The other day my physician mentioned the Powers method relating to HRT. It involves injections rather than pills for those not satisfied with the results of the usual hormone treatment plans. Has anyone tried this? How are the results?
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The other day my physician mentioned the Powers method relating to HRT. It involves injections rather than pills for those not satisfied with the results of the usual hormone treatment plans. Has anyone tried this? How are the results?
If you wish to be treated on his anecdotal experience, have fun.
Just google him. There are a lot of fans and a lot of skeptics. He has a presentation that is used as reference. There are several threads that reference him and his process/technique on Susan's Place (susans.org). Well worth the read. Good luck.
Allie
Hi Brenda,
I am a big fan of Dr. Will Powers. My experience, and a very positive one, is one of those anecdotal experiences that I have been documenting on this website for the past 2+ years.
Not sure how much you had a chance to read, but here are some useful link:
1. Not long ago, a thread was started in the Transsexual Body Issue section of the forum on his method (LINK).
2. There was a lot of information you can find on his reddit (r/DrWillPowers). The main reason I started using reddit.
3. His method is well described in his power point lecture. The most recent version is 6.0 and is available for download from his practice website (LINK). I also highly suggest you to watch a Lecture Video on his YouTube channel titled "DR. POWERS SPEAKS AT THE 8TH ANNUAL WILLIAM DAVIDSON MEDICAL EDUCATION WEEK *(LECTURE VERSION 5.4, OUTDATED)". (LINK)
I can summarize my anecdotal evidence, with real test results numbers. I must say that I have my own local endocrinologist. He is definitely on the conservative side, but he is open minded and he stays on top of research as he shares new published articles with me when available from Endocrine society. I have asked him bluntly once about Dr. Power's method and his response was mixed. There are things he agrees and things he doesn't. In any case, at present, my HRT regime is very close to what Dr. Power's recommends and my endo is on board with it.
First and for most, you will learnt that Dr. Power's rarely prescribes patients anti-androgen medication. He never prescribes Spironaloctone, and if patient comes to his clinic on Spiro, he takes them off Spiro. In those rare cases when he prescribes Anti-Androgen, it would be Bicalutamide. The vast majority of his patients achieve very low testosterone levels and high estrogen level on estrodial valerate IM injections (smaller dose every 5 days is the best due to pharmokinetics of estrodial), and biodeintical micronized progesterone (never use synthetics), administered rectally, rather then orally as it is prescribed. The rectal method is a key in his approach because it allows to achieve much higher levels for the same dose, avoids conversion of 80-90% of it to its metabolites, increases the half life of the drug from 5 hours to 14 hours (more prolonged effect during the 24 hour cycle) (LINK).
As for me, I mentioned about my numbers. When I was on transdermal patches, I could never achieve stable levels of Estogen or Testosterone. Perhaps, in my case, the absorption was not even. I had breast development, and other effect but breast got fuller on oral progesterone. When I switched to IM injections from patches, my FSH and LH when to 0.2-0.4 mlU/ml range, pretty much close to zero. This in turn told the body to stop making testosterone, and my FREE testosterone when down by a factor of 10, from 2.71 NG/dL to 0.24 NG/dL, and the same happened to my Bioavailable testosterone, that went down from 18 NG/dL to 1.7 NG/dL just by switching from patches to IM injection. On 5 day injections, my estrogen levels are 180 pg/mL at the trough (the morning before the injection), and at 560 pg/mL at the peak (3.5 days after injections). I just got my results again. In 6 months, my estrogen level are withing 5% from the last test - i.e. very stable and predictable. My total testosterone is around 46 *NG/dL, which is low but not as low as you will see with spiro but it doesn't matter because what matters is the free and bioavailable testosterone. (I am still waiting for free and bioavailable T from a test I took 2 weeks ago. The numbers for these two above are from 6 months ago). All this was with me taking oral progesterone. Only a week ago, I switched to rectal and I am really happy to feel soreness again in my breasts that mostly has disappeared in winter after 2 years of HRT. My endo was OK with me switching. 3 months from now, I will check my levels, and will likely see testosterone even lower, and hopefully, more breast growth. I also finally stopped taking Dutasteride which I took for 3 years to avoid hair loss. Another advantage of having a low testosterone, you don't need to take one extra drug to block it conversion to dehydrotestosterone which causes hair loss.
