Courtney's life begins here, redux

[Courtney G]

Hi, all. This week, I see the hematologist that may decide my HRT fate. I expect him to order a blood test to see whether or not my levels indicate an increased clotting risk on injections versus patches. I intend to present him with printed copies of studies on estradiol valerate injections and the risk of clots versus patches versus ethinyl estradiol (birth control estradiol, not used for our HRT). I'll tell him that I want to live and I want to do the right thing, but that we need to have an objective look at the data, using the most up-to-date information. I hope I can continue on injections.

My wife and I attended a coffee shop gathering hosted by our little county pride org yesterday. I shaved the little bit of stubble on my chin, put a little foundation/primer on and a little mascara (no lipstick). Told my wife on the way that I'd thought of wearing some lipstick but didn't think I should. She asked "why not?" I'm more worried about her reaction than I need to be, sometimes.

I wore girl jeans, some cute purple sneakers and a native American-inspired woven pullover hoodie with a tint of lavender color. The weather was a little cool but I only wore a cropped red cami/shelf bra with spaghetti straps beneath the hoodie so I wouldn't overheat. Well, it turned out to be pretty warm in the coffee shop, so I ended up taking the hoodie off, which revealed this tiny top with my breasts overflowing it. I felt very exposed but also proud of my body. I was chatting with three ovary-having, estrogen-based people (one of the three identifies solely as a woman) and they gushed about how nice my body looked, complimenting my boobs in particular. I squealed with joy inside. I asked them if I'm "fooling" anyone with my strangely-shaped body beneath a loose sweatshirt and one of them said that they could tell I was "curvy" when I walked in. The other said they love their breasts (despite having a masculine side to their identity) and breasts in general and that mine were amazing, and that they found themself admiring mine. I was so flattered. The whole thing felt so good. I had a wonderful time and my wife really enjoyed herself.

I'm very much involved in my electrologist training course. I completed one chapter and passed the quiz at the end. The chapter I'm on now is a big one and covers all parts of human anatomy. I don't see how I can remember even 10% of the stuff I'm learning. I hope that there isn't much of this in the board exam at the end. My goal is to open my practice early next year, start taking clients in the evenings and weekends and get the education and equipment investment paid off before summer begins.

I'll hopefully have completed the second round of facial feminization surgery before I start heading into the electrology school for hands-on time, so I plan on going there in girl mode. I'll be interacting with instructors, other students and clients (patients) and I suspect they will all be women of one type or another.

[Lori Dee ✅]

I think it is wonderful that you are going through with your training. You are not just starting a business. You will also be providing a very much-needed service to the community. That is wonderful.

[Gina P]

Sounds interesting, even with a hoody they could tell you had boobs. Great place to get comfortable with your new presentation.
 Just curious, how much does an electrolosis machine cost?

[Courtney G]

Just curious, how much does an electrolosis machine cost?

In the neighborhood of $10k, I think.

[Courtney G]

Women who were prescribed transdermal HRT were 22% less likely to have an ischemic stroke, 25% less likely to have a thromboembolism, 26% less likely to have a myocardial infarction (MI), and 27% less likely to have a pulmonary embolism (PE) compared to those who received their HRT vaginally. Women prescribed oral HRT were 26% more likely to have an arterial clot but 7% less likely to have a stroke compared to those who received their HRT vaginally. We did not observe a difference in the likelihood of clotting disorders between injectable HRT and HRT administered vaginally.
Epic Research Study - April 23, 2025
Dual-Team Study
Team A: Kersten Bartelt, RN|Nitesh Mathur, PhD|Joe Deckert, PhD
Team B: Dave Little, MD|Emily Higgs
https://www.epicresearch.org/articles/blood-clot-risk-influenced-by-hormone-therapy-administration-route-in-women-50-and-older 🔗

I'm prepping for my hematologist visit tomorrow and noticed that the results of this study (as quoted above) say that vaginally-administered HRT and injected HRT both have a significantly higher risk than patches.

[Lori Dee ✅]

I'm prepping for my hematologist visit tomorrow and noticed that the results of this study (as quoted above) say that vaginally-administered HRT and injected HRT both have a significantly higher risk than patches.

