HRT Health Requirements

[dreamer_2.0]

Prior to you starting HRT were any health requirements mentioned to you? For instance regarding your weight, smoking, blood pressure, etc...? Were you able to begin HRT right away or were you asked to make some improvements first?

[Marleena]

I have high blood pressure and high cholesterol that are under control with medications. I decided on a complete physical and blood tests to make sure everything was good before starting HRT. Your (my) GP and endo might not be thorough enough so I made sure myself that nothing was missed.

Better safe than sorry.:)

[Leah Lynn]

My previous cardiologist was against hrt, but I found out that he's very religious. New cardiologist is on board, but cautions to beware of blood clots and low blood pressure, due to already being on a B/P med and taking Spiro.

Leah

[mikiSJ]

There are many, many contraindications for beginning HRT and they should (must) be discussed with your MD, whether an internist or endocrinologist, or both.

In my case, I have slightly elevated creatinine levels and if I had started on Spiro, I could have damaged my kidneys. I was prescribed Finesteride mid-year last by my VA internist and when I went to my Medicare estradiol internist, we discussed leaving the Finesteride as my anti-androgen and prescribed Estradiol Valerate as my feminizing hormone.

Even then, when I did my blood workup for my 3 month checkup in March, it was found that I was producing too much prolactin and will need to monitor that issue.

I totally agree with anyone who suggests that you become as smart as possible regarding the various medications and protocols used in the gender transition process, but I totally disagree with anyone promoting self-medicating. Better to wait a little longer and consult with your medical advisers than, as in my case, risk kidney damage or a pituitary adenoma.

You may want to visit this site, which is produced by the very fine transgener clinic at UCSF, http://www.transhealth.ucsf.edu/ as a starting place for your education.

[Frances]

Sure, age, weight and stuff. My endo insisted on patches for health reasons. I am not super old or overweight, but health considerations always have to be factored in.

Has it happened to you or is this preemptive worrying?

[sandra-leigh]

As my cholesterol was on the high side, klinic recommended I start with anti-androgen for a few months, see how it went. They kept an eye on my cholesterol along the route. During one visit I had higher blood pressure; that in connection with my family history and my cholesterol level ranked me as HIGH risk of a heart attack or stroke. But they never suggested that I reduce the estrogen: they worked on the cholesterol instead, including recommending a dietician (free there).

My weight went up while I was on estrogen, which apparently is not uncommon. They know I don't exercise, and they recommended that I start, but they did not in any way "force" me to.

I don't know what would happen if I had had a history of stroke or heart disease. What I can say is that for "regular" bad health, Klinic effectively treated my HRT as if it was "required" and addressed everything around it.

[noeleena]

Hi,

No not needed, i all ready knew about health issues and allso when i was ready to go on meds

i did not look after myself for no reason, i was fit still am no health issues to be concerned about 56 years ago or now, the meds were of no concern to myself 10 years ago and no issues now,

Theres 17 blood tests that should be done there are more of cause over 300 and if theres any doubt then you should have each and every one done to safe guard your self and not have concerns later.

of cause every one is different and not all meds will suit every one, your body can react as to type of dose rate and a reaction of different meds interacting with each other, so its imperitive your in good health, plus no mental issues as some react to meds as well or a mallfuntion can accure,

This is the reason i say talk with an Endocrinologist he/she will have a far better
understanding of the differernt types and dose rates more suited for one, when your dealing with synthic drugs meds it can effect you. as some have found out the hard way and the health issues after, bad news. and something i know to much about,

...noeleena...

[mikiSJ]

Has it happened to you or is this preemptive worrying?

Preemptive. I have heart and lung issues so I investigate almost everything I do medically, but it is not in my character to worry.


I don't know what would happen if I had had a history of stroke or heart disease.


As mentioned above I have lung and heart issues. I was in the Stanford Hospital ER last month for extreme shortness of breath. I reported to the ER staff that I was on HRT. When I met with the head of the Cardiac Clinic, I asked if the estradiol valerate was exacerbating the problem and he was emphatic in his response -'No, it is not having any effect!' They subsequently found during an angiogram two small blocked cardiac arteries. The arteries are too small to ablate or stent, and the risk/reward for surgery is still heavily in the risk column.

BTW, almost every staff member at Stanford when they first met me asked how I wanted to be addressed: Mr., Miss, Ms. I told them Michael was OK. I did not get one weird look or snicker, even when I had to bare my chest and show off the new boobs - and that is the way it should be

[Aprilrain]

I was able to begin HRT right away but I don't smoke, I'm not overweight, and I do not suffer from any chronic diseases which would be exacerbated by HRT.

