September 4, 2008 6:33 AM BST
Hello all,
I haven't dropped in for a really long time, but this thread caught my eye, so I thought that perhaps I could offer yet another perspective through personal experience.
At age 45, I began hormone therapy (2002), prescribed (2x)0.625mg. Premarin twice daily (2.5mg/day). I began feeling relief from the dread of a lifetime of testosterone very quickly, breast development, softening and drying my then oily skin. Of course, my prescription drug plan had some questions and initially tried to deny coverage, however they went along with it. Yea! Over time, my dosage was increased to twice the original dose, to 5mg/day. At this dosage, my eyesight was affected enough (one of many possible side-effects) to require new eyeglasses
A few months after getting new eyeglasses, my prescription drug plan convinced my doctor to switch me to something cheaper, and she allowed them to supply me with 2.0mg estradiol twice daily (4.0mg/day). Once again, I needed to get new lenses, and I had lost some of that feeling of well-being. I asked my doctor (a different doctor) if he'd increase my estradiol back to at least what I thought my body was requiring (Premarin and estradiol are NOT 1:1 equivilent, but what did I know, I'm no doctor.) and he wrote a new prescription for 4.0mg in the morning, and 2.0mg at bedtime (6.0mg/day). I'm still having some difficulty with stable vision, but that's another story.
All was fine for some time, until I asked my new doctor where I now live for a refill. He pleaded with me to reconsider my continued consumption of estrogen, in light of a report released by the "Women's Health Initiative" (WHI) warning of the dangers of hormone replacement therapy, mainly the risk of stroke and DVT.
About that time, April 2008, I attended "California Dreamin'" in San Jose. It was there that I learned of John O'Dea, M.D., an endocrinologist from Los Angeles. He delivered a presentation where he addressed the WHI report on HRT. Basically, (in my own words) he said that yes, the WHI report was 'correct', however, THEY ONLY STUDIED ONE HRT DRUG: PREMARIN. To the best of my recollection, he basically said that estradiol was probably okay, but all ORALLY ADMINISTERED (swallowed) hormones pass through the stomach, and then the liver, where it triggers production of blood clotting factors, and hence increases the likelihood of potentially life threatening conditions. Very little of the hormone actually gets into your system.
There is much information on his website: http://www.hamiltonlove.com/
NOTE: The doctor did not author the website, so read it with care, and above all, get the straight information from doctors you can trust. There are disclaimers on a couple of the pages, one of them is quoted here:
"Obligatory reiteration of disclaimer: The answers in this document are collected from a variety of sources: medical literature, pharmaceutical company advertisement, verbal advice of medical doctors, second-hand anecdotes, and personal experience. Despite the authoritative tone of this document, it is presented for educational interest only, not direct advice. It contains opinions, sweeping generalizations, and at least one mistake. The author is not a medical doctor, and makes no claim or warranty as to the suitability of the information in this document for application to any particular individual. You, the reader, take sole responsibility for interpretation and application of this information. Form your own opinions by doing your own research. May your favorite deity curse you if you seriously consider sueing the author for misinforming you. The endocrine feedback system is intricate, delicate, and poorly understood. Even the experts do not entirely agree on how to best meddle with it. Hormone therapy is fraught with risk as well as promise. Be sure you have fully considered the implications before you start. Work with a medical doctor who is qualified to interpret your signs, symptoms, blood tests, and development in the context of your personal medical history. Do not take hormones that you did not obtain directly from a licensed pharmaceutical distributor; the quality of drugs obtained through other channels is not only suspect, but possibly dangerous--especially those in injectable form."
Estrogen pellets, inserted under the skin, in conjunction with injectables, is the treatment of choice. The pellets last about four months, more or less, and deliver a smooth and steady dose, much like the ovaries do in natal females. I had my first treatment in May, and I'll be getting another dose in September. I've also been getting monthly "booster shots" and on alternating months, getting an injection of progesterone. The doctor told me that there are progesterone pellets, however there is a high incidence of the body rejecting them, so he does not use them.
