Worried about HRT and past health.

[Robin.C]

Phew. I've searched the forums and not really found any advice that is what I'm looking for.

Here's the issue (outing myself here) I'm not certain how or if my liver can deal with HRT (ie the estrogen and blockers) due to alcohol abuse.

It has been over 20 years since I became a non-drinker and until I realised who I need to be and then how do achieve that I have to address my past.

In searching I did find some ladies who have gone through and still with AA, I chose to leave AA after a couple of years and just lead a sober life.

So to be forewarned, before I meet my counsellor and eventually doctor I'm looking for any experience on the different choices available.

My liver might be fine, I don't know yet, 10 years ago a liver function test came back with absolutely no issues.

 

I have read that there are some herbal treatments that are available, though they don't have the kick of Spiro they have an effect just that its lower.

Does anyone know where I can find anything more out, I've only found one research paper so far.

I'm happy to read research papers by the way. I know really weird huh. However my job sort of requires a wee bit of knowledge for such things ?

 

Please accept my apologies if this sounds so disjointed. I've had a bad night wondering and worrying about it.

Maybe I should go see my doctor and get some bloods and liver test to see how things are now rather than worry.

Or at least when things aren't so COVID crazy. We maybe heading for our second wave because people got complacent (sigh).

 

Hugs

Robin

 

[Jani]

Hi Robin, 

I'm sorry but I don't have a direction to point you towards. I will say to avoid herbals.  They can be dangerous.  As you note a previous Liver function test came back good you may very well be all right to start HRT.  There are many people with your history that go on to successful hormone therapy.  I would strongly recommend connecting with an endocrinologist as they would know best and be able to provide options if needed.   

 

Jani

[Lexi C]

Hey Robin

Jani is on point., that said. I still drink Alcohol and I am both Spiro and blocks . I am  not the obvious drunk I use to but I do still love my cocktail,  i have no issues. Now if its being  over 20yrs since yr last  drink( MAJOR CONGRATS bye the way) then I don't see the problem. Less you are no being honest with yourself and there's something else that preventing your from this  decision. I would do what Jani said, Congrats again
 

[VickySGV]

Up until 9 months before I began HRT I had been an very heavy alcohol drinker.  In discovering why I drank, out came the GD.  Just a hint, but quitting the booze was $400/mo savings and it was not good stuff.  I have now been on HRT for 11 years a week ago, and will be 12 years clean on the other in three months. If the doctor is worried about your liver they may prescribe patches or injections which are not as bad as oral meds are on the liver, and I had been on oral meds for 6 years in the beginning myself.  I think you will be fine and good to go if prior liver panels have been in certain guidelines. 

[Robin.C]

Thank you so much for the advice.

It was something that has kept me awake a few nights lately.

Pretty much as usual I'm agonising over what ifs. It is also something that has kept me safe all these years. Always ask questions of yourself and others to understand the motivations for behaviour and feelings.

Okay I missed the biggy, didn't I, silly girl.

 

So once we can get into the city safely I need to organise an appointment.

 

Hugs

Robin

[Jackie C.]

I'm late to the party, but your endo will take blood work regularly... OK frequently... at the beginning and find you something that's not stressing your liver. They keep close, close tabs on all your organ functions while you're under their care. My first endo... who moved to NY. I hope she's OK, we lost touch... anyway, she said, "Don't worry. We can nearly always find some course of treatment that will work for you."

 

Hugs!

[Charlize]

I had issues with alcohol and continue to go to AA after 13 years.  I've been on HRT for 8 of those years under the direction of a doctor.  I have blood tests twice a year.  For various medical reasons other than liver i'm on a topical E and have found the results to be wonderful.  I would certainly recommend against any herbal or non prescription treatments.  One can easily cause damage that might interfere with a lifetime of living comfortably as yourself.

I would talk to your doctor and take the recommended steps.  I can be such a wonderful, safer journey if we travel with skilled advice.

 

Hugs,

 

Charlize

[Dinaki]

What Jackie said is absolutely factious of truth.

 

Tests after tests will be done frequently dear Robin, you just need to reveal everything to your doctors, hide nothing to them pretty Robin.

[Lee H]

Realistically, won't your course of treatment and monitoring depend on the MD you consult for an HRT Rx? My understanding is, they all [reputable docs at least] want a "letter" from a Psychologist, saying you are serious about transitioning [and suffer from dysphoria, I guess]. So, if through working with a counselor, you become able to visualize/define your goal, you can ask her for a recommendation for an MD who would work with you to get there, and monitor your health along the way.  

I dunno. I haven't walked that path -- yet. If I start, it would be with the VA, which in Northern Nevada, has a unit dedicated to trans issues, I think. For me, it would be just go where they send me.

[KymmieL]

I have not been put on HRT due to history of blood clots. That is the only reason. My GYN monitors my blood work. making sure everything is operating as it should.

 

Being I don't have an Endo close to go to. All my medical is taken care of by the VA. The Endo I saw earlier this year. Told me about a program that CU(University of Colorado) is working on for girls like me. Having a history of blood clots. he said something about HRT and Blood thinner patches.   I have an appointment in Nov. With the same Endo that the VA sent me too.

 

Kymmie

 

[Robin.C]

As I've just started this wonderful journey and am now seeing a therapist we will see how things go.

