Hi everyone. I'm a cis 25-year old male who took Pyrilutamide (non steroidal anti-androgen) for 20 days in September. I was just trying it out for my hair thinking if I had side-effects, I would immediately stop and go back to normal.

However what proceeded after I stopped Pyrilutamide on the 20 day mark felt unprecendented. I started getting facial changes where my jaw started moving back, skin thinning all over my body and genitals, erectile dysfunction, and memory issues.

Are my symptoms too abnormal for a hormonal imbalance to cause of all of this and is this reversible with the right treatment? I keep looking at posts regarding PFS and I keep hoping its not that and just a regular hormonal imbalance.

Just wanted to ask folks here who have a bit more experience. Thanks

I tested for precursors and I got this

17oh progesterone 0,590 Ng/ml

aldosterone 11 Ng/dl

androstenedione 2 ng/ml

3a androstanediol glucoride 1,71 Ng/ml

dheaS 245 microg/DL

androstseone 7,98 Ng/ml

dht 40 ng/dl

cortisol 227 nmol/L

all of these values are tested before bedtime (I work overnight)

I am 2.5years post-op, my fsh and lh are fully suppressed and my T is nuked

I inject 6,5 mg EV per week (two times 3,25 mg on 3,5 days cycle) and I am not taking any Prog

I am looking for backdoor pathway of DHT production after 1 year on duta+bica I suspect 5-ar is not the cause of it

also CAH is suspected

are there any values too high? any suggestions?

I am thinking of dropping duta because it seems ineffective for me

My friend told me that, you're mean and putting people down and calling them names also criticizing their illness and calling them fat!, I've seen those messages so it's little hard for you to deny this. I think you should apologize to her.

I was experiencing some weird masculinization while on monotherapy so I started bica 25mg daily like a month ago and it completely crushed any androgenic symptoms I was having. Im happy with how things are moving now but I have like debilitating low energy levels ever since starting bica. I dont have the energy to cook or clean most days but honestly Im scared to stop taking it cus Id rather have low energy than start masculinizing again. I dont have any concerning side affects or anything like otherwise I feel completely fine. Any advice to help my energy levels thats not getting off bica?

My Hrt is 6mg EV Injection every 5 days and bica 25mg daily.

My recent bloods from 11/19 if its relevant at all:

Estradiol: 387 pg/ml

Total Testosterone: 14 ng/dl

Free Testosterone: 1.2 pg/ml

SHBG: 63 nmol/l

DHT: 11 ng/dl

LH: <0.2 mIU/mL

FSH: <0.7 mIU/mL

Dhea-s: 121 lcg/dl

I have started 0.5mg Duta after seeing that in my first test my DHT was 25ng/dl, this was dated 22/06.

I have tested again in the following dates,

10/08, DHT 42 ng/dl

07/09, DHT 39 ng/dl

16/11, DHT 71 ng/dl

I am completely lost at this point, it's been 5 months and instead of dutasteride decresing my dht, it tripled? i am not sure what to do.

All of my test results for relevance.

Test 1 22/06,

E2 638 pg ml

FSH 0.3 mIU/ml

LH 0.24 mIU/ml

Total T 0.19 ng/ml

Test 2 10/08,

E2 266 pg/ml

FSH 0.3 mIU/ml

LH 0.2 mIU/ml

Total T, 0.15 ng/ml

SHBG 122 nmol/L

Test 3 07/09,

E2 380 pg/ml

Total T 0.24 ng/ml

Test 4 16/11,

E2 353 pg/ml

FSH 0.3 mIU/ml

LH 0.1 mIU/ml

Total T 0.24 ng/ml

SHBG 116 nmol/L

This month I reach 18 months of HRT and I would like to share my last blood test and concerns. I have many more blood tests in my profile, if anyone's interested.

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My levels have been great for the last ~15 months or so, however I've had almost no breast development. I'm not talking about only growth, I'm talking about the whole thing. They look like I'm still in Tanner 1 (or -1. Just kidding). I've tried bica for 6 months, I take finasteride every day and duta every other day. The endos that the public health system provide seem to know little about endocrinology.

And yes, my blood was drawn at trough. 5,6 of EV every 5 days. Yes, I'm lowering my dose.

Since I started my hormone therapy last year (estradiol and later also progesterone supplementation, testosterone suppression: cyproterone), my sex drive has been almost nonexistent. This has been tough to deal with for me and my partner.