Now I am wondering if I posted the study I intended to. (Sorry)

They are looking at different types of cardiovascular events, so they are separating clots from strokes and embolisms.

I just had this discussion with my endocrinologist. The simple way to remember it is that oral medications pass through the liver first. When estradiol is metabolized in the liver, it affects the Coagulation Factor (thus clots, strokes, etc.).

Transdermal patches, sublingual preparations, vaginal preparations, and injectables are absorbed into the bloodstream first. So they do their work before the liver clears them from the bloodstream.

Is the risk still there? Yes. Because eventually, everything will get processed through the liver. But with oral medications, a higher dose is needed so that some sneaks past it and can do its job. With the others, they do their job, then get cleared, so a lower dose can still be effective.

And doctors all believe a lower dose of anything is safer. If it were up to them, the dose would be zero, but even that doesn't remove all risk. For them, everything is about risk management, not about what you want to accomplish.

I looked for another study, but they were not helpful. They are from four years ago, say the same thing, and state that more studies are needed because there isn't enough evidence yet.

[Courtney G]

Yeah, I've used the liver metabolism explanation many times. But there's data to show that the mere presence of estradiol increases risk of a cardiovascular event. What I can't find is a study that conclusively shows that injections are as safe as patches with regard to increased risk.

I can't find explain that most clots occurred when the dose was high but the fact that I had a previous clot puts me in a higher risk category, and no doc is going to want to take a chance with me.

I think my only hope is if labs from today show no increased levels of clotting factors.

[Lori Dee ✅]

But there's data to show that the mere presence of estradiol increases the risk of a cardiovascular event. What I can't find is a study that conclusively shows that injections are as safe as patches with regard to increased risk.

Taken at face value, the mere presence of estradiol causing risk would indicate that women are suffering cardio events as soon as they hit puberty. And we don't see that in the population.

The difference in safety between patches and injections is in the resulting serum levels. Patches tend to maintain a steady, even dose, while injections cause peaks and troughs, a pattern also seen with oral doses. They don't worry about the troughs, where we experience mood swings, hot flushes, and night sweats. They focus on the peaks. Because it will eventually pass through the liver and affect coagulation.

So it isn't a case of injections = patches. It is that both have less risk than oral.
With a history of a clot and age factored in, patches might be a safer option because they provide a steadier dose without the peaks and troughs, and the peaks are the risk they are looking at.

[KristaFairchild]

.I've been wearing women's jeans and tight fitting women's tops with a heavily padded bra.  I've been doing this almost full time for about a year.  And you know what, nobody cares.  Or at least they don't say anything. I'm treated the same at work as I've always been, and I've been there a long time.  When I'm out shopping or just out for a walk, no one says anything.  I don't notice that I'm treated any differently. 

I'm at the point now where if someone does say something or tries to make a scene, I'm just going to smile at them and walk away.  I don't know how I would have reacted a year ago, but now I know most people don't care and I'm not going to let the "less than 1%" bother me.

I am having similar experiences. It took three years for me to slowly build up to a truly feminine presentation. Now I realize I didn't need to wait that long. For the last couple of days I've worn skirts to work and nobody bats an eye. In fact, many people are overly affirming of my appearance. My work includes well over 100 people that I come into contact and I've not had anybody say anything negative and many people have come out as affirming.

I live in a county where about 70% of the people voted for Donald Trump. We had our primary election yesterday and it looks like we are going to pass a measure about elections that is illegal according to state and federal law. You can imagine the approach to trans people.

Yet I'm finding as I walk around and grocery stores and department stores that I am not getting a lot of stairs and I'm not getting any negative comments. I'm sure it will happen and then I will take the approach Pauline suggested. Even in this area, I'm finding a lot of people compliment me on my earrings or nails, as a code way of saying that they see me and it's good. 

Where I work, we have a catchphrase every year and this year it is "Make It Happen!" It is said with excitement not obligation. Earlier in the year, our superintendent had a conversation with a high school student who added something to that phrase that I've never forgotten. "And do it scared". She didn't mean that we should be frightened only that we should take on the things we should make happen and we might be scared when we do it.  In fact, that can be an indicator of what we're doing this important. 

Today the important thing I am doing is being in public, wearing a plaid skirt, a cute little red V-neck, peplum blouse, and heeled sandals.