1. Progesterone: not for everyone, but for many people it may increase
sex drive and WILL make your boobs bigger. Also effects mood in ways
that many find positive (but some find negative). Most doctors won’t
prescribe this to you unless you ask. Most trans girls I know swear by
it.
2. Injectible estrogen: is
more effective than pill or patch form. Get on it if you can bear
needles bc you will see more effects more quickly.
3. Estradiol
Cypionate: There is currently a shortage of injectible estradiol
valerate. There is no shortage of estradiol cypionate. Functionally they
do the same shit.
4. Bicalutamide: This is an anti-androgen that
has almost none of the side-effects of spironolactone or finasteride.
The girls I know who are on it are evangelical about it.
Are there HRT medications that don’t increase blood clot risk? I’m already at risk because of my blood pressure, and my doctor won’t prescribe HRT that increases clot risk while I’m on the medication – and I may never not be on the medication.
Absolutely.
The concerns surrounding venous thromboembolic events as a side-effect of hormone replacement therapy can mostly be traced back to one particular study known as the Women’s Health Initiative. This study was an enormous undertaking which, unfortunately, demonstrated significant adverse effects of the hormone therapies studied. As a result of this the use of hormone replacement therapy in postmenopausal cis women was dramatically reduced as the medical community began to question whether or not the therapy caused more harm than good.
Naturally, trans women have been suffering from this fall-out ever since.
What physicians seem to fail to recognize is that the study examined a very specific hormone regimen which was, arguably, outmoded at the time the study was conducted: It examined the use of conjugated equine estrogen (Premarin) with or without the use of medroxyprogesterone acetate. Neither of these drugs is regularly used for the treatment of transgender women.
The estrogen most commonly used to treat transgender women nowadays is 17β-estradiol either in pill form or in the form of a sticky patch that you apply to your skin. Esters of estrogen (e.g. estradiol valerate) are also sometimes used either in a pill form or as an intramuscular injection.
Transdermal estradiol patches are the gold standard when it comes to treating women who are at high risk of a venous thromboembolic event. It simply does not increase the risk of developing a venous thromboembolism. The only thing you should keep in mind is that patches are not always well tolerated because of the lifestyle changes required to keep them from falling off and the fact that they tend to irritate the skin.
It’s difficult to find hard numbers regarding the relative risk of venous thromboembolic events with regards to hypertension. The best I could find after an hour or so of searching was this study regarding VTE in lung cancer patients. Hypertension increased the risk by a factor of 1.8.
As far as the anti-androgen is concerned: The primary use for spironolactone for cisgender people is as an antihypertensive.
Even if the risk of thromboembolism was truly significant with modern hormone replacement therapy it wouldn’t justify what your doctor is doing to you. The fact is that mortality in the transgender community from suicide–caused in part due to the lack of access to hormone therapy–is substantial. The quality of life lost when a trans woman is denied hormone therapy is substantial. The fact that your doctor does not appear to be taking this into consideration when they weigh the risk of thromboembolism against not receiving necessary medical care is deeply concerning.
I strongly recommend that you seek a doctor who is more sensitive to your medical needs as a transgender woman.
Edit: Fixed a minor, but embarrassing, error.
oh wow this is so helpful & good info
Everyone who cares about transfem people please reblog this
this was really fucking helpful
I know a lot of trans women dont have acess to information like this and its very helpful.
Here’s some stuff I could have used being told when I started HRT:
If you do HRT, you are seizing control of and reconfiguring an aspect of your own metabolism, which is fucking cool and amazing, but despite what medical literature and community knowledge exists, you must always be your own advocate in the process (even if you think you have good doctors). As someone who deals with hypervigilance, I’m not going to tell anyone to be more vigilant, but HRT has myriad and subtle impacts on your body and mind (duh). Some of these you probably want, some of these you probably don’t, but telling the difference can be more tricky than you think.
Really watch yourself for side effects. I don’t mean relatively rare side effects like liver damage or blood clots, but simpler stuff that’s much easier to dismiss as just being transient or bearable, like nausea or mood swings. Such side effects are likely to be be small and easy to deal with in the beginning, easily borne, but if they become more serious over time they can do so so slowly that you don’t realize your quality of life is being reduced, especially if you’re loving many of the effects of HRT at the same time. Don’t accept any side effects of your meds as unavoidable, or akin to a price you have to pay for HRT’s benefits. Just adjusting the dosage of your meds, the times you take them, how you take them, and what you take them with can have a huge impact, but doctors can leave out that this is a process of experimentation, and that finding the right combinations of meds and dosages can take time.