I live in Germany where the choices for E are basically gel or patches. I switched from gel to patches a few months ago (for convenience), but I still had quite a lot of gel left over. Since P (200 mg) hadn't done anything for my libido as I had hoped, I decided to use the leftover gel to raise my E to see if that would do anything.

On just the patches, my E has been at about 150 pg/ml. Before that, applying 5 mg daily in gel form got me up to 190. For this experiment, I added 4 mg of gel daily to the existing patches. I don't know how much that actually raised my E levels, but it may possibly have been around 300 or 310.

All I know is that within a week or two, my sex drive was back, including sustained erections. I told my endo about this discovery, hoping he would be interested in helping me with this. But he was just appalled and said I was using way too much, potentially dangerous amounts due to blood clot risk and who knows what else (I thought only oral E came with that risk?!). He didn't even want to test my levels on this dosage, but ordered me to drop it back down to only the patches and maybe .5 - 1 mg of gel. I followed his orders, and soon enough (within a week) my sex drive was gone again.

My questions to the community experts:

1. Is it possible that raising the E up to levels of possibly 300+ could have had the effect I described? Through what mechanism?
2. Would sustaining that level of E long term be dangerous, or is my endo wrong?
3. Could it actually have been increased conversion from P or its metabolites into androgens, somehow facilitated by the higher E?

Thanks in advance for any thoughts on this!

I've been on hrt for 2 years and 4 months, and had basically no breast development since month 9. I'm not concerned about the size, but mostly the shape, of the areolas to be exact. They're huge and conular, they make up like 1/4 of the breasts with their protrusion. But they become "normal" when it's cold, so they shrink down. So recently, about a week ago, i started prog (200mg up the arse). And it made me feel like i have something hard under the areolas, just like breast buds again. I'm concerned that it could be breast tissue herniation and that i could be getting tuberous development. Is it supposed to be like that?

Is 0.7 ng/ml t and 0.9 ng/dl free t high ? Fsh and lh is under 0.1mlu/ml e is 470 pg/ml

I finally got my lab results!!! But I'm a little confused about the levels and the unit of measurement used(pg/mL).

Results: DHT - 96 pg/mL | Testosterone, total - 17 ng/dL

After researching, I found out that apparently the most used/appropriate unit to measure DHT it is (ng/dL). Is this correct?

I did a conversion on a website that turned those 96 pg/mL of DHT to 9.6 ng/dL. Is this conversion are reliable/accurate? If so, is my DHT at an adequate range or still high? Should I be concerned?

Just real confused. Most people say it’s fat distribution that’s changing posture, but Dr Powers says it’s mostly relaxin.

Would dutasteride AND estradiol specifically perhaps relate to height loss…..? I guess there is a strong effect from DHT on the ligaments, and duta is good against DHT… many people claim the atrophy in the muscles and ligaments from suppressing T/DHT results in height loss.

So is it relaxin, or ligaments, or fat redistribution/posture change, or lies? Of course many trans people exaggerate or lie about their results from HRT, or they actually believe they have gotten results from HRT that they haven’t or that aren’t possible.

I am 5’9, but I am super dysphoric about my height. I’m on monotherapy right now 4MG, it’s been 1 month. I’m prescribed 0.5mg of dutasteride. I’ve been holding off on taking it because if I don’t need it why take it… and I’m concerned about duta effecting my already strong ED at 21 (and the estradiol, of course…) and my liver when maybe it’s not necessary. But if I can honestly expect more hair regrowth from dutasteride, not just monotherapy, and maybe even contribute to height loss…….?

Idk I’m desperate here. Is there a way to tell if your muscles or ligaments actually even contribute to your height as an individual, or if it’s truly just long bone….? I think I’m the long bone type. Lmk if I’m wasting my time even imagining I will lose an inch! Thank you!

History

I'm a trans woman, 27 years old and I've been on hrt for 3.5 years and had an orchi last year. My BMI fluctuates between 22-24. I am currently at ~23.5 BMI and ~30% body fat.

I was taking pills sublingually (6mg a day) along with bicalutimide for the first year. I had nipple soreness soreness during this time and managed to develop to a tanner 3 but never got close to tanner 4.

After a year I switched to EV injections which I do 2x a week.

I briefly tried taking prog (100mg rectally before bed each night) for a few months. This resulted in my breasts swelling and some soreness but I felt I was masculinising (my body odour seemed masculine again, my skin was getting less soft and my sex drive came back very strongly). When I tested my DHT levels they were elevated compared to pre-progesterone levels.

Currently my breasts have been stalled at an A cup for the last couple years. They never feel sore and my nipples seem underdeveloped. My breasts also aren't rounded and seem quite cone / moob shaped. My chest could easily pass as a guy's chest with gyno tbh.

