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Thread: Mental effects of HRT

  1. #26
    GG Dutchess's Avatar
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    I don't know about that at all.. I tend to agree with Aunt Kelly about the side effects as the result of so many years of hrt was a contributing factor to my fiances death. Though not the primary , it would've led to his death in the near future without medical intervention( this was part of the medical examiners notes ) but he was so convinced he needed it that he never would've checked anything like that.

    A few years before total meno, I had HAD to be on progesterone I had such severe problems so this was mandatory to avoid hysterectomy, I was just way too low. Yet my ob/gyn was adamant I stay on no longer than 5 years due to side effects.
    IG : Knightress Oxide

  2. #27
    If only you could see me sarahcsc's Avatar
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    Quote Originally Posted by Aunt Kelly View Post
    Thank you, Sarah, for sharing your learned point of view. In your opinion, is the risk of adverse effects low enough to be and inconsequential consideration in "experimenting" in this way?
    Hi Kelly,

    I wouldn't say anything is 'inconsequential' to avoid the risk of invalidating a patient's experience. Every change, no matter how big or small is consequential depending on the patient's perspective.

    The research (https://core.ac.uk/reader/153399329?utm_source=linkout) published by the endocrine society states that most bodily changes of feminizing hormones takes a least 3 - 6 months to trigger the onset of change, and up to 2 - 3 years for maximum change to occur. Therefore, I recommend 12 months because it allows for at least some meaningful change in one's body before considering their next treatment options.

    Risks and adverse effects are a part of life when taking any medication. Yes, one might theoretically develop a DVT 2 weeks into HRT but that doesn't mean the trial shouldn't have proceeded since we cannot predict the future. It is fine as long as the patient is informed of the risks before proceeding.

    I'm not someone who is very overly eager in prescribing hormones because I understand this is a heavy and consequential decision. But when I do, I want to make sure my patients are making meaningful decisions that will ultimately lead to some kind of closure. To me, taking HRT for 3 months on its own not only accomplishes very little, but it could be a reflection of severe resistance or ambivalence which is usually a red flag. Having said that, I never say never to my patients so I always hear their stories out before deciding a way forward.

    For example, I have a group of non-binary patients who really don't want the full effects of HRT and therefore only take a small dose of it for x number of months then stopping it. That's fine too.

    Having said all this, I'd like to point out that HRT may have a very different effect on biological women because they have more estrogen receptors. I've treated a number of patients with PMDD who had a variable response to HRT despite only taking it for a week or two. I bring this up so to avoid the risk of misleading everyone into believing that HRT does NOT affect mood in the short term, because it does. The immediate mood effects HRT has on transgender women, however, is not well documented.

    I hope this helps.

    S
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    Last edited by sarahcsc; 03-20-2022 at 03:33 PM.
    "The question isn't who is going to let me; it's who is going to stop me" - Ayn Rand

  3. #28
    Silver Member Aunt Kelly's Avatar
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    The question was about relative risk, as in "Is the risk worth it if I'm just 'experimenting'". As you have observed, no drug is without side effects and adverse events. Adverse events include stroke, heart attack and deep vein thrombosis. While rare, these are potentially lethal complications. Yes, they are relatively rare, but what reasonable person would take on such risk without being fully committed to achieving the desired effects? There is an alarming trend here, which is not only attributing magical properties to HRT, but is also treating it as no more impactful than a course of antibiotics.
    No, I am absolutely not trying to be a gatekeeper here. I believe firmly in the "informed consent" model. Being informed means acknowledging the potential benefits, risks, and limitations of the course of therapy in question. Not seeing a lot of that in these threads, and as a former health care provider, I find the trend concerning, at best, and dangerous, at worst.
    "Being honest may not get you a lot of friends, but it will always get you the right ones."
    -- John Lennon