Evangelical is not a word I ever thought I’d use for myself, and I’ve only been on bicalutamide for a week, but wow. If you are using spiro and experience any nausea or stomach pain while on HRT, even if you think it has other causes, or if you’re someone like me who carries their anxiety or fear in their stomach, I’d highly suggest at least trialing bicalutamide in place of spiro, just to make sure you know what’s causing that pain and/or nausea. I took 300 mg/day of spiro for about a year, and was waking up in pain and nausea every day without connecting the dots. Now that I’ve switched anti-androgens and tapered off spiro, in just a week I have twice the appetite and almost no stomach pain. What pain I do have dimishes every morning. So far, bica has been literally life-changing for me.
But I only found out about bica from another trans woman, here on tumblr ( @social-justice-cleric ) . My doctor insists he mentioned it as an alternative, more than a year ago, but frankly he stood by as my stomach pain became worse and worse, and only switched me to bica when I did my own research and asked him to. Don’t underestimate the importance of community and its accumulated knowledge- make sure you find other trans people you can talk about your transition without fear of judgment, especially including talking about any and all biomedical components of it. This is especially important for trans women who tend to socially isolate ourselves in response to stress or uncertainty (aka, me).
And as someone who really wanted results from HRT as quickly as possible, it’s ok if you end up wanting to step back your dosages, or if a medication doesn’t work out. This should seem obvious, but it doesn’t make you less of a woman to slow down or even stop doing HRT. Additionally, don’t assume that the speed at which your appearance changes is necessarily correlated to the amount of meds you take- there is for everyone a threshold of dosage past which there is no benefit (and instead just increased risk). For instance, I just finished a two month trial of progesterone- maybe my breasts developed a little more than they otherwise would have, but mostly I just had slight mood swings that trended slightly more to the negatives than the positive, so I’m not going to keep taking the stuff. And if spiro was the only anti-androgen out there, I might have stopped taking one entirely rather than stay on it. But decisions like these are hard, and intensely personal- your doctor can’t, or at least shouldn’t, make them for you.
Ultimately, all the biomedical means of transitioning are for is getting the changes you want to your body and/or mind. And despite the legal-functionary and regulatory components of biomedical transistion, these means do not make you into a woman. Regardless of whether or not you apply these biomedical technologies to your own transition, you are a woman. Some of us trans women come to accept increased medical risks, or endure physical discomfort, in pursuit of the self and life we want. In this, we are hardly alone among women. And, as is the case for any patient heading into a doctor’s office, what medical experts tell us must always be judged against our own embodied expertise.
Biomedically transitioning shouldn’t be seen as a necessary stage of one’s gender transition- it should be an opportunity available to all of us, but not one we all must take, or need to take, to be happy. Since we live in such a cissexist and transphobic society, biomedically transitioning is for many of us a desperately needed means of survival. And at the same time, and in equal measure, it is also for many of us a source of incredible joy. Listen to your doctor, listen to the community, listen especially to your body and to your own heart, and see what works for you.
Also, as a trans woman who has a chronic liver disease, bicalutamide can be hepatotoxic (damaging to the liver) and so far Spiro is the safest antiandrogen if you are a trans woman or AMAB nb in a similar situation as me. However, bicalutimide has not been tested in hrt doses, which are much smaller than the doses bicalutimide was originally for. Feminization begins as low as 12.5mg and the doses tested were 150mg.
estradiol depot is good replacement for valerate as well. 2nding the injections over pills. you can get so much more estrogen into your system SAFELY when it doesn’t have to be processed by your liver (which is what pills have to do).
It seems like a lot of this advice would be useful to anyone considering or taking HRT – man, woman, or enby. And absolutely, always be your own advocate. Your health is ultimately in *your* hands, not those of your doctor.
I am an ER nurse and this is the best description of this event that I have ever heard.
