Hormone Replacement Therapy - Testesterone vs Estrogen

[Danielle (imported)]

Hi,

I am in the process of becomming castrated. I have learned though reading here and at other venues that once castrated, some hormone level needs to be maintained for good health, emotionally and physically.

I have seen discussions describing Eunuchs going back on low dose Testosterone to level things out a bit - - - to improve both mental and physical health.

But, I am a transexual, and my hormone of choice is Estrogen/Premarin. I have been on that (1.25 mG/day) for around 10 years now.

My question is this: Does Estrogen/Premarin provide the necessary health benefits post castration as does low dosage Testosterone? Is the real story here perhaps that a human being must have some level of either Testosterone or Estrogen in order to enjoy good mental and/or physical health?

Put another way, does a genetic male who has been castrated need Testosterone if he is taking Estrogen? (I have a theory on this, but I do not want to bias the group with a simple theory.)

Does anybody have any theories or knowledge of this? Any insight would be greatly appreciated.

Thanks,

Danielle

[Senjougahara (imported)]

I've been wanting to ask the same question so I'll be interested to read the responses.

[bobbie (imported)]

The body needs a sex hormone. If you take a female hormone you should get most the same effects on body as a male hormone. Either one will help. The effects would be different as each hormone effects the body differently. Think about it, a post menopause female takes female hormones to maintain there body. They will help you as well as long as you do not mind the feminization that can take place.

Not being on HRT will effect your body and mental functions. For some that is the desired effect.

Welcome to the archive. Read the threads. Ask questions. We are all one big family.

[Danielle (imported)]

Hi -

That is good to hear; sounds like my game plan is to simply stay on Premarin after my castration is complete.

It is interesting to note that my Endochronologist who prescribes my estrogen does not seem to be very up on these kinds of hormonal relationships. He has told me that there is very little world body experience out there in dealing with people like myself - - - no studies, etc. He is great in providing the blood test results and monitoring them and providing me with the prescription (Premarin) that I seek. But, there is little medical knowldege for guys like him to draw from. He is going to be pretty shocked when he sees the drop in my T level. My E level is around 70 presently and my T level is around 220 by way of the Labcorp method of testing (as of a few months ago).

Ultimately, we sort of have to figure things out for ourselves.

Thanks!

Danielle

[JesusA]

It is interesting to note that my Endochronologist who prescribes my estrogen does not seem to be very up on these kinds of hormonal relationships. He has told me that there is very little world body experience out there in dealing with people like myself - - - no studies, etc.

Danielle,

Contrary to your endocrinologist's comment, there is a very large medical literature on hormone changes for and among the trans population. Your profile says that you live in New Jersey. You might want to check around for a new doctor who has more experience. There are plenty to chose from.

[Danielle (imported)]

Hi,

Do you have a name of a Dr. in N. NJ? A few years back, I spent about a day calling all of the Endochronologists in the area (looking to replace the Dr. that I presently have). None of the some odd 20 that I called wanted anything to do with me.

So a name would be great!

Danielle

[clysmaniac (imported)]

I don't see an endocrinologist but my urologist works with one so they consult at times. I did have a bone density test done and there was the slightest evidence of osteopina, not osteoporosis, in one area. My urologist said I should take either estrogen or testosterone and calcium. He said either of the sex hormones make the body absorb and utilize the calcium much better. I thought it neat that he didn't really have a preference if I used estrogen or testosterone, just that I needed a bit of either. I chose testosterone but my level now (122) is still way below normal so it isn't enough to rekindle any sexual needs.

[bobbie (imported)]

I don't see an endocrinologist but my urologist works with one so they consult at times. I did have a bone density test done and there was the slightest evidence of osteopina, not osteoporosis, in one area. My urologist said I should take either estrogen or testosterone and calcium. He said either of the sex hormones make the body absorb and utilize the calcium much better. I thought it neat that he didn't really have a preference if I used estrogen or testosterone, just that I needed a bit of either. I chose testosterone but my level now (122) is still way below normal so it isn't enough to rekindle any sexual needs.

Would be very wise to get the bone density test. If you are not in the normal range of hormones male or female the risk is greatly increased. A fair number of people I know are on HRT and still have osteoporosis. It can happen in as a few years.

[evai1234 (imported)]

My question is this: Does Estrogen/Premarin provide the necessary health benefits post castration as does low dosage Testosterone?

Yes it does. The dosage may wary. For some people 0.625mg of Premarin may be enough. Some may need 1.25, or 2.5mg per day in order to feel good.

Premarin is not the safest alternative though it is safer than estinyl estradiol.

Safest (from the health perspective) are transdermal estradiol preparations - gells and patches, the next safe option is injectables (estradiol valerate or estradiol cypionate), then oral estradiol (estradiol hemihydrate or estradiol valerate), then premarin or CES, and estinyl estradiol as the last option.

For some reason some people may feel better on premarin than on oral estradiol... or vice versa.

Approx dosage equivalences are:

1.25mg of premarin = 2mg of estradiol hemihydrate = 2.5-3mg of estradiol valerate = 100mcg delivery rate patch.

These equivalences are not cast in stone, as some people absorb one praparation better than the other (i.e. some do not tolerate patches, because of the irritation, some cannot take oral estradiol but are ok on premarin, etc.)

Put another way, does a genetic male who has been castrated need Testosterone if he is taking Estrogen?

No, unless they do not want to feminize, but then why take estrogen?

Some postmenopausal-permenopausal or surgcally menopausal women are prescribbed testosterone in addition to estrogen, but the dose is a lot smaller (1/10-th - 1/5-th) than andropausal males are prescribed.

Natural hormone balance i.e supplementation of cocktail of hormones that are natural for females (estradiol, progesterone, testosterone) and males (the same set but different proportions) would be the best, bet the doctors do not care too much about it.

[evai1234 (imported)]

...endocrinologist..

He has told me that there is very little world body experience out there in dealing with people like myself - - - no studies, etc.

There are quite a few studies, guidelines and recommendations, as well as there are accepted practices of dealing with people like you. Apparently your endo. is (or pretends to be) ingorant about these, or simply just does not want to take any responsibility, as these cases are not very usual.

Intersex people and transsex people treatments are very similar. There is a good bit more IS cases of various degrees.

...

But, there is little medical knowldege for guys like him to draw from.

You can show him these:

http://search.conduit.com/Results.aspx? ... oren+Draft. pdf&meta=all&hl=en&gl=ie&SearchSourceOrigin=2&gil=en&SelfSearch=1&ctid=CT1609479&octid=CT1609479

http://transhealth.vch.ca/resources/careguidelines.html

http://www.transgendercare.com/medical/ ... gimens.asp

My E level is around 70 presently

70 of what? pg/ml? If these are in pg/ml then this level is equivalent to female in mid follicular cycle. If you lose your gonads this level is likely to drop, as part of estrogen is produced in the testicles as well.

and my T level is around 220

220 of what? You see, figure without measurement units is quite meaningless.

Ultimately, we sort of have to figure things out for ourselves.

You seem to be missinformed. There are doctors who specialize in treating TS and IS people, though there are not many of them (the specialized ones). There are conferences about this, where specialists discuss and share their knowledge, there are treatment standards and guidelines. Every bigger country has at least a few medical centers where things can be done, and where research is performed. I know that quite a lot of TS people complain that the doctors are too rigid and concervative in their thinking, but this is not the reason to say that there are no knowledge about this in the medical community.

[intersexed (imported)]

Danielle,

Estrogen will provide you with what you need. As long as you're on (or naturally manufacture) one or the other, you won't face the health risks of hypogonadism.

You don't need to take

testosterone in addition to estrogen.

Though, after 10 years on estrogen, I'd be surprised if you weren't permanently chemically castrated by now. But I am not a doctor.

[devi (imported)]

I have been taking female phytoestrogens. I think they did help but how can you be sure? Anyway I've calculated that if I get normal estradiol (birth control) tablets and quarter them so that I don't get the feminizing effects from them then that should be enough. I guess you could count off 21 days from the full or new moon or else just go straight through assome women do.

[Senjougahara (imported)]

Something I've been thinking about lately: it seems that it's generally agreed you need hormones to maintain certain aspects of your health, mainly bone density and mental faculties. However some people don't want to be either masculine or feminine but some null gender in between. Hormones are detrimental to this goal as they pull the body towards one gender or the other, depending on whether you use T or E. Could such a person take both sets of hormones at the same time to cancel out both the masculinizing and feminizing aspects while still reaping the health benefits, or would the health benefits get cancelled out too?

Also does anyone have any figures on the minimum dosages required to prevent osteoporosis and other problems that can affect eunuchs?

[bobbie (imported)]

Also does anyone have any figures on the minimum dosages required to prevent osteoporosis and other problems that can affect eunuchs?

There are no figures on the minimum dose. Evey body is different. Some people can have no HRT and no bone lose. Bone loss has also to depend on the amount of calcium one takes. With good exercise and calcium you can some times prevent the bone loss.

