Long-Term Study Notes Effects of Hormone Replacement Therapy

[Carolyn Marie]

https://www.news-medical.net/news/20241128/Research-highlights-long-term-health-effects-of-hormone-therapy-in-transgender-individuals.aspx

 

 

It behooves trans folk of both genders who are undergoing HRT to talk with their medical providers about closely monitoring them for various risk factors.

 

Carolyn Marie

[AllieJ]

The challenge of getting long term HRT results is that bioidentical hormones haven't been around for much more than a decade, and using data from synthetic hormones skews the results. This article focuses on HRT outcomes for Trans men, and we have long known that Testosterone is less safe than Estrogen, but we are all different, so relying on data for 'typical' people fails to mention the possible problems if you are out on the fringe. This highlights the importance of finding a doctor who knows HRT, but also knows your history well! 

 

Hugs,

 

Allie

[kat2]

On 11/30/2024 at 10:23 AM, Carolyn Marie said:

https://www.news-medical.net/news/20241128/Research-highlights-long-term-health-effects-of-hormone-therapy-in-transgender-individuals.aspx

 

 

It behooves trans folk of both genders who are undergoing HRT to talk with their medical providers about closely monitoring them for various risk factors.

 

Carolyn Marie

Sounds to me if you carefully read it a game of elimination, on the one hand it talks about muscle volume being decreased on the other that strength stays the same, the other area of concern is about expectations of what hormones can do, many years ago in the United Kingdom if the clinic didnt think you would benefit from hormonal therapy or it could cause more harm than good you were excluded from the clinic. I have been on hormones for 40 years so a very long time, like all things research can be manipulated and we need to include the climate of the country of origin.

[Vidanjali]

On 11/30/2024 at 5:23 AM, Carolyn Marie said:

It behooves trans folk of both genders who are undergoing HRT to talk with their medical providers about closely monitoring them for various risk factors.

 

Agreed. And by "both genders" I will assume you mean both trans women and trans men which the study addressed, exclusively. However, this advice holds for trans folks across the spectrum of any gender who seek hrt for varied reasons.

 

On 11/30/2024 at 7:04 AM, AllieJ said:

The challenge of getting long term HRT results is that bioidentical hormones haven't been around for much more than a decade, and using data from synthetic hormones skews the results. 

 

I agree and there are many other factors which skew the results. Here's the link to the entire research article.  https://onlinelibrary.wiley.com/doi/10.1111/joim.20039

 

Take for instance the sample sizes used. Of the scant 17 trans men and 16 trans women who began, only 12 & 7, respectively, completed the study.

 

 

Additionally, statistics are subtle. There are established paradigms in some contexts for what is considered statistically significant, but in other cases it can be somewhat flexible. If you look at the data points for liver fat in the bottom right corner, for example, you see most of the points clustered with just a few higher than the cluster, and some well above the cluster. Are those outliers or statistically significant? I don't know, I'm just saying with a small sample size and some apparent inconsistency, it's not correct to make generalizations which journalists reporting on this research are perhaps apt to do.

 

 

In the discussion section of the article, the researchers acknowledge the limitations.

 

Our study was somewhat limited by the relatively high dropout rate, particularly among TW. This was the main reason that we, in addition to all data, also present the results in a repeated measures analysis (Supporting Information section), which shows that responses were generally similar and that the overall means for the cohort and patients who dropped out were generally not different from the respective cohorts as a whole. We also acknowledge the limitation of an isometric strength test as the sole indicator of muscle function and that we cannot fully account for lifestyle factors such as exercise training and dietary habits that may affect changes in body composition, even though we conducted surveys that showed no time-point differences in physical activity. Importantly, our blood data confirm that all patients (unless gonads were removed) continued to receive effective hormone therapy.

 

And note that in fact, they do not claim to be making generalizations 

 

In summary, in TM and TW, we observe several changes...

 

5 hours ago, kat2 said:

research can be manipulated and we need to include the climate of the country of origin.

 

Sure. And also check for conflicts of interest and funding sources. I didn't look into all of this. Just noting that Novo Nordisk, according to this article supports LGBTQIA+, they are, however, a pharmaceutical company.

https://builtin.com/diversity-inclusion/companies-that-support-lgbtq

 

 

[awkward-yet-sweet]

2 hours ago, Vidanjali said:

Take for instance the sample sizes used. Of the scant 17 trans men and 16 trans women who began, only 12 & 7, respectively, completed the study.

