term estrogen therapy appears to improve vascular function in male to female transsexuals and occurs despite higher triglyceride levels and the presence of small, dense LDL-C. The beneficial effects of estrogen are not gender specific or solely mediated through endothelium-derived nitric oxide.

(J Am Coll Cardiol 1997;29:1437–44)

Quote from: kelly_aus on April 16, 2012, 09:13:56 PM
These studies only cover those who have their HRT monitored by medical professionals.. I'd be interested to see the morbidity rate of those who DIY.. I suspect those might be a little different..

I suspect that they may not, but I am going to continue looking for them

The danger in the first post was tied to ethinyl estradiol. Isn't Estradiol used so much more (estrace/estrofem).

Are you meaning to poke holes in the thread title with these studies?  Are you saying it isn't as dangerous as some assume?

So i am still looking for that elusive paper that documents the death of TG/TS people due to self medication with Estrogen.

In the mean time I came across this paper:
NOTE THAT THE TITLE MAY IMPLY THAT IT IS THE HORMONE TREATMENT THAT CAUSED THE DEATHS, BUT THEY CELARLY STATE: The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death of unknown cause."


Mortality and morbidity in transsexual patients with cross-gender hormone treatment ☆
H. Asscheman,
L.J.G. Gooren,
P.L.E. Eklund
Division of Endocrinology/Andrology, Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands
Available online 2 April 2004.

Metabolism

Volume 38, Issue 9, September 1989, Pages 869–873
Abstract

Sex steroid treatment is associated with side effects. The number of deaths and morbidity cases in 425 transsexual patients treated with cross-gender hormones were evaluated retrospectively and compared with the expected number in a similar reference group of the population. The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death of unknown cause. Combined treatment with estrogen and cyproterone acetate in 303 male-to-female transsexuals was associated with a 45-fold increase of thromboembolic events, hyperprolactinemia (400-fold), depressive mood changes (15-fold), and transient elevation of liver enzymes. Androgen treatment in 122 female-to-male transsexuals was associated with weight increase >10% (17.2%) and acne (12.3%). In both groups persistent liver enzyme abnormalities could be attributed to other causes than sex steroids (hepatitis B and alcohol abuse). Much of the morbidity was minor and reversible with appropriate treatment or temporary discontinuation of hormone treatment. Thus, the dilemma of prescribing cross gender hormones in view of the needs of these patients is not resolved. Explanation of possible side effects and careful clinical judgment remain the cornerstone of the clinical decision to prescribe cross-gender hormones. Furthermore, follow up of this relatively young population to disclose long-term side effects and to elucidate the association of sex steroids with coronary heart disease, as well as efforts to reduce the risk of thromboembolic events, are required.

So it seems that estrogen is not more dangerous than any other drug. If you take anti cholesterol drug, you are going to have to be monitored. That is the case for almost all prescribed drugs.



Mortality and morbidity in transsexual subjects treated with cross-sex hormones
Paul J. M. Van Kesteren, Henk Asscheman, Jos A. J. Megens, Louis J. G. GoorenArticle first published online: 29 OCT 2003

DOI: 10.1046/j.1365-2265.1997.2601068.x

Clinical Endocrinology
Volume 47, Issue 3, pages 337–343, September 1997

OBJECTIVE
The optimum steroid hormone treatment regimes for transsexual subjects has not yet been established. We have investigated the mortality and morbidity figures in a large group of transsexual subjects receiving cross-sex hormone treatment.
DESIGN
A retrospective, descriptive study in a university teaching hospital.
SUBJECTS
Eight hundred and sixteen male-to-female (M  →  F) and 293 female-to-male (F  →  M) transsexuals.
INTERVENTIONS
Subjects had been treated with cross-sex hormones for a total of 10 152 patient-years.
OUTCOME MEASURES
Standardized mortality and incidence ratios were calculated from the general Dutch population (age- and gender-adjusted) and were also compared to side effects of cross-sex hormones in transsexuals reported in the literature.
RESULTS
In both the M  →  F and F  →  M transsexuals, total mortality was not higher than in the general population and, largely, the observed mortality could not be related to hormone treatment. Venous thromboembolism was the major complication in M  →  F transsexuals treated with oral oestrogens and anti-androgens, but fewer cases were observed since the introduction of transdermal oestradiol in the treatment of transsexuals over 40 years of age. No cases of breast carcinoma but one case of prostatic carcinoma were encountered in our population. No serious morbidity was observed which could be related to androgen treatment in the F  →  M transsexuals.
CONCLUSION
Mortality in male-to-female and female-to-male transsexuals is not increased during cross-sex hormone treatment. Transdermal oestradiol administration is recommended in male-to-female transsexuals, particularly in the population over 40 years in whom a high incidence of venous thromboembolism was observed with oral oestrogens. It seems that in view of the deep psychological needs of transsexuals to undergo sex reassignment, our treatment schedule of cross-sex hormone administration is acceptably safe.

Well i figured that basically older women lose estrogen naturally and so being a post op by 40 and now 14 yr post op and having stopped estrogen back 11 yrs ago i should be safe and mostly at the same hormonal level as most cis woman my age..

i don't understand why people keep taking HRT forever.. it basically only does its thing in the first 2 yrs and then after that its not much in changes..

Firstly, thanks to the OP for this hard work, I find it most educational!

Secondly, HRT is not required if one still has one's gonads which would/will still produce at least some E/T to prevent osteoporosis.

If you have practically no source (little from body fat, and some from adrenal glands) of hormones it is one's choice to gamble with reduced bone density over time. Once osteoporosis has become an issue it can, and will often become an absolutely crippling disease.

