About to start progesterone

[denete]

I'm nervous about adding progesterone next month. I can still do all of the passing in boy mode at this time mainly because I still have kept my goatee. It doesn't cause dysphoria issues. I'm feeling that once P takes hold, I won't be able to hide anymore. Have you been in this spot?

[VickySGV]

Not exactly in that spot, I never went beyond E and Spiro as far as the meds went, and still had very good results without other things, also my beard never became a grand male symbol.  I had very sparse beard hair that seemed to grow in random clumps on my face and never got any length.  I do however remember the anxiety over the "break-over" point when I could not deny that I was on hormones and was going to Transition.  The nervousness is a real thing and for me was one reason I was glad to have continued support from a therapist for the first years after I began HRT.  My real point came one day when I was mid point in my "month" and I got into a confrontation with another employee who was in the early stages of menopause.  I did not come out to the fellow employee, but my boss (a woman) pulled me aside and I did come clean with her.  The boss was surprised a small bit but actually took my real side of the confrontation and some changes were made.  It was several more months, when I decided to retire that I came out fully and had wonderful acceptance by all of my co-workers by then. 

[AllieJ]

Progesterone is generally not recommended by most doctors, mostly as there is no medical evidence that it will help. There is a good deal of anecdotal evidence from trans people, but it is very hit and miss in its effects. My doctor explained to me that Progesterone is naturally produced by cis women prior to breast feeding to mature breast cells, but there is some belief among trans people that it will increase breast size. Maturing breasts does round them out more, but size is mostly achieved by Estrogen. 

 

My doctor told me that maturing breast cells can mean that they cease further development, so taking Progesterone early in transgender HRT risks hindering full breast development. For this reason, there is a recommendation that people achieve Tanner Stage 3 prior to starting Progesterone. Because the effects vary wildly among trans folk, nobody can predict how it will affect you. It is a tool which might help round breasts and increase nipples and areola, and it might also have some effects on mood and sleep, but for most it does little. 

 

Make sure your doctor is up to speed with Transgender HRT, and they can give you solid advice, as there can be negatives.

 

Hugs,

 

Allie

[Heather Shay]

Welcome and congratulations. So glad you are here.

[Charlize]

I have never taken progesterone as, due to my heat condition, it is considered quite dangerous. 

Glad you've joined us here.

 

Hugs,

 

Charlize

[KatieSC]

There has been great debate about progesterone in transgender care. Medroxyprogesterone acetate can have great risk, especially with development of blood clots. More commonly, the safer version is micronized progesterone which has a much safer profile. Medroxyprogesterone acetate is not prescribed regularly because of a greater risk of breast cancer, as well as a much greater likelihood of blood clots, heart attacks, and stroke.

 

Part of the controversy is whether progesterone is useful in the improvement of breast tissue development. The WPATH standards Ver. 8 does not endorse the use, however, there are a number of providers who will prescribe it. The indisputable fact is that cisgender women have endogenous progesterone. It is hard to categorize the existence as harmful, when it occurs naturally in natal females. 

 

There have been a paucity of research involving progesterone, and the studies reviewing micronize progesterone in transgender females is equivocal. Some feel it works well, and some say it does nothing. Prior (2019) is an advocate of micronized progesterone as there is evidence of reduced cardiovascular disease (CVD), osteoporosis, as well as suppressing gonadal androgen production. Prior, as well was other researchers have documented that we as transgender females have an elevated baseline risk of CVD. The micronized form of progesterone is identical to the naturally occurring progesterone in natal females. As an aside, there has been increased discussion about hormone-replacement therapy (HRT) in cisgender females, as some of the latest research has yielded information that HRT may be beneficial.

 

It is certainly worth having a discussion with your provider in having shared medical decision-making. No matter what we take, there is always an equation of risk-reward that we need to assess, and the basis of providing healthcare is to do no harm. I took micronized progesterone for over a year. I had no issues. Again, some people may. The one thing to avoid is any offer of medroxyprogesterone acetate.

 

For more information see this article:

 

Prior, J. C. (2019). Progesterone is important for transgender women's therapy-Applying evidence for the benefits of progesterone in ciswomen. Journal of Clinical Endocrinology Metabolism, 104(4), 1181-1186.

[KayC]

Hi @denete

After a little over a year on estradiol and spironolactone, I started taking micronized progesterone a couple of ymonths ago.

 

My intent was to 'top off' my feminization.  I did a LOT of research and discussed with my provider.  She did not see any issues with it and left it up to my judgement and desire.  She also told me IF I did not get the results I was hoping for (or any negative side effects) I could always stop taking it at any time.

After it seemed I had reached a the maximum breast growth on estrdiol (and other physical feminization) I can say that the couple of months of progesterone has subtly increased my breast size.  I can tell this mostly by how my breast fill out my old bras more than before (so I have a reference from before the 'pro') so I know they're bigger.  They also look more prominent if I am wearing a t-shirt or top without a bra.

That's just My experience.  It can be different for others ... and even if I don't get anymore breast growth I am happy with what I have. 

But, if your intent is to avoid breast growth, then I am not sure why you are considering progesterone.  I have not really experienced any other changes from my HRT (maybe, just maybe ... my libido is up a bit?)

 

 

[denete]

Thank you all for the information. Yes, I'm working with a very good provider and will be re-visiting the topic in my next visit. I feel more informed now than with just my own research. I'll feel even better after my appointment. After all, she went to medical school and I just went to Google. :)