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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[โ€“] 16 points 1 week ago* (12 children)

So much misinformation.... Spiro is a RECEPTOR SITE BLOCKER it does not reduce levels of serum testosterone even if it's working to block all androgenic effects of testosterone!

When it comes to estrogen, you can use the same pills that are infested orally sublingually in order for them not be be broken down by the liver into less estrogenic estrogens (yes there are different types of estrogen that are less estrogen, this sounds like word salad but please God trust me XD)

Progesterone taken orally quite literally has an imperceptible effect on serum levels! It is broken down in the liver to other compounds to a degree that's even more severe than oral estrogen. This is usually subverted by taking progesterone as a suppository, but honestly, prog is the one thing in a transfem hrt regime that actually has a good chance of negative mood effects and the "desirable" effects for transfem hrt are dubious at best so I wouldn't worry about it.

At the end of the day, I am always going to recommend an anti-androgen solution that actually suppresses gonadal production so that serum levels can actually be monitored by your doctor. Estrogen (injections) monotherapy, GNRH antagonists, or synthetic progesterone like cyproterone acetate (in therapeutic doses for hrt NOT in birth control does, PM me if you want to pursue this for more dosage information) are all ways to accomplish this.

Do not listen to random people on the Internet, even other trans people who claim to know what they are talking about (this includes me!!) please due you due diligence to make sure anything you read here lines up with the scientific consensus of the medical community (everything I've said here does!)

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  • [โ€“] 12 points 1 week ago* (last edited 1 week ago) (9 children)

    Progesterone (oral, suppository, or otherwise) has a documented effect specifically during Tanner Stages III and IV, but outside of this specific developmental stage of a handful of months, you're definitely right about it having dubious impact.

    Spironolactone is a prodrug but its active metabolites are actually steroidogenesis inhibitors, which is very specifically relevant for patients with Bipolar.

    Cyproterone is a really good pick for an antiandrogen, but may be harder to acquire for some people who aren't as able to DIY since it doesn't have FDA approval.

    Injection of estradiol is great for most people because it avoids first-pass metabolism, but it's extremely not recommended for patients with Bipolar disorder because it has higher fluctuations in serum levels with dramatic peaking right after the injection which can induce a manic episode. This is actually how healthcare practitioners first discovered that estradiol can induce mania.

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  • [โ€“] [S] 7 points 1 week ago

    Oh God, this is such a manic comment. Normally I delete posts like this when I write them, but honestly I kinda want someone to see what my mania looks like writing wise. It's uh, very interesting I guess is a way to write it. IDK , some of my people think it's amazing others know exactly what it is and hate it. The lesson here is that I could have been the new Jim Jones if I wanted to. The better you know me, the know you know how true that is, I didn't come up with that comparison myself it was my old drug abuse councilor

    Well, she's dating me. Sourcing cypro isn't the problem, I can still get literally any drug I want (recreational or otherwise) right now and I know this to be true. I've had dealer's choice of everything for years, even after I sobered the fuck up. There's nothing stopping me from purchasing any drug you can think of that's available in America. I provided my Mom her bougie ass birth control she gets only because she's married to a vice president in one of America's biggest companies. I'm able to get shit that even rich insurance companies in America can't get for their patients.

    If I think I can convince her to try it, I'll source it and that's no big deal. But that's all contingent on getting her to actually try it and see what she thinks, if I can't get her willing to try it ordering it in will do no good. And uh, I'll just say it isn't easy to convince her to take anything that isn't prescribed by a doctor. She won't even take Ibuprofen when I offer it sometimes, we're not talking about normal drug avoidance I mean she won't even take basic OTC stuff. I'll be like "Gurl you've had a headache for 2 weeks straight" and she'll be like "Yeah but Advil (I actually only carry Naproxen, its always actual Advil) will make my tummy hurt :(" and then I have to fight the hood pharmacist inside of Leyla from just dropping an Advil in her mouth when she sleeps. Idk, I used to literally drug people with kratom to get them through withdrawal from fentanyl, I don't regret anything I did back then because every one of those people is still alive, but I've definitely done some morally questionable shit in this area for the right reason

    Idk, maybe some of y'all don't remember but it was about 2 years ago I was posting on here asking about advice for providing people DIY HRT. I was creating sublingual Estrodial drops for monotherapy for people around me up until I went to rehab. I'd pay rent, people's med shipments, then spend the rest on alcohol to keep from withdrawals. I was also shipping in extras of everybody's meds because there was some fuckery going on with insurance at the time. I don't fully remember the context, but even my mom with bougie insurance was expecting to lose it. There's a reason I have such a great reputation in my city despite spending a very long time in the city as a junkie.

    Sorry, I'm coming off my TCA/Main sleep med, I'm pretty manic and just shooting shit.i should have been asleep 4 hours ago but it just didn't work.

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  • [โ€“] [S] 5 points 1 week ago (2 children)

    Fuck, I'm manic and it's about to affect someone big so I might as well mention this. You might get a chuckle out of this. I have a call scheduled with Brown University for the withdrawal guides I wrote on here forever ago. Someone reached out to me off site and said they had some questions about my withdrawal guides FROM ON HERE, which honestly in my opinion now that some time has passed since writing them, functional but mid, I've done better.

    This is in 4 hours, I should have been sleeping this whole time but I lost access to many of the tools I use for sleep overnight. An ivy League University is literally interviewing me over posts I made on this site about 2 years ago, I feel like I'm getting fucking punked. Like huh, y'all couldn't have picked any other ex junkie that can tell people how to withdrawal from shit? I'm sure I'm not the only one writing shit like that, I'm not unique or special but for some fucking reason some people at Brown think I am.

    Oh well, at least it's Brown. Only Ivy League school I would have answered, I would have told any other one to fuck off. But yeah, fucking with my head that I'm doing an interview where this site is part of it in 4 hours. Like what the fuck? Maybe this is why my fellow bipolar people are all more brain fried than me. They're just constantly getting hit with mind melting shit like this, because ain't no way in hell some neurotypical does anything good enough for people to actually like them a few years later for their actions. If hell exists, it's all neurotypicals because they're like deathly allergic to integrity.

    Goddamn, amazing what manic rants sobriety gets me! I delete 80 percent of everything I type out on this website because I know it's usually just manic bullshit that doesn't matter, but you know what for once I'm going to make it everyone else's problem

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  • [โ€“] 2 points 1 week ago (1 child)

    meow-shark

    I liked reading it.


    โ“˜ This user is suspected of being a cat. Please report any suspicious behavior.

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  • [โ€“] [S] 2 points 1 week ago

    Thank you :) sometimes I get too long winded and lose my conciseness that makes me a good communicator when I'm manic, I don't know how good of a writer I am. Some days I think I'm really good and the people in my life say that I should start writing books and make a podcast.

    All my cis dude coworkers that I work with on my Tuesday shift say that I manage to be one of the funniest and wittiest people they've ever met. Like one time we were driving to the location in the work van. I told a joke that was just a throw away for me, I don't even remember it. But the driver of the car had to pull over on the highway because of how funny they all found this joke. I have the privilege of being able to go on autistic rants because I'm funny, I should do something with that

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  • [โ€“] 5 points 1 week ago* (3 children)

    dramatic peaking

    for valerate or enanthate/cypionate? Enanthate is a lot flatter I didn't know if that was still too spiky for some people.

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  • [โ€“] 5 points 1 week ago (2 children)

    All of the above. The relevant difference between these compounds is their half-life.

    Estradiol enanthate and estradiol cypionate last longer in the body but you're still adding a bunch of it into your body when you inject it, which will cause a spike in your levels.

    The spike will be slightly less dramatic than if you used estradiol valerate because there will be a larger quantity still remaining in the bloodstream, but it's the sudden increase in total quantity that causes the manic episode.

    Unfortunately a lot of practitioners just don't get this at all, and it seems like WPATH doesn't do a good job of identifying or communicating things like this. I've heard a lot of trans people describe WPATH as a gatekeeping org more than anything else, and I'd say that's consistent with how they handle (or rather, don't handle) the niche stuff like this.

