Injecting vs. oral pills

[Maybebaby56]

The UCSF, probably the institution with the globally largest rans care experience, writes about progesterone in this paper, they also mention that progesterone can have a direct androgenizing effect (tara, my hair loss).

Overview of feminizing hormone therapy | Transgender Care

Introduction The goal of feminizing hormone therapy is the development of female secondary sex characteristics, and suppression/minimization of male secondary sex characteristics. General effects include breast development (usually to Tanner stage 2 or 3), a redistribution of facial and body...

transcare.ucsf.edu

Other papers come to the same conclusion, there is no evidence that P will do anything for trans women.

The only constantly positive effect of progesterone is reported by Dr. Powers and his patients. On the other hand, in one of his presentations Powers complains that none of his papers have been accepted for publication. I can only guess that his papers were not peer reviewed?

I conclude from this that one can take it, and hope for some results, or just leave this hormone out of one's body. I take it for the other benefits it could have. I don't need it for boob growth, I have enough of that for my taste, but hope to get a better sleep/wake rhythm fro it. So far, nothing happened.

Hugs
Linde

Well, there is the Dr. Jerilynn Prior paper (J Clin Endocrinol Metab, April 2019, 104(4):1181–1186), but other than that the research is thin.

A proper cohort of trans women is very hard to gather for this type of study because of the wide variation of prior's HRT history, age and medical histories. I actually discussed this with my previous endo and these were the reasons he gave for not starting a clinical study at George Washington Medical School, where he was a professor (he's at Harvard's transgender medicine program now).

I take 400 mg progesterone (oral) at night for 10-14 days a month. It does have a significant affect on my sleep, equal to or greater than 5 mg Valium. (I have had chronic insomnia for the last few years.)

I get my HRT regimen through my OB/GYN, Dr. Laura Pickford, whoso one of the very few physicians in the DC area who treats trans patients. While she is not on board with Dr. Powers' regimen, she is at least willing to keep me on progesterone. The cycling is because of my desire to increase areola size, and other than puberty, menstrual cycle variations in P and E levels are the only other correlation.

Today I learned I have been accepted as a patient at Dr Powers' practice. I sought this out for various reasons, which I won't elaborate on for the time being, but he is the only physician I am aware of that is willing to think through the endocrinology from the ground up and not simply try to mimic cis-women's hormone levels. I had one endocrinologist tell me I should have my estradiol levels at post-menopausal levels because of my age. That is one of the stupidest thing I have ever heard. Post-menopausal hormone deficiencies are something to be avoided, not mimiced!

Anyway, we shall see what we shall see. I simply feel lucky to have these options. Many trans persons do not.

With kindness,

Terri

 

[Maybebaby56]

My skin is super sensitive, too ridiculous levels and, perhaps because of the skin reaction, I couldn’t get the patches to stay on reliably and definitely not if I planned on doing anything such as exercise, driving, walking, showering... actually just anything. Having wanted to move to injections myself I elected to move to estrogel instead as my endo explained to me that as the injections are compounded at a pharmacy they do not have the same degree of consistency than the injections sourced overseas and can vary wildly. It’s hard to say what effect exactly I can attribute to the change from patches to gel as I also switched blockers from cyproterone to bicalutamide at the same time but the changes I have seen in the last month have been profound. We’re all different and you shouldn’t need afraid to keep looking until you find what works for you.

Well said, Michelle. Transgender medicine is still the Wild West. We should all be grateful that the frontier of trans medicine exists, but WPATH dogma is becoming more of an impediment to effective treatment rather than the ground-breaking philosophy it was intended to be. My humble opinion, anyway.

BTW, I had poor results with patches as well.

~Terri

 

[Monica]

Well, there is the Dr. Jerilynn Prior paper (J Clin Endocrinol Metab, April 2019, 104(4):1181–1186), but other than that the research is thin.

