No Dice on The Estrogen

[seanthomas (imported)]

So I got the appointment today with the new urologist and told him what I had in mind - a low dose of estradiol. No dice he said. He would only prescribe female hormones to a dedicated MTF transgender or prostate cancer patient on full androgen depravation therapy. He said I'd become impotent (ED) and I told him I already was. He told me I'd grow breast. I said I was already a respectable A cup. He warned my penis would shrink and I replied it was currently the size of a peanut. Yaddy Yaddy Yaddy and he held firm. No estrogen.

I'm not going to lie and say I'm trans just to try a different approach to hormone replacement. Anyway, aside from making a really ugly woman, I don't have the fashion sense to be female.

Instead, he wants to put me back on testosterone at a different dosing schedule, give me meds or a surgical procedure for the prostate, some anti depressants for the irritability and have me come in monthly for therapeutic phlebotomy and lab work. In other words, he'd rather load me up on drugs and have me paying once a month to draw blood and test it. No thanks Doc. TRT did not play well with my mind or body and I'm not going down that road again.

I'll research some other options. Suggestions welcomed.

[Chesleyt (imported)]

I'm in the same boat I see my Physicans Assistant tomorrow and he already had the receptionist call me and relayed his message no and come in to look into options. I have all this information to tell him about case studies and my printer is broken. I know he's going to say lower dose of testosterone. No that won't work it's taken just over a month to feel happy and not frustrated I'm no longer suicidal. If I have to I'll go without hormones. Testosterone is detrimental to my mental health and I already am on multiple medications for bipolar depression, anxiety disorder and sleep disorders that it aggravated. I was crazy on it and couldn't sleep even with sleeping pills. Synthetic testosterone is poison in my body. Oh I just had the prostate surgery he was talking about yes I can urinate now but I'm under watch for prostate cancer because my 2 prostate biopsies came back with abnormal cells not cancer yet I was told but something to keep me getting PSA tests every 6 months to see if it's still going up.

[Varys2013 (imported)]

This is SO frustrating! These gatekeeping doctors think they know best, or they're self-protecting against some potential lawsuit, or something. This is why "informed consent" is effective. You sign an agreement saying you do understand the risks, the various side effects, and want it anyway. Sigh....

I suggested to another person to try a logical approach to the risks, to speak the doctor's language. So, as a surgically castrated eunuch, I have only minimal testosterone from the adrenals. Therefore I have very low testosterone, and want to offset the symptoms but not with testosterone. So, for the main side effects of no T, we can:

1) Hot flashes - Megace, diminishes but doesn't usually eliminate them. Various herbal things, maybe, not proven effective. No good.

2) Fatigue - Ritalin? Some other stimulant? There are risks taking stimulants for the long term. Let's avoid artificial drugs that have their own constellation of side effects. No good.

3) Loss of bone density - Fosamax? Zoledronic acid? Provenge? These have serious side effect risk like death of jaw bone tissue (jaw necrosis). Provenge costs hundreds of dollars per six month shot. No good.

Alrighty then, since it would take a market basket of measures to address issues from loss of testosterone, and we reject that mess, there are only a couple of choices:

1) testosterone replacement - don't want it for reasons you can explain. No good. (LIsten, Doc. Do you understand? I DON'T want this. It is my body, my choice.)

2) estrogen replacement - concerns about a few physical side effects as mentioned ("feminization" generally speaking). If I'm ok with the limited effects from it, then that's what I want. One simple, cheap remedy that I want. (I DO want this, It is my body, my choice. Is that clear?)

Now cynically, why would the doctor resist simple estrogen? Because they won't MAKE AS MUCH MONEY off of you! Their attitude of petting you on the head like a mildly slow child, and telling you patronizingly what you should do, is just infuriating.

[Edit: This is a link to Dr. Snuffy Myers discussing low dose estrogen patches for, yes, prostate cancer patients, but on permanent "Androgen Deprivation Therapy" (ADT). If one has no balls for some reason, then one is by definition on lifelong ADT! So whatever the reason, this is a valid countermeasure for the side effects of being in this condition: https://askdrmyers.wordpress.com/2016/0 ... rogen-adt/ ]

[Stevenator (imported)]

I hope you can get a 2nd opinion. Small boobs are easily hidden and honestly no big deal. But yeah, doctors are pill pushers in my opinion.

[AnneK_TG (imported)]

Maybe you can ask your GP to refer you to an endocrinologist who does that sort of thing. That's what I did.

[AnneK_TG (imported)]

But yeah, doctors are pill pushers in my opinion.

You can get Estrogen pills.

[seanthomas (imported)]

Yeah.... it took me all of ten minutes to find an online pharmacy with a good reputation that sells estrogen patches without a prescription.

I'm not saying I will buy online and self administer. I am only making a point that people will go elsewhere to find what they want or need and the problem there is without medical supervision self medicating is dangerous. On the other hand I also know you can get blood work done at a private lab at a reasonable cost and with a bit of education (the all knowing google) figure out a reasonable dose and schedule.

