I am gaining body hair despite going on 10mg/6 day estradiol valerate, 200mg spirolactone? Since it's DHT? Do I just add Finnasteride?

I feel like there’s a lot of scattered info about this in terms of people who have actually recovered from the damage and began to feminize again and would love to give people going through it hope, I’m interested in people’s stories and what they did to get out of that situation, please don’t ask me about my personal hrt regimen or anything as I’m not asking this for myself, but only for others stories to help other people, I recovered from it without dutasteride or bica by switching back to oral from injections, doing a ton or cardio, changing my diet to a very low protein diet, keeping stress low, and malnutrition (not proud of this), there’s been a lot of talk lately on the sub about adrenal androgens as well, if anyone has recovered from those as well, leaving info on that would be super helpful too! The reason this is mainly for post-SRS people is because that’s when things tend to get confusing and difficult when there’s androgen issues, when you have gonads usually your body will find a way to feminize again, but the body does a bunch of weird shit after SRS that’s not always easy to reverse or even understand, I’m curious of people who have got out of it

I take 4mg EEn every 7 days. I got my blood drawn bright and early at 7am on the day of my injection. These are my results.

E - 236 pg/mL

T - 41 ng/dL

FSH - 0.7 mIU/mL

LH - 1.9 mIU/mL

What would cause my LH to be so much higher than my FSH? Is this something I should be concerned about and how important is it for these levels to be < 1?

I was thinking they could have just been high since I got my blood drawn so early in the morning and that might be when those levels peak like T but I'm not sure if this is correct.

Does anyone here know of a clinic in Europe that tests for igf-1? Important that they don't need local id

I've been looking for months for a clinic that will test igf-1 where I live, to check if it could be responsible for my sub-par breast development.

public hospitals won't test without obvious signs of growth hormone deficiency, they applies to most private clinics too and the ones that let you pick whatever test you want don't do igf.. and clinics in neighboring countries require a local id.

I'm at my wits end here does anyone have any recommendations? I'll literally fly out anywhere for it

Like a lot of us, I have hEDS. I understand that sex hormones have an impact on our symptoms. They influence the musculoskeletal system and the soft tissues in various ways.

For example, I know it's important to have some testosterone to support the muscles, so as a post-op trans woman I use a tiny bit of T gel. This has helped me gain a little much needed muscle tone after many years of undetectable T levels, allowing my physiotherapy to work better.

I don't take progesterone, and I have read that it can cause issues in hypermobile people because it tends to increase joint laxity via an increase in relaxin. I know it is often recommended for breast growth, and I wonder how to balance that benefit with its potential harm with respect to EDS.

I am also wondering where estrogen figures into all this. It obviously has an impact on collagen, making our skin soft etc. I have read that it supports collagen production, which must be a good thing for us girls with EDS. Post-menopausal women have diminished collagen.

I always feel best on the day or two after my estradiol valerate shot. More energy, a bit less pain and laxity. I seem to metabolize the shots on the quicker side, though, so I do a twice/week interval.

Is it possible that a higher dose of estrogen is appropriate for those of us with EDS to help support our wobbly bodies? I used to take pills for many years. Moving to patches was an improvement, and shots moreso.

How can HRT be optimized not just for feminization but for EDS management?

This page seems to have good info and suggests estrogen stabilizes collagen in women https://www.hypermobility.org/hormones-and-hypermobility

I want to get an orchiectomy because my gonads:

• caused all the masculinization that I loathe with all my heart;
• they just don't feel right in my body, they are not welcome;
• make my life harder and feel like an excess thing that shouldn't be in my body;
• would cause me to masculinize if I could no longer take or obtain anti androgens for whatever reason

My breast development has been poor and my HRT inconsistent for years due to severe executive dysfunction (I suspect ADHD) and some money problems, and my thought process included "well, if those little fuckers are gone, at least there would be nothing fighting AGAINST feminization, estrogen could do its thing freely. One less med is easier to manage!". That idea has been shattered.

It was profoundly shocking to me to learn about paradoxical masculinization, DHT and other nightmare scenarios. At this point I don't know if I'd be doing myself a favor, or merely making my life worse if I experienced masculinization due to DHT.

I am aware that finasteride can help DHT problems, but I'm also worried about post finasteride syndrome, and bicalutamide isn't exactly easy to get in the country I live in. Spironolactone and pioglitazone are all I can get.