A proper cohort of trans women is very hard to gather for this type of study because of the wide variation of prior's HRT history, age and medical histories. I actually discussed this with my previous endo and these were the reasons he gave for not starting a clinical study at George Washington Medical School, where he was a professor (he's at Harvard's transgender medicine program now).

I take 400 mg progesterone (oral) at night for 10-14 days a month. It does have a significant affect on my sleep, equal to or greater than 5 mg Valium. (I have had chronic insomnia for the last few years.)

I get my HRT regimen through my OB/GYN, Dr. Laura Pickford, whoso one of the very few physicians in the DC area who treats trans patients. While she is not on board with Dr. Powers' regimen, she is at least willing to keep me on progesterone. The cycling is because of my desire to increase areola size, and other than puberty, menstrual cycle variations in P and E levels are the only other correlation.

Today I learned I have been accepted as a patient at Dr Powers' practice. I sought this out for various reasons, which I won't elaborate on for the time being, but he is the only physician I am aware of that is willing to think through the endocrinology from the ground up and not simply try to mimic cis-women's hormone levels. I had one endocrinologist tell me I should have my estradiol levels at post-menopausal levels because of my age. That is one of the stupidest thing I have ever heard. Post-menopausal hormone deficiencies are something to be avoided, not mimiced!

Anyway, we shall see what we shall see. I simply feel lucky to have these options. Many trans persons do not.

With kindness,

Terri

Terri, please check back and tell how this goes for you, okay!

 

[Maybebaby56]

Terri, please check back and tell how this goes for you, okay!

You will get a full report, sweetie!

BTW, you look... different in your new avatar.

 

[magic_michelle]

Well said, Michelle. Transgender medicine is still the Wild West. We should all be grateful that the frontier of trans medicine exists, but WPATH dogma is becoming more of an impediment to effective treatment rather than the ground-breaking philosophy it was intended to be. My humble opinion, anyway.

BTW, I had poor results with patches as well.

~Terri

It is such a shame that forty year old WPATH guidelines are still the norm overall for transgender healthcare even though they have done little more than minor tweaks here and there in that time and little to no peer reviewed research has been done in that time... ultimately I think that any method contrary to what the body would naturally do should be avoided and so oral oestrodial should not be administered at all and not just because of first pass problems but because this is not how hormones are distributed in the body. In those afab the hormones are produced in the ovaries and sent to the fatty deposits around the hips and buttocks predominately before then being utilised. This is, of course, a vast oversimplification of the process but the point is that they do not go via the stomach and liver and the reality is that many trans women have liver mutations that can see all sorts of problems arise. It works for some, undoubtedly, but it’s not mimicking biological processes and that can cause issues that often have zero explanation.

 

[Donica]

Terri, I am taking prometrium (oral) at a quarter of the dose you are taking. I've been wanting to double my dose for some time now. P has worked well for me, but I think it can do better. Time for another visit with my endo.

 

[Linde]

At some other place in this forum I mentioned the latest research results concerning progesterone. It was found that P designed for oral purposes is not very efdective if taken rectally. There is a special vrrsion for this application route.
However, P taken orally together with fatty food causes it to not make the first pass through the liver, and be fully available to the blodstream.
The Mayo switched me now to a female endocrinoligist, a rather young woman who originates in South Africa. She seems to be pretty progressive, and recommended that I double my dose of P. I have to say that I don't take P for breast developement, but for the same reason I take testosterone, to provide me with a hormone level pretty normal for an ovulating woman. I inject E for quite some time already, and by far prefer this over patches or pills.
For the first time in my life, I am on a normal adult hormone level, because my body hardly produced any of those on its own.

WPATH was updated about a year ago, at about the same time the DMV 5 was created. WRATH is a guideline, and if your docs don't follow it, or the updated versions, it is not the fault of WPATH.


