Latest HRT study

[LaurenS.]

Is anyone else as scared as I am about the results of last weeks HRT study? I'm not trying to be an alarmist or anything. Just looking for some discussion on the subject. I guess I want to hear not to worry, everything will be fine.
I have a endo apointment next week and I guess I'll be looking for some serious info and advice.
Lauren

[Melody Moore]

I am a little concerned, but not scared - I think its too early to start worrying to that
extent, I think regular blood tests & check-ups will help to avoid most of the problems

[Traci Elizabeth]

OK, count me as in the dark. What study?

[Stephenie S]

Yeah, what she said.

[Kiera79]

Exactly I want to know what study.

[Danni Bear]

ladies,

Here is one of the many links to the study released last week

Danni


http://www.suite101.com/content/study-links-hrt-to-more-deadly-breast-cancers-a299037

[ColleenW]

Well - breast cancer can develop in men using HRT to transition, I've seen it. That said it is rare. The best defense would be what's recommended to every woman, monthly self exams and annual mammography.

[Sarah Welch]

The study referenced above only pertains to one type of drug regime for postmenopausal women. Before freaking totally out I would like to see a comprhensive study of MtoF subjects and considering several different drug regime's.

[Bree-asaurus]

So we're more at risk now... I wouldn't be surprised if the risk for MTFs on HRT was similar to genetic females not on HRT. That's life, and you just need to be more aware of the risks.

Everything causes cancer these days. I'd rather get cancer from HRT than cancer from the chemicals in a Big Mac!

EDIT: Also agree with Sarah ^^

[Danni Bear]

Sarah,

you and me three although my Dr. did make me aware of it today. He did say that it is only perliminary study dealing primarily with post-menapausal women.

Danni

[thechic]

Just more stuff to worry about, there's already enough problems,Such is life.

[pamela_a]

Hummm let me think here. The options are die from not transitioning or maybe experierience the possiblity of an increased chance of breast cancer. Now THAT is a no brainer.

Is it something instinctive that people feel the need to scour the planet looking for things to be alarmed about? Judging from the preliminary results of that study I STILL have a better chance of getting hit by a bus than I do getting breast cancer.

[Inna]

Once not long ago before I struck a decision to go for transition, I stared death straight into its eyes, and it felt good because in it, I was no longer committed to live a lie. The only thing which made me stop from jumping into the inevitable was love I have been blessed with from my child, sister and mother. As I see it, I have died once and have been reborn again but in love and truth. I know there is no turning back for I would trail back into agony again, so if I shall die because of HRT I will die the happiest death I could imagine.

Quote of part of poem I wrote not long ago:

"just for once let me, to joy in her presence
where life begins, she is delight, bliss, heaven
even if a lie, how sweet deceit, intoxicating poison
I will sip it down until darkness becomes her"

[ReineD]

I was considering taking HRT for menopause, but I certainly won't take any synthetics now. I'm making a mental note to read all available research on all types of HRT. :p

Back to topic though ... it doesn't surprise me that the studies focus on the effects of estrogen and progesterone on women, since it is primarily women who take them. But it would be great to know if the risks are the same for birth males. If something causes cancer in XX, why wouldn't it in XY? Anyone out there with good guesses?

[Melody Moore]

I also agree with Colleen in that breat cancer can develop in transsexuals on HRT but it is rare - its more common with natal females who are using HRT for menopausal reasons and that is also what this report is really all about. There is no mention whatsoever about transsexuals being involved in this study




HRT Follow-Up Study

In 2002, the Women’s Health Initiative study of postmenopausal women found that estrogen and progesterone hormone replacement therapy poses an increased risk of breast cancer. Researchers continued to follow the women volunteers and discovered that not only does HRT place menopausal women at a greater risk of getting breast cancer, they tend to be diagnosed with later stage cancer that is more likely to cause death.
Natal females face a natural risk of breast cancer even without HRT, so therefore that risk would obviously be increased ten-fold with HRT - so I personally don't believe that the risk is as great for transsexual females who dont have a high amount of naturally occurring Oestrogen. Also from my understanding... Post-op transsexual females are put on a much lower dosage because the body isn't producing anywhere near as much testosterone, so therefore there wouldn't be as much risk with HRT as there would be in being pre-op transsexual female.

[JulieK1980]

I was considering taking HRT for menopause, but I certainly won't take any synthetics now. I'm making a mental note to read all available research on all types of HRT. :p

Back to topic though ... it doesn't surprise me that the studies focus on the effects of estrogen and progesterone on women, since it is primarily women who take them. But it would be great to know if the risks are the same for birth males. If something causes cancer in XX, why wouldn't it in XY? Anyone out there with good guesses?

