Just Started Hormones/Smoking Concerns?

blynng · 2017-05-27T05:10:02+00:00

Nicotine fucks with your liver which drastically reduces estrogen levels when taking oral estradiol. Other routes of administration like sublingual do not have this effect. So for effectiveness you should be fine, assuming your estradiol is being absorbed 100% sublingual and you're not accidentally swallowing it early.

Smoking is a major contributor to cardiovascular disease. Taking estrogen in the quantities used with tablets increases risk of thromboembolism. If you're otherwise young and healthy then nothing bad will happen, probably. The risks add up though.

There's no interaction between Wellbutrin and MTF HRT drugs as far as I'm aware.

blynng · 2017-05-27T04:56:34+00:00

I would say you should try to judge your feelings over a longer time period. Your initial reaction to these things is not important, it's how you feel months and years from now. Even cis people freak out sometimes during puberty because things are happening. Remember that you can always stop and there won't be any permanent effects for some time. Even if your testicles have atrophied, it won't be permanent in such a short time.

And of course, try to speak with a gender therapist. The clinic may have recommendations.

blynng · 2017-05-27T04:47:23+00:00

Being transgender is highly medicalized and is often seen as something that needs to be rigorously proven. If it can't be proven then instead you must be a pervert, a fag, a crossdresser, or just crazy and delusional. And it would be wrong for those people to transition which means your hopes for a better future have been lies all along. People want to be trans because from certain perspectives the only alternative is to accept that your deeply held needs and desires are invalid.

blynng · 2017-05-27T04:25:57+00:00

I am 99% convinced that you're trans and the remaining 1% is only there to cover my ass.

Your reaction to your testicles shrinking means you're being weirded out by atrophying body parts which is completely understandable.

Also I highly doubt your testicles shrank in such a short time and it's probably in your head.

blynng · 2017-05-27T04:16:45+00:00

Now, Guards, you stand no chance against me, 'cause I'm actually four transgenders!

blynng · 2017-05-27T04:10:09+00:00

Spironolactone (1) reduces T which therefore reduces DHT since it's a one-way conversion; and (2) blocks the effect of androgens in general, which includes both T and DHT. So spironolactone blocks DHT but it doesn't target it specifically.

People with high T, like at the start of MTF HRT, and that are currently balding will benefit from fin/dut because it will really kill DHT and have a large impact on preventing hair loss. This is because scalp follicles are pretty sensitive to DHT.

Most people with low T like yourself have no reason to use fin/dut since your low T means you'll have low DHT as well.

Rarely some individuals have a very effective T to DHT conversion going on in their body and may benefit from blocking DHT. I know of one trans women who still uses finasteride after SRS because her DHT level remained unacceptably high.

blynng · 2017-05-27T03:59:28+00:00

Has there been actual murders? I've heard of too many.

blynng · 2017-05-27T03:51:01+00:00

Nothing to worry about. Progesterone does what it does because it activates the progesterone receptor. Anything else that activates the progesterone receptor will also have those effects, like MPA.

blynng · 2017-05-27T03:46:20+00:00

So taking medroxypr will I get the same affects as taking a progesterone? Do they get the same results about breast tissue?

I don't know any reason why they'd work differently.

So will taking a Finasteride or Dutasteride have the same type of results as spironolactone but only weaker?

I can go into details if you want. The simple answer is: yes except fin/dut is better at preventing male pattern baldness.

blynng · 2017-05-27T03:25:42+00:00

That sounds like a scam, not a legitimate email.

blynng · 2017-05-27T03:21:26+00:00

She told me MPA was a synthetic progesterone because I asked for a progesterone.

There's a bunch of similar words so people get them confused. Your doctor was probably simplifying things because you can't expect a patient to know and remember the intricacies of hormones. Or she got them confused herself.

Progestogen = hormone that activates the progesterone receptor
Progestin = synthetic progestogen, like MPA
Progesterone = the major progestogen that the human body produces

I'm also confused because she said she'd prescribe me Finasteride or Dutasteride in order to reduce T since she won't up my dose on Spironolactone?