All effects of castration can be a problem. There is just no simple answer on health problems.

[devi (imported)]

Though I don't think it'd hurt to obtain a 21 day supply of estradiol from one of your female friends on the pill and quarter each tablet for an 84 day supply which is equal to one season minus nearly a week. The one week would be your "period" so to speak. A quarter of the amount of estrogen isn't going to be enough for feminization. The body will simply take the estradiols and convert them into the necessary type of estrogens that your body needs for bone and heart maintenance is all. Testosterone which tecnichally is an estrogen -that is a masculinizing estrogen as opposed to a feminine estrogen or a neutral estrogen, is a little bit harder to obtain.

[EricaAnn (imported)]

Hi,

My question is this: Does Estrogen/Premarin provide the necessary health benefits post castration as does low dosage Testosterone? Is the real story here perhaps that a human being must have some level of either Testosterone or Estrogen in order to enjoy good mental and/or physical health?

Put another way, does a genetic male who has been castrated need Testosterone if he is taking Estrogen? (I have a theory on this, but I do not want to bias the group with a simple theory.)

Does anybody have any theories or knowledge of this? Any insight would be greatly appreciated.

Thanks,

Danielle

Hi Danielle,

In response to your questions, I have the following to offer.

Since you are transsexual you won't need real amounts of testosterone in your system after castration. Estrogen would be the preferred hormone for people like us. My endocrinologist, who has a great deal of experience treating transsexuals and hormone therapy wants my estrogen level somewhere between 400 and 450. I'm currently on a dose of 0.3 cc's of injectable estrogen weekly which has maintained my level right around 425-430. I also take a daily dose of 200 Mg's of oral Progesterone.

Contrary to what your doctor has told you, there has been a great deal of medical research done on transsexuals and hormone replacement therapy and their effects upon us.

Once your testosterone levels have been reduced substantially by castration, you will see a big difference in the way that the estrogen affects you both mentally and physically. Your breast development will increase greatly as well as the development of the subdurial fat layer under your skin which soften your skin. You will also begin to see the effects of fat transfer in your body and will begin to develop hips and what we girls call a "mother's pouch" which is a little tummy below your naval. The final effects will be an increase in your hair density, lessening of your general body hair and the softening of your facial features.

Please make certain that your doctor is carefully monitoring your hormone levels through regular blood test, which are the most accurate method of determining your body's response to the hormones.

I wish you all the best of luck. Should you have any questions that I can help with, please feel free to PM me.

[Danielle (imported)]

Quoting Evail:

"

220 of what? You see, figure without measurement units is quite meaningless.

"

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Of course, this is true. I think that the standard unit is picogram per millileter as I recall. I think all the major testing companies use the same units, but I do remember that I got slightly different results between Quest and Labcorp.

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Quoting Evali again:

"

You seem to be missinformed. There are doctors who specialize in treating TS and IS people, though there are not many of them (the specialized ones). There are conferences about this, where specialists discuss and share their knowledge, there are treatment standards and guidelines. Every bigger country has at least a few medical centers where things can be done, and where research is performed. I know that quite a lot of TS people complain that the doctors are too rigid and concervative in their thinking, but this is not the reason to say that there are no knowledge about this in the medical community.

"

------------------------

Yes, I know that there are doctors spread throughout the US who do treat GD/TS/IS people. However, I did spend a full day calling every endochronologist in the phone book looking for another doctor to handle my case who might be better than the one that I presently use. The all told me that they do not deal with these conditions. And that is all that there was to that.

So, I just stick with the one guy (however ill informed that he may be {or pretend to be}) who is willing to provide the blood tests and the prescription for Premarin.

Danielle

[Danielle (imported)]

Quoting Intersexed:

"

Though, after 10 years on estrogen, I'd be surprised if you weren't permanently che

mically castrated by now. But I am not a doctor.
[/quot

e]
"

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The numbers show that my T level is in the low range for a male, but not out of range as one would expect of a castrated male (roughly 220 {pG/mL} on the Labcorp scale). Anecdotally, I also observer that I still have a pretty hearty labido, so the T is still there doing its (unwanted) thing.

Danielle

[Danielle (imported)]

Quoting Erica Ann:

Once your testosterone levels have been reduced substantially by castration, you will see a big difference in the way that the estrogen affects you both mentally and physically. Your breast development will increase greatly as well as the development of the subdurial fat layer under your skin which soften your skin. You will also begin to see the effects of fat transfer in your body and will begin to develop hips and what we girls call a "mother's pouch" which is a little tummy below your naval. The final effects will be an increase in your hair density, lessening of your general body hair and the softening of your facial features.

