HRT for novices. Does the process vary?

[docrobbysherry]

A couple of us CD's were discussing hormone treatments. We wondered if they differed among individuals and between different dr.s?

Can some TS's clearify the general process for us? When u begin hormones, is it always injections and is it ever in an oral form?

How often do u receive these treatments? R they weekly or monthly, or ?? Do they continue at the same frequency for the rest of your life? Or, do they taper off over time?

Inquiring minds need to know!:straightface:

[Megan G]

Yes sherry, they are for the rest of your life. You can drop the blocker once/if you go thru SRS or have an orchi but the estrogen is for life..

There are a few different delivery methods, injections, patches and pills so yes you can get them in oral..

[Ashley in Virginia]

Sherry, I take pills. I don't know how injections work but I know you can also get it in patches. My Dr suggested against it, he said they tend to fall off. Plus the pills are super cheap at Walmart. So that's a positive.

[Georgette_USA]

Yes sherry, they are for the rest of your life. You can drop the blocker once/if you go thru SRS or have an orchi but the estrogen is for life..
There are a few different delivery methods, injections, patches and pills so yes you can get them in oral..

I have heard the thing about taking estrogen's for rest of life. Does anyone have some link for that info. Or is that something they recommend now. It would seem odd to re-start now after 30 years.

I took pills back in the 70s-80s, then stopped all after 10 years in 1985, 7 of that after SRS. I was taking estrogen(Premarin) and Progesterone(Provera). MY OB/GYN couldn't see any reason to continue. They didn't have the T blockers back then. They didn't have all these fancy blood testing with Endocrinologists back then.

[Angela Campbell]

I've heard that there are endless variations for how hrt is administered from town to town, state to state, country to country. I've heard of some starting with low doses of anti androgens and slowly bringing the dosage up over time, then beginning the estrogen and possibly progesterone.

Or some begin with full dosage of all. ....many variations. Mostly there is an anti androgen coupled with hormones. The anti androgen is usually a pill, while the hormones come in many variations, pills, creams, patches, pellets under the skin, injections, maybe even others. A doctor may offer any of these.

yes barring health complications the hormones are for the rest of your life. Once the gonads are pretty much killed by the treatment , say a year or less in, or if removed by orchi, or srs, the body no longer has hormones being generated. You need either estrogen or testosterone for general health. Not having any can open you up to several health risks.

I used spiro and pills in the beginning, switching to injections later, then after srs dropped the spiro and back to the pills sublingual.

The pills are usually twice a day, patches usually twice a week, injections usually every two weeks or lower dose once a week. Pellets can be implanted under the skin every 6 months.

The important thing to know is that the treatment does cause some permanent changes.

[LeaP]

I started spironolactone and finasteride a couple of months prior to starting estradiol. My doctor added a minimal dose of estradiol then ramped up both the spiro and estradiol over the next year or so, the dosages being based in part on her medical opinion as to approach, and partly on test results (I test high for potassium, so that was a major factor). All estradiol has been oral, despite my age. I don't personally know anyone who takes injections. In fact, my doctor's preference is for topical gels and creams, which I rejected due to cost and lack of insurance coverage.

Some doctors emphasize anti-androgens. Some estrogen. Some combination therapies including progestogens. Some emulate the menstrual cycle. I've seen references to estradiol maximum dosages at my current dosage as well as 3x that dosage! Ditto spiro. Serum level targets also vary by practitioner.

Cross-sex hormones administration is off-label. It's a dark art.

[Jennifer-GWN]

Sherry; Angela is spot on. Your body needs a predominate hormone, be it estrogen or t. Osteoporosis is one big issue that comes from not having enough of a predominate hormone. Heart risks and others also factor in.

For me.. Blockers first... I had my time with e pills but moved to injections weekly which I do myself... Nice big needle into a big muscle somewhere. I also fall into the progesterone daily camp as well (knowing that the medical jury is still on the fence about usage this was something my dr and I discussed in advance).

