HRT questions

[Betty_42]

Know I've been gone for some time now. I had "issues" and while I'm working on getting help. I do have a few questions. Now I was on herbal hormones for a time and while they did give me results, my wife finally confronted me about it. She said that if I'm to get on hormones, she wants me to do it the legit way with a doctor supervising and such. Well I've been doing quite a bit of research as I absolutely want to know what I'm doing when this goes down! But I still have a few unanswered questions.

Now I heard that injections would be safer than pills because it's easier on the liver. Is that true? I heard that you can do it yourself with monitoring and that really wouldn't bother me as I'm not scared of needles.

I also heard that you have to continuously ramp up your doses to potentially dangerous levels. Is there any way that I could um, not do that?

And I have a bad habit since my mother passed away. I'm a smoker! Now, I've mostly switched to electronic cigarettes as I know that's a bit better for me since I'm just getting nicotine, which is what I'm addicted to and nothing else. But still, is there any risks I should be aware of? I suppose I could just switch to Red Man? It would disgust my wife, but I'd get my fix!

Finally, while I believe that I have located a couple of gender clinics in my area, is that truly necessary or is it possible to just go to my regular family doctor for these sorts of things? I also understand that an endocrinologist may be necessary at some point or another and there are at least two that I know of in this town. Please clarify the doctors and their uses for me?

Thank you in advance and I'll check back later!

[Angela Campbell]

Normally you would go first to a gender therapist and then when ready they will help choose a medical Dr who will prescribe the proper doses. No you do not continuously ramp up the dosages to dangerous levels. You would be smart to go to Dr.s and therapists who are informed on this instead of the family Dr.

Smoking is a big risk when using estrogen.

[stefan37]

Many doctors will not prescribe hormones if you are a smoker. The odds of dangerous side effects increases dramatically. The first step usually is to find a gender therapist to get a letter to start hormone therapy, then find an endocrinologist or other medical doctor to examine and prescribe hormones. The doctor will probably order quarterly lab work for the first year or 2. Injections are relatively safe if done properly. Continuously ramping up dosages is not the norm. Go see a gender therapist and good luck on your journey.

[steph1964]

Hormones can be very dangerous if not taken correctly and monitored. In my opinion a doctor’s supervision is a must.

I take estradiol sublingually to reduce the effect on the liver.

I personally have never heard about ramping up the dosage, in fact my doctor will not go above a certain dose.

My doctor will not prescribe hormones to anyone who smokes. She requires the person to have quit for a certain period of time. The side effects on Estradiol are greatly increased with smoking and include strokes and blood clots.

My doctor specializes in internal medicine but she is experienced in the administering of hormones and was recommended by my counselor. You generally need a letter from a therapist before a doctor will prescribe hormones but this isn’t a requirement, although it is there for a reason.

[I Am Paula]

My Dr. swears by estrogen patches as the safest delivery. Each Dr. and patient uses what's best for them. Higher doses of estrogen do not give faster results. Sometimes you have to up the dose to find the minimum effective dose.
The smoking will be a concern, or even a deal breaker with ANY Dr.
See if you can find an endo with considerable transsexual experience, it beats having to train them yourself. Mine has had one hundred trans patients and I trust him absolutely.

[LeaP]

I'll echo the comments on smoking. My doctor will not prescribe to smokers, either. You will also read comparisons of smoking while taking hormones to kids smoking during puberty. It can stunt your development, and that's the last thing most want!

Estrogenic effects are not dosage-dependent. They are time and dosage dependent. Take lesser dosages than your body can take up and it will simply take longer to reach your potential. Take more than your body can take up and you will excrete the excess while increasing your risk. That's why doctors target blood serum levels and not dosages per se.

The other side of the equation is androgens. Take estrogens without suppressing androgens and you are giving your body very mixed signals at the cellular level. One way is to take very high dosages of estrogen, which will naturally suppress androgen production ... but that's very dangerous. The other is to incorporate anti-androgen meds. Are you ready for the effects that accompany THAT?

[Ariamythe]

The smoking thing is definitely something I've read in every resource I've ever encountered. Luckily, I'm not a smoker!

I am overweight, however. While I've actually improved that -- 25 lbs down since March -- I'm still concerned that I might be denied hormones because of weight. Has anyone had an issue with that?

[Rianna Humble]

I am seriously overweight as a result of two unrelated medical conditions, but my endo is happy with the levels of hormone therapy that I am on at the moment.