I only wished to do a trial of low dose estrogen to see if it would help certain lowT symptoms. Instead, going to my doctor for this I felt as though I had just entered a shady used car dealer's lot.

[uuMachine (imported)]

I'm not sure why you'd go to a urologist for estrogen... endocrinologist handle hormones.

[Riven (imported)]

I know what you mean seanthomas. Back in 2005 I asked my doctor for meds to lower my testosterone because my (late) wife was on hormone reducing meds for breast cancer, and my sex drive was much higher than hers. Would you believe, the doctor said it's not a treatable condition, and even suggested I have an affair! So I bought myself some cyproterone from and online pharmacy and self medicated. I also felt I'd entered 'a shady used car dealer's lot', as you put it, and was not really happy about not being under the doctor's care. But sometimes we have to make our own path. I'm considering trying cyproterone again; this time as an alternative to Finasteride (prescribed for BPH) to see if I prefer the effects.

[seanthomas (imported)]

Yeah Riven, many doctors seem to be narrow minded and intransigent and some are just downright incompetent. Now rather going to the "shady used car lot online pharmacies" it simply dawned on me that my menopausal and very supportive wife could simply acquire estrogen for me and insurance would pay for it to boot. Without medical supervision I'd be starting on a very small dose and titrating up to a level that relieves the brain fog and fatigue then holding that dose steady. If it works it works, if not I can chalk it up to a good theory and move on. I'm going to do a bit more research before making any decisions though. Now as far as the side effects I am ready to accept a few but don't want to go full female by any means.

[TopManFL (imported)]

Hey @seanthomas,

First, I just want to say I admire you for going to the doctor and speaking your truth to him. It is not easy to do. Doctors will complain when patients don't tell them everything and yet doctors can be so difficult to deal with it's no wonder many patients only tell the doctor what they want the doctor to hear.

Also, staying with pharmacists that your trust is a very smart decision.

If you do get estrogen from a source other than your primary care doctor, I'd recommend that you keep your quarterly appointments with the doctor and let the doctor do your blood orders.

Doctors are very used to patients that do things the doctor doesn't want them to do. Patients eat foods the doctor tells them not to eat, they sit in their easy chair instead of exercising, and they take too many over the counter medications. Nevertheless, the doctor will still do a followup three to four times per year which should include bloodwork and an explanation as to what the results of the bloodwork mean.

Yes, you can order your own bloodwork online and have the draw done at LabCorp or another facility. Yet it's not the same as having a doctor keep track of the way all the organs, glands and medications inside you are interacting who can help you stay healthy.

Regarding starting estrogen. Tell the doctor you are taking it. Even if the doctor doesn't want you to take it, it's better that they know you are taking it and can track how it affects your body rather than having the blood results being a mystery to the doctor.

One thought is to start the estrogen first and quickly find a new primary care doctor. I've noticed that doctors are hesitant to stop a medication that a patient new to them in already on. You have a very good reason for being on the estrogen and I think a new doctor might be comfortable leaving you on it and even writing the prescription for it - after all, they would only be keeping you on the medications you were on when you became a patient.

Thank you for sharing your experience.

Every doctor and patient relationship is different and adding in situations doctors are not accustomed to and it can get downright contentious. So, the details and honesty you've shared help all of us. Namaste.

[seanthomas (imported)]

Thanks to all for their input and last night the wife an I spent hours scouring the internet regarding the benefits and risks of estrogen in lieu of testosterone. While most of the medical research has been related to men on ADT, as has been pointed out here a castrated man not taking testosterone replacement is deprived of androgens and therefore "on ADT". Funny how when you compare the risk of TRT to HRT in castrated men the HRT carries far less risk of blood clots and heart issues.

So we have made a decision and I will start on estrogen as soon as my wife gets an appointment with her girlie doctor and a prescription (she previously stopped her HRT). I hate to go the surreptitious route with this but have neither the time nor inclination to go doctor shopping just for a prescription of my own. Since I have my labs from my annual physical last month we have a baseline since a full hormone panel was done. Then like suggested I will find another urologist eventually, declare I am happily and healthfully on estrogen and go from there. If all goes well with the HRT then I will have an argument for remaining on it and get my own prescription. If I am not getting what I think I should from the hormone then I'll stop or adjust.

Now perhaps she hides her concern for the side effects of having her husband on estrogen but damn if she is not supportive and recognizes my over-all health trumps any feminizing effects of estrogen.

[Chesleyt (imported)]

Your a lucky man to have such a loving and supportive wife

[seanthomas (imported)]

Your a lucky man to have such a loving and supportive wife

Yes, I am and I appreciate it every single day. And I can assure you I married a helluva lot better than she did.