So... What gives? I'm now unsure about this. An orchi would provide some moderate bottom dysphoria relief (I'm most dysphoric and traumatized by male secondary sex characteristics) but the biggest drive for me was theoretically preventing any new masculinization, and learning that my gonad-less body can find some creative ways to fuck me up even more (DHT) is an appalling thought.

Assuming I do go forward with this, is there any way to predict if this could be my case? How could it be prevented? Would I just need to continue taking spiro for some months, or is that not enough? (pretty sure I read a woman here say that after her orchi she took spiro for 6 months, only for DHT to spike up right after she stopped, which remasculinized her).

I'm 11 months into transition and I do see changes. Over the last 6 months, my last two blood tests indicated at trough:

80 ng/dL, 387 pg/ml 80 ng/dL, 334 pg/ml

I'm taking 8 mg daily, sublingual, 4 mg morning and 4 mg night, .5 mg Finasteride( 1/2 1 mg dose)daily in morning. No blockers. They drew blood, just before taking my next dose at about 12 hours apart.

What does Dr. Powers like to see for T and E?

Generally, what kind of baselines/endocrine levels/parameters, metabolically speaking, does Dr Powers try to maintain or stay within.

TY

so i got prescribed estradiol valerate injections but they didn’t give me needles for the 16 quintillion syringes they gave me, anyone know what gage i’m supposed to use because the resources my doctor gave don’t have it they are left blank

I kind of wanted to ask about this on here since most trans women go from oral to injections and always mention a boost to breast growth and feminization. I went from oral straight to pellets and now after 4 years of hrt I'm starting injections and I guess I'm just wondering if anything exciting will happen even though I'm at a point where I don't really expect much more to change.

From what I can tell the hpa axis is a major factor in feminization. When I’ve tried to do monotherapy I actually get hair loss despite taking dutasteride and DHT being fine. I find the need to take hot showers to enhance estrogen, because it’s a way to calm the body down so that the androgens connected to the stress response decrease. I’ve tried splitting my spiro dose to 50mg and with patches or injections the spikes and general instability of the estrogen is what seems to cause the masculinization.

It was changing spiro brands that caused a huge shift in my hrt and increased hpa sensitivity, because the stronger one was stabilizing the very fast absorption of the patches, and the weaker one doesn’t do that as much. my breasts grew slightly larger on the weaker brand as well. in fact they hardly grew at all on the stronger one. switching brands and going to injections caused me to quit my job because of how all over the place i was. and i’ve never even been able to drink alcohol on this weaker one, which shows just how sensitive the balance is being held in check. Bica didn’t work for me, it did seem to suppress the hpa axis but it also created backdoor androgens that were extremely potent and upregulated androgen receptors. I have a script for lexapro to see if that will help suppress the hyperactivity. the anxiety goes hand in hand with the androgenic symptoms. i could probably take the strong spiro and be better but when i did last week my lips got really red and chapped. not exactly a great sign to continue doing something, but i am on patches right now so could’ve been that they stopped absorbing and made that whole thing worse but once i switched back to the weaker one it went away. but it probably would be better on it but i keep refusing because for some reason i’ve convinced myself it’s overkill and i don’t need it, and i don’t want to be stuck on it, etc.

I was recommended to take these. The estrogen is injections and the andro is a pill I cut into 4 and take a quarter daily, as the injection (2 ML) weekly. Can someone please confirm if this is good or not as l'm starting my diy soon (1 week at max) and are the brands safe.

A quick brief: I'm a 30 year old in the Middle East and getting access to hrt is hard, these are what I'm able to get and I just want to know if they're good as "prescribed". I do not have access to bloodwork as I still am willing to take a leap into this. Is that okay? Thanks in advance

Hi all, I've been ready to take pioglitazone but am planning on fasting (72 hours) and was wondering if pioglitazone would still be effective or if I wouldn't be able to take it. I was planning on fasting each month.

Would I be able to do this ? Any experience fasting while on pioglitazone?

Thank you !

essentially the title. I’m taking my first attempt at progesterone. Testing six weeks after starting. Because I’m on EVIM every 3.5 days, I need to get bloodwork done in the morning (prior to when i would take my shot).

So should i hold back on progesterone the night before? does it matter? what sort of peak/trough delta would be expected for steady-state, once-a-day, rectal P4?

Hello all,

quick question: Is it useful to inject een twice a week instead of once per weekly?