-------------

Hi Erica,

Most of those things that you mentioned, I have already had occur via the Premaring for 10 years of steady use. The only thing that I have not experienced that I desire is a reduction of my body hair and a reduction in labido. I have had all of my beard removed via Electrolysis (expensive and time consuming and sometimes quite painful).

Danielle

[Danielle (imported)]

Hi all again,

I appreciatete everyones council and advice here. It is great that there are people out there who have experience and first hand knowledge of this.

One thing that I forgot to mention is that I am performing castration by ethyl alcohol into the testes (drinking alcohol from a liquor store). Initially, I used 2 mL of 80 proof Vodka per teste every two days. I did that for 5 cycles and then switched to 1 mL of 190 proof per teste.

It seems to be going ok as I am taking some precautions with its administration. Initially, the pain was about a 6 on a 10 scale. Now, it is down to a 2.

Danielle

ps - my Endo refused to prescribe Depo Provera or anything like that for me. Just Premarin. He does not know enough to feel comfortable with that combination. If I were him and did not know, I would also refuse to prescribe both - - - so it is kind of understandable.

[evai1234 (imported)]

...

ps - my Endo refused to prescribe Depo Provera or anything like that for me. Just Premarin. He does not know enough to feel comfortable with that combination. If I were him and did not know, I would also refuse to prescribe both - - - so it is kind of understandable.

If he *really* does not know then I would doubt his qualification. Most likely he is just too uncomfortable in dealing normally with people like you (for whatever reasons it may be - religion, his personal views, legal considerations etc.). If he really wanted to help - it would be not too difficult for him to read guideliness on the internet, or a book about transgender care. Apparently he just does not want responsibility.

1.25mg of premarin is nearly nothing if your body still produces male hormones, as it cannot suppress them.

[evai1234 (imported)]

Yes, I know that there are doctors spread throughout the US who do treat GD/TS/IS people. However, I did spend a full day calling every endochronologist in the phone book looking for another doctor to handle my case who might be better than the one that I presently use. The all told me that they do not deal with these conditions.

It sounds similar to saying "person with chest infection called to the GP who refused to treat them as they do not deal with this particular sort of chest infection...". The thing is that if a patient comes in the doctors must treat them in the best of their ability in the area they specialize in, else all less usual cases will be left untreated.

May I suggest you to register on specialized TS forum and ask there about endos? In any big and decent enough forum one should be able to get list of doctors, and then they could identify which one is closest to their location.

[kristoff]

ps - my Endo refused to prescribe Depo Provera or anything like that for me. Just Premarin. He does not know enough to feel comfortable with that combination. If I were him and did not know, I would also refuse to prescribe both - - - so it is kind of understandable.

If I were him and presumably a competent doctor, I would do a bit of reading and learn what needs to be learned from the literature. Your doctor is lazy, and as a result of that, likely dangerous. I'd make the effort to look a bit further afield for someone competent. Are you near any major universities with a medical school - a good place to look.

[Danielle (imported)]

Hi -

Just two general comments. I do not think that any given doctor is required to treat any given malady. If they feel that they are not competitent in an area requested to be treated, they can simply say no to the potential patient and that is that. That has been my general experience.

I agree that there are folks out there who can treat me properly and I need to do more research. I have been lazy in that regard since I have received the basics that I originally sought.

As a matter of fact, someone here (and I thank that person for that information) has sent me two names of NJ doctors who are apparently willing to treat for GD/TS. I plan to find out geographically where they work and then contact them.

Danielle

[Senjougahara (imported)]

I do not think that any given doctor is required to treat any given malady. If they feel that they are not competitent in an area requested to be treated, they can simply say no to the potential patient and that is that. That has been my general experience.

I don't know much about the American health care system, but in Britain if your doctor doesn't have the expertise to treat your condition she will refer you to a specialist. For example when I became partially deaf as a child my doctor referred me to an ENT (ear nose and throat) specialist who did some tests and discovered that my nose wasn't draining correctly. This was cutting off the airflow to my eustachian tubes which resulted in the air pressure behind my eardrum being lower than the outside pressure. He taught me how to inflate my ears manually.

Oh good lord that's far too much irrelevant information, what is wrong with me today?

Testosterone which tecnichally is an estrogen -that is a masculinizing estrogen as opposed to a feminine estrogen or a neutral estrogen, is a little bit harder to obtain.

There's such a thing as a neutral estrogen? Where can I get me some of that?