Hormones After Srs

[Guest rayne1]

What are the level of hormones needed after SRS? Is it just estrogen that is required? or is there others that you need to maintain? I know I am still aways away from all this but I like to get all the facts about everything so that I can be prepared for what needs to be done. I looked up several sites on what all supplies and personal effects that are required after a surgery in Thialand, but they did not go into any great detail about the level of hormones that you need to continue after the surgery.

[Guest Elizabeth K]

Well its policy not to discuss dosages here at Laura's. In any case, I doubt anyone knows for post op. You would probably do better finding a post op person and asking, and I know what they will say, YMMV, Your Mileage May Vary. That is why all hormone regimines are monitored by physicians.

Sorry I can't help much with this.

Lizzy

[Sally]

Well its policy not to discuss dosages here at Laura's. In any case, I doubt anyone knows for post op. You would probably do better finding a post op person and asking, and I know what they will say, YMMV, Your Mileage May Vary. That is why all hormone regimines are monitored by physicians.

Sorry I can't help much with this.

Lizzy

All that you can be sure of is that they will be less and no more need for any blockers as the culprits there will be removed during the SRS.

That's all that anyone can tell you until afterward the operation and hormone levels are checked - then a new prescription is issued and you are set and the checks become much less frequent.

Love ya,

Sally

[Guest Little Sara]

What are the level of hormones needed after SRS? Is it just estrogen that is required? or is there others that you need to maintain? I know I am still aways away from all this but I like to get all the facts about everything so that I can be prepared for what needs to be done. I looked up several sites on what all supplies and personal effects that are required after a surgery in Thialand, but they did not go into any great detail about the level of hormones that you need to continue after the surgery.

The level should be the same as pre-op, provided it wasn't either too high or too low to start with.

Some doctors like to start too high and others like to start too low (or to stay that way throughout) for reasons I can't guess. But it will depend on your doctor and their policy versus dosage more than anything.

The anti-androgens become unnecessary. A separate progesterone may be needed (cyproterone actetate has some progestin, but without it, that is lost). Estrogen dosage should remain the same post-op if it was adequate beforehand.

Wether it actually was adequate is actually hard to verify. Even if I could discuss actual dosages here, I wouldn't be able to tell you what dosage is adequate. Doctors who prescribe it would probably be biased over "how they do it" as being "the only right way". So you really have to look around, ask people, check what works for you etc, you'll eventually find out. If that's the dosage you're at, awesome. If not, you might want to try to convince your prescribing doc or shop for another if he or she refuses to accomodate reasonsable concerns. From what I hear, it isn't uncommon for doctors to rely on very old studies regarding dosage and take them as Holy Gospel.

[Guest Leah1026]

Well its policy not to discuss dosages here at Laura's. In any case, I doubt anyone knows for post op. You would probably do better finding a post op person and asking, and I know what they will say, YMMV, Your Mileage May Vary. That is why all hormone regimines are monitored by physicians.

Sorry I can't help much with this.

Ummmm Leah raises her hand.

YES, after SRS estrogen is continued. In fact it's usually continued for life.

After SRS the dose needed is lower since there is no longer testosterone to overcome.

The amount of the new dose is up to you and your doctor.

Yup, no post-ops around here.

[Guest Little Sara]

After SRS the dose needed is lower since there is no longer testosterone to overcome.

Wasn't that the 'job' of anti-androgens?

Androcur killed my testosterone to abyssmal levels, both total and bio-available. While an orchi or SRS could do a slightly better job of that, I'm not convinced it necessitates a lowering of the dose.

I know spironolactone is less effective though, so you might be basing it on that?

[Sally]

Wasn't that the 'job' of anti-androgens?

Androcur killed my testosterone to abyssmal levels, both total and bio-available. While an orchi or SRS could do a slightly better job of that, I'm not convinced it necessitates a lowering of the dose.

I know spironolactone is less effective though, so you might be basing it on that?