 

The sample size is a big issue with a lot of studies.  I know that research is expensive and time-consuming, but small sample sizes like this limit the usefulness of the results.  Just think of the typical sample size for clinical drug studies.  Study participants frequently number in the hundreds.  Even then, there's often data that shows up years later, after thousands and thousands of people have been using the drug. 

 

That said, the conclusions drawn from the study aren't exactly news.  "HRT can change fat composition/location and muscle tissue."  Ummm.... the sun also rises in the morning as the earth rotates.   Be careful what you take, because any drug can do anything to anybody at any time.  Know your body, work with your doctor, and report any changes.  Pretty basic.    

[kat2]

On 11/30/2024 at 12:04 PM, AllieJ said:

The challenge of getting long term HRT results is that bioidentical hormones haven't been around for much more than a decade, and using data from synthetic hormones skews the results. This article focuses on HRT outcomes for Trans men, and we have long known that Testosterone is less safe than Estrogen, but we are all different, so relying on data for 'typical' people fails to mention the possible problems if you are out on the fringe. This highlights the importance of finding a doctor who knows HRT, but also knows your history well! 

 

Hugs,

 

Allie

yet ironically for me synthetic hormones produced the best outcome, i am very cautious under the current climate (and movement against the existence of transgender) We seem to have moved from the reason why we are taking hormone therapy and now as i call it in the UK we play the numbers game we seem to have become trapped in a range game (female range) rather than our real reason is to align our bodies not to match a female hormonal range . 

[AllieJ]

Synthetic Hormones have higher health risk factors, hence the lower doses and reliance on anti androgens, and is why they are being phased out. Bioidentical Hormones are much safer at higher doses, which can eliminate the extra complications of anti androgens, but confusion in the medical fraternity sees doctors referring to the old studies like the Women's Health Initiative which is about synthetics, and applying those risk factors to bioidenticals. This is why we see so many doctors mandating low levels for bioidenticals, and still relying on anti androgens. 

 

This misinformation in the medical fraternity is why the effectiveness of bioidenticals is sometimes seen as inferior to synthetics, and has been the cause of much suffering in trans women, and cis women seeking menopause relief. I've heard it said that this will die out as older doctors retire, but I am seeing many younger doctors falling into the same mistake as so many professional bodies base their standards on whether WHI. I have read medical publications from this year which are still referring to the WHI, so it will curse us for many years to come.

 

Hugs,

 

Allie

[kat2]

16 hours ago, AllieJ said:

Synthetic Hormones have higher health risk factors, hence the lower doses and reliance on anti androgens, and is why they are being phased out. Bioidentical Hormones are much safer at higher doses, which can eliminate the extra complications of anti androgens, but confusion in the medical fraternity sees doctors referring to the old studies like the Women's Health Initiative which is about synthetics, and applying those risk factors to bioidenticals. This is why we see so many doctors mandating low levels for bioidenticals, and still relying on anti androgens. 

 

This misinformation in the medical fraternity is why the effectiveness of bioidenticals is sometimes seen as inferior to synthetics, and has been the cause of much suffering in trans women, and cis women seeking menopause relief. I've heard it said that this will die out as older doctors retire, but I am seeing many younger doctors falling into the same mistake as so many professional bodies base their standards on whether WHI. I have read medical publications from this year which are still referring to the WHI, so it will curse us for many years to come.

 

Hugs,

 

Allie

I am not sure i would agree regarding synthetic hormones?, being on hormones for 40 years alot longer than most and what was known at that time and has since improved, "smoking" fewer people smoke now, "Sedentary life style" people are more active now and there is a Champaign to live a more healthy life. I was on Premarin --- per day and cypotrone or androcur at a high dosage. The biggest risk factor was if you were protein S or C deficient, which could be checked for by a blood test. I am not sure why a new trend of what is termed female hormonal range and a target range of 350 to 700 in blood tests, again here in the UK if you go above 750 your hormones are reduced, yet when i started on hormone therapy we went off degrees of feminisation, in other words if the hormones you were taking did not produce results then they were increased over time.Sadly today once that number of 750 is reached then trans patients are told sorry hormones are not working for you!!! As with anything we read please consult with your GP or endocrinologist. The subject matter is purely from a user point of view reflecting upon changes made over the years, hugs to all

 

levels quoted are UK and will differ from US

Edited December 8, 2024 by Carolyn Marie
Dosage info removed per Community Rules