October 4, 2010 3:46 PM BST
Riley, once again I’d suggest you are wrong to associate your “symptoms” with your hormone regimen. Over the years you have tried Premarin, ethinyl estradiol, estradiol valerate, Estrofem and Zumenon (both 17-Beta estradiol), cyproterone acetate, Estrogel, Sandrena, Organon implant, progesterone cream, progynon depo… have I missed anything? You say your vital statistics are now 32/28/38 with a DD-cup, an awesome figure for even the most stunning-bodied supermodel! People can put on a little weight in their 20’s, for a woman to increase her waist by 2 inches would be entirely normal, and is certainly no reason for changing your hormone type or dose. Indeed, as I said, the switch between hormone types and doses is likely to cause minor changes like this; it’s not the new type of hormone that you have switched to, but simply the fact that you have switched that may cause problems. Your body needs time to adjust. As an extreme example - immediately after SRS many patients experience a surge in testo. The testo factory has been suddenly shut down and your body tries to compensate for this by increasing production from the adrenal glands. It’s all to do with the body’s hormonal “feedback loop” (and it’s further complicated by the usual cessation of hormones and anti-androgens some weeks before surgery). You can get the same or other unwanted effects when you switch hormones; it’s practically impossible to exactly replace a particular dosage of one type of hormone with another, so your body will go through an adjustment phase. Having apparently tried every hormone type under the sun, I’m not surprised you are not feeling settled. Two inches on your waist is nothing to worry about, and no reason to think about switching yet again. It may be water retention, it may just be your age, it is most likely the fact that the body does not stay the same forever, nor does the way you feel, the condition of your hair, the dryness of your skin…etc. It's almost certainly not due to the difference between one type of hormone and another. The same goes for facial hair. Sometimes it just happens to women. I don’t believe ongoing facial hair is entirely testosterone driven. In natal males it may only take a year or two of early testo production (which you will have had) to trigger some growth, it could be years before that shows, but the follicles will be "programmed" to start growing at some point. Taking hormones and AA’s during puberty will surely help inhibit this, but it may catch up with you later, especially if you keep changing hormones and your hypothalamus doesn’t know whether it’s coming or going. So once again, Zumenon didn’t cause the growth, nor does such a small dose of cpa prevent it.
You say you have now been on hormones for nine years, post-op for about 3. I don’t believe in pre-op vs. post-op doses; your body doesn’t magically start producing oestrogen after surgery, and the idea of testosterone opposing oestrogen is a misnomer. Oestrogen is opposed by progesterone (the reason non-hysterectomised women on HRT need to take a progestin to prevent endometriosis). The term “opposed” has been hijacked, wrongly, by the TS community leading to the myth that oestrogen is more effective post-op. It isn’t. The oestrogen receptors haven’t changed, testosterone in the body doesn’t stop the oestrogen slotting in where it’s supposed to, nor does it affect the action of oestrogen which is comfortably “slotted in”. You hear many post-ops saying their breast growth improved post-op, they probably also believed that breast growth was supposed to stop after two years (perhaps coinciding with the end of their RLE and therefore their impending surgery). Breast growth doesn’t stop at 2, 3 or 4 years… and after the cessation and resumption of hormones, and the hypothalamus going into reverse then perhaps into overdrive, many are bound to get a growth spurt.
So you asked if a certain dose was high for a post-op. No, not as such. However, you don’t want to be on a high dose forever, and I’m surprised by your doctor’s attitude here. But I’m not questioning him. All I would say is that if I was a DD-cup I would be lowering my dose, and taking the safest form of oestrogen possible to keep me healthy and prevent osteoporosis in later life. Which is partly why I use both pills and gel. Firstly, why should one not use both? Secondly to get the same dosage with just pills would be considered a “high dose” by my former gender clinic, so my GP is happy to give me the little extra that I want as it’s in a safer form (not that 17-Beta tablets are particularly “dangerous”).
Riley, you should be taking oestrogen for the rest of your life, which could be another 60 years or whatever. So I repeat, I think you should be looking at settling down to a steady “maintenance” dose rather than freaking out about minor changes to your body, which are inevitable for all living creatures.
I don’t believe in putting any emphasis on measuring serum oestrogen levels. Doctors’ “target levels” are entirely arbitrary, and not based on any research for TS feminisation. The blood test itself is simply a snapshot of free oestrogen at that moment in time, and will vary hugely throughout the day. Upping dosage when your level comes out low on a test or vice versa is equally nonsensical. What matters is not what’s in your bloodstream, but how the receptors react and your general genetic predisposition, and this will vary enormously for everyone. So, “You should have a level of 600…” is really without basis, and attempting to achieve that through tests and dosage adjustment is ridiculous. But that’s how gender clinics and most GP’s in this country operate, so we have to go along with it to some extent.
I’m surprised you dismiss your doctors as being unhelpful, especially your current GP who appears to be bending over backwards to keep you happy. No endo in the world can tell you what is the “right” dosage or type of hormone for you, it’s all about experimentation, and it seems you have done plenty of that!
As far as I’m aware, Serenity Cream isn’t available on prescription, nor is it recommended by the NHS, so once again I’m surprised that your GP is recommending when you should use it. Do you get NHS prescriptions? Is your GP a regular NHS doctor or do you see him privately? I’m also surprised by his thoroughly intricate suggested monthly cycle; I’ve never seen anything like it from any UK doctor or endo.
There is undoubtedly some truth in the desensitisation effect of continued hormone use, so there is an argument for cycling in some way or other, but there’s also an argument that the constant monthly cycles that women endure is what causes cell mutation and subsequent oestrogen-induced cancer. Sorry, I’m not going to come out on one side or the other here.
I’m not anyone’s doctor, and I can’t recommend anything for anyone, I can only offer my opinion. As such I think you should be looking at other opinions and ultimately drawing your own conclusions.
But it’s my considered opinion that if you keep switching between hormones, keep taking unnecessarily high doses, and keep taking dangerous AA’s long-term, you are going to have problems.
Riley, I’d be really grateful if you could tell me the name of your GP, he sounds like an angel.
xx