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  • [โ€“] 4 points 1 week ago* (1 child)

    Okay cool, thank you. Just was looking at this and valerate, especially weekly like a lot of providers like to prescribe it, looks noticeably worse. enanthate doesn't look that sudden. But that does make sense, no matter how you slice it its a dose once a week compared to constantly like patches. But will try to remember for when I'm giving advice in the future.

    Yea wpath sucks for a lot of reasons.

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  • [โ€“] 4 points 1 week ago

    Yeah, don't get me wrong Valerate is much spikier. For most people enanthate is really smooth and consistent because of the long half life, but that comparatively teeny little spike is just too much variation on the brain side of the blood brain barrier for some folks.

    I feel like a lot of people don't even know that estradiol can cause manic episodes.

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  • [โ€“] [S] 6 points 1 week ago

    I take everything I read online with a grain of salt, even stuff here. She has a good doctor and goes to what I'd consider one of the best places in the US to get hormones. I don't know much about other places, but I know that simply the founding principles of where she goes makes it better than 99 percent of medical places. By queer and POC people for queer and POC people, informed consent for pretty much everything.

    So I actually do know about sublingual dosing. I actually used to provide DIY HRT through sublingual drops to people in my area. So everything in that paragraph makes sense

    I've also suggested rectal progesterone. She actually gets great reactions from progesterone, but recently she's been struggling with nausea. Now I've personally never boofed prog, but I was quite a junkie a few years ago and would shoot fentanyl up my ass specifically to cut down on naseua. So I don't think it's much of a stretch to think boofing progesterone would provide that same benefit as back when I'd reverse shit a fake perc 30 with an N on the front.

    Thank you! I will add that to my list of things to look into :)

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  • [โ€“] 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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  • [โ€“] 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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  • [โ€“] [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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  • [โ€“] 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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  • [โ€“] 8 points 1 week ago (1 child)

    Okay okay okay the thing about spiro is, and I cannot stress this enough, and I'm not yelling at you or any of my trans siblings, but if there is one thing that gender affirming care practitioners need to get through their skulls its this:

    THE EFFICACY OF SPIRONOLACTONE CANNOT BE DETERMINED VIA BLOOD TEST

    Spiro works by changing how the body deals with testosterone by binding to the the receptors that would normally take it. Its still going to be floating around in the bloodstream but it wont be used for anything. Ideally, at least. The trouble with spiro is that you cant really test to see how much of that testosterone is actually binding with the receptors, so its difficult to quantify how well its working. Generally speaking, I have seen most gender affirming care clinics take an approach that is guided by patient satisfaction and I suspect that this is why. Things might actually be fine with her T levels.

    What's happening with your girlfriend's (congrats btw, wishing you an happy first anniversary in advance) numbers happened with me and I'm pretty happy with my results, so take that for what its worth. I'm wondering if estrogen patches might help her safely get her numbers up. Oral estradiol has a pretty short half-life and can cause some pretty dramatic daily spikes whereas patches deliver a much more consistent level over time. If she decides to try those out I recommend the twice weekly patches since its less of an issue if you lose one/its easier to create backup stashes.

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  • In order to get her testosterone under control, she needs a higher dose of either estradiol or spironolactone (or both), switch antiandrogens, or she needs to have her testes removed.

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  • [โ€“] 4 points 1 week ago*

    cis women have higher levels, and bipolar shrug-outta-hecks did her doctors tell her that or did she come to this conclusion on her own?

    88 is pretty bad tbh. wpath recommends 100-200 but even that is conservative and based on post menopausal women. Personally I stick with 200+ but that's just me.

    Either way she should at minimum be taking her E under her tongue (sublingually) and her prog rectally. Disagree with some of the other people here, prog is good to take if you're tanner 3/4+. If the mood effects are fine. Just take it rectally. I'd +1 Emma's suggestion for switching to patches as they are extremely stable if taken correctly. I don't like AAs like spiro so one of the other commenters probably has better advice on it.

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  • Are those numbers pg/mL or pmol/L?

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  • [+] 1 point 1 week ago