[dreamer_2.0]

Preemptive worrying. Blood tests have been done and I've got a dr's appointment at the end of the month, likely to discuss the results and HRT. Not sure what to expect so I'm curious about people's experiences.

[Frances]

I have known perfectly healthy people who ended with blood clots. I know unhealthy people who take HRT orally and have no problems. I was over 40 and a bit overweight. My endo went with patches, and I have had any problems. I get the preemptive thing, as I am an anxious person, but there seems to always be a way to get HRT depending on your situation. I have a 71 year-old friend who takes it orally. You'll be fine.

[Cheryl123]

One of the requirements for me to receive HRT was to acknowledge I knew the risk of hormones. I was given a brief talk on the most serious problems and a pamphlet which gave detailed information. Self education is very important even after your doctor explains the risks.

A major problem with ingested estrogen is liver damage, so the trend now is patches, injections, or pills which can be dissolved under your tongue like estrafem. These methods by-pass the liver. If you have elevated creatinine levels or they become elevated (an indicator of liver damage) this should be corrected if you take estrogen.

As Miki mention, estrogen can cause excess prolactin production. If it becomes uncontrollable, this can be serious.

The most common problem with estrogen is that it interferes with the cell’s ability to absorb insulin. If you have uncontrolled diabetes, there’s a good chance you won’t get estrogen until it’s brought under control. Likewise with any history of heart problems. Because of this, it’s important to control your weight, keep any high blood pressure under control and stop smoking – even if your doctor doesn’t actually require it.

Another important factor (and I’ve found many transwomen are unaware of this) is the antibiotics can cause the concentration of estrogen in your blood to increase to dangerous levels. So if you are prescribed antibiotics it’s important to tell your doctor that you are taking estrogen.

Having written all of this, please understand that most transwomen have no trouble at all taking estrogen. But there are possible long term side-effects, cancer being the biggest. This is why orchiectomy or SRS should be considered down the road. When the testicles are removed, far less estrogen is required and this reduces the risk of cancer.

Spiro is something different all together. (Why Spiro is prescribed in the US as an anti-androgen and not Androcur baffles me – sorry for the rant!). You won’t have trouble with this in Canada – insist on Androcur. Spiro can play havoc with your blood pressure, it can dehydrate you (I tried walking a little 5K charity event while on Spiro and I nearly passed out in the hot sun) and it can give you cramps like you wouldn’t believe. But the biggest danger is elevated potassium levels – this happened to me – and this can cause irregular heart beat or even a heart stoppage. Doctors treat this seriously.

Finesteride is not as effective an andro-blocker as spiro but it’s great at reducing DHT levels and it’s far safer. An added benefit is that it reduces the size of the prostrate, which is a good thing for those over 40. Likewise, it prevents male-pattern baldness. Even though you can take Androcur, some doctors prescribe both. You might ask your doctor about this.

There is an increased risk of depression with Finesteride and/or Androcur so be aware of this. In the long run, Andro-blockers are not needed, but they can speed up the physical changes brought on by HRT.

Enough said. Relax and don't worry. I’m sure you will do fine on HRT. But if you smoke, try to stop or cut down so you can enjoy the new woman you will become for a lot longer – and the money you save can get you a fabulous new wardrobe! (Sorry for the Nanny nagging, lol)

[Cheyenne Skye]

I got baseline blood tests done before I started HRT. Everything was fine. After about six months, my blood work came back with high cholesterol. My doctor added Lipitor to my regimen. After another six months, it was under control, so he reduced the dosage. At my last appointment he took me off the Lipitor altogether. As long as it stays under control, I won't have to go back on it. That was my only issue with HRT.

[Michelle789]

From what I have read, it's best to be practicing healthy lifestyle habits. Not smoking, not drinking (moderation is okay, but not excessively), not doing any drugs, as well as eating healthy and maintaining a good cardio exercise (40-45 mins, 4-5 times per week) will help with getting better feminization result with HRT.

[Kathryn Martin]

I am not super old or overweight, ....

What is super old? Oh and I smoke.... got healthier with the right hormones....

[vetobob9]

I am on spiro and I was getting a pain in the area of my kidneys. I did not know what it was except that I had a couple of hernias in the past.

After a week of this, I noticed it went away when I drank a bottle of water. Spiro is primarily a diuretic which takes all the water in your body. Perhaps the pain is cramps from not enough water in the body to accomodate the spiro???