The major source of testosterone is removed there is still trace amounts produced, just as in natal females, but your body will still only produce the trace amounts of estrogen that a male produces - you r body needs hormones of one sex or the other so you must take hormones for life, even post menopausal women produce hormones - more male than female at that point as child birth is no longer an issue (or it didn't used to be).

Also by the time you are post op you should have finished developing and puberty levels are no longer required.

Whether you were on the 'low dose' build up very slowly regimen or a higher dose let's 'knock her back to her teens' levels, once the major breast growth and fat redistribution have been accomplished maintenance levels are all that is required, like HRT for post menopausal women.

I hope that will clear things up for you.

Leah and Jendar are two of the post ops her and you have already heard from Leah.

Love ya,

Sally

[Guest Little Sara]

Also by the time you are post op you should have finished developing and puberty levels are no longer required.

Whether you were on the 'low dose' build up very slowly regimen or a higher dose let's 'knock her back to her teens' levels, once the major breast growth and fat redistribution have been accomplished maintenance levels are all that is required, like HRT for post menopausal women.

Personally, I'm fine with maintenance levels, but not with post-menopausal levels. I'm 26, not 55, wether my breasts are done developing or not, I need the energy and all that. Heck, even at 55, I'd rather keep the dose just as high (and menopausal women sometimes supplement their hormones, that's how the market even exists).

Docs are usually either in category a) Low dose and slowly build up or normal dose for an *adult* woman - very few give a high teenage level dosage at any point.

My endo bases his dosage on getting me in the middle range for adult women, for example.

[Guest Leah1026]

Wasn't that the 'job' of anti-androgens?

Yes and no. Your primary anti-androgen is actually estrogen. It's true! The Spiro or Androcur are only helpers. For example when I started HRT the endo put me on estrogen only at first. The estrogen alone drove my T levels into the basement. Now YMMV, but estrogen can do a pretty good job by itself. I added Spiro months later and it had it's own benefits: For me it greatly reduced body hair, especially on the legs.

Now after SRS your body still produces testosterone. The adrenal glands produce a miniscule amount, not enough to cause any problems. However, on rare occasions the adrenals can go into overdrive after SRS and produce too much testosterone. This usually subsides within 6 months, but I actually know one person that had to continue using Spiro post-operatively to keep the T ion check. Again, that is a very rare case.

Now for the brain warp. Some post-op women actually start taking testosterone. What!? Sometimes the T levels after SRS are too low. So low that a person has absolutely no, or very low, libido. So to help things along some post-ops take low dose testosterone supplements.

Hope this helps.

[Guest Elizabeth K]

I still say Laura's does not want too much discussion on dosage amounts, but a general discussion like this is still helpful. But again - your prescribing physician is your guide, hummmm.

Now let me add that it is your best interest to make certain what he is doing is the latest and most up-to-date recommended practice.

The real problem is there is a terrible LACK of concensus with how to properly manage a transsexual individual, particularly a MTF. Apparently the FTM treatment is somewhat less complicated because testosterone is such a powerful agent. But, as an example, I am also on progesterone and I cannot get a straight answer on what it does (my doctor suggests it aids in breast development when taken with natural estrogen - it sure does put me on a roller-coaster!)

That said, I get my information from other places, as there is a tremembous amount of information out there on the internet. It's just a question of who's right and who's wrong? And personally, post op is pretty far away for me, so I concentrate on my HRT pre-op regimen.

And I suspect that in two years it will have changed for post op anyway, probably several times. So why worry. Post op people will tell you now that they have to continue a HR regimen forever (dropping the T - it's no longer 'therapy').

Just my opinion.

Lizzy

[Guest Little Sara]

Now for the brain warp. Some post-op women actually start taking testosterone. What!? ohmy.gif Sometimes the T levels after SRS are too low. So low that a person has absolutely no, or very low, libido. So to help things along some post-ops take low dose testosterone supplements.

