I’m so fucking excited, but this is the first time I’m really feeling nervous about it. I wish I knew more of what the process is like? I’ve heard its dead simple, and everyone I’ve talked to at the clinic on the phone has been super lovely , but I can’t help but feel like somehow it’s all going to go wrong.
Congrats on your upcoming BiHRTday!
:trans-heart:
I think that’s the term, but I’m enby and just on t-blockers right now, so idk.
My doc was nice about it, we went over complications and he asked me to describe what dysphoria felt like to me (no wrong answers, but it did give me a bit of a panic attack describing it). It took a couple appointments before I started. It's not like it was 10 years ago where they made you have to live fully out for like a year or whatever, or if you don't fit exactly the gender stereotype they wouldn't prescribe. It's much better now.
They'll probably talk about route, cause E gets metabolized by the liver first pass you don't get as much of it by the usual oral route. They'll probably talk to you about T blockers, spiro is like the default one but it's a potassium sparing diuretic so you should be aware of the signs of hyperkalemia (rare side effect, but you should know about it). Spiro is also pretty cheap, dunno if it's cheap in the states though. You might get progesterone as well, my doctor recommended we wait a year or so with estrogen based on the clinical evidence, I'm happy to defer to his judgement but there is evidence that starting progesterone earlier can lead to better outcomes (e.g. breast growth for example).
E has side effects, cis women are at higher risk of embolisms and DVTs and hypertension and shit like that because of their endogenous estrogen. You will be at higher risk too - you should know the signs of a pulmonary embolism for yourself. They'll also talk about irreversible effects, regret over transitioning is VERY VERY small compared to like every other medical procedure but it is a thing and you should know what may be irreversible (fertility and breast growth basically) so you can give informed consent about taking HRT.
They'll screen you. They ought to know your baseline hormone levels so you'll do some blood work and probably urine work too. After starting for a while, you'll have to be screened again so they know if the prescribed HRT is working as intended or if the dose/route/med needs to be changed.
Also, the number one users for HRT are actually cis people, lol. Tons of cis women take E, some take t blockers too. It's not just a trans thing and it is fairly well known and studied and the meds are all very safe.
Thank you. I’ve tried to read up on side effects as best I can, but reading it from another person is way better then in kind of fear mongery articles.
The side affects and risks are also significantly lower than they used to be. A lot of the data on the rate of severe side affects often comes from trials with other populations that are not trans because there has historically not been very much research into our healthcare needs.
This can result in inflated perceived health risks because you can sometimes see a number that looks severe, but when you look up the population the study came from its 60 year old+ cis men with pancreatic cancer or whatever the fuck.
Other times, the risks won’t get updated even though HRT is improved. Good example is that the type of estrogen now used in HRT is bio-identical instead of synthetic and has waaaaay lower health risks.
There’s also the issue of the medical community fixating on increased rates of medical conditions that while higher for a cis man, are close to or identical to the risk of those conditions in a cis woman. Example: breast cancer.
Obviously doctor’s are going to be risk-averse, but they can sometimes over do it. Important to be mindful either way so you can stay safe. I’m nervous about starting too!
Everyone online seems to have shitty side effects from Spiro but I've been on 25mg 2x a day and haven't noticed any ill effects like peeing more frequently or whatever. l saw amazing changes in the first couple months, though my morning erections came back recently so I upped to 2mg E 2x day oral from 1mg 2x day sublingual.
Anecdotally I think you can tell the difference between sublingual and oral E just based on tells like skin softness. So there's definitely a difference there and it's easy to try either one.
Tbh unwanted side effects from feminizing HRT seem a bit overstated on the internet and I wouldn't be surprised if there was a sampling bias there.
50mg/day of spiro is a very moderate dose. My doc had me on 4x that (while on 6mg E), and it barely suppressed my testosterone while the diuretic effect was pretty major. I think there's a lot to be said for how people's bodies react to medicine differently.
As always, it's good to get regular blood tests to see what you need, the dose makes the poison, all that good stuff.
I think there’s a lot to be said for how people’s bodies react to medicine differently.
Oh absolutely! There's no one “right" way to do HRT, which is why I think it's important not to generalize different treatment options. Blood tests are so important and I'm glad I found a gender clinic that is up for ordering them frequently.