Hugs
Linde

 

[magic_michelle]

At some other place in this forum I mentioned the latest research results concerning progesterone. It was found that P designed for oral purposes is not very efdective if taken rectally. There is a special vrrsion for this application route.
However, P taken orally together with fatty food causes it to not make the first pass through the liver, and be fully available to the blodstream.
The Mayo switched me now to a female endocrinoligist, a rather young woman who originates in South Africa. She seems to be pretty progressive, and recommended that I double my dose of P. I have to say that I don't take P for breast developement, but for the same reason I take testosterone, to provide me with a hormone level pretty normal for an ovulating woman. I inject E for quite some time already, and by far prefer this over patches or pills.
For the first time in my life, I am on a normal adult hormone level, because my body hardly produced any of those on its own.

WPATH was updated about a year ago, at about the same time the DMV 5 was created. WRATH is a guideline, and if your docs don't follow it, or the updated versions, it is not the fault of WPATH.


Hugs
Linde

This is funny Linde as my endocrinologist, a young and rather processive guy, has recommended that I take progesterone for mood stabilization and other positive effects, with breast development being an outlier effect that is merely a bonus if it happens. I will be starting progesterone next month simply as a part of my treatment plan and I think it will be interesting to note any differences to how I feel now.

 

[Linde]

This is funny Linde as my endocrinologist, a young and rather processive guy, has recommended that I take progesterone for mood stabilization and other positive effects, with breast development being an outlier effect that is merely a bonus if it happens. I will be starting progesterone next month simply as a part of my treatment plan and I think it will be interesting to note any differences to how I feel now.

Michelle, you probably know that I am intersex and have XX chromosomes. My body does not produce ant sex hormones, and everything has to be introduced from the outside. My breasts are fully developed Tanner stage 5 boobs, with typical female areolae and nipples. There is not much, P could do there anymore.
But my endo feels that a pretty average female bormone level is what we are trying to mimic, and progesterone and testosterone is a part of this. I know that one result is the retun of a very mild libido, probably typical for a woman of my age.
I have not noticed any other measurable changes, and that was the reason for my endo to increase progesterone, to see if it does something for me.

Hugs
Linde

 

[magic_michelle]

Michelle, you probably know that I am intersex and have XX chromosomes. My body does not produce ant sex hormones, and everything has to be introduced from the outside. My breasts are fully developed Tanner stage 5 boobs, with typical female areolae and nipples. There is not much, P could do there anymore.
But my endo feels that a pretty average female bormone level is what we are trying to mimic, and progesterone and testosterone is a part of this. I know that one result is the retun of a very mild libido, probably typical for a woman of my age.
I have not noticed any other measurable changes, and that was the reason for my endo to increase progesterone, to see if it does something for me.

Hugs
Linde

I am in the same boat there Linde, XX chromosome, other weirdness with my anatomy, I was producing some T but it was negligible and I was also super sensitive to it because bodies are weird... I was told that they no longer diagnose this as intersex as it is such a grey area but I have also seen phenomenal breast development in a very short time. I am at Tanner 3 now and I am possibly moving to Tanner 4 but that is not clearly defined and my nipple and areola development are presenting as typical female at this point but I will see what the doctor says on Monday. I am not interested in the potential outlier effect of progesterone for further breast development and I simply feel that this is just a part of having a complete hormonal profile though it is worth noting that progesterone has a negative effect upon mood in some women and so I will just have to see next month at the endo

 

[Linde]

Michelle, this interessting. I assume you were AMAB, and having XX chromosomes is clearly an intersex condition. I have the De la Chapelle syndrome with negative SRY gene, and some kind of chimerism/mosacism to boot, because some tissue of my body has some Y floating around, as it was found lately.
I think you are alqays considered intersex if your phenotype is mostly in opposite to your chromosomes.
People like us eeact to outside hormones different than natal males or females. The medical profession hardly knows anything about the best treatment for us, and we have to actively with our docs to receive the best possible care for our somewhat weired bodies.