[Stevenator (imported)]

Every time I read something that you say about your wife, my internal voice says what a lucky man you are. It's obvious the love & bond that you both share. I wish you success going fwd with your new program. I'm rather envious of your situation. You're about to be opened up to a wonderful world that is estrogen. I wouldn't worry about growing huge boobs, as that rarely happens with (mtf). Since you don't have the DHT factory, I can't offer too much advice, but I've only seen a handful of attempts that got beyond a C-cup. 98% of us are stuck at a B-cup. I've been growing for four years and sports bras flatten me out. It will take two [plus] years for you to get any real growth. My advice is like others to seek out an endocrinologist. I'm eager to follow your journey, results, etc. Good Luck.

[Chesleyt (imported)]

I'm going to talk to my counselor about how testosterone has been effecting me and how being off of it has resolved all my problems and see if maybe the psychiatrist knows anything about this and if so could he write a recommendation letter to the endocrinologist for estrogen therapy. I see my counselor Monday I will let you know what happens.

[seanthomas (imported)]

After the hassle at the urologist my wife made one phone call to her gyno and picked up a three month supply of Climara 50 yesterday afternoon. I put the first patch on last night. I kind of feel like this is a new journey for as soon as I walked out of the bathroom she said "I guess you get to feel what a woman feels now". Well so far this morning I don't feel any different but of course new hormones are just being introduced. Now if I don't like this weekly dosing of estrogen I'll stop and go to plan B. Although I don't feel like a woman this morning, one thing I noticed after donning the patch is that I had the best night's sleep in a long time.

[Stevenator (imported)]

Congratulations Sean. From what I understand, it takes many many months before you see any changes, and then it takes several years before things finish growing. I think it takes a while before you start feeling them, too. I applaud you for your courage here. I know you have apprehensions. I read your latest blog post and on the whole, you truly have a wonderful and incredibly supportive spouse. I wish you all the best going fwd.

[Varys2013 (imported)]

Hey seanthomas, glad to see you've taken the plunge. My previous post was too long, but importantly this link supports a castrated male taking estrogen patches

: https://askdrmyers.wordpress.com/2016/0 ... rogen-adt/

On one 0.1mg patch, twice weekly, I felt "pretty good". No hot flashes, fatigue was not too bad, energy was more or less ok. My blood E2 level ranged around 50-60 pg/ml. That's also the recommended minimum to prevent loss of bone density.

Doc suggested for best Quality of Life to try two patches, get my blood E2 to 100-150 pg/ml or so. I've been on that for almost 2 months now, and I feel better than I have in years. I feel great! I am also seeing a little more fullness in my breasts, but I'm willing to take that side effect. Unless my shirt's off, no one notices.

So glad to hear you're on the patches. After a month or so, it might be worth getting at least your blood E2 level checked.

All the best!

[Tclosetgirl (imported)]

SO this very thing is happening, although he was gentle and just said he did not think the insurance would pay, I don't care, I will pay!

So I am going to ask next month, or I'm going to just get the TRT and put it away but overall the OTC stuff is helping as I lower the TRT...

[TgEunuch (imported)]

I hate those damned gender gatekeepers!

Hopefully with more people coming out as something other than heterosexual male and/or female, that things will change for the better!!!!

[Chesleyt (imported)]

I saw my counselor Monday and she has seen a dramatic change in me since I saw her 2 weeks ago. It was about then the effects of testosterone were gone and I started to enjoy my life again. I told her about the endocrinologist assistant letting me know that he wasn't going to allow me to have estrogen therapy and wanted to talk to me about alternative (testosterone) therapies. I missed my appointment with him because of an ice storm. I will be rescheduling it soon

I need to use my mother's computer to print off the research data I have to show him. My printer is broken. Thanks

[seanthomas (imported)]

I hate those damned gender gatekeepers!!

Screw the gatekeepers, just jump over the fence as I did.

I'm not trying to change genders. I am who I am and if I believe my long term health is compromised by one hormone then why should I be denied the only other hormone available? How ridiculous that I would have to claim I have gender dysphoria and jump through a multitude of expensive hoops to prove it...... just to receive a simple prescription and monitoring?

It's much the same as those who choose to become a Eunuch having such a hard time with the medical community agreeing to cut out their balls? All this medical intransigence does is drive people to a dangerous underground.

If, after a three month trial, I decide to stay on estrogen then I hope to find a doctor who will legitimately prescribe a hormone regimen and monitor my health while on it. If not, I can further educate myself, acquire the estrogen through unconventional means, have bloodwork analyzed by a private lab and forego the profit-driven medical community.

Rant over. For now.

[Stevenator (imported)]

I'm not telling you what to do, by no means, but would an "informed consent" clinic be of any help to you? Not all States have them, I think. Also, and the main reason for the reply, is the subreddit, "r/TransDIY". They offer good advice on doing this alone and how to self monitor your health.

https://www.reddit.com/r/TransDIY/

Best of Luck to you ....

[Chesleyt (imported)]

I just ordered 2.5 estriol and estradiol cream it's bio identical off Amazon. Do I use it every day? I just want to stay healthy and not feminization. Endocrinologist said no to helping me, so I'm on my own. Were do I find testing and when should I get it done? I want to do this so I can show him that it's working for me and maybe get him convinced to help me.