The risks are definitely going to be different. Most of the literature connecting cancer to HRT relates to an overabundance of specific hormones. As men taking HRT to transition to women, the effects are slightly less severe, as their body naturally has less estrogen, and less progesterone than a naturally born female. (This assumes they are also taking a testosterone block)

All cancer is, is a mutated or broken cell that no longer respects its growth boundaries and multiplies exponentially causing a tumor. These are either benign, (non-cancerous) or malignant, (cancerous.) Now if we look at what the job of a hormone is, it's to stimulate growth in some fashion. Female hormones stimulate growth of female secondary sexual characteristics, and male hormones stimulate male sexual secondary characteristics. It stands to reason that a hormone that "stimulates growth" would create a risk for "unmitigated growth" of a tumor. For example one of the treatments for an enlarged prostate is to take synthetic estrogen, and testosterone blockers which inhibit growth of the specifically male organ. Thus MTF transexuals are actually at a lower risk for many male associated cancers. While they will most certainly increase the risk of female associated cancers it (educated guess) should still be significantly lower than a female at birth.

In a nutshell this study will just enunciate the importance of the proper regulation of the levels of hormones provided. As with any hormone therapy there are inherent risks to weigh with the benefits. This study should be encouraging to most, as it's just more knowledge for doctors to weigh in on, and create a more ideal dosing regimen that has the lowest possible risks with the greatest possible benefits. Just as they have dramatically improved HRT for women post-menopause to a MUCH safer level in recent years.

What I would be extremely curious would be a study of someone such as Melody who is actually intersexed, as her hormone levels aren't necessarily the same as someone who was born entirely one gender or the other. (sorry, I don't mean to call you out, just a great example.) ;)

[ReineD]

Thanks Jody! :hugs:

[Hope]

Well it certainly is not encouraging, but lets keep a bit of perspective here.

The study suggests that post menopausal women taking HRT including both estrogen and progesterone had a significantly (40% if memory serves?) greater risk of getting breast cancer than women on HRT involving estrogen alone, or women not on HRT at all. Ok, a 40% greater risk of getting breast cancer is nothing to sneeze at... but there is a simple way to mitigate the risk - leave progesterone out of your HRT regimen. That is option 1. Option 2 would be to look at prevalence rates, instead of increased risk rates. If my memory is working correctly (always a chancy proposition) we are talking about 1.6 women in 10,000 per year developing breast cancer w/o progesterone, versus 2.6 in 10,000 per year developing breast cancer with progesterone. Those are slim odds, they are not winning-the-lottery type of slim odds, but they are slim odds. I would still like to lower them, but comparatively speaking - those are slim odds.

And when you consider that taking E (with or without progesterone) basically prevents you from developing a variety of specifically male cancers, it is easily a wash.

So - to recap, not good news... but not that bad... Certainly not so bad that any one should loose sleep over it, and if it is causing that sort of anxiety - the easy solution is to remove, or at least reduce one's progesterone level... the hormone that is already sort of controversial...

This is something we can control.

[MarieTS]

Don't fret, Lauren-- We both knew this going in. Plus, we're patching it, which is reputed to be safer in other ways. Also, we're not taking progesterone, which when combined with the estrogen creates the the problem, according to the research I read. Wish we could meet in Trinidad! Hugs :hugs:.

[Melody Moore]

What I would be extremely curious would be a study of someone such as Melody who is actually intersexed, as her hormone levels aren't necessarily the same as someone who was born entirely one gender or the other. (sorry, I don't mean to call you out, just a great example.) ;)
LOL, its OK.... I'm curious to know as well for obvious reasons, however I am not even sure yet what my chromosomal mosaic is yet because I am still yet to go through a series of tests & scans to find out where I do actually fit in the intersex spectrum - not that I really care much to know now anyway because it will only to dislike my parents even more for never telling me about my intersexuality.

So I am a little concerned, but not overly concerned because of these types of issues with hormones that could have a more serious affect on me if its not monitored. I am also not too worried at this point of time either because I only started HRT 2 & half months ago, so the doctor doesn't seem too concerned either right now about my current oestrogen levels or I would have got a phone call about it by now. He promised to give me the results of my latest blood tests at my next visit on the 15th of November.

Another doctor has already told me that if I was born with ovaries, they were more than likely removed as an infant or they would have caused me problems and most likely caused me to be infertile as a male. But I have kids, so that doctors believe that ovarian tissue is not present and the reason why I am not too overly concerned. So Im not sure I would be the best candidate for such a study.

[alyssaenglefield]

I've got a copy of the report on PDF - courtesy of University of Otago's medical journal access. (The benefits of being a student!)

The cumulative incidence rate (number of new cases per population over a given time) for HRT woman was 4.2 cases of invasive breast cancer per 1000 women. For the placebo woman, it was 3.4 cases per 1000 women. Divide 4.2 by 3.5 and you get the risk ratio: 1.2 or 6/5. That means for every six HRT woman who contract invasive breast cancer, only five placebo woman will contract invasive breast cancer in that same timeframe.

Unless you have studied epidemiology, that is the best way I can explain it.

[noeleena]

Hi.
To my otago friend .

Our Uni of Otago has been doing some research on a hormone called Mullerian Inhibiting subtsance = M I S
& they would like to do tests on T S people to see if we are pre disposed to develop as M t F or F t M. so as a ? this could be a point of interest as to those of us who are on meds = H R T .

The research is headed by
Ian S McLennan
M I S Neurobiology Center
Brain Health & Repair Research Center
Dept of Anatomy &structural Biology.
School of Medical Sciences.
Uni of Otago.

...noeleena...

[ReineD]

Does anyone know if there are alternatives to synthetic HRT? The article linked above described: "Prempro contains estrogens from horse urine and a synthetic version of progesterone". Is there such a thing as natural or "real" estrogen, and where would this come from?

[CharleneT]

Does anyone know if there are alternatives to synthetic HRT? The article linked above described: "Prempro contains estrogens from horse urine and a synthetic version of progesterone". Is there such a thing as natural or "real" estrogen, and where would this come from?

The closest available is Estradiol Valerate, which is called "bio-identical" estrogen. It is synthesized to have the same molecular structure as naturally occurring estrogen ( in the estradiol form). EV is made, I believe, from Sweet Potatoes. Technically it is 17beta-estradiol. In humans there are three forms of estrogen around: estradiol, estrone and estriol.

Premarin is congucated estrogens from horse urine, not exactly "synthesized". The advantage they believe exists with it is that what you are getting is a group of estrogen molecules. The idea being that you stimulate more estrogen receptors that way. The progestine (not progesterone) that is mixed with Premarin to make PremPro is Medroxyprogesterone Acetate, which has its own set of bad side effects and controversies.

This may help:

"The major forms of estrogen in Premarin are estrone (>50%), equilin (15-25%) and equilenin. The estrogens in Premarin are often called "conjugated equine estrogens" (CEE) because the estrogen molecules are generally present with hydrophilic side-groups attached such as sulfate. Thus, estrone sulfate is actually the major active constituent in Premarin. Estrone sulfate is easily absorbed into the blood after Premarin pills are taken by women. Estrone sulfate is converted to estradiol, an active estrogen normally found in women. It is not clear if estrogens such as equilin that are foreign to the human body have effects in women that are significantly different from the estrogens like estradiol that are normally made in the human body."

[Billijo49504]

What about this articual linked on the page you had. http://www.suite101.com/content/estrogen-therapy-is-it-really-harmful-a59169 It seems to go against what the first one said..BJ

[ReineD]

Thanks Charlene, and also Billijo for your link.

I had read an article last April in the New York Times Magazine that I promised myself I would go over again more carefully, to compare what it suggests to the studies and info that is out there. But, I haven't done this yet.

There's a lot to go through, and it's daunting for me, not having a strong understanding of chemistry and biology.

But, here's the article in the NYT, if anyone is interested:

http://www.nytimes.com/2010/04/18/magazine/18estrogen-t.html?pagewanted=all

[CharleneT]

Reine, that article is great ! Thank you for the link. The WHI study has caused a lot of people to jump off of HRT, as well as a lot of controversy about whether it is a good idea. This article won't tell you what to do, but it does point out the limitations of the WHI study and just how complex the whole issue of HRT is for natal females. I do think that the second WHI study, the one where the women didn't have the Provera added (and had had hysterectomies) seems to point out just how specific of information the original study created. Yes, there were significant problems with the patients, but there is also a strong chance that the reasons are linked to the specific drugs used.

It is all very murky, especially what to do ??? One thing is for sure though; if I were a natal female, over 60 and considering HRT, I would stay the he@# away from PremPro !!

[Kathryn Martin]

Back to topic though ... it doesn't surprise me that the studies focus on the effects of estrogen and progesterone on women, since it is primarily women who take them. But it would be great to know if the risks are the same for birth males. If something causes cancer in XX, why wouldn't it in XY? Anyone out there with good guesses?

Reine, it is important to note that it appears the combination of estrogen and progesterone creates higher risk not estrogen treatment on it's own. Elizabeth received estrace only because our GP was aware of the issues. I got my "letter" yesterday and will see my GP on Tuesday. I am armed with extensive information and many questions but am so happy to begin my treatments. Clearly, Transwomen on hormones must take their baseline breast screening and continue like any other woman annually. But the findings were although significant still in the range of 0.12 versus 0.29 % of treated women with incidents of breast cancer and 0.12 representing women on placebo.

[LaurenS.]

I was hoping this would create some valuable discussion and it did. Most all of you had something valuable to contribute and I leaned more precious info on the subject. The study I was refering to was the results from an ongoing 11 year HRT study that was concluded prematurely
because of the conclusive results that were being found. It appears that not only does HRT increase the risk but also is more aggressive and most likely had spread to the lymph system when it is found. I know what most of you are saying about there not being much of a choice when it comes to transitioning but I tend to worry. I have to say that thanks to you an your words of wisdom I feel better.
Thanks to all for the info.
Lauren