Thoughts about HRT
Jul. 27th, 2010 07:22 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
seishunLast night, while talking about HRT on Twitter, a friend mentioned the hormone urban legends page at T-Vox and suggested that I read what they had to say. While we were initially discussing breast growth, I quickly focussed on the fourth entry, titled "Pre-op vs. post-op HRT (FTM and MTF)".
Now, unless you've been living under a rock or are a new reader, you know that in late June I had an orchiectomy.Prior to surgery, I met with Dr Maddie. She told me that post-op I should reduce my dose from 6mg to 4mg, and then eventually to 2mg per day. The reason being, she said, that I would no longer need the same amount to achieve the same results. And dutifully I complied, reducing my dose and barely enduring the depressions which followed each reduction. At some point a friend asked why I was reducing my dose. Surely I'd still need the same amount of estrogen now. No, I told her, my doctor said I wouldn't need as much. Doctor's orders.
But there was something about those orders which set off a little bell in my head. The purpose of spironolactone is to reduce the amount of testosterone in one's bloodstream so the estrogen can go to work. If I needed 6mg before while on spiro, when my T levels were artificially suppressed, why on Earth would I need *LESS* estrogen now that my T levels were naturally low? I took Maddie's word for it because hey, she's the doctor. I trust her opinions about this stuff, so even though this was niggling at me, I went along with her advice. Then I read this: "Removing the Testes almost certainly removes the need of any anti-androgen aspect to one's regimen, but how does it otherwise alter the levels of estrogens and Progestogens needed for proper development?"
How indeed. It's not like I magically grew ovaries (don't I wish!) to replace my testes. My adrenals and prostate are producing androgens but what in my body is producing endogenous estrogen? Nothing, that's what. Excess testosterone is converted to estrogen in the body, but there's not one drop of excess testosterone to be found here. Logic (not my strong suite, I admit) would seem to dictate that, hormonally, I'm essentially the same post-op as I was pre-op on a full dose of spiro and that if I needed 6mg of estrogen pre-op, I'd need 6mg post-op.
I had noticed over the last month that my breasts were no longer tender as they were pre-op. They are definitely larger than they were in early June (they are now obvious when I wear a bra, even in a men's tee) but they are no longer sore, which means their growth has slowed. This will not stand. I'm going to go for a couple months at my old dose and see how I feel. If things work for me (and if on my next meeting with Dr Maddie I am given the go-ahead to do so) I plan to stay at 6mg for my second year of HRT. Then I will drop to 4mg for the next several years. I think by the end of year eight I will drop to 2mg. By that point I may have had surgery, but more importantly, I will have reached the (approximate) end of second puberty and will not need the higher doses for further feminisation.
I am also considering adding progesterone to my regimen, though nothing here has been decided yet.![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
lietya pointed out a study involving post-menopausal women who were given estradiol and a form of progesterone called medroxyprogesterone acetate. The study was stopped after three years because there was a slight but significant increase in the risk of breast cancer associated with the regimen. And I've got to admit, that's enough to give one pause. And there's a lot of conflicting information floating around out there. Some folks say it's useless while others swear it's given them boobs they'd never dreamed possible. In women who were female assigned at birth progesterone seems to kick in after a few years of puberty, and it appears to play a role in helping women reach full bust development. It makes sense for trans women to at least consider taking it for a year or two about midway through second puberty, possibly even until the end of puberty. The study cited above only included post-menopausal cisgender women. These are women whose breasts were already fully developed. I don't pretend to know this for sure, but I believe this is significant. I am going to consult with Dr Maddie about adding progesterone to my regimen, and if she agrees to it, I will probably add it some time after my second year on HRT. I don't believe it would do me a lot of good right now, but after two or three years it might be more effective. We shall see.
What I think is significant though is how the conventional wisdom about breast development (which says you can expect breasts about one cup size below your nearest female relatives' growth, and if you're starting after 35-40, expect an A cup at most) is utter bullshit. I remember reading this as a hard-and-fast RULE, mind you. There were no exceptions. Everything I read told me that I'd be lucky at my age to develop a full A cup after a five-year puberty. Now I'll grant you that I'm not quite an A right now, *BUT* it's only been a year. I now have almost as much development in one year as I was ASSURED I would *EVER* get. Chances are good that by Christmas I'll have gone up another half cup or so. By this time next year I hope to be a solid B, or even a small C. So if you're a woman just starting on hormones and you've been reading this "rule", ignore it. It's bullshit. You might wind up with an AA, you might wind up with a DDD, but starting early just means you'll have longer to enjoy your breasts. Older ladies? Do not despair! It's got more to do with your genes than with your age!
And if you're curious to see my own development, click here. (SFW link—I am *NOT* taking nude pictures) That picture was taken today. I'm wearing my (one and only, sadly) bra. From my vantage point, the girls are *VERY* obvious. From the front they're less so. Naturally they're visible from the side, too. I'm about an A right now, I think. I haven't measured to see. But even if this is all I ever get, I'm beyond thrilled to actually HAVE breasts at last.