I was reading somewhere at this sub that stable levels are preferred (not so drastic increase in shgb?).

I was thinking about 2mg een injected subq every 3.5 days instead of 4 mg every 7 days. Or is this nonsense?

Thanks for any suggestions :)

Edit: Remove biweekly, unfortunately can't edit title

MtF, divigel (gel), estrofem (pills), cypro, fina now switching to duta

Does everything look okay based on these results? I did more extensive blood work to investigate the causes of minimal feminization and hair loss. I also considered potential issues with NCAH, but looking over the results, everything seems...fine(?) I was honestly expecting worse findings. My DHT levels are higher than I’d like, though honestly, I thought they would be much higher considering my history with hair loss and masculinisation. I’m currently working on lowering my prolactin by reducing cypro. What do you think about these results? I feel stuck now and don't know where to find the culprit.

Estradiol (E2): 150 pg/ml

Testoterone: 0,54 ng/ml

DHT: 150,9 pg/ml

FSH: < 0,1 mlU/ml

LH: < 0,1 mlU/ml

SHBG: 128,3 nmol/l

Prolatin: 94,01 ng/ml

Progesterone: 0,50 ng/ml

DHEA-S: 412,5 ug/dl

3-alfa-diol-G: 0,6 ug/l

17-OH progesteron: 1,64 ng/ml

I take injections and that has lowered my T to the lower level of female range which is perfect. I've been taking 25mg of bica every 2 to 3 days this whole time and its been working well but its got me thinking, don't I need SOME T to bind to receptors just to be healthy like cis women. Is the low dose of bica blocking ALL T from binding or am I safe to continue?

The main reason I take it is to stop DHT from binding btw.

So from April 2024 left and now right I fell like I’m regressing in my transition only big difference ive done is gain a lot of weight I went from 200 to 234 and my estrogen levels went from 390 pg/ml to 568 pg/ml I feel like my eyes are sunken in so much more now but you can’t see it that well in this picture

I want to take Pioglitazone for weight cycling but my face is pretty flat and I'm really crossing my fingers on when I gain weight that HRT will put it up there, but I really don't wanna take it this run if it'll prevent face fat from being stored.

today I had my lab test results

E2 330 Pg/ml T 0,108 Ng/ml DHT 45 Ng/dl SHBG 43,30 nmol/L fsh 0,30 mUI/ml lh <0,100 mUI/ml

I am on Ev injection, 3 mg every 3.5 days, test done before the injection on injection day

what concern me is I am taking dutasteride 3 times a week and bicalutamide every day for 1 year and my DHT didn't drop at all, I am the same level as 365 days ago

I am not seeing any androgenic effects anymore but this is due to bicalutamide blocking receptors more than dutasteride actually stopping dht conversion

idk what to do to stop my body producing dht, I am not even taking progesterone

I was planning to add P now I have no more acne or hair growth but looking at my DHT levels I feel discouraged and demotivated, I just can't stop dht conversion even with duta, how is it possible?

Increase the dose of estradiol, spiro or switch to Bica? What is the best option? I take 50 mg of spiro, 25 mg twice a day and one application of Lenzzeto (1.53 mg). I had my first blood tests done and the results: Estradiol 95.77 pg/mL and total testosterone 4.800 ng/mL. I have been taking spironolactone for three months and estradiol for one month. I have an appointment with my doctor, who apparently doesn't have much experience in this, on Wednesday. But on the phone he told me about those options and that we would start with a low dose of bica. What should I choose?

I have been experienced a period of high stress this month. This has lead to frequent nausea and vomiting, right after eating with a sore throat. I puked hard two days ago and today I been having these mini pukes that are just saliva. Blood pressure is usually around 110 dys 90 sys. I´m taking 6mg Estradiol valerate daily, 12.5 mg Cypro every 2 days, Jarrow B right and a Zinc/Calcium/Magnesium complex. Back in my country, the only estrogen available right now is the oral pills, injectable anticonceptives and conjugated (not). Cypro is part of my stock, but only anti androgen availabe is Spiro. I have buy an aluminum hidroxide antiacid but that is just bandaid solution. Could the problem lay in my regime or there is something else.

https://www.reddit.com/r/DrWillPowers/s/UTua0MigwM

His finding matches a lot of symptoms I have i match the demographics, 5,4, 55k tho my fat redistribution is good and looks very feminine. I am Diagnosed with anxiety and recently moderate ptsd. I currently afraid of my body even tho I’ve been on hrt for a year, it causes panic attacks and i often get stress pain which triggers my stress as it feels similar to growing pains. This happens randomly and sometimes triggered but gives me intense fear and stress. This research state trans people who experience Chronic stress may feel like they’re remaculating but I’m unsure if he mean the testosterone increases which I had to ask chatgpt as I can’t find any other studies, it say it can be both, confirming my worst fear that we don’t have control over our body (increasing testosterone even with anti androgen)

I would really like if someone could clarify if this true.

Hi Dr. Powers and gang,

I have a classic problem with my testosterone treatment: high hematocrit and hemoglobin after a couple years on T. I started low, got off T to retrieve gametes, and got back on T in 2022. Since then, I’ve been on 40–50mg of T, applied daily as topical gel.

If my hcrit is not lowered in the next six months, they want me to go off t. Obviously, I don’t want that to happen.

Usually blood donation is recommended to lower hcrit, but apparently this doesn’t really improve health outcomes.

Since this is a fairly common problem, my question to you, Dr. Powers, is how do you treat trans or cis men on TRT who experience an elevation of hcrit and hemoglobin?

Personal info:

• On the morning of the blood test, I usually drink a small glass of water and nothing else. Next time, I will double my water intake on the morning of. But I do want to address the actual cause and lower it as much as I can.

• I haven’t been great at hydrating ever, so currently, I make an effort to drink two glasses of water about 4–5 times a day. I also eat one grapefruit per day. Thinking of getting grapefruit oil, but not aware of any evidence pertaining to gf-oil.

• I’m currently overweight (99kg/170cm), but am on 2mg semaglutide weekly. I’ve lost 3kg in a couple of months, so not a super responder, but I’m going to keep at it.

• I have sleep apnea and use a cpap at 12–13 pressure setting. AHI is supposedly 0.8-ish according to machine, but who knows…

• My E levels are unfortunately high, likely due to fat deposits. Working on it. But this also makes weight loss difficult. I have not been rX’d anything for this.

• I suffered perimyocarditis 10 months ago. I’ve had echo and ECG many times. Structure and function are normal. Initial ST elevation has been mitigated, and is showing signs of improvent.

Many thanks, Dr. P., you’re doing important work for the community!

Hi there, I (18 MtF) just started taking 100mg prog nightly. I am currently on 3mg/week intramuscular estradiol valerate injections (monotherapy), and was previously on 4mg/day oral E + 150mg/day oral spiro

My most recent levels are at 14 ng/dL testosterone and 155 pg/mL estradiol.

I have heard a lot of good experiences about progesterone, including from one of my closest friends. What sent me over the edge and convinced me to try it was that some people experienced cognitive improvements, and as someone basically paralyzed by executive dysfunction, I was excited at the possibility of there being another thing that could potentially help. My logic was that even without the aforementioned cognitive benefits, I would still benefit from the feminizing effects of progesterone.

I have heard that prog is a wildcard; for some people it feminizes them, and for some it masculinizes them. As such, I'm a bit worried, but there's only one way to find out what its effects on me are. So my question is this:

What should I keep an eye out for to see how it's helping/not helping my transition? And what are the odds of it not helping? It seems like I hear a lot about it not working, but that could easily be a bias of it working for most people, but for those it doesn't work for, they post about it, changing the perceived effectiveness online.

Thanks!

This is one of those things that I just sort of know as "second nature" because I see it constantly all day long. PFM now has 5000 patients, of which 3000+ are transgender, and 1500+ are LGBQsomethin'

When I do 4 or 5 physicals in a day on AMABs and 2-3 of them have a hypospadias or an extra nipple, you sort of just get used to seeing it and it being "normal" in your population. (the extra nipple will look kind of like a mole, but it will be positioned slightly more medial on the chest and usually a few inches below the two regular ones. Think about how they look on male cats, similar concept.)

Its like seeing an abnormally high SHBG or high estrogen level in a gay man on no meds. It just...happens more often than seeing it in cishet dudebros that wander into my clinic accidentally based on google reviews having no idea what kind of medicine we do there (And they are still just as welcome!)

Then I mention it to a colleague and they are like.....what?

So yeah, this is one of those.

I see mild, subcoronal hypospadias, or scarring from neonatal hernia/undescended testicle surgeries or hypospadias surgeries on the penis of my patients at an absurd rate compared to what it apparently should be (1 in 300).

Interestingly, the rate of hypospadias is about the same rate of MTF gender dysphoria in the general population.

I am having a bitch a of a time finding any published research on this, nor even any other anecdotal reports of such a thing on the internet. At this point, I don't think anyone on earth has more trans patients as a single doctor than me (though if there is someone, please tell me as I would be thrilled to make friends and share notes).

I've become friends with Dr. Rixt Luikenaar recently whom is an absolutely stellar Ob/gyn out in Utah who takes care of trans people and treats based on biochemistry rather than dogma. They are awesome if you need one! Its been really great to start to get to find some colleagues out there that are seeing what I'm seeing and have a mind open to change, but I would be thrilled to have more of them. Rixt is probably one of the few doctors in the USA with a comparable volume of trans patients and experience with them. The other one I can think of is Dr. Kristen Vierregger in California. I don't know her personally, but I've inherited patients from her a few times that moved and I was always impressed with her treatment plans. I usually changed nothing. Dr. Vierregger knows how to do HRT well.

There are tons of cool centers like Fenway or UCSF that have thousands of trans people like I do, but more spread across their entire program over 20+ clinicians. Not all just sort of super distilled down to one guy.

As a result, there are very few humans I can confer with and be like "are you seeing what I'm seeing" as they just lack the sheer volume to see the patterns come out of the noise of seeing thousands of these people a year.

In short, if anyone out there is aware of anything published on this, or other clinicians want to speak up, I'd appreciate it, as its hit the threshold of "I can't not say something about this" at this point. When I say "I'm the only one" its because I am the only one I know about, but if someone is aware of others, please, comment, I would love to talk with them and know their thoughts and experiences to see if these patterns are unique to Michigan or not.

Thanks!

- Dr P

PS, Edit: For only a select few for whom I have whole genome sequences on, I've noticed when poking around their nebula and looking at the literal codons for their AR gene, they tend to have a longer CAG repeat (trinucleotide repeat) sequence than your average joe. Typically 30+ CAGs, but sometimes even longer which starts to trend towards PAIS. If your trinucleotide repeat gets absurdly long, your androgen receptor just doesn't really work. I'll be clued off to this possibility by spotting the hypospadias, and then when I get their pre-mtf labs, they will have a gargantuan LH and FSH and very very high testosterone despite sort of looking like an under-masculinized lithe femme human at baseline. They can be 30 and have the facial hair of a 15 year old boy. The Androgen receptor chills on the X chromosome, so a single bad copy for an XY human is enough to disrupt things. Actually looking this up on there gene browser on nebula is a pain in the ass, as you have to zoom into the gene from the start and then slowly scroll through the codons until you see the trinucleotide repeat sequence, then manually count each one. I haven't yet found a better way of doing this, so if anyone knows how, please comment.

The most common form of this I see looks like the bottom of the head of the penis is cleft. Aka glandular to coronal.

Here is a very obvious example of what it looks like. Sometimes they are a little more subtle than this.

I recently got the results from a blood test i did like a week ago (blood taken the day of injection, before the injection obv), and my levels are:

T: 48 ng/dl

E: 437 pg/ml

DHT: 78 ng/dl

My current routine is: 12.5mg CPA, 5mg EEn weekly injection. Been on hrt for 2 years 3 months now.

The DHT levels scare me a lot, but i don't understand how they could be possible? My T is within the female range, and at the time i wasn't taking prog (started it just a few days ago, before i got the results). Where could the DHT have come from? Will i have to stop prog? I already ordered duta and plan to take another test like 2 weeks after starting it.

I've meant to ask for a while because I love my cats more than anything in the world. I usually apply in a designated space that cats do not have access to at all. Avoid the cats getting too close to spots that I've applied. And wear a bonnet when I sleep to prevent them licking my head or getting residue on my bedding. And I dont touch my hair at all during the day to prevent accidental transfers between my scalp and other surfaces. Do I need to take so many precautions? I've been using it for quite a while now with no incident. I just worry. My understanding is that as long as I don't literally put it directly on my cat or allowing them to touch it in liquid form it should be okay. But any reassurance would be helpful. Thank you.

I have always injected E. I want to change to implants for convenience. Now 3 years HRT. My breast growth has picked up a bit in the last 6 months and I don’t want this to stop. I attribute it to starting P. For those who swapped from EV injections to implants, how did it affect your development?