Hugs
Linde

 

[magic_michelle]

Michelle, this interessting. I assume you were AMAB, and having XX chromosomes is clearly an intersex condition. I have the De la Chapelle syndrome with negative SRY gene, and some kind of chimerism/mosacism to boot, because some tissue of my body has some Y floating around, as it was found lately.
I think you are alqays considered intersex if your phenotype is mostly in opposite to your chromosomes.
People like us eeact to outside hormones different than natal males or females. The medical profession hardly knows anything about the best treatment for us, and we have to actively with our docs to receive the best possible care for our somewhat weired bodies.


Hugs
Linde

OMG yes on everything there! I agree this is an intersex condition but for me personally I just find it easier to say transgender and ultimately I access the same services and the same treatments and deal with the same BS from society and so I identify as trans as I had thought that for the longest time that I was trans and it was only very recently that I discovered how many things that I thought were normal just were not. I am still searching for a diagnosis however for they can't work out how on earth I managed to have daughter and so I am engaging in a study at the end of this year in the hopes of getting some answers... It is essentially just to satisfy my own curiosity though as I am who I am and the knowledge of how I am who I am is ultimately irrelevant to the way that I live my life.

 

[Linde]

Well, Michelle, because I fathered a son, which is not really possible for an XX male, they searched more and found those few Y floating around.
Those tests are involved tissue analysis, and go beyond the standard karyotype tests. Along with it they found other genetic mutations, and I think those mutations make my body react different to hormones.

I fohnd that I am mkre accepted as an intersex person compared with trans. I think trans is still seen widely in the US that one can controll it, and decide to transition, while intersex is a tragic thing that happened to us upon birth, and us poor people need all the rspect we can get. It also causes a cold shiver on the back of natal people, because most think we were born with two sets of organs, and we might be able to impregnant ourselves.

Hugs
Linde

 

[magic_michelle]

Well, Michelle, because I fathered a son, which is not really possible for an XX male, they searched more and found those few Y floating around.
Those tests are involved tissue analysis, and go beyond the standard karyotype tests. Along with it they found other genetic mutations, and I think those mutations make my body react different to hormones.

I fohnd that I am mkre accepted as an intersex person compared with trans. I think trans is still seen widely in the US that one can controll it, and decide to transition, while intersex is a tragic thing that happened to us upon birth, and us poor people need all the rspect we can get. It also causes a cold shiver on the back of natal people, because most think we were born with two sets of organs, and we might be able to impregnant ourselves.

Hugs
Linde

well tyvm Linde, I was being told that it was impossible to be diagnosed with De La Chapelle syndrome because I had a child, this draws new light onto the issue and I will push harder for answers now instead of the lazy shrugs I am currently receiving. In terms of acceptance I Will agree that it has helped my family accept me as there is a medical causality that they can hang their little hats on but I just don't want to have to educate everyone I meet on what my condition is and how the SRY gene can malfunction and when I have attempted it I have just seen peoples eyes glaze over and they either cannot or will not follow... I just say trans and let the cards fall where they may

 

[Linde]

Most of the time I don't even mention anything anymore. For most of the world I am just an older cis woman these days. I am simply tired of having to explaupin why I am a little different.
I was lucky that I was also born with hypogonadism, and my body never developed any secondary male sex characteristics, and I did not have do do all the stuff the average trans woman has to do. Getting across as cis was very easy for me. My only male like attribute was a minimal amount of facial hair.

Hugs
Linde

 

[Rachel]

Terri, we spoke a while back in the summer about Dr. Powers. How long was the wait? 400 mg of P. I need to discuss that with my doctor.

I meet with Dr. Rachel Blubond Longer to review depth and cosmetics of my vagina. She made a stipulation to seeing her that I have professional pelvic floor training and do that for 3 months. I did then purchased a Sybian. It is so much better than the pelvic floor manual exercises. Anyhow my depth is at or close to the #4 dilator slit above the white dots. I was not happy with the labia proposed solution and did not peruse it with her. I will see Dr. McGinn again and ask her to repeat the last procedure. I received good results and wish to expand on that. My issue is not having much fat to harvest and inject into the vulva. I am thin.

I use to inject inter muscular 40 mg per 2 weeks with USA made deletrogen from big pharma. I switched to sub Q and like that better. I inject 20 mg per week which is fantastic. I also take 2 mg pill at night. This is so I get E2 and E1. I like the results I have been getting when I switched to E1 and E2.

I really need to get P at a high dosing. I was thinking about Dr. Powers and applying to his patient. I want my genetic results first and find about allies that I have first. The future of medicine will be genetic based individualized care.

Rachel

 

[Maybebaby56]

Terri, I am taking prometrium (oral) at a quarter of the dose you are taking. I've been wanting to double my dose for some time now. P has worked well for me, but I think it can do better. Time for another visit with my endo.

Hi Donica,

I was first prescribed oral progesterone at 100 mg daily at night. It did nothing as far as I could tell, so I dropped it. Some time later I tried P again, this time at 200 mg/night. Still nothing.

One day I just decided to try two 200 mg capsules before bed and I was very surprised by the substantial increase in dreaming (REM sleep) and the fact I didn't wake up at 2 or 3 AM, which is unfortunately normal for me. I started paying much more attention to progesterone after that. It works for me at higher dosages. but I restrict my usage to 10-14 days a month (I want areola growth).

I have no idea about the rectal admin, but if you follow the Dr. Will Powers subreddit, a lot of trans girls say it makes a big difference. I am not ready to go that route yet. I have long, sharp fingernails and it seems to be begging for a disaster.

~Terri

 

[Maybebaby56]

Terri, we spoke a while back in the summer about Dr. Powers. How long was the wait? 400 mg of P. I need to discuss that with my doctor.

I meet with Dr. Rachel Blubond Longer to review depth and cosmetics of my vagina. She made a stipulation to seeing her that I have professional pelvic floor training and do that for 3 months. I did then purchased a Sybian. It is so much better than the pelvic floor manual exercises. Anyhow my depth is at or close to the #4 dilator slit above the white dots. I was not happy with the labia proposed solution and did not peruse it with her. I will see Dr. McGinn again and ask her to repeat the last procedure. I received good results and wish to expand on that. My issue is not having much fat to harvest and inject into the vulva. I am thin.

I use to inject inter muscular 40 mg per 2 weeks with USA made deletrogen from big pharma. I switched to sub Q and like that better. I inject 20 mg per week which is fantastic. I also take 2 mg pill at night. This is so I get E2 and E1. I like the results I have been getting when I switched to E1 and E2.

I really need to get P at a high dosing. I was thinking about Dr. Powers and applying to his patient. I want my genetic results first and find about allies that I have first. The future of medicine will be genetic based individualized care.

Rachel

Hi @Rachel !

Hey girl, we need to talk. It's been too long.

For those of you who don't know, I first met Rachel through Susan's, and we both had the same surgeon in Dr. McGinn. When I went for an SRS revision with Dr. Bluebond-Langner last summer, I didn't have anyone to get me out of the hospital, and she stepped up big time. She took time off from work and came up to NYC to help me out. I am so, so grateful to you, Rachel. You have been a wonderful friend.

Anyway, so much to say.

1. Labiaplasty. Dr. RBL advised against it (as did Dr. McGinn when I first inquired). I was very disappointed because I am very unhappy with my current labia. I was thinking about inquiring again at Papillon because Kristal (McGinn's PA for those who don't know) said they were going to do a one-year study and to get back to them. Well, that was well over a year ago, so maybe I should call them. But then there is the out-of-pocket expense, the time off, and the fact it's another fucking surgery, and I am sick of surgeries. I am undecided.

2. Hormones. I started off on 10 mg/week of EV subQ. My E2 levels were sky-high (500-700 pg/mL) and my OB/GYN was very concerned. I am now doing 6 mg/week and I am still around 180 pg/mL at trough. She is willing to prescribe the progesterone, which is very progressive for most physicians since they all want to stick to WPATH guidelines. Plus, of course, she is gynecologist who treats trans patients, so I have local health care for any urgent pussy problems.