The bottom line - you have one shot at this medical transition and get results that you could get. The puberty doesn't last forever. Everyone says here your mileage will vary but it doesn't mean you have to ride in the same vehicle as everyone else. The reason I like the method is because you (1) take fewer medications, and thus subject yourself to fewer side effects (b) avoid using synthetic drugs and only take what the hormone that the body produces, (c) your levels don't differ much from what a woman would experience through the ovulation cycle. The most important thing is to work with endocrinologist, check the levels. It is cool that your dr is already aware of Dr. Powers.
Good luck!
Katya
Thank you all for the information. Don’t know if I will do it, but it is interesting.
As Laura912 points out, "the Powers method" is supported by not a single credible clinical study.
This is misleading because while there were no clinical studies called "The Power's Method" (that would be silly), there were lots of studies that individually backed what he does. You can say that the dosages, and levels that he aims are outside of WPATH recommendations but saying that his approach is completely made up is misleading at best.Quote:
Originally Posted by Aunt Kelly
Citations, please?
Fair warning we've been here before and the sad fact is that there is nothing, beyond anecdote, that supports Powers' claims. No, studies on the FAB population do not apply, nor do hypotheses based on biochemistry. The latter may present an intriguing line of inquiry, but again, not credible clinical evidence.
To my knowledge there has never been a controlled, clinical study involving HRT and mtf transsexuals. If there was funding ever provided for this kind of research, where would they get the control group? The group of transwomen who would agree to take a placebo for several years?
Maybe Powers is on to something. Time will tell.
Odd that he has no records indicating the success of his approach. He says that they were destroyed when his home burned. I never heard of a doctor/researcher only keeping records at their house but maybe he is on to something. Time will tell.
He also says that, in addition to a bunch of trans patients, he has a family practice and is also a wound care specialist. Maybe he doesn't require much sleep.
In his video he also confesses that he is not an Endocrinologist and has no formal training in the field but he is practicing endocrinology. Hmm.
Are you freakin serious? This guy prescribes super High levels of estrogen and piggybacks that with 81mg of aspirin to thin blood (assuming to try and counteract formation of clots)WTF. His goal seams to focus specifically on breast growth and not on pt safety.
I?d rather do it safely and get BA than play Russian roulette with his method and hope I don?t get a MI or CVA.
My reading is over.......
Just read through Powers' materials. Meh. TONS of irrelevant material. When reduced to essential content, there's really nothing new except the commentary on excess Estrone levels, which I found interesting and will investigate.
Commentary on blockers in general: He's in the anti anti-androgens camp, which makes him something of a throwback. His relatively high estrogen dosages support the approach. This was pretty standard stuff years and years ago, particularly very early on when massive doses of ethinyl estradiol were prescribed. That raises other issues, but was premised on the knowledge that high estrogen dosages suppress androgens. (Power's dosages are relatively high vs most regimens, but nowhere near as extreme.) Current regimens that employ both cross-sex hormones are viewed as a balanced way to administer HRT.
Commentary on Spironolactone: Power's overstates things, IMO. Spiro is used as an anti-androgen in MtF HRT in the US because it's generally viewed as very benign, particularly vs the alternatives Powers mentions. It is true that anti-androgens may often be lessened or eliminated after being on estrogens for some time - and are not. In fact, I raised this point with both my prior doctor about 3 years ago and my current doctor last year. Both preferred NOT to reduce my Spiro dosage. My Finasteride dosage, however, is fraction of what it was in the beginning (sorry, can't be specific on dosages in this forum).
Administration Mode: Injections view - conventional. Anti-implants view - conventional. Oral vs anal - UNconventional. Anal admin can be substituted for oral (swallowing specifically) and vise-versa. BOTH, however, hit the hepatic portal. His related commentary (e.g., on half-life) is definitely in the anecdotal category here.
I'd prefer a much more condensed presentation and a clear delineation among facts, practice, and accepted research vs opinion, extrapolation, anecdotal experience, etc. I saw scores of comments, text, reference, statistics, and practices that minimally require perspective ... if not actual investigation.
