So I've been on hormones pretty regularly (except for times I forget to place a refill order and have to wait between shipments) for about 6 years now. I have a prescription, but because I am self-insured and have to worry about potentially being dropped by my health insurance for any little thing, I order my hormones from overseas, and I adjust my dosage myself. While I am somewhat buoyed every time I read that some more major companies now have health insurance policies that cover transsexual top and bottom surgeries, it pisses me off that this has no effect whatsoever on me, because as an individual, I have absolutely zero bargaining power and would have to pay astronomical premiums to have a policy that covers such procedures.
Anyway, based on research on normal hormone levels, and the way they change over the course of the day, I've pretty much settled on an alternating day schedule of taking 6 mg of beta-estradiol at night (at the upper limit of recommended dosage), and the next day, I take an anti-androgen (dutasteride seems to work best for me) in the morning and 4 mg of the estradiol at night. One week each month I also take progesterone with the estradiol each evening. This has worked pretty well for me - I think my genetics limit my breast growth to what meager assets I have now (barely fill a 38A bra) - based on a hard-to-define feeling of "rightness" with my body. I can definitely tell if I've skipped a couple days because I let my drugs run out and have to wait for the next shipment.
Having said all that, knowing in my head that I am very careful about knowing how my body usually feels, and keeping in good physical shape, every spring and fall when my seasonal allergies give me horrific sinus headaches, I occasionally am seized by somewhat irrational fears that the estrogen is going to give me a stroke, and I'll have to go off the E, and I'll be depressed and masculine again. I flash back to an early episode of Chicago Hope (a medical drama that started on CBS about the same time as ER did on NBC, but didn't last very long). Mia Sara (you probably know her as Sloane from Ferris Bueller's Day Off) played a transsexual whose hormone therapy was causing her medical problems, and the episode ends with her suicide or attempted suicide (I can't remember) because she didn't want to keep living while fighting her body's re-masculinization. There were all kinds of medical inaccuracies in that show mostly due to the need for time compression in a show like that, but it definitely struck a chord with me. I start thinking about losing some (though not all) of my breast growth, and to be honest, that's actually secondary to a change in my mindset when on hormones. Going back to having a "purely" male body and hormones would be extremely depressing. No, I'm not suicidal, but it is sort of funny that something as relatively minor as seasonal allergies can send my mind into such a crazy stream of fears.
I am completely stumped at the hormonal doses and the amount you have been taking over a long time. Are you under medical supervision with this?
ReplyDeleteHi Kathryn,
ReplyDeleteI check in with an endo from time to time for blood work and consultation. Keep in mind that effective hormone levels can differ greatly from person to person. Basically, for estrogen, we started at 2 mg/day of oral estradiol. You'll see that is at the bottom of the current recommended guidelines, although when I started those were not published, and it was based on my endo's experience. As for the antiandrogen, I was started on spiro, but it drove me nuts to get up and pee ALL THE TIME, so I tried proscar (finasteride) and then dutasteride - sort of the next generation. This works quite well - I skip days partly because I find this allows my penis to continue to function for now, which is very important to my wife, but still minimizes body hair growth and should theoretically support breast growth (inhibited by testosterone). As far as timing, I doubt it really matters that much, but for the hell of it, I take E at night because natural levels of E in women are higher at night, and I take the antiandrogen in the morning because natural levels of T in men are higher in the morning. Talking to my endo, he felt that for some people progesterone sometimes helped with breast shape, so I have taken it for a while. I can't tell if it is doing much though. I don't have that much to shape. :-(
By the way, although I've been taking hormones for about six years, I started very slow because I didn't want any major physical effects showing up, but the mental effects were good. So I've only been on this particular drug regimen for about a year. I'm reasonably happy with it for now.
Oh, I mentioned current guidelines and forgot to say where to find them! The most current sort-of-official guidelines can be found in an article by Hembree et al (2009)in J Clin Endo Metab, entitled Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. You can download the PDF here: http://www.endo-society.org/guidelines/final/upload/Endocrine-Treatment-of-Transsexual-Persons.pdf
ReplyDeleteMy feeling is that this is meant as a starting point for endocrinologists who have little or no experience with transsexuals. I was fortunate enough to find one with quite a bit of experience, and therefore what I think was a better understanding of the need to monitor and adjust based on the patient's needs and body.
Viv:
ReplyDeleteI am taking 100mg Spiro twice a day, Finesteride 5mg once a day, and 2mg over 24 hour patches of estradiolB17. That is why I was stumped. You are of course right that each person is different.