I live in the San Francisco Bay area, so it was a long drive (400 miles) to Los Angeles for my first treatment, but he has since arranged monthly trips to the bay area for the many patients he has here.
So far, I am pleased with my treatments from Dr. O'Dea.
Nicole
"Knikol"
September 4, 2008 2:19 PM BST
Nicole, that was a great post. It sounds like you are very happy with your new doc. I read through your doctors site and it does a good job explaining the why's and what's for proper HRT. I receive estradiol cypionate 5mg injections every two weeks which does a better job preventing the roller coaster effect estradiol valerate is known for. Pellets sound like a reasonable option, but right now I am extremely pleased with my regimen.
I think your post also does a good job showing that there are doctors out there willing to take care of you without the bearaucracy of Psychologists or Psychiatrists. I see this as a physical condition, biological, not mental. Having a therapist help you deal with social issues related to being TG is one thing, but they have no business controlling the physical aspect of transition.
Also to get back on topic, Nicole's post included a great disclaimer that everyone should read as far as using an online pharmacy. Also things like lab tests that need to be done occassionally. I just received my lab test results back yesterday and would be glad to discuss them with anyone who wants. Nicole's doctor points out the differences between taking a lower dose and the dosage needed for transition, the safety of using non oral estrogen rather than pills. Nicole and her doctor also both point out how different forms of delivery, pills, patches, gels, injections and pellets; are not equal when it comes to strength. 2mg for one doesn't mean 2mg for another. Also you have the issue with pills that very little actually makes it into the bloodstream.
One other thing that gets overlooked often is the use of anti androgens that stop testosterone production or block receptors. The most recognized is probably Spironolactone. For those who think they can just stop all the testosterone and either not replace it with estrogen or maybe just a low dosage, I have one word for you. Osteoporosis. That is why you take lab tests, it is not just for the liver, not just to make sure you won't get DVT, strokes or heart attacks. Using Nicole's doctors own words "The endocrine feedback system is intricate, delicate, and poorly understood. " Take the time to understand what you are doing.
Hugs,
Marsha
June 16, 2008 12:24 PM BST
Hi Sheila
Look in the forums Hormone City. You can get a lot of info from there.
You'll also read that to take these with out getting blood work done to keep an eye on your liver & other effects can have very bad & lasting results. Many girls do self medicate.
But you can still get regular blood work done.
June 16, 2008 3:23 PM BST
Don't feel silly ask anything.
And welcome to TW.
June 18, 2008 1:34 PM BST
My best advice would be to do lots of research, and not just follow the advice of one person (even me!) on a forum such as this.
My opinions on types of hormones are:
Absolutely avoid ethinylestradiol and Premarin. They have the highest risk of clotting and other unwanted possible side effects and complications.
The safest type of estrogen is bio-identical (17-Beta estradiol) eg Estrofem. Start on 2mg per day for at least a month, If you think you need it you can then "ramp up" to 4mg a day, see how you get on with that for a few months. Sensitivity in the breasts show that growth is occuring. Don't expect miracles - it's a very long, slow process. Using gel applied to the skin eg Oestrogel is even safer than oral estradiol. Injections also reduce risks of clotting but should only be done by yourself if you really know how to. I don't, so I use tablets and gel.
At your age you really don't need anti-androgens. They carry more risks than estradiol, which alone will lower your testosterone just fine. Save your money, keep risks to a minimum, avoid anti-androgens.
It isn't a bad idea to get liver function tests done once a year, you can do this online I think, but probably cheaper to have it done locally.
Listen to your body, and don't be reckless.
xx
August 4, 2008 7:50 PM BST
Sheila, you seem to be intent on trying too much too soon. In your initial post you asked if there was a way of doing this within fairly safe boundaries, well, pretty much – yes there is. One thing at a time, start slow, and forget about supplementing one thing with another at this stage. Completely forget about Siterone or any other anti-androgens; they are risky and shouldn’t be taken unsupervised, and you don’t need them anyway. Forget about Provera; it is not an anti-androgen it is medroxyprogesterone - a synthetic progestin which has all sorts of problems, side effects and risks associated with it. It is not progesterone, it will not help you in any way.
