Breast Growth Development, Time, and Type of HRT

[emeraldmountain]

Hi! I hope everyone is having a splendid weekend!

 

I was just wondering if other people could please chime in on your or other people's personal experiences with breast growth outcomes?

 

I am particularly frightened with what I've read, as I'm under six months of HRT and have a large rib cage and wide shoulders, so minimal breast growth is very concerning.

 

According to the UCSF Trans Care website "it’s important to note that breast development varies from person to person. Not everyone develops at the same rate and most transgender women who begin hormone therapy after puberty, even after many years of treatment, can only expect to develop an 'A' cup or perhaps a small 'B' cup." (https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy)

 

The same website also says "the estrogen receptor agonist activity of spironolactone may play a role in reduced breast development due to premature breast bud fusion." (https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy)

 

A study I found has this in it's abstract:

 

"Results

The median age of the included transwomen was 28 years (range, 18 to 69). Mean breast-chest difference increased to 7.9 ± 3.1 cm after 1 year of CHT, mainly resulting in less than an AAA cup size (48.7%). Main breast development occurred in the first 6 months of therapy. Serum estradiol levels did not predict breast development after 1 year of CHT (first quartile, 3.6 cm [95% confidence interval (CI), 2.7 to 4.5], second quartile, 3.2 cm [95% CI, 2.3 to 4.2], third quartile, 4.4 cm [95% CI, 3.5 to 5.3], and fourth quartile, 3.6 cm [95% CI, 2.7 to 4.5]).

Conclusion

This study shows that, after 1 year of CHT, breast development is modest and occurs primarily in the first 6 months. No clinical or laboratory parameters were found that predict breast development."

Citation: Christel Josefa Maria de Blok, Maartje Klaver, Chantal Maria Wiepjes, Nienke Marije Nota, Annemieke Corine Heijboer, Alessandra Daphne Fisher, Thomas Schreiner, Guy T’Sjoen, Martin den Heijer, Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study, The Journal of Clinical Endocrinology & Metabolism, Volume 103, Issue 2, February 2018, Pages 532–538, https://doi.org/10.1210/jc.2017-01927

 

Thank you!

 

[emeraldmountain]

I should also note another study, which states "the use of spironolactone as an antiandrogen seemed also to be associated with an increased incidence of breast augmentation in transwomen. The other, more specific antiandrogens and GnRH analogs were not. Spironolactone is a mineralocorticoid receptor antagonist that acts as an androgen receptor partial antagonist as well as an estrogen receptor agonist. As such, in addition to blocking the androgen receptor (which is its primary purpose in this situation), it also has a significant estrogenic action at the doses used in transwomen. One can postulate that this could lead to an excessive estrogenic action and consequent poorer breast outcome by the same mechanism as that seen when patients self-medicate with estrogens. It is interesting that the other antiandrogens, cyproterone acetate and finasteride, do not appear to be used more frequently in those requiring breast augmentation compared with controls, suggesting that this is not a class effect of antiandrogens."

 

I am truly sorry if this information is triggering to other folks. I wish that others here could provide us with some hope.

 

I feel literally sick to my stomach and depressed thinking about this information. I really do not want to get breast augmentation, as I do not want foreign bodies in me that might require expensive removal and re-implantation over the years, as well as health problems.

 

Citation: L. J. Seal, S. Franklin, C. Richards, A. Shishkareva, C. Sinclaire, J. Barrett, Predictive Markers for Mammoplasty and a Comparison of Side Effect Profiles in Transwomen Taking Various Hormonal Regimens, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 12, 1 December 2012, Pages 4422–4428, https://doi.org/10.1210/jc.2012-2030

[Carolyn Marie]

@emeraldmountain, I would not take the above info as definitive on what anyone can expect.  There are variations; that said, most people will not get larger than B cup-sized breasts, in my experience.  So if you're looking for larger than B, you may be disappointed.  I'm very happy with my B-cup size boobies.   