[I Am Paula]

I'm overweight due to badly managed hyperthyroidism. My endo is treating that now too, and says it should be easier to lose some now that he has that under control.

[Betty_42]

Okay! I'll just switch to electronic cigarettes completely before anything else. Which reminds me, I actually need more cartridges soon? Also, I'm having trouble finding gender clinics in my area. I got a couple of leads, but nothing solid so far... Which is a good point? I should probably ask the gender education group in Dallas about that as well?

[LeaP]

Whether switching matters depends on whether you are using them to ingest nicotine or not. If you are, the risk is the same as conventional smoking. If water vapor only, no problem as far as the meds go.

Very few gender clinics exist anymore. In fact, the ones I CAN think of are focus areas in larger clinics, not gender clinics per se. You need to find a therapist with gender experience and knowledge. If you know of a local support group, it's a good place to ask around.

[Betty_42]

Local support group? Well no, not really... I did however meet a transgender person from my area and she recommended a doctor to me from Dallas. As a next logical step, I intend to buy breast forms with my wife's birthday present next month (while I'm there) and try out having big boobs for a while... I start making calls about this near the end of next month!

[DebbieL]

Know I've been gone for some time now. I had "issues" and while I'm working on getting help. I do have a few questions. Now I was on herbal hormones for a time and while they did give me results, my wife finally confronted me about it. She said that if I'm to get on hormones, she wants me to do it the legit way with a doctor supervising and such.

Good for her! This is a really good idea. You really need to AT LEAST let your doctor know what you are doing and what you are taking. Better yet would be to have an endocrinologist who can recommend the best combination of testosterone blockers and estrogen, along with progesterone if appropriate. There are many factors that need to be evaluated.

Well I've been doing quite a bit of research as I absolutely want to know what I'm doing when this goes down! But I still have a few unanswered questions.

It's good that you are doing the research, but you do NOT want to substitute information you are gathering via the internet with medical advice. Normally, before the doctor even STARTS you on hormones, there will be a number of health questions, a review of your current medical history, any current medications, and any concerns.

Now I heard that injections would be safer than pills because it's easier on the liver. Is that true?

One of the things your doctor will want to check for is liver function, also cholesterol, triglycerides, and current testosterone and hormonal levels. Different medications can have different side effects, and the doctor will discuss those with you as well. Furthermore, some of the side effects will come later and you will need to decide if they are problems or not.

Side effects can include liver problems, thyroid issues, blood clotting, heart issues, fibroids, testicular cancer, breast cancer, and even a risk of stroke. That's why you DON'T want to do it yourself.

Other side effects you should consider and discuss with your doctor include shrinking penis, testicles, and prostate (could be a blessing, depending on your age), the inability to have erections, and the inability to ejaculate. You may also find that you cry more often, because you are happy or sad. Lowering testosterone levels will open you up to a wide variety of emotions other than anger and fear, and you will experience a much wider range and depth of emotions.

There is no way to completely eliminate these side effects, but there are ways for the doctor to moderate those effects.

I heard that you can do it yourself with monitoring and that really wouldn't bother me as I'm not scared of needles.

I hope you are referring to giving yourself injections. Yes, if that's what your doctor recommends, you can give yourself injections in your thigh or stomach, depending on what the doctor recommends. You have to maintain a steady supply of clean disposable syringes, one for each dose.

I also heard that you have to continuously ramp up your doses to potentially dangerous levels. Is there any way that I could um, not do that?

The biggest problem, and the one that leads to potentially dangerous level is the desire for "instant boobs". If you are willing to be more patient, you can start with a very reasonable dose, take it for a much longer time, and in 6-8 months have gradual and controlled growth. Often, girls get impatient and want to make things grow faster by taking more. The problem is that doing so can lead to complications that can require a stop or substantial reduction of hormone levels to get back to safe levels and assure that there won't be those nasty side effects.

And I have a bad habit since my mother passed away. I'm a smoker! Now, I've mostly switched to electronic cigarettes as I know that's a bit better for me since I'm just getting nicotine, which is what I'm addicted to and nothing else.

Starting hormones should be a very strong incentive to quit! You might even want to check out the American Lung Association's "Freedom in 21 days" program, which lets you taper and eventually stop with no significant withdrawal symptoms. I did it and by day 19, I was done. That was 27 years ago.

But still, is there any risks I should be aware of? I suppose I could just switch to Red Man? It would disgust my wife, but I'd get my fix!

