I'll sum up the doctor's appointment Yesterday:
1) I got my hormones. Testosterone blocker and Estrogen replacement. Premerin (25 mg once a day Mea culpa. it's 1.25 mg once each day) and Finasteride (5 mg once daily)
2) My cholesterol is wonderful according to the tests.
3) My BP was 112/82 WITHOUT my meds
4) My blood sugar was 160 after eating, also without meds (it's been running 250+) dropped later to 116 then I ate and took my meds.
In bad news we have the following items:
1) I'm going to be on Insulin within 2 years, I can stretch that to 10 years if I go on a no starch/no carb/no sugar diet and REALLY work that, but he wasn't too encouraging with it.
2) I gained 15 lbs. I lost everything I gained because I didn't exercise for nearly a month.
3) He's not too sanguine as to if I will have any result from the Premerin. He said that the only other TS he had didn't have much in the way of results.
4) one of the side effects is blood clots.
5) he was pointing out that it wouldn't help with my receding hair or really with my beard or body hair.
6) He told me that even if I had an orchodectomy right now (removal of testees), it wouldn't have any appreciable effect for THREE YEARS. Apparently the Testosterone stays in the system that long.
7) TennCare probably isn't going to pay for these drugs and definitely won't pay for the surgeries.
I'm really and seriously thinking about getting the orchodectomy since I won't be using them. They just get in the way, it just hangs there and I have to get them out of the way, crushed in my panties or something, and they are targets. The penis I can get out of the way, the scrotum too, and I need both of those if I decide to have a vaginoplasty at some point, but the testicles are pretty much useless equipment right now. I've had all the children I'm going to have and don't need to have them anymore. Maybe some lady can use the sperm.
He seemed really down on the whole TS thing, and I'm not really sure that he was giving me the best advice he could. On the plus side my fear of not being able to get the hormones because of my diabetes and so on was unfounded. But with the rest of it, I'm still just bummed right now.
So that's the news here. Put up the "Letter to my family" on Daven's Journal and unscreened it so everyone can read it. I expect a frantic call any day from my mother or sisters. It's open to everyone and you can comment if you want. It can be found at http://bit.ly/czqW7y
Comments
HOLY CRAP!!
25mg of Premarin??? That is pretty damn high!
Is it a typo? 2.5 would be high but not unusually so.
Nobody.
Exact quote:
"Premarin 1-25mg PO qdaily #30 (thirty)" with 11 refills.
So, no typo.
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May the Stars Light Your Path
Maid Joy
http://i-know-i-know-but.net/
okay.... dr knows best and all that.
premarin has health risks. typical HRT (for menopausal women) dosage is 0.625mg. At this dosage drs have to check liver function and blood clotting factors every 6 months or so. And at 0.625mg your risk of heart attack or stroke is upto 4x the normal for your age group. I can't imagine how those numbers might change.... but my intuition says its worse... much worse. Premarin increases the 'thickness' or 'viscousity' of your blood.
Please talk to your pharmacist before taking that dosage.
Nobody.
T* Antagonists
In addition to a blocker... you should consider asking for a T* Antagonist like spironolactone.
Cons: Mild diuretic.
Pros: Diuretics can help with weight loss, Competes with T* for binding sites... prevents what the blockers didn't block from acting (mostly), Slight reduction in blood pressure at significant dosages, Hair loss STOPS no reversal but it stops (well at least comes down to what approaches normal rate of hair loss). Not expensive!
Nobody.
Premarin = bad
I was on Premarin for 2 years. While nothing terrible has happened to me, both my psychologist and my doctor got wind that Premarin is pretty bad for a patient's health. I got switched for something "more natural": Estrace, 1.5mg twice daily.
25mg once per day...that sounds *massive*. How about a second opinion?
-Christelle
"Fun-loving geek-chick who's addicted to sunlight!"
-Christelle
"Fun-loving geek-chick who's addicted to sunlight!"
Orchiectomy = no results for 3 years = hoooey!
I'm beginning to agree with you that this guy doesn't like TSs.
People I know who have had orchiectomy go through within days a reaction to a sudden reduction in T*
Its a lot like menopause (heat flushes, moodiness, etc.)
If you wouldn't get any results from orchiectomy... this just would NOT happen as the body would have 3 years to get used to the reduction.
Nobody.
ps. btw. blood clots cause embolisms if they are large enough. These can and often do kill those who get them.
edit:
pps. Sorry to worry you but I think 25mg is dangerously high. please talk to your pharmacist.
You do need
You do need a better endo who has experience treating TS. Spirolactone would be better than whatever he's using for blockers to control T, and 2mg Estrace (once or twice a day depending on response) would be better for HRT. Spiro has been used for a long time as a diuretic and BP control, but has the side effect of decreasing the testosterone uptake, and it is potassium sparing. That is only a concern if you work outside and sweat a whole lot, but it is controllable. You might have to lay off bananas and grapes, but only if you start retaining to much pottasium. After 4 years of Spirolactone, my T levels were at .001 (should read between 20-60 for female norm), and my endo actually has me using a testosterone cream to balance things out to female norm.
Premerain is I understand from horse urine, and is actually kinda vile even in concept and is not human compatible, and is more likely than estrace to cause clots. It is not even recommended for use for menopausal women due to the enhanced risk of blood clots. The dosage is very high and of potential danger from what I have read. Get a second opinion from an endo experienced in treating TS.
In the experence of those in our support group, a female endo is better than a male as most have no negative feelings about TS. From what I have heard about Tennessee, it's a lousy state for transitioning. Can you relocate? And if you are native born Tennesseean, you cannot change your birth certificate, which sucks and makes document changes most difficult.
As far as your other stuff, make sure you combine exercise with a good diet to control your diabietes. It is a progressive chronic disease, but keep your weight down and your sugar down (consider it poison) and controlled, and you can do well. You would likely be rejected for surgery by the Thai surgeons, but then they seem to be aware of their limitations and go only for low risk patients. In the US or Canada, diabetes is mostly no problem, but do try to stay off insulin. Just makes it better. Right now I am on two 1000 units caplets of Metformin per day, with one 2mg tab of Glimperide, and walk 2 miles a day and ride the excercise bike at moderate resistence for 4-6 miles. The a few other things to get my nether parts strengthened for surgery with Dr. Brassard in November. I have been type II diabetic for three years, but was not careful for the first year. Much better now, with blood sugar readings around 110-95 depending on time and diet. Definitely control carbs. Carb counting works well and you get plenty to eat without feeling like you are starving.
And he is wrong about the effects of an Orchie. Decrease is so fast it will make your head spin with some hot flashes, depending on how long you are on spiro first. Stabilizes within a month or less, with HRT.
It has been my experience and that of my friends that body hair reduction is pretty quick, and most hair loss is greatly reduced, when on estrace and spirolactone. I cannot speak for the effects of Premarin, but it has so many other problems. Facial hair you will need laser or electrolysis to remove, though there are some new things some of my friends are trying that you can buy for $200 and maybe get some results, but the jury is still out on those. I know laser (and there are several forms out there) can work on darker hair, but not on lighter, and electrolysis does work for sure. E-3,000 in Texas (e3000.com) works very well but requires large chunks (for me) of money, but becomes less each appointment as hair is successfully reduced.
If you get a good Endo, they can send a letter to any insurance company stating that your HRT is a medical necessity, and so far almost any will cover the hrt less copay. At least that is our experience.
Your Endo sounds like a sourpuss and very pessimistic and is likely not experienced in treating TS and probably thinks you are nuts and will not do his best for you. Or he is stupid. Find another, IMHO.
CaroL
CaroL
Dear Joy,
Congrats on the good stuff!
Switch endo's.