I've had fairly good feminisation in most other areas. Reduced body hair, muscle loss, facial changes, fat redistribution to my hips and legs. When looking at my mother and sister they're both D cups too so genetically I should have decent growth in theory at least.

Blood test 27/09/24 (taken before next injection was due):

Estrogen - 387 pg/mL

Testosterone - 11 ng/dL

SHBG - 102 nmol/L

DHT - 3.4 ng/dL

Current ideas for HRT regimen changes

1. I'm going to switch to using EEn injections 1x a week instead of EV 2x a week. This is mostly for the convenience of having to inject less often but maybe it will result in more stable E levels with less variance in peaks and troughs and hence lower SHBG
2. I've started taking 6mg boron daily in order to increase free estrogen levels (unfortunately I don't have access to labs that will confirm if this is working as intended so will just be monitoring for breast soreness and assuming that soreness means growth)
3. A recent bloodtest showed that I was low in magnesium and vitamin D (UK weather) so I'm taking supplements for this too. Perhaps this will help.
4. I might start taking 2mg estrogen tablet orally before bed for the first 10 days each month. From what I've read this is supposed to help if your E1S is low (unfortunately I don't have access to labs that will confirm if this is working as intended so will just be monitoring for breast soreness and assuming that soreness means growth)
5. I might try progesterone again. Last time was pre-orchi so maybe I won't get a DHT increase this time. If I do then I can try dutasteride to reduce DHT levels.

Are there any other things I can try? My plan for the next 18-24 months is to run through the above options. If I'm still underdeveloped I will officially give up on natural breast growth and get a BA.

Would really appreciate any feedback or further tricks I can try to get my breast growth unstalled.

Also if any trans women live in the UK and know of a place I can get my E1S or free estrogen levels tested then please let me know. My doctor doesn't offer these and I couldn't find any private options either.

I've been applying 1.25mg worth of t gel to my vagina weekly for more than 3 months now and have noticed some effects of masculizing. I feel like my face looks more rough/masculine, im having acne for the first time, Ive been sweating more, I've gotten a couple chin hairs when I've never had facial hair, been more horny. I've also increased my prog during this time and was worried it might be that but my dht is apparently good and it isn't backdoor converting. My levels seem to be ok: at trough e is 600 and my t 8 and the day after hormones: e is 700 and t is 70. Im very confused why I'm masculinizing with these levels. I've started taking 25mg of bical a week and am wondering if that will be enough or if I should stop the t outright?

I've got blood work done by my endocrinologist and i can't figure out why my T levels are still so high.

I take 12.5mg cpa and 6mg estrofem buccal daily. I used to be on lustral aka sertraline 50mg for close to 3 months which I've been changed back to prozac 20mg.

Lustral does explain the hdl cholestrol and ast level but i can't understand why my testosterone is still at 54ng while still having 196 Estradiol level... Please help me to gain insight on whats going on because im truly at lost...

Results

Creatinine 0.89 mg/dl

Estimated Glomerular Filtration Speed 120. 54

Glucose 79 mg/dl

AST 32 U/L

ALT 18 U/L

Free T3 3.68 ng/L

Free T4 0.9 ng/dl

TSH 2.046 ulU/mL

Prolactin 63.88 ug/L

Total testosterone 0.54 ug/L

Estradiol (E2) 196. 41 ng\L

Progesterone 0.68 ug/L

Insulin Starvation 6.16 ulU/mL

HOMA INDEX 1,20158024691358

Luteinizing hormone (LH) 0.26 U/L

Follicle stimulant hormone (FSH) <0.2 U/L

LDL cholesterol (Direct) 31 mg/dl

Triglyceride 63 mg/dl

VLDL Cholesterol 13 mg/dl

Cholestrol 115 mg/dl

HDL cholesterol 71 mg/dl

Sorry I just had to make a thread that cat is adorable and I never saw the profile pic until now somehow 😭

Some days I wake up with a puffy face, dark eye bags, headaches, chest tightness with a deep anxious feeling, etc. Only when I’m on EV. I just started back a few days ago after being on tablets for a while to reset my receptors. Just symptoms I’ve noticed happens on EV only. Is the higher dose of estradiol increasing cortisol levels?

Side question: while I’m starting back on EV should I still take my tablets until the injections reach a stable point in blood levels? Or is it instant and I can immediately stop tablets? My doctor didn’t inform me. And should I slowly taper my 200 mg of Spiro?

This is gonna be a long one but i thought i would post about it here.

I started HRT in March of this year, monotherapy with 7mg EEn per week. This went fine for a few months.

However, slowly a sort of "flu" like feeling appeared. It kept getting worse and worse until I decided to go to the ER. (Now it developed into full blown nausea).

My E2 level was around 400pg/ml. My T was fully suppressed at 22ng/ml.

What's interesting is that the blood test showed that my lymphocytes were way under the minimum. They were 0.8 absolute and 8% relative (1.0-4.0 and 25-40% reference).

These rise again when I have more testosterone. They don't seem to be related to Vitamin B12 or Vitamin D. Before HRT they were at 1.4 and 20%. (which is also kinda low)

I dropped my dose and these symptoms kept persisting but were a bit lifted.

Recently I tried Cyproterone acetate - which caused these symptoms too, in an even worse fashion than when i was at 7mg EEn. (Literally "I will die any moment) But now i am down to 3mg EEn...

In addition, my gums are bleeding heavily aswell and ot feels like my teeth are about to fall out.

These symptoms also happened to a lesser extent when I was on Finasteride and Dutasteride, which are the reasons I stopped those meds and went on HRT.

My GP and the ER are stumped. They don't know what it is and sent me to a psychiatrist...

It is worth mentioning that as a kid i always felt tired, got sick very easily and no one believed me either. I was always told to eat a "healthy" diet and when i did so they always claimed i cheated cause it made no difference in blood tests - I have suffered from chronic diarrhea and gastritis forever. Recently had a gastroscopy and colonoscopy done and they found unexplainable gastritis.

I think I suffer from a sorr of anemia.

Hi, my recent blood work after 11 months on hrt has me concerned. My last labs were around month 4-5 when I was on patches and things looked on track, E was just low. So we moved to injections and I’ve been on EC & EV since. I felt not great on EC no matter the dose - depression/fatigue/brain fog/anhedonia etc, so after one vial of it, we switched to EV injections 4mg every 5-7 days and immediately felt better. Sometimes I do 5 days sometimes 7. I just think 5 is too frequent to do this for the rest of my life so I try for 7, for 3 months or so.

Anyways, my E was 187 and my T was 780. What the hell is going on?! With no hrt my T was like 270-310. Since discovering this, I’m in the process of going off raloxifene to see if it was the culprit but aside from that any ideas? Only other meds I take is 2.5mg finasteride daily.

Thanks

One of the services I do for my patients is to review any available genome results for potential hazards or other additional things that I can optimize to improve their health.

Typically, I will use a 23andme raw data dump, or an ancestry.com data dump.

Many people are concerned about privacy when it comes to these, and I always tell them, you can purchase the kit from Amazon, register it under a fake email, and give a fake name. And they will never know who you really are.

Routinely, I review the genomes of Clark Kent and Lois Lane.

These kits are on sale on Amazon until Monday for as cheap as $40 a kit.

MTHFR gene testing from quest can be hundreds of dollars, but for $40, that's just one of thousands of different things that I can check on someone's genome.

Some of the things that I can learn about from someone's genome include COMT status, vitamin D receptor genes, MTHFR, MTR and other methylation defects, certain hormone enzyme anomalies, things relevant to transition, certain cancer risks or other genetic syndromes or hypercoagability risks. I can't tell you everything because I can only tell you what I have found, but there's hundreds of thousands of single nucleotide polymorphisms available on these arrays. In terms of spending your money to get something useful in regards to genetic testing, this is absolutely the best deal.

I don't have a strong preference between either kit, and the chip for the various companies is the same chip no matter which tier of service you order.

Basically, the raw data from the cheapest version is the same as the raw data from the most expensive one, you pay them for the interpretation. This is something I do for people who are my patients for free. So if you want to do one of these, you can buy the cheapest option. One is on sale for Cyber Monday for as cheap as $40

Ive attached a photo of what one of these reports looks like (this specific one is about methylation defects, and has nothing to do with cancer or other risks)

If you do choose to do one of these, and get the raw data, let me know, because I will be happy to analyze it for you and make sure there's nothing that we need to be aware of! I do this for free for anyone who is my actual patient (but sometimes the results are complex or serious enough that we need to have an appointment to talk about them.)

So I started 100mg P4 once a night and a little P4 cream on one breast (I'll update to see how much later but I recall it was very little concentration). Been doing this for about 2 weeks or so along with my new EC 0.34ml @ 5mg/ml once every 7 days. Used to do 0.17ml @ 10mg/ml a week prior.