I always went the informed consent route, which made things super easy. The doc tells you a bit about what effects you might potentially have from the meds, they have you sign some papers, and get your blood drawn to check your baseline levels and make sure you don't have anything wacky going on. If you're lucky, you might head out the door with a prescription. If you're unlucky, you'll be asked to come back after results or maybe just given low dose spiro to start.
The biggest difference is what meds you're given. Most docs I've been to have preferred estradiol pills and spironolactone. Pills are annoying (have to absorb them, not swallow, 2-3 times a day) and spiro fuckin sucks. If you can avoid spiro by either taking a different t-blocker or doing monotherapy, you can save yourself some hassle. Unless you or your partner is into omorashi - then spiro is great!
Some docs prefer patches. Patches are neat, but a little weird to keep on while showering. They come as either nice tiny discreet transparent films, or awful big bulky irritating patches that are the worst thing ever.
Injections are fucking dope if you are okay with needles. Idk if they give them to people starting hormones, but it's nice not needing a t-blocker, and instead just jabbing yourself in the thigh once a week. Eventually adding progesterone properly administered supposedly helps with booba. Anecdotally, I do prog and have nice ones.
I started on the good patches + spiro about 12 years ago, moved to the bad patches when I lost my insurance, did pills+spiro for many years, switched to cyproterone as a t-blocker (much better t-blocker, may cause brain tumors), and finally EV injections + progesterone, so I feel like I have a pretty decent grasp of different estrogen delivery methods.
This post and a bunch of others has made me feel a lot better already. I’m going through the informed consent route, but the clinic I’m going through is very scant on details online, so I don’t know their preferred prescriptions.
A little bit scared of getting prescribed spiro honestly, because I already have to worry about keeping hydrated bc of where I live, but I know its the most common t-blocker in general, and I don’t think/know if they’d change it just bc of dehydration worries.
If its a general physician ask about getting GNRH agonist shots. Even if they are not covered by your insurance you still might want to pay for them if you can afford it. They are by far the best way to block testosterone production.
It’s not with a general physician, but I appreciate the advice, I’ll have to look into it.
Transfemscience has some good stuff: https://transfemscience.org/articles/puberty-blockers/
hey friend, this is pretty intense considering the tone of the post.
Spiro works well for a lot of people and in many states is the only option some trans folx have for a t-blocker. It’s also one of the most affordable options for an anti-androgen.
Cone shape is pretty common for many cis women as well, especially during early puberty. Often it’s something that just takes time to develop through the different tanner stages.
progesterone is kind of a trade off in terms of timing. If you start it early, you’ll get more breast growth sooner, but there’s also a lot of anecdotal evidence that it can sometimes cause breast growth to slow after a certain point. Normally not recommended to start with it. Definitely a trade off for people and depends on your goals. I’m going to probably wait a year or so, but that could change.
Hopefully I’m not coming across as too harsh here I know your intent is positive :soviet-heart:
Edit: that's awesome you adapted the comment! Solidarity. ☺️
spiro has the most research behind it in the US and is also much more affordable than some other options.
I’m personally looking at using bica instead, but that’s more experimental. I decided not to go with spiro personally over concerns around brain fog (not everyone gets that, but some folx do) and already being on other meds that dehydrate me.
I’ll be taking bica too! I’m really excited about it and was happily surprised when I found out my doc prescribes it. If this isn’t too personal of a question, do you feel like it helped with breast development?
Spiro is definitely more old school, but I’ve heard it’s often one of the only antiandrogens available in more conservative states / countries. I know a lot of gals who are on it and aside from craving pickles and needing to pee more, it’s working well for them.
my holy grail is lupron depot 45mg cause it perfectly shuts down all T production full stop and lasts 6 months on one dose but uhhh 12 grand for one shot
:what-the-hell: is that even with insurance? jesus…
Cone shape is pretty common for many cis women as well, especially during early puberty. Often it’s something that just takes time to develop through the different tanner stages. Progesterone helps round/fill out your breasts after you’ve reached tanner stage 3-4.
Responding to multiple comments just so anyone reading through here has the info.
:soviet-heart:
Thank you for inspiring me to set up an initial consultation. For tomorrow :squidward-nervous:
