Negative Effect of HRT

I think it is only fair after sharing all the positive effects of five months of HRT that I tell about a negative effect that has appeared. I am a very fit person and exercise almost every day, including a workout on an exercise bicycle with a heart rate monitor. About a month or so ago I started to notice that my recovery heart rate time after a strenuous workout was taking much longer. I also noticed being out of breath in situations that in the past had no effect on me. My wife and I have a morning routine of an uphill hike that she leads. This is her cardio workout, I never breath heavy from it, it is too easy for me. Lately, when I reach the top of the hill, I too am out of breath. So this week I went to my family doctor and asked for an EKG. After reading it he said there is a minor irregularity, nothing to worry about for now, but we should keep an eye on it. My last EKG of two years ago showed no irregularities. So my hope is that these adjustments of my heart to the new hormone balance will stabilize. I am aware that without hardly any testosterone in my body, my muscles will weaken somewhat. So my question is has any one else on HRT experienced anything similar? Also, if you did experience something like this in the beginning, how long did it take to stabilize?

Dorit, from a medical perspective, I cannot think of a reason why estrogen should decrease your exercise tolerance. It definitely does not in the post menopausal women to whom I have prescribed the replacement hormone. There is a reasonable chance that this is coincidental. However, the only way to test this is to stop estrogen which I doubt would be a popular idea. The EKG was a good idea.

Thanks,Laura, for such a prompt response. But what about my testosterone blocker that has brought me down to only .25 ng/ml, which I understand is even low for genetic females? Of course, this change could be unrelated to HRT, but I had complete blood work only three weeks ago and everything was normal.

Dorit -- I haven't seen a similar thing. I take regular walks of 4 to 6 miles with a couple of challenging hills in them and haven't had a problem with cardio fitness. I have lost significant muscle mass and I note that my testosterone-fueled self could easily carry 50 pound bags of ice-melt (winter - feh!) one-handed, my estrogen-fueled self can barely manage one with two hands, but only strength seems to be affected.

While I do not consider it a negative, like Pat, I have noticed a significant loss in upper body strength. I never had a lot to start with, but it takes noticeably more effort to lift or carry heavy items, and I am more tired after extended bouts of manual labor. I get annual check ups and nothing is worse compared to pre-HRT, and, in some cases, better since I have lost some weight. As far as cardio-vascular issues are considered, my doctor only mentioned the increased possibility of blood clots with HRT especially in those over 40.

The decreased testosterone and decreased muscle mass go together but other than weight lifting, one should not have shortness of breath caused by decreased testosterone, usually.

I've noticed that I am frequently tired. I have a lot going on simultaneously with the HRT. Perhaps that is a reason; but I've experienced prolong, extreme stress in my life and never was so tired. Oh well, naps are nice!

Just had a physical for cataract surgery, and my MD found I have an irregular heartbeat, something I'd noticed in early march. He did a cat scan right there. Occasionally I had a feeling of being "left breathless" momentarily. Cardio was intermittent this winter, treadmill is boring and heavy snows in northern climate, do not allow for pasture walks without snowshoes and the dog wouldn't be able to go. Just thought I had let physical fitness slack off to much, and barn work wasn't enough. So back on treadmill 2x daily, w/planks. I've been on estradiol patch and spiro since mid October 2017. My primary care put me on xarelto to help prevent stroke and go back in a month and will also see a cardiologist. Both endocrinologist and MD said to continue hormones and workouts. Like others, upper body strength has diminished and exposed skin(face) feels the cold air more than ever.

Dr Laura. (Laura912);

Thanks for chiming in on this.
Of course I'm motivated and inspired to transition towards HRT. But I've always been concerned about possible negative effects.
I've heard and read some summary reports that hint about HRT increasing the risk of heart disease and other cardiovascular disorders (increased plaque accumulation?) I'm still researching on it.
I already have a slight natural sinus bradycardia and have enjoyed a fit and active life; still do. Heart disease doesn't run in my family, so to speak. I would hate to have HRT make my face and skin soft and pretty (oh how I wish), but make my heart and vascular system brittle.