Cheers... Jennifer

[Badtranny]

I have heard the thing about taking estrogen's for rest of life. Does anyone have some link for that info. Or is that something they recommend now. It would seem odd to re-start now after 30 years.

If I go 3 or 4 weeks without my patch I start getting pretty sick. How does your body operate with no sex hormones for 30 years?

[I Am Paula]

If you're had SRS, and you're not taking estrogen, this can cause a very nasty condition called hypogonadism. You have to be dominant in one, or the other.

[Nigella]

Paula, I had to google that one :o

To confirm what many have already said, my endo told me, as soon as I started HRT, HRT is for life, the body, once the "gonads" have been removed, just does not produce enough hormones for the body to function normally.

To answer Sherry, HRT is delivered in numerous forms as with natal femals undergoing HRT after menopause. The type of delivery method in my case is patches, more to save extra medication being filtered by the liver. In other cases it can be determined by cost.

[Georgette_USA]

I do Thank You all for your inputs.
It is hard to answer all at once. Since I don't know all your histories of HRT and SRS, hard to tell.
I openly spell out my treatments of what I can remember. These are the reasons I have gone around websites and local for advice to a long time transition. Have gotten some advice from people in UK, NHS has some good papers on things. As people know in US, no central storage of information. I point out that in the mid 70s, our local group of 6-12 were the guinea pigs for all the doctors and surgeons. Which is why my partner and I just said the hell with all the doctors for a long time. 30 years sneaks up on you.

Melissa, what kinds of symptoms of sick do you get. Apparently mine and my partners bodies have/had done quite well. Neither of us had any sickness problems. Did find Type 2 diabetes in my 50s. Have had High Blood Pressure from before transition on and off. She was also a MtF Post-Op, 6 months prior to me. She died in 2014 of Lung Cancer at 79, 60+ year smoker so that could have been a factor.

Paula, Hypogonadism seems to be anything causing the lack of Estrogen or Testosterone. Some of the symptoms can be from other factors. Like low libido, I assume physical, as my mental libido is off the charts lately, in 60s-70s not uncommon.

In the last 1.5 year. I have had a Mammogram - Bone Density - Major Heart testing (EKG, sonogram, treadmill and fancy body scan) - PSA - Testosterone and LH/LSH tests. Did not get Estrogen levels.
Blood tests are in the Post-Menopausal ranges for a woman, and that is what my long ago OB/GYN said I am similar to.
I may have to see if our local GIC will take me on for other testing, or see if I can get a referral to an Endocrinologist from my primary GP. Again I am educating the doctors.

[Eryn]

Sherry, for those of us over 50, the E is almost always administered by patch or injection, usually patches. The goal is to maintain liver health. TS people tend to need larger doses than genetic females to maintain reasonable levels, so that means multiple patches.

Spiro is in pill form, and an endo will usually ramp you up slowly as it does cause blood pressure to drop. Mine was borderline high to begin with so the "side effect" was welcome, but if you ramp up too fast you tend to feel faint.

As far as "E for life", that is up for debate. GGs don't have E for life and the cessation of E production is manifested as menopause. Not fun at all, but survivable.

And yes, this is all experimental. With the increase in the population doing something about their GD, a lot more endos have had to learn about how to treat us. Most just follow the endo society guidelines and watch the blood work for anomalies. We're usually more knowledgeable than they are, but of course one has to be very diplomatic about that!

[Badtranny]

Melissa, what kinds of symptoms of sick do you get?

Nothing specific. Head-achy, nauseous, dizzy, tired, just generally feeling pretty darn bad.

I'll let the people with actual medical knowledge explain why, but my old doctor (Charles Moser) says quitting estrogen isn't an option.

[PretzelGirl]

Eryn, I don't know where you get your data that those over 50 almost always go with a patch or injection. This is why I am not a fan of statements that make "everyone" or "almost everyone" statements. I know many that take the pill, including myself. This is why it is done sublingually. Maybe it is true for your area? My doc prefers this method for the stability of levels. She is investigating the subdermal method, but I haven't had an appointment with her recently, so I don't know if she has conclusions yet. She typically gets her own case studies going and closely monitors those individuals with frequent blood tests.