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  4. #29
    If only you could see me sarahcsc's Avatar
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    Quote Originally Posted by Aunt Kelly View Post
    The question was about relative risk, as in "Is the risk worth it if I'm just 'experimenting'". As you have observed, no drug is without side effects and adverse events. Adverse events include stroke, heart attack and deep vein thrombosis. While rare, these are potentially lethal complications. Yes, they are relatively rare, but what reasonable person would take on such risk without being fully committed to achieving the desired effects? There is an alarming trend here, which is not only attributing magical properties to HRT, but is also treating it as no more impactful than a course of antibiotics.
    No, I am absolutely not trying to be a gatekeeper here. I believe firmly in the "informed consent" model. Being informed means acknowledging the potential benefits, risks, and limitations of the course of therapy in question. Not seeing a lot of that in these threads, and as a former health care provider, I find the trend concerning, at best, and dangerous, at worst.
    You are right that the informed consent model of care is gaining favor but there will always be reservations about it for the reasons you mentioned. This is not to say there isn't a role for gatekeeping because I will still advise against prescribing 10x the recommended dose of estrogen just because my patient is wanting it. However, the risk of someone developing severe adverse effects when taking the recommended dose is still exceeding small. I compare this to the risk of getting into a major car accident when driving to work. Yes, the risk is present and potentially fatal, but one still has to work to put food on table.

    If you want to start a conversation about informed consent, then just start it on another thread. I have delivered tutorials nationwide about 'informed consent' to educate people on this topic. It is very nuanced and most people misunderstand what it means on a practical level.

    S
    "The question isn't who is going to let me; it's who is going to stop me" - Ayn Rand

  5. #30
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    I wasnt “fully committed”. I was miserable though, and decided to “experiment” with a low dose and see what happened and see how i felt about it. and while i had some anxiety about the changes, and stopped for a week or two, I decided to press on.

  6. #31
    happy to be her Sarah Doepner's Avatar
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    We are complex systems where the relations between cause and effect are not always evident. When I started changing my hormones with spiro and estrogen I was very pleased the doctor was scheduling follow up appointments at 3 and 6 months. I saw that as perfect points to stop and evaluate what was happening to me and either continue on or stop and look for other alternatives to address my gender concerns.

    It took a little while but having made a decision rather than continue to fuss and stew over my concerns was a great relief and I felt better for that at least. At each subsequent appointment I spent less and less time considering the full stop option. I still had some dysphoria and after counseling and a lot of consideration I recognized I was going to have to make some additional physical changes to my body. Again, making the decision felt like I was peeling away another layer of the dysphoria onion, exposing more and more of my desired self to the world. I can't hide any longer, it's not an option. It feels amazing to no longer have that fear or lack of self-confidence as part of my decision making. I wouldn't suggest estrogen itself has directly changed anything about my mental state but making that choice toward honesty and life was much easier after I started. Go figure.

    I wish I could offer a path forward for your wife. I delayed any changes beyond superficial things to make crossdressing a little easier because my wife was opposed to the prospect of me beginning to transition. We talked often and her position never varied. After she was diagnosed with cancer those conversations became unimportant in the grander scheme of things. After a multi-year battle, she passed away and even then, it was still about 5 years before I was able to move forward toward transition. The relationship was more important to me than my discomfort from dysphoria, but I'm lucky there. As strong as my feelings were, they never go to the point where I couldn't choose her needs over mine. I know others who suffer a much deeper form of dysphoria and again, I understand my criteria and restraints are not theirs.

    Best wishes to all who travel this path, it's not often easy.
    Sarah
    Being transgender isn't a lifestyle choice. How you deal with it is.

  7. #32
    Little Mrs. Snarky! Nadine Spirit's Avatar
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    Quote Originally Posted by sarahcsc View Post
    I bring this up so to avoid the risk of misleading everyone into believing that HRT does NOT affect mood in the short term, because it does. The immediate mood effects HRT has on transgender women, however, is not well documented.
    I think some on this thread need to reread these sentences. Just because something is not well documented does not mean that it does not happen.
    Last edited by Nadine Spirit; 03-27-2022 at 08:33 AM.

  8. #33
    Silver Member Aunt Kelly's Avatar
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    Sorry, Nadine, but it does not work that way. If someone is going to assert that a thing is so, the burden is on them to show substantive evidence that supports the assertion, not the other way around. Without such rigor, we're left with speculation, myth, and wives tales.
    "Being honest may not get you a lot of friends, but it will always get you the right ones."
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  9. #34
    Super Moderator Jeri Ann's Avatar
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    Quote Originally Posted by Elizabeth G View Post
    So my question to the group is, during your initial period of HRT how did it effect you from a mental standpoint?
    Thank you,
    Elizabeth
    Elizabeth originally asked for this, personal experiences. She has received a good response and it is time to close this thread.

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