 

You will find on the Internet some trans women who claim C or D sized breasts.  Anything is possible, but I think most such claims are bunk.

 

Carolyn Marie

[emeraldmountain]

Thanks for this reply @Carolyn Marie. Very true, there are variations, so I'll stay hopeful and if I don't reach a size I want, I'll try to be happy with what the estrogen elves built!

[KayC]

HI @emeraldmountain - I also don’t plan on breast augmentation, and would like to have a least a B-cup.  But I will take whatever I get.
I have been on Spiro for almost year, and started Estradiol about a 3 months ago (but only recently got up to my max daily dose).
I noticed sensitive nipples/breast buds within a couple of months on Spiro and a very small amount of breast growth - ‘man-boobs’ I guess I could say.

Since starting Estradiol it seems I have some expanded breast growth.  I am not sure how to measure them, but I would say I am probably A/AA now.  I expect (hope ) I will get some more.  But I have found ways to accentuate my breasts/profile with shapewear and the type of clothes I choose.

I hope you get the results you are looking for.  

[AllieJ]

This is a sensitive topic top most MTF trans people, and much has been written over the years. From what I have read and researched, I concluded that many of the longer term studies on feminising hormones were carried out on older regimens of HRT which included many on synthetic hormones, and thus minimal dosing of oestrogen, and a strong reliance on anti androgens. Many of these women also used progesterone early in their HRT.

 

Studies of modern HRT regimes are rare, and there are a number of different techniques meaning there still hasn't been a reliable regimen of HRT developed to provide measurable results. I have spoken to doctors who swear by low E levels, and doctors who feel higher levels are more effective. Some doctors concentrate on reducing T levels with anti androgens and some are promoting mono therapy using E only to suppress T. A prominent doctor in my country told me that progesterone matures breast cells and when it has done it's job, no more development is possible. 

 

Results seem strongly influenced by age and genetics, but too many variations present to form any sort of prediction at this time. In reality, Hormone Therapy for trans people is still in its infancy, and there hasn't been a universally effective regimen developed. To add to the difficulties in this topic, we monitor our hormones by levels in our blood, but this does not indicate the amount of hormones taken up by our receptors, so we still don't know exactly how much hormone is acting on our bodies. I know we would all love to know how our medical transition will work out, but the reality at this time is that all we can do is rely on the most experienced doctors we can find and be prepared for results less than our ideals. Because we are all so different, I believe that doctors who design specific strategies for us are essential, and if your doctor says this is what they do for all trans women, start looking for someone else.

 

I did lots of research, started my HRT journey after more than 15 years of low testosterone ( which meant I did not need anti androgens) and developed a plan to try 18 months at low levels, 18 months at medium levels, and 18 months at high levels. When my doctor determined my breasts were at Tanner Stage 3, and my estrogen therapy had been steady for over 6 months, we tried a year of progesterone with different levels and different methods, measuring blood levels for each. I started at 65 years old, had AA size already, and achieved A1/2 cup left, and B cup right, with good nipple, but little areola. Like many MTF I have a large chest, so even B was not proportional, and also like many, I had noticeable asymmetry, (and it's hard to buy bras a half cup different to suit). I was encouraged to get augmentation as I wasn't seeing further development, and the year on P had matured my breasts, so now I am a D both sides and happy with the result.

 

This should not influence anybody else, as your particular situation in respect to age, genetics, biology, doctors experience, social position and expectations are different to mine. So with all these factors, and no reliable therapy, we just have to accept what we get with our best attempt. 

 

Hugs,

 

Allie

[Mirrabooka]

What breast growth boils down to for natal males is hormone imbalance whether it is naturally ocurring or due to the intervention of hormone therapy. What's important to remember though is that everyone has a different starting point. Age and genetics certainly does have a lot to do with it too, as Allie said above. Some older men have pendulous breasts due to the natural decline of testosterone and the resultant dominance of estrogen in their bodies. Others, just look like floppy old men. Some transwomen have large breasts due to starting treatment early. Some others hardly grow at all.

