So, if you have been following my blog, you may remember from my entry on March 7th when I explained that, due to health issues that have been manifesting over the past few years, I had been taken off my HRT in July 2019 with no real promise of ever being able to go back on them. Just to clarify, this is normal protocol for any trans woman who develops any type of blood clot(s) - life-threatening or otherwise - until her physician(s) can determine whether or not there would be any compelling reason(s) for not putting her back on HRT... such as any potential (or imminent) threat to her health or her life. Estrogen is known as a potential instigator for serious complications, such as blood clots, heart attack, and stroke. But telling a trans woman that she must choose between a life spent worrying about mitigating these risks or a life without hormones at all is devastating, at best.
Although the absence of HRT does not make you any less transgender, not having it is akin to not having access to life-saving medication as many (if not most) trans people rely on hormones to help create and maintain the corrections in the outward appearance as to be consistent with who they are on the inside. For instance, a trans woman who began her transition thirty years ago is removed from HRT due to health complications. After eight months of no estrogen in her system, and even though she has continued to take a testosterone blocker, reduced levels of testosterone have still begun to take over and cause unwanted and undesirable changes to her body, such as redistribution of fat, an increase in body and facial hair, and noticeable evidence of thinning hair due to an increase in DHA, a protein that is responsible for (among other things) male pattern baldness. With very few affordable (i.e., obtainable) options to reverse these changes in the absence of HRT, other mental health issues such as anxiety and depression can arise. As well, being on a testosterone blocker and having no estrogen at all coming into her system leaves her susceptible to osteoporosis as she gets older.
The scenario I just described is exactly what I have been going through since July of last year. Anxiety has been a part of me for years, although I am fortunate that is is not (yet) debilitating. I, myself am not worried about depression. However, it's still a possibility depending on how far my body is allowed to "de-transition" before I am able to resume HRT... which brings me to the reason for this blog entry.
I finally had the opportunity to spend some time on the phone with my endocrinologist from Sharp Rees-Stealy Medical Group on Monday afternoon. She was very nice and very knowledgeable and asked me to share my medical history with her in detail, in addition to what she could already see on her computer screen. After I had filled her in on pretty much every detail, she shared her thoughts as to how she feels we should proceed. Because I still have A-Fib (and my cardiologist will not yet sign off on cardio ablation), I am still at risk (albeit a reduced risk) of stroke. So, my cardiologist and primary care physician feel that it is in my best interest to remain on blood thinners (Xarelto) indefinitely. I had been told by my cardiologist that if I had any plans to pursue HRT again, then there was no question that I would need to stay on the blood thinners to mitigate clotting. I advised my endocrinologist that, since I am being told that I need to stay on Xarelto indefinitely, I see no reason that I shouldn't resume HRT. Fortunately, she agreed. She said that she sees no reason not to restart me on a low-dose estrogen patch (which is considerably safer than oral estrogen) as soon as possible.
😊😊😊😊😊😊😊😊😊😊🙌🙌🙌🙌🙌
The only caveat is that she wants me to wait until the results of my stress tests and related blood work have come back to rule out any further issues with my lungs. I had originally been scheduled to have those tests done yesterday. However, in light of current events, I felt unsafe to wander through a hospital given that I am immunocompromised and at high-risk. So, the tests have been rescheduled for April 30th, instead; we'll play that by ear, as well. In the interim, my endocrinologist did increase my daily dosage of Spironolactone (a diuretic that helps control hypertension and blocks testosterone) from 25mg to 50mg. Providing that I stay adequately hydrated and my body handles the higher dose with no complications, we may increase it a little more in a few months.
So... YAY! Please keep your fingers crossed that everything goes well between now and April 30th; I need that estrogen patch! If you've made it this far, thank you for caring... and stay tuned as I have more blog entries to follow.
Trish 💖
Although the absence of HRT does not make you any less transgender, not having it is akin to not having access to life-saving medication as many (if not most) trans people rely on hormones to help create and maintain the corrections in the outward appearance as to be consistent with who they are on the inside. For instance, a trans woman who began her transition thirty years ago is removed from HRT due to health complications. After eight months of no estrogen in her system, and even though she has continued to take a testosterone blocker, reduced levels of testosterone have still begun to take over and cause unwanted and undesirable changes to her body, such as redistribution of fat, an increase in body and facial hair, and noticeable evidence of thinning hair due to an increase in DHA, a protein that is responsible for (among other things) male pattern baldness. With very few affordable (i.e., obtainable) options to reverse these changes in the absence of HRT, other mental health issues such as anxiety and depression can arise. As well, being on a testosterone blocker and having no estrogen at all coming into her system leaves her susceptible to osteoporosis as she gets older.
The scenario I just described is exactly what I have been going through since July of last year. Anxiety has been a part of me for years, although I am fortunate that is is not (yet) debilitating. I, myself am not worried about depression. However, it's still a possibility depending on how far my body is allowed to "de-transition" before I am able to resume HRT... which brings me to the reason for this blog entry.
I finally had the opportunity to spend some time on the phone with my endocrinologist from Sharp Rees-Stealy Medical Group on Monday afternoon. She was very nice and very knowledgeable and asked me to share my medical history with her in detail, in addition to what she could already see on her computer screen. After I had filled her in on pretty much every detail, she shared her thoughts as to how she feels we should proceed. Because I still have A-Fib (and my cardiologist will not yet sign off on cardio ablation), I am still at risk (albeit a reduced risk) of stroke. So, my cardiologist and primary care physician feel that it is in my best interest to remain on blood thinners (Xarelto) indefinitely. I had been told by my cardiologist that if I had any plans to pursue HRT again, then there was no question that I would need to stay on the blood thinners to mitigate clotting. I advised my endocrinologist that, since I am being told that I need to stay on Xarelto indefinitely, I see no reason that I shouldn't resume HRT. Fortunately, she agreed. She said that she sees no reason not to restart me on a low-dose estrogen patch (which is considerably safer than oral estrogen) as soon as possible.
😊😊😊😊😊😊😊😊😊😊🙌🙌🙌🙌🙌
The only caveat is that she wants me to wait until the results of my stress tests and related blood work have come back to rule out any further issues with my lungs. I had originally been scheduled to have those tests done yesterday. However, in light of current events, I felt unsafe to wander through a hospital given that I am immunocompromised and at high-risk. So, the tests have been rescheduled for April 30th, instead; we'll play that by ear, as well. In the interim, my endocrinologist did increase my daily dosage of Spironolactone (a diuretic that helps control hypertension and blocks testosterone) from 25mg to 50mg. Providing that I stay adequately hydrated and my body handles the higher dose with no complications, we may increase it a little more in a few months.
So... YAY! Please keep your fingers crossed that everything goes well between now and April 30th; I need that estrogen patch! If you've made it this far, thank you for caring... and stay tuned as I have more blog entries to follow.
Trish 💖
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