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Question about HRT for my girlfriend (hexbear.net)
submitted 1 week ago by [M] to c/traaaaaaannnnnnnnnns@hexbear.net
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Hello! As some of y'all may know, I locked down a trans MILF baddie about a year ago (actually 11 months as of yesterday!). She's 12 years older than me and like twice my size, I live for this shit.

Well anyways, she's been on hormones for 2 years. She's been taking low doses considering how long she's been on it because she is bipolar (y'all know I haven't dated someone without a cluster b personality disorder since Chapo was still on Reddit) and taking anything more than what she's taking will make her dangerously manic. So yeah, none of that.

Her appointment was a couple days ago. Got her blood drawn, and we're both confused by the numbers. So she's at 88 estrogen, which is below the 100 they look for typically but is close enough really. However, her testosterone was even higher than when she started HRT, around 160.

I'm still waiting for her to text me doses, but she's on Estrodial, Progesterone and Spiro, all oral, no needles or sublingual. Losartan for blood pressure. And CBN at night (with her progesterone dose, mentioning that because I know the two have interactions).

She's calling her nurse practitioner tomorrow, but I figured I'd ask a bunch of trans people what they think of it

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[–] 8 points 1 week ago* (last edited 1 week ago) (5 children)

First off, Bipolar disorder is not a Cluster B personality disorder, it's a mood disorder and can be treated with mood stabilizers like Lithium and many others.

I don't identify as trans, but I'm an intersex woman with let's say a greater than average understanding of pharmacology and sex hormones.

Without knowing the dosages of anything, there's not much we can tell you other than that she absolutely does need to modify and increase her doses.

Spironolactone

Whatever amount of Spiro she's taking may not be enough.

Increasing the dosage of Spiro absolutely cannot increase her risk of mania. High Testosterone levels are positively linked with mania and hypomania, so reducing her effective T impact by increasing Spironolactone intake will actually reduce her risk of becoming manic or hypomanic.

Progesterone

Medroxyprogesterone Acetate is a synthetic progestogen and can cause manic symptoms, but this is because it's a steroidal antiandrogen. Using a different form of progesterone should have zero impact on mania, regardless of dosage.

DO NOT CYCLE on/off progesterone. Some people do this to try and more accurately reflect the cyclical hormone levels associated with the menstrual cycle because they believe this is beneficial, it's just a lasting urban legend in the transfem DIY community from like 30 years ago. Cycling HRT is only deleterious to health and increases risk of side effects. Nobody should do this, even if they're not at risk for bipolar.

Estradiol

So, Estradiol has impacts on dopamine and serotonin, which is why it can cause mania. But it doesn't cause mania based on the amount you take or the amount in your bloodstream, it's caused by fluctuation in the amount of estradiol in your system. Increasing the dose could cause problems, but maintaining the higher dose once increased would not cause a greater chance of mania than the current dosage.

Switching to a topical cream or transdermal patch would be the best method for maintaining extremely consistent levels of estradiol which is what you need to do to reduce the chance of manic episodes.

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  • [–] 10 points 1 week ago (1 child)

    body is converting the estradiol she's taking into testosterone instead

    That doesn't sound right. The human body has an aromatase which converts testosterone to estradiol, but we don't have a pathway for doing the reverse.

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  • [–] [S] 5 points 1 week ago (1 child)

    Ah yes, you are right about the cluster b thing, sorry I'm dumb sometimes. I will say though, the ex I posted about all the time a few years ago hard Borderline and my current roommate is histrionic. The only thing wrong with my statement about loving cluster b people is including bipolar in that, I love all my cluster b homies and stand with them even when it isn't easy. Maybe sometimes even when I really shouldn't like with my ex.

    So her issue with Spiro is that upping her dose makes her very tired and groggy throughout the day. This week, she's been trying taking 2 one day and then 3 the next, alternating between the two to try to minimize side effects. Still waiting on her to text me her doses, but I know how many pills she takes and how often.

    Good to know about the cycling, I've actually never heard of that, but she's 12 years older than me so there's a higher chance she's heard that outdated info. However, progesterone is very stabilizing for her, so she takes it every night without issues and doesn't want to be off it. However, recently it's been making her nauseous, so I suggested that she look into boofing it. I know it's a thing within this community, but you seem to understand the pharmacology of these secondary HRT meds far better than me. What's your opinion on boofing it?

    That is good to know! Back when I made and distributed those sublingual Estrodial drops for monotherapy, I didn't have any clients that actually gave two shits about their mental health issues, so this was never something I looked into. I would have my people get blood tests done after they were 6 months in, so I have some knowledge of this stuff but really I just knew how to follow a flow chart. I knew whether to suggest a higher/lower dose and I knew when to stop providing it to a given person. I really appreciate you taking the time to type this all out!

    She goes to a place I consider one of the best in the country just by it's founding principles. Founded by queer/POC people in our city in response to the Aids crisis. It's meant to be healthcare by people's given community. There's a gay doctor that loves force femming (offering informed consent HRT) all the twinks to the dismay of other gay men and bi goth girls. Really I think it's because he's an old twink and wants to protect his status as the only man in his 40s in KC that's still a twink. Oh yeah, there's also lots of bilingual staff, obviously I only fluently speak English so I haven't really engaged with this side of it. But all of the Hispanic coworkers I've had over the years that don't speak any English speak very highly of the Spanish speaking doctors

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  • [–] 3 points 1 week ago* (last edited 1 week ago)

    ...issue with Spiro is that upping her dose makes her very tired and groggy throughout the day. This week, she's been trying taking 2 one day and then 3 the next,

    This is fine. I'm assuming she typically splits the total daily dosage so she's taking it about 12 hours apart? The half life is about 12 hours so this is the way you're supposed to do it. Again, more consistent levels are best for this. She could split the dosage so that she takes 1/3 in the morning and 2/3 at night. This might be more helpful for reducing grogginess.

    I actually do personally take Spironolactone as a diuretic and only take it at night which is uhhhhh not what you're supposed to do if you're using it as an antiandrogen.

    However, recently it's been making her nauseous, so I suggested that she look into boofing it.

    Honestly, go for it. It absolutely works better as a suppository, but it also comes with a higher chance of negative side effects like depression or anxiety. It also typically has a much stronger sedative effect when taken via this route so do it pretty much immediately before bed. Watch out for a lowering of mood and if you do notice that, just switch back to the oral route.

    If it's the micronized estradiol capsule that looks like a rugby ball, she can just shove it up there about an inch or two. Like, to the second knuckle of the index finger.

    Fuck synthetic progesterones though. These are much more strongly associated with low mood and I'm not sure which if any can be successfully used as a suppository.

    I'm really glad she's got a great healthcare org! Having providers that actually give a shit about their patients is so important and upsettingly not universal.

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