Take 2mg estradiol tablets, OR use Estrogel, OR try the patches, forget about combining them. You MUST start slow.
Rushing into taking what you think might be the most effective regime would be reckless, especially with so little knowledge on the subject.
Choose one or the other, take the minimum dose, give it a couple of months or more and see how you get on. But don’t start taking more just because your breasts haven’t grown within 2 months – they are not supposed to; it takes years.
Take it easy, and give priority to getting some basic blood tests done. Never mind about serum estrogen/testosterone levels, but do mind about liver function, prolactin levels and so on.
And it will help if you put on a little weight if you are extremely slim. Eat healthy, eat plenty, think healthy, be healthy – don’t be reckless.
xx
August 8, 2008 5:16 PM BST
Good, Sheila, you have the right attitude. I’m sorry if I sounded like a schoolteacher, I didn’t mean to.
I imagine patches are a good way to start (never tried them), they are extremely safe and deliver a low dose.
As for diet, I eat loads of meat, I believe animal fat is not such a bad thing, I had a girlfriend who became vegetarian, she went from a normal healthy looking girl to a scrawny rake, and completely lost her breasts. I certainly won’t be giving up meat! If you want your body fat to be redistributed, you first have to have some. But I have nothing against vegetarians, whatever their reasons for being so. I eat lots of fruit and vegetables too. Like I say, it will help with your feminisation if you put on a little weight.
Stay well away from Provera. If you wish to use progesterone use bio-identical – ie micronised progesterone (Microgest, Prometrium, Utrogestan are some brand names). Synthetic progestins, such as Provera, have all the problems and none of the benefits.
xx
September 3, 2008 10:26 PM BST
"...maybe still unknown in Europe and USA"
And you're certainly doing your best to make it known.
Post after post telling us about this miracle herb, which "your friend" who you tell us is so wonderful, sells on her website. I don't buy it either, or you.
By the way, Utrogestan (that's your progesterone right?) is not classed as herbal, it is bio-identical, also known as micronised progesterone and is exactly the same as human progesterone.
Bio-identical estradiol and progesterone is what I, and any doctor who really knows the risks and side effects of the alternatives would recommend.
Estradiol is cheaper, probably a fraction of the price of any herbal remedy, it’s also tried, tested, approved, controlled and proven to work. Why would anyone in their right mind pay a small fortune for something else which is sheer quackery?
Might as well buy a bottle of snake oil while you’re at it.
xx
September 3, 2008 11:40 PM BST
What did you buy, Sheila?
xx
September 4, 2008 6:11 PM BST
For the sake of accuracy, the main compound in the herb that Anne (Betty) talks about is NOT bio-identical. Like other phyto-estrogens it is similar to human estradiol. If it was bio-identical it would be called estradiol.
Also (again), she refers to the progesterone she takes as “herbal” and “not real hormones”. She’s told us that it is Utrogestan which in fact IS bio-identical progesterone, and not a herbal product. Many TS’s take this to improve breast growth. I take Utrogestan too, wow, we have something in common…
There is some confusion about the difference between “natural” products and bio-identical hormones. In actual fact they are all natural. Bio-identical hormones are plant extracts which have been modified to be (as the name suggests) exactly identical to human hormones. Since they are identical to human hormones they can’t be patented, though attempts have been made (unsuccessfully so far) to patent the process. So-called “natural” products are plant extracts in their raw, considerably weaker form. They are no more safe than bio-identicals.
Oral estradiol is cheaper than any herbal product and proven to work. I’m glad Sheila chose wisely.
My suggestion to you “Betty”, if you really “don’t want to advertise” this product, is to stop referring to it repeatedly in post after post. It doesn’t do you any favours. We know what you think about it (and we know you sell it); ‘nuff said.
xx
September 4, 2008 10:21 PM BST
Well that's just bizarre.
And, strangely familiar...