[TNRobin]

Once I had a letter, or actually a referral, from my therapist I was able to begin right away. I don't have any health issues, no weight problems, never smoked, drink very little, no cholesterol problems, but I am a paraplegic.

The paraplegic part was only an issue because it increased my chances for a blood clot, not a good thing. So I'm on an Estradiol patch instead of oral medication. I'm still new to HRT, so we may introduce shots as well, it depends upon how my blood works is in June. I had a lot of issues with Spiro, actually not a lot in number, but I was constantly tired to the point that I was almost a zombie, and I became dizzy easily. Seeing that my level of injury is at T-4, balance is always an issue anyway.

Be 100% honest and open with your doctor about everything, including any vitamins or supplements that you might be taking. That's my only real advice, and you probably already know that.

[tina99]

I was on Spiro, but it was causing cramps in my feet. It affects your Potassium level. My doctor took me off Spiro and put me on Medroxyprogesterone instead. No more problems, and I'm getting some more breast growth besides. I also take Estradiol.

[spandexgirl188]

i went about it a bit backwards, im not recomending my way to anyone. i just know myself and know my body. i started doing herbals and from there i noticed alot of changes, but my best friend who is also my wife recommended that i go to my doctor and tell him the truth. it was the best advice i got. i got blood tests, my first blood test came back completely fine. no issues whatsoever and my cholesterol perfect. i even lost 52 lbs. the second set of blood tests suggested my estrogen count was at 300 and my testosterone at 41. so he sent me to a specialist and i got put on the right path. i was lucky that i was in good health and no side effects happened because of the herbals. the moral of this story:
SPEAK TO YOUR MD FIRST, AND BE COMPLETELY HONEST WITH HIM. I CANT STRESS THAT ENOUGH. DONT BELIEVE ME?? JUST DO A SEARCH FOR HORROR STORIES.

[dreamer_2.0]

Well, had my doctor's appointment today to discuss recent blood work and have a physical. Turns out despite various destructive habits I'm healthy and was given the green light for HRT which I'll be starting towards the end of June (again with the waiting...). The clinic would like to get my therapist's opinion but there shouldn't be any concern there as we've already discussed HRT and she appears to be not just fully supportive, but also encouraging me. I'm not sure how to interpret her, is she being sincere or just telling me what I want to hear? I'm actually leaning towards the former considering she's the therapist in my city who the clinic and various other trans areas go to for patient assessments (are we "patients"?). So I think I trust her...famous last words?

Interestingly, regarding my blood work, it turns out my testosterone levels are within the average range (19.5, I think she said, on a scale of 30. I'm not sure what units these numbers represent though). My estrogen is actually a little above average, which is proof to me that perhaps it's time to step away from my denial. Embarrassingly I don't remember what the exact level was. I feel strongly it was a double-digit, perhaps 80? 86? I could be completely wrong here. Regardless, the doctor said it would be an advantage for me (finally an advantage rather than disadvantages such as balding).

It bugs me I'll have to wait yet another month before seeing how I'll respond to HRT. Another month of living like a zombie. I've heard transition forces you to learn patience. Let the lessons begin.

God I hope this isn't a big mistake...

[LeaP]

God I hope this isn't a big mistake...

You won't turn day-glo purple overnight. And you will know definitively in no longer than a few months if it is a mistake or not. In fact, you may know within a week or so.

Scenarios I have from my therapist include a client that was increasingly weirded out by growing breasts, another who hated the loss of sexual function, and a third who disliked the emotional changes. All reversed course without permanent effects (including the breast case).

By the way, my total cholesterol was 340 and my blood pressure roughly 170/120 when I started hormones. She started me on cholesterol and BP meds, too! Both are now fully controlled.

[TNRobin]

There are always people, male and female, that turn back. If you do so, don't beat yourself up over it, there's absolutely nothing wrong with doing so.

That being said, like LeaP said, you can change your mind with no effects of a permanent nature. I had some real problems with Spiro, side effects that I couldn't deal with and had all but given up on transitioning then my endocrinologist tried a higher, but still safe dose, of Estradiol and it seems to be working. I've been on that for about 6 weeks now and have breast tenderness and small lumps under each nipple, still not enough to show unless I take off my shirt, raise my arm to pull my skin tight and say, "Hey, look at this."

Be ready for an emotional roller coaster, at least that's what I'm going through. You may wind up crying at the strangest things, such as something in a sitcom that before was just a part of the show.

But it's a ride, what little I've taken of it, and since you've gone this far you're probably ready for it.

My expert opinion as someone that's still new to it and has no medical training, but I did stay at a Holiday Inn Express at some point in my life. :)