Temporarily stopping HRT for surgery??

[thelittlemermaid]

I am having jaw reduction/genioplasty on March 14 and read in the medical sheet that hormones aren't allowed to be taken for 2 weeks prior to surgery... as someone who has been on HRT for almost 3 years, this sounds terrifying :/ what is going to happen to my body because of it??

[Anne Blake]

All I can tell you is of my experience of going off of estradiol for a couple of weeks prior to GCS. My biggest immediate concern was that I got a bit cranky, my partner mentioned it to me often. That might have also been influenced by getting so close to GCS and my excitement over my long looked forward to surgery.

I also noticed that for the first time my breasts no longer hurt. This surprised me but my OB/GYN said that it was common for her CIS women patients on hormone therapy to lose the breast pain after stopping hrt for a couple of weeks. I finally did recover breast soreness and subsequent growth about a year after GCS.

This is just my story and ymmv. No long term effects and I am glad that my surgeon was as safe and conservative as she was. But I have ffs coming up in another 7 weeks and I hope that they do not make me stop hrt again....if they do, so be it. It is a small price to pay to attain what I am going for.

Tia Anne

[HollyKay]

I take Estradiol Valerate and Progesterone. I asked my endocrinologist this very same question long before my surgeries. He shook his head left to right and said that he doesn't believe it is necessary to discontinue hormones before surgery. Now here is my caveat: If you have high cholesterol and high counts on your CBC (complete blood count), or if you're diabetic and don't have your glucose levels well controlled, then maybe the risks may be too high to keep on them. There are other factors that are also considered like personal history of blood clots or DVT (deep vein thrombosis) that need to be considered. Discuss with your doctor, always. I have never stopped taking hormones for a surgery, but then again, I am not making a blind decision. It's always with careful consideration. One HRT medication I believe cause an increased risk of DVT is medroxyprogesterone as it is not bio-identical to progesterone. I'm sure there are more. My argument has always been that a) stopping causes more harm than required for trans people both psychological and physical stress.  b) tests that rule out clotting factors are performed prior to surgery, usually within two weeks. c) they don't say to cisgender women that they need to reduce their estrogen levels before surgeries, leading to the fact that it has nothing to do with being male or female, but rather legal liability based on woefully outdated information from a time when bio-identical hormones had not been available because they didn't yet know how to synthesize them yet. My advice, ask your doctor, not your surgeon to test for risk factors for the reasons that your surgeon has indicated as to why you must stop. If you must ask your surgeon, ask inquisitivly and tread lightly. Doctors always want to be right, so don't challenge them.

[jill610]

Here's the problem with not doing what your surgeon requires:

If a complication does occur that can be pointed at you not following directions, you lose your ability to win any kind of settlement because now you are also complicit either wholly or partly.

In the OR, your surgeon is king and it does not matter what your or your GP think because it's their neck on the line and it's their job to make sure you survive. Do what your surgeon requires.

It's really not the end of the world but I also remember thinking it was going to be this really horrible experience. I was off for close to six weeks in total when I had my gcs and I feel like I lost so fat distribution in my hips and face and of course I was pretty much a raging bitch for the last week or so of that.

But then you get it back and life continues.

One thing that surprises me is some surgeons withhold estrogen both before and after the surgery. I heard through the grapevine that Spiegel requires 4w prior and 2w post. When I had my gcs and ffs with Meltzer, they gave me pills the day afTer surgery. It was like a narcotic at that point.

[Denise]

YMMV

Everyone has different reactions to anesthesia.  Some people have very negative reactions emotionally.  I wasn't too bad but it is "a thing" enough that I didn't want that piled on top of PMS.

Yes, stopping my injections cause emotional weepiness and mood swings.  I didn't want that combining with surgery.  So for GCS I stopped E injections 4 weeks prior to surgery and I didn't start back up until 2 weeks post surgery.  My surgeon is considering requiring 2 weeks but suggesting more based upon how well did for GCS compared to FFS.

You shouldn't see any physical changes in the same way that how much do you charge in a few weeks normally; not much.

Good luck with surgery.