FEMALE HEART ATTACKS
I was aware that female heart attacks are different, but this is description is so incredibly visceral that I feel like I have an entire new understanding of what it feels like to be living the symptoms on the inside. Women rarely have the same dramatic symptoms that men have… you know, the sudden stabbing pain in the chest, the cold sweat, grabbing the chest & dropping to the floor the we see in movies. Here is the story of one woman’s experience with a heart attack:
"I had a heart attack at about 10:30 PM with NO prior exertion, NO prior emotional trauma that one would suspect might have brought it on. I was sitting all snugly & warm on a cold evening, with my purring cat in my lap, reading an interesting story my friend had sent me, and actually thinking, ‘A-A-h, this is the life, all cozy and warm in my soft, cushy Lazy Boy with my feet propped up.
A moment later, I felt that awful sensation of indigestion, when you’ve been in a hurry and grabbed a bite of sandwich and washed it down with a dash of water, and that hurried bite seems to feel like you’ve swallowed a golf ball going down the esophagus in slow motion and it is most uncomfortable. You realize you shouldn’t have gulped it down so fast and needed to chew it more thoroughly and this time drink a glass of water to hasten its progress down to the stomach. This was my initial sensation–the only trouble was that I hadn’t taken a bite of anything since about 5:00 p.m.
After it seemed to subside, the next sensation was like little squeezing motions that seemed to be racing up my SPINE (hind-sight, it was probably my aorta spasms), gaining speed as they continued racing up and under my sternum (breast bone, where one presses rhythmically when administering CPR).
This fascinating process continued on into my throat and branched out into both jaws. ‘AHA!! NOW I stopped puzzling about what was happening – we all have read and/or heard about pain in the jaws being one of the signals of an MI happening, haven’t we? I said aloud to myself and the cat, Dear God, I think I’m having a heart attack!
I lowered the foot rest dumping the cat from my lap, started to take a step and fell on the floor instead. I thought to myself, If this is a heart attack, I shouldn’t be walking into the next room where the phone is or anywhere else… but, on the other hand, if I don’t, nobody will know that I need help, and if I wait any longer I may not be able to get up in a moment.
I pulled myself up with the arms of the chair, walked slowly into the next room and dialed the Paramedics… I told her I thought I was having a heart attack due to the pressure building under the sternum and radiating into my jaws. I didn’t feel hysterical or afraid, just stating the facts. She said she was sending the Paramedics over immediately, asked if the front door was near to me, and if so, to un-bolt the door and then lie down on the floor where they could see me when they came in.
I unlocked the door and then laid down on the floor as instructed and lost consciousness, as I don’t remember the medics coming in, their examination, lifting me onto a gurney or getting me into their ambulance, or hearing the call they made to St. Jude ER on the way, but I did briefly awaken when we arrived and saw that the radiologist was already there in his surgical blues and cap, helping the medics pull my stretcher out of the ambulance. He was bending over me asking questions (probably something like ‘Have you taken any medications?’) but I couldn’t make my mind interpret what he was saying, or form an answer, and nodded off again, not waking up until the Cardiologist and partner had already threaded the teeny angiogram balloon up my femoral artery into the aorta and into my heart where they installed 2 side by side stints to hold open my right coronary artery.
I know it sounds like all my thinking and actions at home must have taken at least 20-30 minutes before calling the paramedics, but actually it took perhaps 4-5 minutes before the call, and both the fire station and St Jude are only minutes away from my home, and my Cardiologist was already to go to the OR in his scrubs and get going on restarting my heart (which had stopped somewhere between my arrival and the procedure) and installing the stents.
Why have I written all of this to you with so much detail? Because I want all of you who are so important in my life to know what I learned first hand.
1. Be aware that something very different is happening in your body, not the usual men’s symptoms but inexplicable things happening (until my sternum and jaws got into the act). It is said that many more women than men die of their first (and last) MI because they didn’t know they were having one and commonly mistake it as indigestion, take some Maalox or other anti-heartburn preparation and go to bed, hoping they’ll feel better in the morning when they wake up… which doesn’t happen. My female friends, your symptoms might not be exactly like mine, so I advise you to call the Paramedics if ANYTHING is unpleasantly happening that you’ve not felt before. It is better to have a ‘false alarm’ visitation than to risk your life guessing what it might be!
2. Note that I said ‘Call the Paramedics.’ And if you can take an aspirin. Ladies, TIME IS OF THE ESSENCE!
Do NOT try to drive yourself to the ER – you are a hazard to others on the road.
