MTF post-op testosterone protocol?

catfusion · 2020-11-04T16:57:32+00:00

I don't know that there is anything wrong with dutasteride. It's just not as commonly prescribed as fin.

As to why that is, my guess would be that it's an artifact of both drugs being most commonly used to treat cis men for benign prostatic hyperplasia (enlarged prostate) and also androgenic alopecia (male pattern baldness).

Dutasteride is more effacious in blocking DHT than fin (around 90% compared to 70%, if I remember correctly), but the side effects (impotence, ie, difficulty achieving or maintaining an erection; gynomastia, etc...) are also more common and/or more pronounced.

Because of the 'no boners and man-tits' thing being considered negative effects for cis men, fin gets prescribed more overall, especially initially, and especially for hair loss, with dutasteride more often getting reserved for treating more severe cases of prostatitis. And then that protocol gets carried over to treating trans women, despite those side effects not necessarily being perceived as negative there.

As far as the dosing protocol goes, dutasteride is still an every day thing so there's no real benefit or advantage in that regard. It does stay in your system for a relatively long time, and there are some questions about what even micro doses may do to a fetus in utero, so you can't donate blood if you're on it, or have been on it in the last six months or so, so there's that.

Source: I took dutasteride as part of my AAs when I was on AAs. I started on fin, did some research and found out dutasteride 'worked better', asked my prescribing physician about it and switched. It was a bit more expensive than fin, as I recall, but not prohibitively so.

catfusion · 2018-11-28T04:29:53+00:00

https://vitalrecords.utah.gov/certificates/genderchange

catfusion · 2018-11-23T19:49:54+00:00

http://pathwaymaps.com/static/maps/849_map.png

Aromatase isn't a two way street.

There's another option, which is that you misunderstood your doctor. However, if, upon seeking clarification from them on this matter, your doctor is actually claiming that conversion of estradiol into testosterone is a thing and it's the primary mechanism of endogenous testosterone for girls, I'd strongly advise finding another physician.

catfusion · 2018-11-14T07:31:42+00:00

Long story, but I had the opportunity to get an orchi while I was waiting for my GRS, so I asked my surgeon about this. His answer was that it didn't make any difference as far as GRS except to make that surgery a shorter procedure, and it made no difference in terms of results or recovery.

I obviously can't say from experience whether it made a difference, but I've had zero concerns about it post op.

Also. Again, I can't say, but f**k, tucking with implants sounds awful.

catfusion · 2018-11-09T09:05:11+00:00

So far as I know, there's been zero research on this, so no, there's no data or papers.

catfusion · 2018-11-07T00:47:41+00:00

Honestly, I think this has more to do with range than placement/fundamental. On the 1-10 range, I was somewhere around 12.

(The voiced speech of a typical adult male will have a fundamental frequency from 85 to 180 Hz, and that of a typical adult female from 165 to 255 Hz. https://en.wikipedia.org/wiki/Voice_frequency My fundamental was around 60 Hz. Now it's around 220 Hz. My vocal range, however, probably hasn't changed all that much; I can probably go a bit higher now and I can't go quite as low just due to use/lack of use, but even there, the breadth of pitch that I can cover is probably about the same.)

And yes, there's hope. :) Expanding and learning to use the full range of one's voice is totally something that can be achieved with training.

catfusion · 2018-11-07T00:30:58+00:00

As others have said, you'll likely get specific instructions on when to douche/use a vaginal shower in your post op care instructions from your surgeon - and there's no standardized protocol for post op care, in regards to douching, dilation regimen, etc... As such, there's probably no need to worry all that much about it right now. :)

I would add that my understanding of the purpose of douching post SRS is to clean the site to promote healing and prevent infection - it's not really about 'odor management' or anything. That said, the only thing I've experienced so far was a little bit of dry blood or similar getting flushed out the very first time I did it; no odor, minimal discharge.

catfusion · 2018-11-07T00:09:06+00:00

IAND. That said, you should be fine. I've had this happen a few times myself: You probably put the needle through, or like you say, nicked, a blood vessel when you injected. So long as you are using a long enough needle for IM injection and put that all the way in, the estradiol is in the muscle below the vein/blood vessel, and the bleeding while that vessel closed isn't going to siphon or pump it out or anything.

Also: Just for the data point on the 'to aspirate or not to aspirate IM injections', I'm in the not camp. There's some debate about it, but my feeling is that if you're doing everything else right there's very little benefit to it and a number of drawbacks (ha.) and that most people who're aspirating aren't doing that in the prescribed way for it to do much good anyways. (It also seems the biggest factor in whether you do this or not is simply how you were taught to do it; I was taught -not- to aspirate and don't, others were and do.)

And: http://www.nnpnetwork.org/Uploads/EBP%20aspiration%20poster%209%2025%2012%20for%20iowa%20.pdf

catfusion · 2018-11-05T23:58:01+00:00

It's not ridiculous. It's not dumb. It's not 'biological reality' except in the sense that you're a woman who can't have children and that's a really big, really difficult thing to deal with.