I posted a topic a few months back that got very few replies, about how pre-HRT I had 0 libido, nothing. With mid-range adult male total T levels. And starting HRT I did get some, with high estrogen and spiro at the time. I still have some now, with androcur and even lower T levels.

Yes and no. Your primary anti-androgen is actually estrogen. It's true! The Spiro or Androcur are only helpers. For example when I started HRT the endo put me on estrogen only at first. The estrogen alone drove my T levels into the basement. Now YMMV, but estrogen can do a pretty good job by itself. I added Spiro months later and it had it's own benefits: For me it greatly reduced body hair, especially on the legs.

Compare the high dose estrogen I had back then (I'm not saying the amount) and it drove my levels to slightly below the male adult range (this being 10~35 nmol/L, I was at 8.4 nmol/L), coupled with spiro.

Now I started androcur, with a medium-lowish dose of estrogen, but with androcur, the difference was stark. Within 6 months I was at 3.1 nmol/L and within a year I was at 1.4 nmol/L (the dosage of estrogen was increased between the two, slightly).

The normal adult female range of total T is 1~3.5 nmol/L (or 10% of the male one). Spiro and high estrogen never got me there. Androcur almost did by itself.

[Guest Leah1026]

Spiro and high estrogen never got me there. Androcur almost did by itself.

Hence why I said YMMV (Your Mileage May Vary).

[Guest Zenda]

Kia Ora Rayne,

As Leah and other have already said ...Your doctor/endocrinologist are the best people to ask...If you take advice from the internet regarding HRT dosages you are asking for trouble??? Leave it to the professionals...

Metta Jendar

[Guest Little Sara]

Personally, I'd rather take my advice from the internet in many sources, take some and leave some than blindly trust someone who has a single track mind about what to do with me, and may have harmful ideas about treatment. At least I know I'm getting something good.

[Guest Elizabeth K]

Personally, I'd rather take my advice from the internet in many sources, take some and leave some than blindly trust someone who has a single track mind about what to do with me, and may have harmful ideas about treatment. At least I know I'm getting something good.

My goodness - I have to say something about that (sound just like an old woman - hee hee).

I think most doctors are fairly well trained - my prescribing physician is a gay man and a supporter of our local GLBT group. He seems really up to date on the latest techniquesa and wants me to have good, fast results. And I am getting them! I cannot see how you might think a physician might be someone "who has a single track mind about what to do with [you], and may have harmful ideas about treatment." I just don't understand where that comes from and I hope you haven't had that kind of bad experience. I KNOW its possible to get a jerk of a doctor. But I think that situation is rare.

And I think most gender dysphoric theapists are well trained. Mine is a PhD and a consultant to the GGA (Gulf Gender Allliance) and the local GLBT community, She also happens to be out as a lesbian. She has treated over 100 transsexual people, and I am fortunate to have her. Again, she wants me to have a smooth transition and good, positive results with HRT. She is another I could NEVER say " has a single track mind about what to do with me..."

And finally? You write: "Personally, I'd rather take my advice from the internet in many sources... At least I know I'm getting something good."

How can that be possible? Everything on the internet conflits with itself! The information is DANGEROUS! So please be careful.

In my Great Aunt Lizzy mode.

[Guest Little Sara]

I cannot see how you might think a physician might be someone "who has a single track mind about what to do with [you], and may have harmful ideas about treatment."

Every PhD involved in my treatment has been a jerk about it, save my endo maybe, but he's been rather clueless about stuff he should know, still.

Two MDs, five psychiatrists (three I only saw very briefly, since it was an 'assessment').

My endo? He apparently doesn't know about intersex conditions. I mean, it's his frigging domain. A MD not knowing, fine, but an endo? Not buying it.

[Guest Little Sara]

So yeah, my trust in people with PhD is built from the ground up, meaning very slowly. I definitely don't trust them from the outset, as this has been a very bad experience.