Do NOT have your panicked husband who will be speeding and looking anxiously at what’s happening with you instead of the road.
Do NOT call your doctor – he doesn’t know where you live and if it’s at night you won’t reach him anyway, and if it’s daytime, his assistants (or answering service) will tell you to call the Paramedics. He doesn’t carry the equipment in his car that you need to be saved! The Paramedics do, principally OXYGEN that you need ASAP. Your Dr. will be notified later.
3. Don’t assume it couldn’t be a heart attack because you have a normal cholesterol count. Research has discovered that a cholesterol elevated reading is rarely the cause of an MI (unless it’s unbelievably high and/or accompanied by high blood pressure). MIs are usually caused by long-term stress and inflammation in the body, which dumps all sorts of deadly hormones into your system to sludge things up in there. Pain in the jaw can wake you from a sound sleep. Let’s be careful and be aware. The more we know the better chance we could survive to tell the tale.“
Reblog, repost, Facebook, tweet, pin, email, morse code, fucking carrier pigeon this to save a life!
I wish I knew who the author was. I’m definitely not the OP, actually think it might be an old chain email or even letter from back in the day. The version I saw floating around Facebook ended with “my cardiologist says mail this to 10 friends, maybe you’ll save one!” And knew this was way too interesting not to pass on.
Female heart attacks are much different, and most people don’t know it!
This is so much more helpful than the fucking lists that basically describe everything that happens during a really nasty panic attack and then tell you to go seek help as if you don’t have an anxiety disorder that does this to you on a regular basis and can afford to go to the emergency room.
The new budget bill recently passed in Ohio added unprecedented new restrictions on abortions. Ohio state law OAC 3701-83-19 (E) currently requires that “Ambulatory Surgical Facilities” maintain a transfer agreement with a hospital as part of their licensing requirements. The new budget bill, starting at line 10257, states that
(B) No public hospital shall do either of the following:
(1) Enter into a written transfer agreement with an ambulatory surgical facility in which nontherapeutic abortions are performed or induced;
(2) Authorize a physician who has been granted staff membership or professional privileges at the public hospital to use that membership or those privileges as a substitution for, or alternative to, a written transfer agreement for purposes of a variance application described in section 3702.304 of the Revised Code that is submitted to the director of health by an ambulatory surgical facility in which nontherapeutic abortions are performed or induced.”
In short, in order to maintain their license to practice, abortion clinics would be required to maintain written transfer agreements with hospitals that the new law prohibits.
Furthermore, doctors are prohibited from using public hospitals to provide abortion services by Ohio law ORC 5101.57 (B) which reads:
(B) No public facility shall be used for the purpose of performing or inducing a nontherapeutic abortion.
If these provisions stand, only a written transfer agreement with a private hospital can keep abortion clinics legally operating in the state, and abortion clinics are the only facilities legally allowed to provide abortions.
They are getting sneaky with this shit in Ohio.
What’s really amazing to me about all of this is how abortion has become even MORE villainized within the past few years even though the number of people who identify as pro-choice has grown.
If I’m reading and interpreting this information correctly what republicans have managed to do with this has been to ban all public hospitals (that receive funding from the state) to even assist abortions clinics and patients.
Like, if you think about this, the requirement for a surgical clinic in an abortion clinic is truly unnecessary but even if it WAS something that was needed, the transfer agreement basically allows you to move a patient who may be experiencing a complication from getting an abortion to be moved to a hospital that can provide emergent care. A complication that could be life-threatening in very rare circumstances.
So putting a requirement on abortion clinics to have a transfer agreement with a hospital and then barring public hospitals from being able to enter into agreements like that is essentially preventing any patient who may experience complications to be seen at a hospital, basically (because the overwhelming majority of private hospitals are religious-based and will not enter into a transfer agreement with an abortion clinic either).
So, basically, your options are to have the patient die at the abortion clinic or send them to a religious-affiliated hospital that doesn’t allow abortions (and won’t complete one that had to be stopped half-way through due to complications) and let them possibly die from sepsis or hemorrhage.
Not only are we punishing patients and doctors for wanting or performing abortions but now we’ve allowed republicans to villainize abortion to the extent that they have now, essentially, stopped any hospital (in Ohio at this point, this will spread though) receiving OUR tax dollars from even treating a patient who needs emergency assistance that the abortion clinic cannot provide.