On the premerin, the endo made a mistake; the pharmacist will have to call him. The largest dose premerin pill, the "purple football" is 2.5 mg. A 25mg pill is not made.
I agree with the others that permerin is far from the best source of estrogen. If not estrase, you could take estradiol. I take mine sublingually; this avoids one pass through the liver. An oral med/all that is absorbed by the stomach, goes directly to the liver (I think) and this stimulates the clotting factor more.
Someone recently had her HRT Rx on a blog. She was taking estradiol, I can't remember how much, and 200 mg of Prometrium, a stomach absorbable form of progesterone. I advise against taking any of the artificial Progestins. Progesterone is the only natural hormone in this class.
About switching endo's, can't you get a recommendation for an endo more TS friendly and experienced from a gender therapist or TS friendly pshrink? I've never heard of anyone on (competently prescribed) HRT not having effects, although sometimes one doesn't get a lot of breast growth. HRT causes all kinds of other changes, maybe the most important to the brain. It also makes one's face softer and more fem. Over years, my body hair has lightened, hairs are finer, etc. considerably. I had maybe 20 chest hairs; I plucked them when I started HRT and none ever grew back, but that might be unusual.
The HRT, actually just the T blocker, will stop male pattern baldness from getting any worse, immediately. With the estrogen and progesterone, you may get some regrowth; I've seen some gals get it and some not. The orchiotomy will not be much different from being on good T blockers. Get info from GRS Dr.s; Biber didn't want his patients to get an orch', it made something in the surgery more difficult, can't remember what. If the surgeons don't care, I'd go for it!
I have no idea what the guy is talking about re: 3 yrs before any effect? Weird. F2M TSs on T get injections more often than monthly, weekly maybe. Everything in the blood stream breaks down/gets excreted if it's not used up by some tissue, eg. glucose. T turns into DHT and some other breakdown products as well as gets converted to andro then to DHEA then to progesterone or an estrogen. The endocrine glands excrete hormones daily to replace those used up or excreted. I doubt that T half life after excretion or injection is more than one or two weeks, probably less.
I had my HRT payed for by my insurance by the Dr. calling it "hormone imbalance", which I guess could happen to anyone, M or F. The Dr. should not mention anything to do with TSism or transitioning, obviously. I bet a T friendly endo would know what to do to get the HRT payed for. You might also find info on endo's from "Tapestry" magazine/international foundation for gender education, Dr. Becky's website or Lynn Conway's website. I think those 3 are all linked to each other.
Hugs and Bright Blessings,
Renee
Ready for work, 1992.
Hugs and Bright Blessings,
Renee
Hormones
Maid Joy - RUN don't walk to any clinic & ask for an endo consult. READ Dr. Becky's advice to males on HRT - she is a post-op TS cardiologist & can also be accessed from Lynn Conways site. My endo has me on the Estrsdiol Derm !00 (each patch has 8 mg of estradiol-17ß) - 3 patches per week & am doing just fine in my 4th year of HRT & will be joining Dr. Pierre Brassard's alumni on January 25th.
My cardio has no problem with my regime even after my triple by-pass in 2001. My blood pressure & statin meds are not in conflict & I non-diabitic & don't worry about age - I will be 73 in a month or so.
Ruth
May the sun always shine on your parade.
I wrote a similar letter, not that long ago.
Good for you!
If your family can't accept you, it'll hurt, but not as much as trying to be who you aren't.
Good luck on your journey and like pretty much everyone else has said, ditch the asshole doc. That idiot's gonna kill you.
Abby
Mistake in the Premerin dosage
I can't read doctor's handwriting. At all apparently.
His "1-25" was actually "1.25" or one and a quarter mg.
Wow.
The T blocker was put on hold by my insurance. They want an authorization before paying for it since it's so expensive. I got the Premerin.
I will be looking around for a new Endo. I'll ask my shrink to help if she can.
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May the Stars Light Your Path
Maid Joy
http://i-know-i-know-but.net/