 

I have done a lot of research into the side effects of hormone therapy when it is used as a treatment for prostate cancer. It is used as an adjuvant to radiation in some circumstances, and as a stand-alone in others. For clarity, I am experiencing a 'biochemical recurrence' of PCa (it's only a technicality. Don't worry, I'm well) and face the prospect of hormone therapy in the future. I also have natural A-Cup breasts (I only have to slouch ever so slightly to be able to hold a pencil )but mine is a case of pseudo-gynecomastia - there is no glandular tissue present. Happily, I'm not obese either, so my breast size is disproportinately large compared to most men of my size.  @KayC, your sensitivity and growth is due to your treatment, so your breasts are not man-boobs like mine. They are REAL. Enjoy having them, whatever their size. If you are aware of their presence due to jiggling when you climb or descend a flight of stairs, or the pain of accidentally brushing them up against something, then you are experiencing exactly the same as most women.

 

An anti-androgen such as bicalutamide (Casodex) carries an 85% risk of real gynecomastia if taken at 150mg/day. Spiro, depends on the dose too. Cypro is effective but banned in the U.S. Apparently in the U.K., LHRH Agonists like goserelin (Zoladex) are the preferred way of dealing with testosterone instead (happy to stand corrected) but by itself, that only carries a 15% risk of real gynecomastia. Some sort of E is required too.

 

[emeraldmountain]

@KayC@AllieJ@Mirrabooka Thank you very much for your kind replies and relating your personal experiences.

 

On another note, has anyone here seen an NP (nurse practitioner) in the US at a Planned Parenthood for HRT? Do you feel that they are well-equipped in their knowledge and experience to treat with HRT? Or should we strictly see a doctor, especially an endocrinologist?

 

[Ivy]

39 minutes ago, emeraldmountain said:

On another note, has anyone here seen an NP (nurse practitioner) in the US at a Planned Parenthood for HRT?

When I first started this is what I did.  I was 67 at the time, and was told that PP would not prescribe estrogen to anyone (male of female) at that age.  They did give me Spiro - which didn't work out well for other reasons.  I was able to switch to the VA system after this.  But I would still say my experience with PP was positive overall.

 

23 hours ago, emeraldmountain said:

I was just wondering if other people could please chime in on your or other people's personal experiences with breast growth outcomes?

As mentioned above, I started with PP, but then moved to the VA.  There, my endocrinologist would prescribe estradiol.  I don't take any anti-androgens.  I've been on increasing doses for about 5 years now.  There was not much breast growth, but there was enough sensitivity to satisfy me that the girls were quite real.  For me personally, that is the goal.  In the last year I have been able to add some progesterone and I have noticed a bit more growth and the girls seem to be a bit more noticeable.  (Just yesterday I met up with a cis friend in town that I hadn't seen for awhile.  When we hugged, she told me my boobs were bigger.  Made my day!)

For me personally, it took a long time for the growth to start - much more than the 3 months I hear about - but it has happened.  

I should also note that neither my mother or sisters were particularly large.  Family genetics are a factor.

 

Just my personal experience.

[emeraldmountain]

@Ivy

 

Thank you for your input.

 

It's curious that you were told PP would not prescribe estrogen to anyone, as I know of providers there that do.

[Ivy]

1 hour ago, emeraldmountain said:

you were told PP would not prescribe estrogen

They told me it was because of my age.

I think they do provide it for other trans women.

I had to sign the informed consent papers for both PP and the VA.

[emeraldmountain]

32 minutes ago, Ivy said:

They told me it was because of my age.

I think they do provide it for other trans women.

I had to sign the informed consent papers for both PP and the VA.

Oh, I see. Thank you.

[Ashley0616]

I was at 42C already and now at 42D but I'm overweight by twenty-six pounds and will probably go down.