As far as E after menopause, it isn't necessarily gone. That could be a reason for a woman to go on hormone therapy herself. I just read multiple articles to double check myself and the wording varies, but the general gist I get is that it doesn't totally go away (similar to our levels of T), but can dip or remain slightly strong. They certainly indicate that potential total loss of E is typically more than a year after menopause. Below is an extract from my last blood test and it indicates that post-menopausal women have a range that is not necessarily insignificant. Of course actual number ranges vary based on the actual testing method of the lab.

http://www.crossdressers.com/forums/attachment.php?attachmentid=257621&stc=1

[Peggie Lee]

Hi Sherry, currently I am taking the pill form of E now that I am on Medicare before I was on patches only because my company insurance would pay for it, patches are expensive and the pill is cheap besides I hate needles.

Peggie

[arbon]

I don't personally know anyone who takes injections.

.

I did for over 5 years, imported what I needed.
On oral since last august. Much easier.
Just need to find a new doctor once again.

[LeaP]

[rewind] I personally know ONE person who has taken injections ...

(got a feeling I'm going to hear of more ...)

[Stephania]

Well, I'm 58 and they started me out on patches. I don't know why, maybe oily skin but they didn't work so well. So he put me on oral and been on it since. Just over 2 years.

Stephania

[LeaP]

257721

... And I'm over 50.

(Note – nothing in this picture indicates dosage. What is indicated on the bit of the bottle that I show is the pill size, the number to take and when is indicated elsewhere. The pills shown are also not my current dosages.)

[Cindy J Angel]

Sue and Eryn please keep posting on this and Sue stay I do went to hear what you have to say. I am getting so close to starting. Eryn I Cancelled
my last app because of miss info. I got scared I had a friend pass because of a blood clot in his leg the day before my app. but there is a test to see if you are prone to blood clots. My Dr had the test run and I do not have to worry. Sue like u I went to take pills or injections patch is just not going to work for me. I listen to what aver body says and I read Up and then ask my Dr. if he dose know he tell me he will find out. From what I have read on here it all over the place. Hay it just my thoughts after I start then we will c how I answer.

[Rianna Humble]

Regardless of sweeping generalisations, I would strongly encourage anyone considering HRT to consult a medical practitioner first.

I would also urge anyone on this site to consider why they want to take hormones. If it is not for transition, then I would also suggest talking to a therapist before doing anything else.

[Jennifer-GWN]

Lea... Great idea.

.257727

I'm 53 I think. Must be the pills.


Cheers... Jennifer

[Heidi Stevens]

I was going to sit on the side lines of this one and read how the others are being treated. But the over 50 discussion has me wanting to add my experience to the mix. Under the care of an OB/GYN, she placed me on estradiol and Spironolactone last March. Both in tablet form. I will be 60 in three weeks and she has never hinted at changing my method of delivery other than to tell me the options available.
I also come from an unique prospective in the fact that my wife had endometriosis when she was 27. Back in the 70s the only remedy for this was a hysterectomy. For nearly 40 years she had to take HRT to help live her life. She used every form available in the 37 years she was on estrogen replacement: pills, then weekly injections, and later when they came out, patches. So I was lucky to have first hand knowlege in how to keep estrogen levels up. I wanted to go patch for my delivery seeing how convenient they were. My OB/GYN said pre orchie people couldn't use patches because the doses were so low they would have no effect on hormone levels, even if they were taking a blocker. I saw nothing but problems when my wife got shots every week at her doctors office. It leaked all the time and literally was a pain the butt.
That's why we went with pills and things are going just fine so far.

[LeaP]

What's missing from this conversation is the facts. So ...

1) Risk information re clotting issues is based on old studies and practice. In the case of cross-sex hormones, to a time when much larger doses were common, when combination therapy with anti-androgens was less common, and when ethinyl estradiol was prescribed in MASSIVE dosages. In the case of cis women, primarily to early birth control formulations, which were subsequently adjusted. Hormone therapies in cis women are more associated with cancer risk. I'll add that age is a general risk factor associated with clotting issues, but whether or not that applies to a given individual is another question.