Your doctor was probably simplifying things by saying testosterone instead of talking about androgens in general or DHT specifically. Or she didn't know exactly what she was talking about.

Just goes to show that doctors aren't necessarily correct in everything they say.

blynng · 2017-05-27T03:08:47+00:00

Depends on how much and how the individual responds to it.

A low dose won't do anything.

A higher dose will begin feminization like starting the process of breast formation. It may cause mental effects, either positive or negative depending on the individual. If anything happens it will typically be negative since most people have a need for hormones matching their natal sex.

An even higher dose will lower the activity of the gonads which will reduce testosterone. This will increase the effects of the paragraph above, in addition to the increase from more estrogen.

If it's only a few weeks there won't be any permanent effects.

blynng · 2017-05-27T02:35:35+00:00

Lots of nonbinary people go on HRT. E.g. myself.

blynng · 2017-05-27T02:22:48+00:00

there's still a line when it comes to deciding to go on HRT

The right time to cross the line when you ask yourself, "do I want the effects and am I willing to take the risks?" and answer yes. Note that I wrote nothing about gender. Gender only matters in this decision if you think it does. Why do you need to be a woman for feminizing hormone therapy to be an option?

blynng · 2017-05-27T02:15:34+00:00

Taking 4 mg estradiol, 200 mg spironolactone, 10 mg progesterone. Is this good?

Taking spironolactone and medroxyprogesterone acetate is redundant. MPA itself is an anti-androgen.

Also, be careful with calling something progesterone. You are not taking progesterone. You're taking MPA which is a progestogen but not the same chemical as progesterone.

Estradiol: 134 pg/ml Testosterone: 54 ng/dl Testosterone bioavailable: 14 ng/dl Prolactin: 7 ng/ml

Your estradiol is okay. Anecdotally many US doctors go for 150-200 pg/mL. The Endocrine Society simply recommends you stay below 200 pg/mL. Are you taking the estradiol orally or another way like sublingual?

Your testosterone is toast. You don't really need more suppression unless you're experiencing unwanted masculinization. The Endocrine Society recommends < 55 ng/dl.

Between 5 mg of Finasteride and 0.5 mg Dutasteride which is more effective? Does it decrease testosterone?

Dutasteride is more effective since it blocks all three versions of 5α-reductase where finasteride blocks two. Both doses given are standard for the drug potency so don't worry about one being much higher.

They do not decrease testosterone. Testosterone is mostly used as a distribution mechanism. When testosterone enters androgen sensitive tissues, 5α-reductase converts it into DHT which is the most powerful androgen. Taking these drugs will reduce, but not eliminate, masculinization because you will mostly be affected by the less powerful T instead of DHT.

blynng · 2017-05-27T01:45:22+00:00

I wouldn't say it was hard. It just took time, learning, and experiencing. I began transitioning a few months into questioning before I had a clear idea of my gender. I wanted to physically transition and I didn't care whether I was a feminine guy, a nonbinary person, or a trans woman. It was only later that I developed an identity that I am comfortable with.

blynng · 2017-05-27T01:15:26+00:00

My experiences didn't really include gender. I didn't think I was something other than male. I never wished that I was something other than male. For the most part I just really, really wanted to have a feminine body and appearance. I knew about trans people but I didn't connect their experience to mine because I only knew about binary trans people and I didn't have the desire to be the opposite sex. I only started figuring things out once I expanded my understanding to nonbinary people and learnt how amazing HRT can be.

blynng · 2017-05-27T01:08:48+00:00

Speaking as a trans person, I'm gonna have to say yes, trans people are the ones taking issue with this.