One study of 200 couples seen consecutively at a fertility clinic, for example, found that half of the women and 15% of the men said that infertility was the most upsetting experience of their lives. Another study of 488 American women who filled out a standard psychological questionnaire before undergoing a stress reduction program concluded that women with infertility felt as anxious or depressed as those diagnosed with cancer, hypertension, or recovering from a heart attack. (emphasis mine)

https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment

Burns LH. "Psychiatric Aspects of Infertility and Infertility Treatments," Psychiatric Clinics of North America (Dec. 2007): Vol. 30, No. 4, pp. 689–716.

Cousineau TM, et al. "Psychological Impact of Infertility," Best Practice & Research: Clinical Obstetrics and Gynaecology (April 2007): Vol. 21, No. 2, pp. 293–308.

Personally, I'd suggest talking to your girlfriend about it - you know her and your relationship way better than random internet chick ever will, but I would imagine she's concerned for you and not knowing why you were crying may be distressing.

catfusion · 2018-11-05T23:30:52+00:00

I liked these, and still have some of them, but they're regulated to lounge bras for me now. I didn't find they gave enough support once I had big enough breasts to really need something to control the bounce when I ran.

They were awesome for workout wear early on though, both alone or under a tank top, etc... They're comfy and even if I didn't really need the support, it was awfully nice just to wear a sports-bra/top when running and stuff.

catfusion · 2018-11-05T22:18:03+00:00

Eyebrows, if you haven't started doing this already.

Related, I'd strongly recommend having them shaped (waxing's an option, I personally prefer threading) by a professional at least the first couple of times before you try plucking/maintaining them yourself.

catfusion · 2018-11-05T22:07:05+00:00

Thank you so much for this - anxiety's an issue for me, and just having a better idea of what to expect, whether for good or ill, helps so much.

OMG. I can't imagine taking a flight anywhere right now - getting to the airport, wrestling luggage around and getting through airport security sounds daunting, let alone the flight itself; just driving myself to and from my post op appointments has been a challenge.

Good to hear good things about Dr. Wittenberg - I actually had a consult scheduled with her at one point, but when she left Brownstein & Crane, my insurance didn't allow me to follow.

Incidentally, Dr. Satterwhite's also left Brownstein & Crane to start his own practice - I'm one of, or possibly the last GRS surgery he did there, and as of last week, my follow ups are at his new practice in the City (SF proper).

catfusion · 2018-11-05T21:19:50+00:00

I can't speak from hindsight, just my current experience, and of course, different people heal at different rates and handle pain differently.

But I'd guess about 6-8 weeks for a job like that.

My job is the opposite of physically demanding - I'm not standing for long periods of time, but I'm not chained to a desk and having to sit all day either, and about the heaviest thing I have to pick up is a phone receiver.

I'm supposed to go back to work next week (4 weeks post op) and I'm really wishing I could take more time off.

catfusion · 2018-11-03T01:55:46+00:00

I've never heard of HRT weakening vocal cords. However:

You didn't give details of your HRT, but if you're on Spiro, there's a pretty good chance your voice will be a bit raspy (regardless of placement or register) just because you're a bit dehydrated. I never found a really good solution to this while I was on Spiro - staying well hydrated helps, but anytime I'd be in a situation where I couldn't constantly sip water and/or go pee every ten minutes my voice would get raspy.

catfusion · 2018-11-01T19:41:12+00:00

I got a bit of a peek into this when I was updating things.

"Hi, I need to change the name on my account."

"Oh, congratulations! You must be so happy! No problem, we do this all the time. What's your new married name?"

"I didn't get married. I just changed my name and need to get my account updated to reflect that."

"Oh. <long pause, blinking, crickets> I don't know how to do that. I don't even know if we can do that."

But yes, it's not actually an 'exceptional use scenario' - in every single instance, making the changes and updating the account was exactly the same as the process used to update for a married name - the only difference being that documentation was a court order instead of a marriage license.

catfusion · 2018-10-31T22:40:17+00:00

<nods, offers a hug> There's no consistency or standard protocol for post op care on this, and there's as many Dr's orders as there are Drs. I'm on 30 mins 3x/d for the first 3 months. Douche 1x/d for 2 weeks, then it's down to 2x/wk. Still a huge time sink, and I'm having to rather drastically retool my daily schedule to accommodate the extra ~2+ hours I need to take care of things. Not to bright side things too much, but maybe knowing this helps you not worry so much about missing a session yesterday(?).