2) Injections, transdermal application (gels, creams, patches, implanted pellets), AND sublingual oral administration ALL bypass the hepatic portal, which contrary to what many believe, is more than a "first pass" through the liver.

3) Different administration types result in varying patterns of release into the bloodstream. Injections, implants, and patches yield either a steady release followed by a decline near dose time, or a steadily declining dose amount over the period. Patches, creams, gels, and oral administration (sublingual or not) spike levels relatively rapidly, with levels declining at a varying rate depending on the individual's metabolism. (Average half-life in the bloodstream is known, however.)

4) Sublingual administration results in the highest levels at the fastest rate, followed by conventional oral (swallowing), then patches, creams, and gels. Whether or not that matters is the subject of speculation, as studies on that aspect in regard to feminization (MtF context) are non-existent. (I'm not sure where injection falls in the relative rise rate of levels, though I'm pretty sure it would be below sublingual, which is direct to bloodstream.)

5) Desired HRT effects depend on a large number of factors, including the individual's own hormones levels and hormones production, the number, location (generally and at the cellular level), and sensitivity of their receptors, as well as their propensity to up-or-down regulate, their genetic makeup, various related biofeedback mechanisms, etc.

6) HRT side effects are due to some of the same factors as positive effects, but often trace more directly to direct drug effects and specific issues (e.g., potassium or prolactin problems)

7) Not all people are suitable candidates for all administration methods. (Heidi provided examples.)

8) Whether or not higher or lower hormone serum levels, combination therapies, timing and sequencing, etc. are better, faster, more or less effective, optimal for an individual, etc., is not knowable, by anyone, physician or patient. There is plenty of anecdotal information that may or may not apply. You can also believe what you will, retrospectively or not, based on your experience. You cannot, however, know what might have happened in scenarios you did not experience.

9) The best a physician can do is to adopt an approach that is informed by whatever information they have. And since they almost NEVER have any beyond what they get from blood tests and can glean from your medical history (including family), that means that they are first and foremost monitoring for problems (not progress), and secondarily applying whatever general medical approach to which they adhere (i.e., not necessarily tailored to you at all beyond issues management).

In addition to the above, add the practicalities and limitations ... Testing methods and results vary, test results can vary wildly depending on test type, conditions, specimen handling, etc. Did you have that cancer, clot, emotional/psychological issue before? Was it really the HRT that improved it or made it worse - and regardless, whose should decide on starting/continuing HRT and why? How much does your doctor actually know? Do you have special considerations as to administration type, timing and availability (e.g., frequent or extended travel)? How will other medications interact with HRT for you? Generic or not and why? Blah, blah, blah.

Fortunately, for most people a handful of more-or-less standard approaches work just fine and without undue problems. Just don't believe anyone who thinks they know best, because that knowledge doesn't exist. Believe your doctor when he/she tells you what you should NOT do, however, as that is much better known.

[Megan G]

7) Not all people are suitable candidates for all administration methods. .

Just to touch on this a little and provide another example of how this is spot on. I have been on HRT for over 2.5 years now and have seen two different endo's, both only prescribe the oral form of estrogen.

Ever since I began HRT and was given the pills they struggled to get my "E" range where they wanted it. For over a year I was taking more than what was considered the "safe limit" for maximum dosage but still they could never get my level high enough, I was only 1/3- 1/2 of where they wanted me..

I switched endo's for another reason and once again all his patients were on the oral form. I asked to be switched to injections and he agreed so given my history of low "e" he put me at a dosage that was considered "higher than normal" starting range.

At my first bloodtest 30 days later my estrogen level was sky high, double the target range we have been adjusting it for the last 6 months to get it to where I am finally where I need to be..

When asked why oral did not work for me his reply way not everyone's body is the same and everyone processes medications in different ways.

[Kaitlyn Michele]

i had issues to, all in line with the above


bottom line if you want a more feminine figure, its probably best to stick with bodysuits