Sent from my LG-H910 using Tapatalk

[Devlyn]

I am having jaw reduction/genioplasty on March 14 and read in the medical sheet that hormones aren't allowed to be taken for 2 weeks prior to surgery... as someone who has been on HRT for almost 3 years, this sounds terrifying :/ what is going to happen to my body because of it??

You'll be grouchy, your skin and hair will get oily like a male again. Nothing to be terrified about, you'll be fine. Getting back on HRT will be a huge relief, almost like getting a birthday present. 

Hugs, Devlyn

[thelittlemermaid]

Thank you all so much! I'm definitely going to follow protocol which states very clearly to stop it for 2 weeks prior. I'll try to alert my friends that I may be extra sensitive.

[Michelle_P]

I'm going through this drill for the third time.  A few days past your Estradiol 'due date' you will feel more irritable, possibly have a headache, and may start experiencing hot flashes.

Welcome to womanhood, as you share an experience many women have, as their Estradiol level fluctuates.  In discussions I find that my experience is shared by many perimenopausal women.  As long as you recognize what you are going through, and are prepared to feel a bit cranky, you'll do OK.  For folks who do not anticipate the impact, it can be uncomfortable, and bring on waves of 'down' emotions and self-doubt.  Know that this is temporary, and that you will soon be back on Estradiol and feeling better.

Look out for post-op depression, which may bite a few weeks to months after surgery.  In my case I strongly suspect it is tied to general anesthesia, as it has bitten after every procedure where that is used on me, whether or not transition related.  I had it after Gender Confirmation Surgery (GCS) and Facial Feminization Surgery (FFS), and I have had it after cancer and bladder surgeries.  Again, being aware of it, and not letting it sneak up and sink it's hooks into you helps tremendously in coping.

[Dorit]

It is like menopause.   Only you get to reverse it in three weeks.

[LizK]

Grouchy was my worst and the only surgery I have had to stop for was my GCS...and even then it is debatable as to whether is necessary however the safest thing to do is to follow your surgeons instructions. If you don't and then do have a problem it will be too late.

Liz

[jill610]

I was a little entertained that it seems only the surgeons that specialize in trans care require this.

My BA was done by a general cosmetic surgeon that was in network, when I asked about discontinuing, he said "why would you do that?"  Where the more trans focused ones were adamant.

Looking into body contouring (lipo 360) and a tummy tuck (lost a lot of weight and have the skin to show it), and kind of the same story.

Always follow your surgeons advice because it's their neck on the line when stuff doesn't go right, but dont hesitate to challenge the thinking.

For the record it wasn't as bad as I thought it would be, but I was kinda bitchy towards the end.

[Michelle_P]

I believe the trans care specialists are more aware of the intersection of risks between our medication and surgery, and are making an honest effort to remove as many risk factors as possible.

I can put up with a few weeks of discomfort before surgery.  I know there is much more in immediate recovery, and I also know that a few months after that I won't recall the discomfort, and have an improved chance of reaching that point and enjoying the result.

[thelittlemermaid]

I was a little entertained that it seems only the surgeons that specialize in trans care require this.

My BA was done by a general cosmetic surgeon that was in network, when I asked about discontinuing, he said "why would you do that?"  Where the more trans focused ones were adamant.

Looking into body contouring (lipo 360) and a tummy tuck (lost a lot of weight and have the skin to show it), and kind of the same story.

Always follow your surgeons advice because it's their neck on the line when stuff doesn't go right, but dont hesitate to challenge the thinking.

For the record it wasn't as bad as I thought it would be, but I was kinda bitchy towards the end.

I had a lower body lift and arm lift (similar procedures as I lost 200 lbs)! It was pre-hormones though... good luck with it!

[thelittlemermaid]

Thursday is the day I stop Estradiol and Spironolactone... it's scaring me more than the actual surgery itself. :/

[Jessica]

I am having jaw reduction/genioplasty on March 14 and read in the medical sheet that hormones aren't allowed to be taken for 2 weeks prior to surgery... as someone who has been on HRT for almost 3 years, this sounds terrifying :/ what is going to happen to my body because of it??

Interestingly enough when I had surgery on my vocal cords, the only thing they had me stop was spiro on the day of my surgery.

[Rachel]

For FFS I was off HRT 2 weeks before and one week after. I felt dull at the end of three weeks and it took a few days to feel right after being back on HRT.