Ilene, find an endocrinologist who is very experienced in gender hormone therapy. Should be several where you live. Go with what they say and be careful with Dr. Google.

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Originally Posted by Laura912

The decreased testosterone and decreased muscle mass go together but other than weight lifting, one should not have shortness of breath caused by decreased testosterone, usually.

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I have noticed that with T < 3 and E 300+ HRT has had an impact on my energy level. When it comes to housework, I can hardly move. My legs are weak, I have no strength and I get lightheaded, short of breath and an insatiable thirst for a glass of wine, or more.

However, when it comes to shopping I can go from open to close. I may have to take a break for Margaritas, chips and salsa but after getting suitably nourished I am ready to go again.

Now, my recent surgery kicked my butt and it was five days before I could shop for a few hours in Tanala. Eight days after surgery I was able to shop most of the day in Tlaquepaque.

Now that I am home the HRT has affected my energy level again. My kitchen needs deep cleaning and I just don't seem to have any energy. But, I just got a text from Barbara Dugan about shopping Friday and I am doing my happy dance. Maybe there is hope for me.

Ilene,
If you read all the info that you come across about Estradiol, especially the information that comes in the package, you will see every symptom known to man. I have had conversations with my doctor about the safety of hormones and delivery systems. She said that among her several hundred trans patients and hundreds more from her colleagues, there has not been a single incident of heart trouble caused by Estradiol. That is not to say that it might complicate a preexisting condition though. You can find anything on the internet to negate or substantiated any concerns. Just talk to your doctor and follow their recommendations.

Let me know if I can help you.

Ilene, when I started HRT a couple of weeks ago they put me on t-block and Estradiol patch because it is the easiest on your system.

Jeri Ann,

You are always the voice of wisdom and experience. Thank you. Your reminder to keep reading, researching and to consult the experts is timely and sound.
I have all the time I wish. I'd say I'm a year or years away from even making a decision to proceed with medical transition in any form. There's so much other normalizing and socializing, and LEARNING to do. I'm just beginning any kind of professional counseling at all. I believe this path is long for almost all who faithfully follow it, as did you.

BTW, I'm quite pleased that you have recovered post-op enough to even get about at all. Quite amazing. Blessing for your continued health and well being.

I don’t know about HRT direct effects in this regard but one possible side effect is electrolyte imbalances. Low potassium, for example, can cause shortness of breath. I’m not suggesting that – in fact, high potassium is more likely on HRT, at least with Spiro. Still, with your aggressive exercise routine, combined with HRT, you may want to look into it.

My issues to date with HRT have been HIGH potassium and perpetual dehydration. Both are due to Spiro. And unfortunately, I’m not particularly good at recognizing thirst, so I often go long periods without realizing the problem. The result is dizziness and earlier than normal fatigue.

Thank so much for all the comments and suggestions. I so much appreciate this site, it has really been a help to me. In Israel the common prescribed T-blocker is Cyproterone Acetate, not Spiro. Maybe someone knows the difference between the two, I do not. However, it also is a diuretic so I have to watch out for dehydration. My potassium is normal, along with all my blood chemistry. I have heard from other, especially younger TSs that are runners, that HTR significantly lengthened their running times. So there is an obvious effect on endurance, cardio strength, whatever. Maybe this is what I am experiencing, or it may be unconnected to HRT. In any case, I can still pedal over 10K in twenty minutes, even if I find myself breathing harder than I used to! What do I expect from a 70 year old woman?:heehee:

Realize that your issues may not be related to HRT. Men (and women) can have these problems for other reasons, especially as they age. I find that I don't have the strength and stamina that I had when I was younger. I am not on HRT, in fact, I am on testosterone replacement therapy. I suggest following this up with your doctor before it gets worse.