Now, unless you've been living under a rock or are a new reader, you know that in late June I had an orchiectomy.Prior to surgery, I met with Dr Maddie. She told me that post-op I should reduce my dose from 6mg to 4mg, and then eventually to 2mg per day. The reason being, she said, that I would no longer need the same amount to achieve the same results. And dutifully I complied, reducing my dose and barely enduring the depressions which followed each reduction. At some point a friend asked why I was reducing my dose. Surely I'd still need the same amount of estrogen now. No, I told her, my doctor said I wouldn't need as much. Doctor's orders.
But there was something about those orders which set off a little bell in my head. The purpose of spironolactone is to reduce the amount of testosterone in one's bloodstream so the estrogen can go to work. If I needed 6mg before while on spiro, when my T levels were artificially suppressed, why on Earth would I need *LESS* estrogen now that my T levels were naturally low? I took Maddie's word for it because hey, she's the doctor. I trust her opinions about this stuff, so even though this was niggling at me, I went along with her advice. Then I read this: "Removing the Testes almost certainly removes the need of any anti-androgen aspect to one's regimen, but how does it otherwise alter the levels of estrogens and Progestogens needed for proper development?"
How indeed. It's not like I magically grew ovaries (don't I wish!) to replace my testes. My adrenals and prostate are producing androgens but what in my body is producing endogenous estrogen? Nothing, that's what. Excess testosterone is converted to estrogen in the body, but there's not one drop of excess testosterone to be found here. Logic (not my strong suite, I admit) would seem to dictate that, hormonally, I'm essentially the same post-op as I was pre-op on a full dose of spiro and that if I needed 6mg of estrogen pre-op, I'd need 6mg post-op.
I had noticed over the last month that my breasts were no longer tender as they were pre-op. They are definitely larger than they were in early June (they are now obvious when I wear a bra, even in a men's tee) but they are no longer sore, which means their growth has slowed. This will not stand. I'm going to go for a couple months at my old dose and see how I feel. If things work for me (and if on my next meeting with Dr Maddie I am given the go-ahead to do so) I plan to stay at 6mg for my second year of HRT. Then I will drop to 4mg for the next several years. I think by the end of year eight I will drop to 2mg. By that point I may have had surgery, but more importantly, I will have reached the (approximate) end of second puberty and will not need the higher doses for further feminisation.
I am also considering adding progesterone to my regimen, though nothing here has been decided yet.
lietya pointed out a study involving post-menopausal women who were given estradiol and a form of progesterone called medroxyprogesterone acetate. The study was stopped after three years because there was a slight but significant increase in the risk of breast cancer associated with the regimen. And I've got to admit, that's enough to give one pause. And there's a lot of conflicting information floating around out there. Some folks say it's useless while others swear it's given them boobs they'd never dreamed possible. In women who were female assigned at birth progesterone seems to kick in after a few years of puberty, and it appears to play a role in helping women reach full bust development. It makes sense for trans women to at least consider taking it for a year or two about midway through second puberty, possibly even until the end of puberty. The study cited above only included post-menopausal cisgender women. These are women whose breasts were already fully developed. I don't pretend to know this for sure, but I believe this is significant. I am going to consult with Dr Maddie about adding progesterone to my regimen, and if she agrees to it, I will probably add it some time after my second year on HRT. I don't believe it would do me a lot of good right now, but after two or three years it might be more effective. We shall see.What I think is significant though is how the conventional wisdom about breast development (which says you can expect breasts about one cup size below your nearest female relatives' growth, and if you're starting after 35-40, expect an A cup at most) is utter bullshit. I remember reading this as a hard-and-fast RULE, mind you. There were no exceptions. Everything I read told me that I'd be lucky at my age to develop a full A cup after a five-year puberty. Now I'll grant you that I'm not quite an A right now, *BUT* it's only been a year. I now have almost as much development in one year as I was ASSURED I would *EVER* get. Chances are good that by Christmas I'll have gone up another half cup or so. By this time next year I hope to be a solid B, or even a small C. So if you're a woman just starting on hormones and you've been reading this "rule", ignore it. It's bullshit. You might wind up with an AA, you might wind up with a DDD, but starting early just means you'll have longer to enjoy your breasts. Older ladies? Do not despair! It's got more to do with your genes than with your age!
And if you're curious to see my own development, click here. (SFW link—I am *NOT* taking nude pictures) That picture was taken today. I'm wearing my (one and only, sadly) bra. From my vantage point, the girls are *VERY* obvious. From the front they're less so. Naturally they're visible from the side, too. I'm about an A right now, I think. I haven't measured to see. But even if this is all I ever get, I'm beyond thrilled to actually HAVE breasts at last.
