GenderLife Forum: The Information Exchange

So, my endoc decided to wait another two weeks before seeing me. I was kind of glad though because at first she said 'oops something happened wait 34 more days'. So, since I'm not really confident about her yet I'm going to DIY the hormones. It's in case she'd want to do blood work, have me wait an eternity again and then give the go ahead for hormones. At this point I'm definitely not getting my hopes up on this although I've only heard good news about her. I just looked at the online site and I'd only have to pay just over 10 dollars for a month supply of 1 mg daily estradiol. This would be without progesterone or anti-andros until I actually get the scripts from the endoc. I'm guessing it or premarin 5mg a day would be fine until I get the scripts. What do you think? Would it be a waste of money? I'm figuring on only estradiol right now because I don't want to be too high a level and then be less sensitive to the endoc's regimen. I would just rather have this as a back up in case she cancels another appointment. Patience has never been one of my virtues.

Won't hurt to have some E in the bathroom will it?

I think you're right. It's best to have a backup supply in case of anything. In the end I plan on having like 100's of bottles just to feel safe in case someone else decided against it. Always better to be prepared.

You're young, two weeks won't matter, but I understand your impatience. Like so many others of us, I've been there, and waited several months longer than I would have liked (seven months instead of the standard three). I think I'm in the minority, I was a good girl, despite how impatient a person I am.

One consideration might be to call her office and ask if she's willing to order the blood work early. There's no real need for you to see your endo herself to get the blood work done; it'll be good for her to have that available when she does meet with you. Further, if you can get the results, you'll be able to see for yourself if things are out of norm. If you've started to self-medicate before you get the results, and anything is out of whack on the report you should probably stop and wait for your endo to go over them. If they're ok, well then, it is unlikely your endo will ever know you started taking them early as your first blood work will be pre-hrt.

It's also very possible that since you're young your endo will write the scrips on the day you see her, in particular if she has many transsexual patients and understands their impatience. She might plan on calling you or changing your prescription only if she sees something wrong with your bloodwork later. If that's the case, there's no real need to order online - it's going to take a couple weeks to get them to you anyway. But, as you've said, at least you'll have them if you want them and she postpones again.

I have to agree with Cassie. Two weeks feels like an eternity, but it is totally worth the wait to know you have a good Endo checking your labs.

If you have never taken hormones before it's a good idea to wait to have basal level tests done. The most essential are your base levels for total T, free T and vascular health (usually the glycosilated haemoglobin test, Hg A1c).

Also, the better endocrinologists order a liver panel and thyroid function tests before starting.

The initial level tests are invaluable in case you have problems later on.

From all the advice it sounds like a complicated, exact science. Since that's the case I'll go ahead and not DIY it for now. Two weeks is really not that bad and I've got responsibilities to stay busy with. The delay has actually been good to get my head out of the final countdown mode. Nothing worthwhile ever came quickly.

One major thing you want to watch out for doing it yourself is without the andro blockers you take the chance of developing tubular breasts. It's not a pretty thing to have happen to you especially if you want to develop a beautiful set of breast.

Where in the world did you hear that, PhotoGurl? I have never heard that before. I am not saying it is or isn't correct. It just doesn't make sense. What role would anti-androgens play in preventing tubular breasts? Estrogen *is* an anti-androgen.

I can't find any evidence that Estrogen is a particularly effective anti-androgen. It will decrease Total Testosterone and Free Testosterone over time, but these levels will likely still stay within the spectrum of normal male testosterone levels.
Only infrequently will Estrogen cause you to drop to hypogonadal ranges.

In other words; you could take estrogen all your life and still have fairly average or slightly below average testosterone levels - and certainly not the recommended levels for a female.

Anti-androgens such as spiro and CA are the most effective way to drastically reduce testosterone production - other than having your testicles removed.
While testosterone levels are still within the male 'normal' they will inhibit breast growth.

As a medical student, I can tell you that is partially incorrect. Estrogen is an anti-androgen. Virtually any doctor you speak to will confirm this. Many transwomen, myself included, did just fine with no anti-androgen. Prior to SRS, my testosterone stayed around 20 ng/dl. That is the low range of female.

The rest of your post, I completely agree with. Without a doubt, using an anti-androgen is more effective especially if a person has high testosterone levels to begin with. They are certainly not required though. As a side note- I never took more than 6 mg of estradiol per day (4 mg for most of my transition) and my T levels were low-range female. As always, YMMV.

It works indirectly. The system goes more or less like this (simplified):

Hypothalamus ---((Gonadotropin-releasing hormone)) ---> Pituitary

Anterior pituitary ---((LH / FSH )) ---> Gonads release hormones

LH in males triggers the production of T in the Leydig cells of the testis. In females, makes the ovary release an egg.

FSH in males is necessary to produce spermatozoa. In females, causes the follicle to mature (necessary for the egg).

Both mechanisms are regulated through feedback: if there is evidence the body has responded to either, the production of LH is slowed.

Since the feedback signal doesn't consider which sex hormone is present, if you have enough estrogens in your system the signal will go back to the hypothalamus saying: "enough," the GnRH pulses will slow down, the production of LH will also slow down, and production of T and (eventually) sperm will slow down and it may even stop.

The canonical study for it is:

Prior, J.C., Vigna, YM., & Watson, D. (1989). Spironolactone with physiological female gonadal steroids in the presurgical therapy of male to female transsexuals: A new observation. Archives of Sexual Behavior, 18, 49-57.

The current view is, of course, a lot more complicated. LH and FSH act in sequence: LH first, to release the egg or raise T, after FSH to make the follicle mature or form the spermatozoa. The sequence is modulated by a careful interaction of several polypeptide signals, and the fact that those interactions happen mostly at the hypothalamus level for LH and partially at the pituitary level for FSH.

If you want to make your way through the current view, this is a good starting point:

http://www.pnas.org/content/92/13/5813.abstract

Estrogen drove down my T levels like Whack-a-mole and that's no lie.

Read the section on Hypoplastic Breasts at www.secondtype.com/breastdev.htm it covers it a little but not alot. There are other articles on the web about it though.

What dose were you taking?