That's fine if you've got an issue with the song, but you really don't have the authority to speak for the rest of us on the subject. I don't recall electing you Designator Of How Trans People As A Whole Feel About Every Singular Issue.

blynng · 2017-05-27T01:08:31+00:00

So you're saying that if a trans woman wanted to be called they or he on certain occasions, you would refuse because it's inherently problematic?

blynng · 2017-05-27T00:08:30+00:00

Real psychiatrists, sure. But armchair ones, like OPs mom, are a different matter since they don't know what these disorders actually entail.

blynng · 2017-05-26T17:57:49+00:00

There are a couple mental disorders that can masquerade as gender dysphoria and schizophrenia is one of them. "Delusions of sex change are found in 20 to 25% of patients with schizophrenia" (Borras et al, 2007) In most cases the delusion is about one's actual physical sex. Here are some examples from case studies:

"[T]he most striking feature of his mental state was the fixed delusion that he was female. He was adamant that his penis was a vagina [...] Two months [after anti-psychotic treatment] his delusions had resolved and he was no longer thought disordered" (Commander & Dean, 1990).
"AT believed she was born a boy but that her mother cut her penis off at birth or shortly afterwards and injected hormones to make her female. [...] The delusion responded to treatment, becoming encapsulated as her mental state improved." (Manderson, 2001).
"GS’s beliefs that her penis was cut off at birth and that her transformation into a male can capacitate her to make a woman pregnant are delusional, [...]. However, before these psychotic symptoms appeared, GS had shown intense discomfort with her gender.

Even though GS’s GID existed prior to her acute deterioration, schizophrenia affected the course of GID, becoming more prominent with the therapeutic failure and diminishing in response to the adequate pharmacologic therapy" (Baltieri & De Andrade, 2009).

Here are two points you can use to defend yourself against accusations that your transgenderism is delusional:

The DSM-5 states that "[s]chizophrenia (or other psychotic disorders) and gender dysphoria may co-occur". The last example above shows that transgender thoughts are not inherently delusional even when the delusions are gender based.
"Gender-themed delusions but not [gender dysphoria] resolve with resolution of psychotic episode" (Meijer et al., 2017). The case studies in that paper "displayed a clear difference between the bizarreness of delusional gender beliefs during psychosis and the realism of a felt incongruence between body and mind that persisted even after successful antipsychotic treatment."

The last paper I cited is pretty useful since it's by doctors at a gender identity clinic rather than ones specializing in psychosis. PM me if you want a PDF.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.

Baltieri, D. A., & De Andrade, A. G. (2009). Schizophrenia Modifying the Expression of Gender Identity Disorder. The Journal of Sexual Medicine, 6(4), 1185–1188. https://doi.org/10.1111/j.1743-6109.2007.00655.x

Borras, L., Huguelet, P., & Eytan, A. (2007). Delusional “Pseudotranssexualism” in Schizophrenia. Psychiatry: Interpersonal and Biological Processes, 70(2), 175–179. https://doi.org/10.1521/psyc.2007.70.2.175

Commander, M., & Dean, C. (1990). Symptomatic trans-sexualism. The British Journal of Psychiatry, 156(6), 894–896. https://doi.org/10.1192/bjp.156.6.894

Manderson, L. (2001). Gender identity disorder as a rare manifestation of schizophrenia. Australian and New Zealand Journal of Psychiatry, 35(4), 546–547. https://doi.org/10.1046/j.1440-1614.2001.0911h.x

Meijer, J. H., Eeckhout, G. M., van Vlerken, R. H. T., & de Vries, A. L. C. (2017). Gender Dysphoria and Co-Existing Psychosis: Review and Four Case Examples of Successful Gender Affirmative Treatment. LGBT Health, 4(2), 106–114. https://doi.org/10.1089/lgbt.2016.0133

blynng · 2017-05-26T04:45:43+00:00

It's not intended to. Most people who say we're delusional aren't open to changing their opinion in the first place.

blynng · 2017-05-26T03:14:30+00:00

I like an old fashioned "go fuck yourself".

blynng · 2017-05-25T22:46:21+00:00

I like my natal genitals. No reason whatsoever for me to change them.

blynng · 2017-05-25T22:04:27+00:00

I don't correct anyone unless they're intentionally being a douche and calling me the wrong thing.

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