Axélle

Quote from: Axélle-Michélle on April 19, 2012, 09:33:38 AM
Firstly, thanks to the OP for this hard work, I find it most educational!

Secondly, HRT is not required if one still has one's gonads which would/will still produce at least some E/T to prevent osteoporosis.

If you have practically no source (little from body fat, and some from adrenal glands) of hormones it is one's choice to gamble with reduced bone density over time. Once osteoporosis has become an issue it can, and will often become an absolutely crippling disease.

Axélle

Thanks Axellle !! You are very right about the osteoporosis risk.

Amazon:

Note that: '" Conclusions. Long-term estrogen therapy appears to improve vascular function in male to female transsexuals and occurs despite higher triglyceride levels and the presence of small, dense LDL-C. The beneficial effects of estrogen are not gender specific or solely mediated through endothelium-derived nitric oxide.

(J Am Coll Cardiol 1997;29:1437–44)"

I would encourage you you revisit your decision with your MD

As far as this post, what triggered is the repeated "estrogen is powerful and dangerous drug" mantra that is repeated over and over again, and for which there is little scientific evidence. Again, I am not advocating self medication of any kind. 

My doctor sent me for a bone scan last year for that very reason.  Well two reasons, I'm 67 and been on estrogen for many years, both are risk factors.

Maybe one repeat "marker" ... "Estrogen" the wording, is ever so often used, but this is actually more like some conjugated 'compound' produced by the (mostly) female gonads.

So it is almost always that Estradiol 17b (E2) is meant.

If we look at this for a moment... there is the Ethinyl Estradiol (EE) as is still used in BC pills, and about 10x stronger then any Estradiol 17b and it's estered variations.

It is Ethinyl Estradiol (EE) that mostly created the "powerful & dangerous drug" comments - and quite rightfully so - in particular once 4x or more! the amount of a normal 1 pill a day was taken for HRT.
Note: It (EE) was NEVER tested for this, and never meant to be used for ERT to prevent vasomotor symptoms of menopause.

Just for the record

Axélle
PS: EE works of course for HRT, is also much used more often for DIY - because it's more easily obtained without having a prescription - BUT... at a rather much higher risc.

Quote from: Axélle-Michélle on April 19, 2012, 09:33:38 AM
Firstly, thanks to the OP for this hard work, I find it most educational!

Secondly, HRT is not required if one still has one's gonads which would/will still produce at least some E/T to prevent osteoporosis.

If you have practically no source (little from body fat, and some from adrenal glands) of hormones it is one's choice to gamble with reduced bone density over time. Once osteoporosis has become an issue it can, and will often become an absolutely crippling disease.

Axélle

i do lots of hard work and i have not had any issues so far. My Dr has only prescribed me vitamin D

Quote from: Amazon D on April 19, 2012, 10:13:04 AM
i do lots of hard work and i have not had any issues so far. My Dr has only prescribed me vitamin D

Yes, hard physical work does have a bone strengthening effect, any doctor will tell you. No question.

Keep up the good work

Axélle

Plus i drink about a gallon of raw milk every day .. i love milk.. what i have expereienced though is some pains from working too hard.. if i relax a week or so i always heal.. i am not 20 anymore bt try to work like i am .. ouch

Quote from: Amazon D on April 19, 2012, 10:30:02 AM
Plus i drink about a gallon of raw milk every day .. i love milk.. what i have expereienced though is some pains from working too hard.. if i relax a week or so i always heal.. i am not 20 anymore bt try to work like i am .. ouch

Wow, a ~ gallon... every day... raw milk i.e. full fat, hum.
Good for calcium, not that you body will ever use all of it, ever
Now HOW about your cholesterol if I may ask?

Axélle
PS: BTW, I love milk and milk product of course too! Love it

If you take 17 b estradiol (AKA as estradiol) and add an acetylene group to the 17 carbon, you get ethinyl estradiol. We do that to reduce the hepatic (liver) degradiation of orally ingested estrogen. Once inside the cells ethinyl estradiol is converted to estradiol.

The so called conjugated estrogen, as in premarin, are steroids that have been obtained from pregant mares urine. The urine of mares contains estrone, equilin, and equilenin. The mares estrone, like the human estrone (made by the ovaries and the suprarenal glands of humans), is an estrogen albeit less potent than estradiol. 

Quote from: peky on April 19, 2012, 11:55:16 AM
If you take 17 b estradiol (AKA as estradiol) and add an acetylene group to the 17 carbon, you get ethinyl estradiol. We do that to reduce the hepatic (liver) degradiation of orally ingested estrogen. Once inside the cells ethinyl estradiol is converted to estradiol.

Quote
Yet it's propensity to cause blood clots when used for HRT, at the volumes I mentioned 4 time and more then the 1 pill of 0.3mcg for BC is not to be discarded. PE, Pleural Embolism not being the least of it...

Quote
The so called conjugated estrogen, as in Premarin, are steroids that have been obtained from pregant mares urine. The urine of mares contains estrone, equilin, and equilenin. The mares estrone, like the human estrone (made by the ovaries and the suprarenal glands of humans), is an estrogen albeit less potent than estradiol.

If informed correctly, even this (conjugated -Estrogen-) is now also produced synthetically from pant basis...
My information has it, rather what is being said it (e.g. Premarin) is slightly MORE potent then Estradiol 17 ß (~ plain), as it is conjugated, i.e. it already contains Estriol, and Estrone, in addition to Estradiol,-  never mind some of the other odd components in the case of Premarin. Therefore Estriol, and Estrone, in addition to Estradiol are 'available' to receptors before first having to be metabolized from Estradiol by the liver.

This being my information... (I may speak under correction)
Axélle