Powers comes off as sincere and I'm inclined to attributed his over-the-top presentation to passion rather than BS, but he's delivering a hard sell nonetheless.
"Powers comes off as sincere and I'm inclined to attributed his over-the-top presentation to passion rather than BS, but he's delivering a hard sell nonetheless."
I agree with this statement and the fact that there are so few true studies about HRT for MtF people. I think as Jeri Ann said, "that he may be on to something". Unfortunately, unless he spends more time lobbying for adequate funds to do some quality studies, he can only try and push the current window. Maybe that is why he is trying that hard with the commercial sell, in order to get some interest ($$).
I belong to Susan's Place (susans.org) and there have been several long and detailed threads about his methods. Some posters were for and some against or questioned it all just like this site. However, on that site there are more people following his method then on here, as far as I know. I have never read of any issues that he has had so far by following his method. That may be a good sign or not.
I do believe that the posts that I have read about people following him, many of the posters had endocrinologists supporting that patient. I have also read enough that even regular endocrinologists have little knowledge about HRT treatments. Some learn as they go, and they are usually following the older recommendations established in the past. Time will tell for what happens in the future with his patients. I hope it is all good. Has anyone read any negative patient comments?
For the record I do not follow his process for my trans medical care. Though I admire his courage to break out from the norm, as long as his patients and others do not suffer. Someone has to try to modernize our treatment, which in my opinion is in the dark ages for treating our unique situations, and I am not talking about negative comments regarding his process. I mean from those who are following his recommendations.
Not sure what do you mean by anecdotal category. Here are few links:Quote:
Originally Posted by LeaP
Pharmacokinetics of progesterone
https://en.wikipedia.org/wiki/Pharma...f_progesterone
Pharmacokinetics of estradiol
https://en.wikipedia.org/wiki/Pharma...s_of_estradiol
About the last point - if you read his post from a week ago, he comes off as someone who is not thinking that he is a smartest doc in town, which could be an impression from watching his only video from a year ago:Quote:
Originally Posted by LeaP
https://www.reddit.com/r/DrWillPower...m_source=share
My hormone doctor is very familiar with the Powers method. I asked her about it. She is not an endo, however she specializes in trans hormone therapy and bio-identical hormone replacement, and has actually been recognized and awarded special recognition by the trans community. Anywho...... I asked her what she thought about his E levels and especially about anal administration of progesterone.
Her thoughts about the E was that it was a bit high, but not crazy high, especially when you consider the highs and lows an AFAB will experience throughout their lives. However, she does take issue with the idea that you can simply use an oral medication anally as Powers recommends with progesterone. She told me of one of her patients who did a bunch of experiments about it. Basically here is what this woman did. She would insert it at night, as recommended by Powers. Then the next morning, after she would use the restroom, she then examined the stool. (Disgusting if you ask me!) Anywho, the woman found the P pill, and it was still 100% intact, with no P having been expelled from the pill casing. Anywho..... this woman did this apparently several times, even going so far as to slightly nick the pill casing to try and weaken it. Nope, nothing would get that pill casing to dissolve within the colon.
My doctors recommendation is that neither she not her patients have seen any real evidence to support placing the P anally versus orally. However, if I wanted to try it, she would send my prescription to a compounding pharmacy to produce a progesterone suppository that would actually dissolve in the colon.
Why do I relate this story? Most of the internet commentary of Powers supporters indicate you can just shove an oral progesterone pill into your anus and you are then supposedly absorbing tons more of the P, uh yeah, not necessarily!
Oh, and for the record I take my progesterone orally, yes still.
to... Wikipedia? Seriously?Quote:
Originally Posted by Katya@
Again... Citations pointing to anything other than credible, peer reviewed clinical research, on the effects of progesterone on MtF transsexuals, do not pass muster as anything other than "an intriguing line of inquiry".
anecdotal
adjective
(of an account) not necessarily true or reliable, because based on personal accounts rather than facts or research.
Similar: informal unreliable unscientific
(source: google.com dictionary)
This thread is only repeating the comments from a previous thread. Time to move on.