Get off ALL NICOTINE! Taper if you can, gradually reducing the amount you take each day. Write down your feelings and emotions before you take the first puff (even if artificial cigarettes). Then track how many "puffs" you take, and stop as soon as you have taken the edge off. You want to be able to see that you are using less and less, until you are using none by the end of the third week.

Would you really want to have to have a mastectomy a year or two after you finally grow the breasts you've always wanted?

Keep in mind that you will also need to eat less (hormones reduce metabolism, lean muscle mass, and caloric need), and exercise more (loss of upper body strength, need to sit with better posture, and more weight in the rear). You want to be a beautiful woman rather than "the old fat lady", right?

Finally, while I believe that I have located a couple of gender clinics in my area, is that truly necessary or is it possible to just go to my regular family doctor for these sorts of things?

Your family doctor can prescribe the drugs, but you need to be seeing a therapist who is qualified in gender therapy. The doctor will call the therapist to confirm that you intend to transition, and based on this, the doctor can provide the standard prescriptions and tests. The doctor may still want to consult with an endocrinologist.

Keep in mind that your gender therapist may come up with an alternative diagnosis for insurance purposes. Many times, transsexuals experience severe depression prior to making the decision to transition, and may even struggle with the choice (actually the consequences) even after the transition begins. The therapist WILL monitor you for indications of depression, back-tracking, and other mood changes before and during hormone therapy until you have reached the level of transition you desire. Many of us struggle with setbacks, persecution, and frustration, and the despair can become so intense at times that we become severely depressed, even suicidal or self-destructive. One therapist explained it really simply "If you try to kill Debbie, Debbie WILL kill you". Research by transgender physicians such as Jessica Birch, Laura Amato, and others, many surveys covering over 1 million respondents, has led to the determination that once someone is diagnosed as transsexual, it is UNETHICAL to attempt to persuade them to accept their birth gender.

I also understand that an endocrinologist may be necessary at some point or another and there are at least two that I know of in this town. Please clarify the doctors and their uses for me?

The AMA has not yet made it unethical to not treat transsexuals with hormones and to discourage or delay treatment. Doctors with strong religious backgrounds, moral backgrounds, or homophobia/transphobia can be very clever about trying to discourage proper hormonal therapy. This can include delaying tactics, such as insisting on numerous extra tests, running one test at a time, THEN referring you to endocrinologists, and sending you to a specialist who is also committed to NOT treating you.

I got the runaround for over 50 years, actually longer. I was born with undescended testicles, which is an indicator of transsexual biology (lack of testosterone in early pregnancy, smaller hypothalamus,...), but back in the 1950s, doctors new little about it, other than that I might need surgery at 11 or 12. Even though I was obviously transsexual, and told my parents I wanted to be a girl and was damaging myself, therapists threatened them with giving me electro-shock and when I tried to bring it up with psychologists and therapists who were trying to help me control my asthma, I was told that I was not allowed to even talk about my desire to be a girl. They knew I wanted to be a girl, and they even noticed a PROFOUND improvement in my physical health when I spent most of my time with women and girls, and a dramatic deterioration when I was forced to spend much time around boys my own age.

Even when I was struggling with drug addiction, alcoholism, depression, and suicidal actions on a regular basis, I was forbidden from discussing my gender disphoria with them. In some cases, there were restrictions on their grants, there were religious affiliations, and there were personal religious and personal issues with the therapists.

Part of the problem was that until the early 1980s, my state would revoke the medical license and hospital privileges of any doctor who "mutilated" a transsexual by performing surgery to make them appear more female.

Even though the laws and policies have changed within the profession, there are still many social, political, and religious pressures on doctors to withhold hormone treatments, delay treatments, and deny insurance coverage, even when corporate health insurance includes such coverage.

You've been through hell to get to the point where you could do what is necessary to begin the transition. Give yourself the chance to get the support you need so that you can enjoy your transition process as well as the benefits of transition when you have the body you want.

Thank you in advance and I'll check back later!

[Betty_42]

Well DebbieL! That was quite informative! And I can easily taper with an electronic cigarette when I'm ready to quite and I have no problems switching there as it is a lot safer that way anyway. Although I am aware that it's not completely safe...

In any case, I've had quite a few revelations in this whole thing. Evidently, I'm not a "mistake" as I previously believed, but rather I'm incomplete. I have no desire to get SRS surgery at this point however as I do not believe myself to be a true transsexual, but rather a variation of transgender. There's about 20 variations you realize yes? I have an appointment with a new therapist, although I still need to get a few things squared down with him and we can work with one another from there. I understand that this is big and these revelations keep hitting me! I should take it slow...