My current belief is that once I have a letter that essentially confirms my present dysphoria I can then consult a GP, whether my therapist has knowledge of any that are comfortable with my situation I do not know at this stage. My research has found a few that have some experience though I know not how much. It is in consultation with them that a referral to an Endocrinologist is given and that is when the blood test, etc start and also the determination as to what type of HRT therapy I begin.

I will probably get a LFT done prior to all of this as I usually try to get one done every 5 years (ish). It's just the not knowing stuff that gets to me sometimes.

Must let go and allow things to take there course, and be grateful that I can. ?

[Lee H]

Letting go is the key to whatever sanity I may have. "Accept the things we cannot change, change the things we can." If I realistically list everything except my own attitude under the first line, I can then do my best good faith effort to stay calm and enjoy the trip, and know I'm doing my best. It's like swimming in rapids. Go with the flow.

BTW -- Hi to all you fellow friends of Bill W. I'm sure you've heard this share before.

 

[Alexxiss]

Hi Robin, these lovely ladies are correct in telling you that it's best you start finding a doctor whom can oversee your transition from a bird's eye view. If you find a doctor who can monitor all of your levels and overlook the results of the work of all other medical providers involved in your transition. Find a therapist which you can comfortably bounce ideas off and then they'll likely connect you to doctors, endo's, and surgeons in your area. If you search online many therapists list LGBT or Transgender "Issues" under their specializations. I found that many therapists also will list a religious viewpoint, so that's something to look for as it can be greatly beneficial or cause adversity. It's best not to overwhelm yourself with worry when in fact most of us cannot adequately diagnose ourselves. It's no issue to establish a relationship with new medical service providers on the basis of "I am transgender and need care." I managed to find the below research and while it does not provide a basis of the effects of HRT on Trans people, it does provide the basis of the effects of HRT on those with preexisting liver disease, and since you never mentioned liver disease this is likely to be informative for you in that you'll see even HRT is not only safe for people with liver disease, but advised. On the contrary, when you worry about HRT and your liver I totally understand your concern and again, neither of us are doctors, so I hope you've done your homework and found one or three!

While it's tempting to dismiss the below research on the argument that genetic male and genetic female biology are inherently different, I argue the research still provides insight to your questions.

 

From An International Journal of Obstetrics and Gynaecology on HRT in Women with Liver Disease:

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.1997.tb10638.x#:~:text=Apart from protection against osteoporosis,have elevated mean serum cholesterol.

 

"Apart from protection against osteoporosis, HRT is associated with favourable changes in serum lipid levels in normal postmenopausal women which could be especially important in women with cholestatic liver disease (especially primary biliary cirrhosis) who have elevated mean serum cholesterol... 

HRT is well‐tolerated by the liver

The effect of HRT on liver biochemistry in normal women has been examined in two reported studies involving 45 and 30 patients, respectively. No cholestasis or hepatotoxicity, as assessed by elevations in serum alkaline phosphatase, bilirubin ortransaminases, was observed in women receiving combined HRT (i.e. oestradiol, conjugated oestrogens but not ethinyloestradiol) who had regular measurements of liver biochemistry. UK data on suspected adverse drug reactions contained in reports to the Committee on Safety of Medicines concerning preparations containing oestrdiol, oestrone and conjugated oestrogens show few reports of jaundice (Committee on Safety of Medicines, personal communication)...

 

 

Other risks and benefits of HRT

Apart from protection against osteoporosis, HRT is associated with favourable changes in serum lipid levels in normal postmenopausal women which could be especially important in women with cholestatic liver disease (especially primary biliary cirrhosis) who have elevated mean serum cholesterol. Addition of progestogens in combination with oestrogen for 10 to 14 days of the cycle does not decrease the cardioprotective effect and protects against the increase in endometrial cancer observed with oestrogen therapy alone. As with patients without liver disease, caution should be exercised in treating women with venous thromboembolism and those with a history (or family history) of breast cancer. Other benefits of HRT, including preventing or reversing vaginal and breast atrophy, improving hot flushes and psychofunctional disturbances, and (probably) decreasing the incidence of ischaemic heart disease, are of just as much potential value to women with liver disease as to those without...

 

We would suggest that HRT should be considered in all women with chronic liver disease who are postmenopausal, have primary or secondary amenorrhoea, or have had oophorectomy. Women with a diagnosis of primary biliary cirrhosis or primary sclerosing cholangitis, alcohol or tobacco abuse, or those on long term corticosteroid therapy (e.g. for autoimmune hepatitis) are especially at risk of osteoporosis. Current World Health Organization guidelines recommend measurement of bone mineral density for women with chronic liver disease, and this is useful both to identify women most at risk and to monitor the effect of treatment. Oestradiol (rather than ethinyl‐oestradiol) should be used, preferably by the transdermal route; a dose of 50 μg/day is sufficient to stabilise bone mineral density in most postmenopausal women26. As in women without liver disease in whom bone mass is lost after oestrogen therapy is stopped27, long term therapy (probably lifelong) is justified. HRT may be used with caution in women with a history (or family history) of jaundice due to specific defects of bilirubin excretion (e.g. familial conjugated hyperbilirubinaemia or intra‐hepatic cholestasis of pregnancy) provided liver biochemistry is monitored."

While it's tempting to dismiss the above research on the argument that genetic male and genetic female biology are inherently different, I argue that human biology is largely the same. And while our 

 

 

[Robin.C]

@Alexxiss thank you so much for that info.

I honestly hadn't thought to look into cis-women liver information.

 

Hugs

Robin