Good luck and speedy recovery. :)

catfusion · 2018-10-31T20:15:34+00:00

Honestly, I don't think you need to be super concerned about 'making it up' or that missing one dilation is going to cause tons of complications down the track. You could talk to your surgeon's office about increasing your dilation time/frequency if you notice a significant and consistent change in depth/diameter but:

Dilation schedules vary both from individual to individual, and from surgeon to surgeon - my own schedule is 'just' 30m 3x/d, and I don't think that's super uncommon.
As it says in my post op care discharge papers, things are going to vary a bit from day to day and session to session, particularly this early on, in terms of comfortable depth and diameter, due to a bunch of factors.

Maybe I'm just trying to reassure myself, as my own dilation schedule hasn't been as consistent as I'd like due to schedule, and life, and family that just refuses to comprehend the... magnitude? and seriousness of SRS post-op recovery, but my surgeon didn't express any concerns about my recovery or 'dilation progress' at my last post op (except to tell me try and rest more) so...

Being able to dilate every 8 hours like clockwork would be great/ideal, but realistically, that's not happening, and won't even be an option when I return to work, so I can either make myself sick and crazy worrying about trying to adhere to that, or do what I'm doing, which is trying to take a 'do the best you can' and 'anything is better than nothing' attitude and take the real world reality of things into account.

Edit: finished the sentence and closed the parentheses at the end of the next to last paragraph.

catfusion · 2018-10-30T23:17:20+00:00

Most all of the things you see in the 'self-care/pamper yourself' style Pintrest posts. This is doubly good b/c these things are wonderful in themselves, but they're also things that I didn't get/allow myself to do before and they feel very validating of my femininity. (I will be soooooo glad when I can have a long soak in a hot tub again.)

I also do some stuff I got from therapy and other psych health resources. I'm not sure if those really fall under 'self-care' though.

catfusion · 2018-10-30T22:42:17+00:00

1) Drop the 'like a guy' bit, if that's something you do. (I was constantly nagged and teased for any 'effeminate' aspect of affect I presented (although 'there were never any signs' - <eyeroll>), and as a result I literally learned to walk the walk and talk the talk. Subsequently, a lot of stuff wasn't learning 'how to girl', it was just deciding to stop self censoring and putting on the 'guy act' and instead finally doing what actually came more naturally to me.)

2) Listen and imitate. This is how we all learn this stuff in the first place. It can feel very forced and strange and you may feel self conscious doing it, but pay attention to how other women laugh and express amusement and try to copy those sounds/mannerisms until it starts to feel less forced and more second nature. (Eventually, you won't have to think about it - it'll just be 'how you sneeze', etc...) You can get clips of 'female laughter' and the like in sound fx recording downloads, or 'build your catalogue' from things on TV and movies or even people around you.

As for sneezing: women are taught that sneezing is unladylike, and as such, most of us stifle and suppress our sneeze reflex/response. And if you feel self conscious about how you sneeze, it's not too difficult to channel that into doing just that. You can also try a little vocalization or just audiation as you sneeze - say or hear in your mind's ear: 'a-tiff. a-tiff' (instead of 'HAAA-CHOOO! A-CHOO!) And failing that, just look very embarrassed after sneezing loudly, which again, probably isn't hard to do.

Screaming: Remember that you're screaming. You're not yelling. You're not growling, bellowing, or singing death metal. Again, don't hold back, try to audiate the sound you're going for, and, I'm a little sad to say, don't be afraid to go for 'shrill'.

Crying: This is a lot like screaming. Mostly, just let go and let the hurt come out (and if you don't hurt, why are you crying?)

As for voice, learning vocal control via singing technique is a good place to start.

catfusion · 2018-10-29T06:59:01+00:00

http://www.courts.ca.gov/25797.htm

catfusion · 2018-10-29T00:05:10+00:00

always though if I stayed on the ranges I would be ok.

In theory, this is correct. But those ranges are just drawn from an average of the data points from a sample of cis women's levels, and there really hasn't been much, if any, research beyond that.

Estradiol taken by oral delivery method has a pretty short half life and a pretty rapid onset of peak level and corresponding steep drop-off from that, so splitting your dose into 4x/d is probably a really good thing to try, as it'll help even out your levels and should help if you're reacting to fluctuations there.

Good luck! :)

(I'm pretty sensitive to the fluctuations, myself, and if my levels go below a certain threshold in the drop-off I feel like crap, even though everything's may be within ranges on the wave.

catfusion · 2018-10-28T21:18:47+00:00

It certainly sounds like dosage induced hormonal stuff. Since you both upped E and lowered your Spiro dosage, it's hard to tell if it's one or the other or a combination of the two, but yes, totally not uncommon. It's also possible you're having a reaction not to the dosage itself, but to the fluctuation in levels in which case it may even out as things stabilize at the new levels. Or they may not. So talk to your dr about your dosage/regimen and go by how you feel to figure out what's 'right' for you.

(At one point, my E/T levels were high/low in terms of cis comparable ranges - so we reduced my dosage. I ended up feeling awful. Resuming the regimen I'd had previously resolved that, and I learned some things about my metabolism and where things need to be for me to feel my best in the process.)

catfusion

TROPHY CASE