3. Dr. Powers. I applied to his practice before the pandemic, so everything got put on hold, but it was about a year before they got back to me (a couple or three months ago?). I turned them down because they said they didn't accept my insurance, they wanted a $300 out-of-state fee, and it would mean flying to Michigan for an office visit (when they started them again). I already had my OB/GYN as a hormone provider, so I didn't see the point. Surprisingly, they called me again last week, and this time I said yes. I figured this was fate. There is a huge waiting list for new patients and I figured "Hey, I am getting this opportunity, why not see what this is about?" So now I have a televisit scheduled for Feb 2nd. They now say they will take my insurance (but I still have to pay the $300/yr).

4. I like your take on the future of individualized patient care. I'm not sure how that will play out for transgenders, but I have had nothing but first-rate medical care everywhere, from my PCP, to radiology/imaging services, to endocrinology, to hospital/surgical care. It is the logical next step.

Hope to talk to you soon,

Terri

 

[Linde]

To show how different we all react to hormones. I am currently at 0.6 ml of the Depot stuff, and I am 329 pg. My target is 200 or less. My endo wants me to take 200 mg progesterone orally, but I still have no measurable outcome from this.
I have a pretty positive breast developement. I am clearly Tanner stage 5, with a bra size of 38 D, and still seem to have some growth. I might end up with a 38 DD.

It is all in the genes, how our bodies react to hormones.

Hugs
Linde

 

[Rachel]

I was Papillion's first labiaplasty patient. I was told it would be some removal of fat from my thigh and injected into the place where my labia is.
I awoke and both my thighs were wrapped. I was told later she had to scrape both of my thighs inside full length in order to get enough fat. My labia ballooned out. The pain made GCS, FFS and BA a walk in the park. CVS denied my script for oxi. After 3 days the pain was intolerable. I called and they said I could pay out of pocket and that the oxi was denied by the insurance company.

I was upset, all this time in 10 pain and I could have had oxi I needed. It was rejected by the insurance co because the copay was more than the oxi. I did drive through and took the oxi immediately (live 2 blocks away). Went home and finally could sleep.

I have very little fat. I think I lost 15 pounds from covid and was. I am 160 today and need to gain back weight. I had a reaction the vaccine dose 1 and lost 2 days of eating (Friday and Saturday).

Results from the labioplastyy, I would estimate 20% of the fat remained ( I had none, think skin and bone down there). The upper half of the labia had good skin stretch and looks good. I really would not mind doing it again. Maybe this summer.

When I had my appointment with Rachel Longer in NYC she reviewed my labia ( my depth issue was and is resolved). She said she did not recommend fat injections because a good amount will reabsord. She said she could stretch my upper labia skin to the lower area. However, it could open up (split) if there was a lot of stress on it. I go to parties with very large males so I immediately thought I could rethink the issue. Although partial fat success and good upper labia success and some lower labia success Dr. McGinn. Could redo the procedure. I would ask her if she would mix the fat with PRP and inject the solution. PRP may make a huge difference.

The issue is more in my head I think. Guys never complained. I go to parties and there are maybe 2 other girls there and 30 to 50 guys. Everything is done in a group setting and lights on. 100% condom use and no anal allowed. Just oral and vaginal. There is a lot of stress in the vagina from the guys. So if I had what Dr. Longer suggested it would not hold up.

I need to review my HRT with my NP-c. Maybe cut the e in half 20 mg per week seams high post op. Plus I am taking a 2 mg pill at night.

I was prescribed 100 mg oral progesterone for 2 or 3 months when I first started hormones. I did sleep but saw no progress. I will ask about reducing my E and taking 200 mg P daily. Maybe try doubling up 15 days a month.

NYC was dead in May and September. It was very sad.I have no idea what will happen post covid. I suspect life will change, some for the better and some for the worse.