I have 2 yellow spots on my arm that sort of look like a bruise that's been there a week and a good amount of little red dots on me. I have a physically demanding job that requires a lot of walking up and down stairs and I recently got a shortness of breath after 3 flights when normally I do them all day and barely get winded...

Could this be P4 or my new formula of e2? It seems to have different carrier oil and preservatives than the last stuff, but no side effects like pain, which is good because EV always gave me issues with pain.

I've read little raised red bumps are from e2 and hrt can cause skin discoloration... I also read shortness of breath is not a good thing and hrt can cause it.. But I've been on Hrt for over 3yrs... But only EC subcut injections for maybe 4months now.

I've also noticed a good amount of hair loss, but I also changed to a tea tree shampoo that seems to be aggressive and I won't use again... So I got a lot going on and will reveal after a few weeka but figured I'd put it out here.

Any info or experience?

Just like the title says, I started HRT on my 19th birthday and it didn't really do much for me. It made my skin look mildly better and it seems to have kept me from masculinizing any more. I'm 6'0, 135 lbs., never got breast growth beyond very mild gynecomastia. I've had FFS with a very famous surgeon and it didn't change the fact that people either avoid gendering me or gender me male.

My initial regimen was 2mg oral estradiol 1x day, 100mg spironolactone 2x day. When COVID happened I was off HRT for nearly a year due to being forced to move back in with my transphobic parents for a bit, then I restarted that regimen but with my E dose upped to 3mg.

About two years ago I switched to injections and now every appointment I have with my provider he tells me that my E levels are too high and lowers my dose. Currently I inject 0.3mg from a 20mg/ml vial of estradiol valerate, once every week. Previously it was 0.4mg.

Here are my two most recent bloodwork results:

12/12/2023:
Testosterone, 13 ng/dL
Estradiol, 556 pg/mL

3/30/2024 after cutting dose:
Testosterone, 10 ng/dL
Estradiol, 369 pg/mL

Both times blood was drawn sort of in the middle of my cycle, maybe not precisely the midpoint. The newer result was closer to the end of my cycle. I don't think injections made a huge difference for me, maybe a very subtle improvement.

Is there anything I can try at this point? I know my height plays a role but I want to believe there are still options left. I've ordered boron supplements to see if that does anything although I've never had SHBG tested.

I have some genetic abnormalities like elongated disproportionate limbs, hypermobile joints, pectus excavatum, nearsightedness, and intermittent strabismus (which I can largely control). I developed permanent stretch marks all over my back when puberty hit that almost look like scars. My skin is very sensitive and even things like Cerave cause a red, irritated reaction on my face, but my skin is clear and I've never really had acne issues. Before my surgery I had a bifid nasal tip. I've had doctors point out tachycardia in the past. I have dental crowding and a bit of a narrow palate. My face is kinda long. As a teenager a doctor thought I might have Marfan syndrome, but the cardiologist said my heart was healthy and they said I didn't quite meet enough criteria to be diagnosed with that.

I had Rh disease as a fetus and jaundice when I was born. I weighed 9 lbs. I have no learning disabilities and was considered academically gifted as a kid, but socially slower to develop. I've never been formally diagnosed with autism but I probably have it and my mom said she always assumed I had it. I've always been very bad at sports or any kind of physical activity, like just no endurance or coordination. I never developed any chest hair before starting HRT. Facial hair was maybe patchy but definitely present, dark, and thick before laser (I never grew it out to see how patchy). I had a prominent Adam's apple before surgery.

This sounds like a lot but I don't think I look "unattractive", just not necessarily feminine enough. People have considered me attractive in the past at least and I've been in romantic relationships with people I considered attractive. A lot of people seem to view me more as a twink-ish teenage male than a 28 year old woman. I don't think my skin got the same "glow" I see a lot of other people get on HRT even though it's clear and fair. I get misgendered even when I haven't spoken so it's not my voice. I get misgendered every, single, day.

Anyone got any advice? After the boron is there anything else I should try? Maybe dietary suggestions? A lot of people are very rude to me because I don't pass. I'm willing to try anything. Every doctor I've ever had has come across as kinda clueless and they treat me odd/rude too.

Hi I’m 18 yo MtF I’ve been on HRT for 2.5 months and my current dosage is 4 pumps of lenzetto, scrotally, two each 12 hours , 75 mg. of spiro everyday and 1 inyection of depo provera every 3 months I begin taking lenzetto in the arm to weeks but then decided to go with scrotally, the first two weeks went great , begin to have breast development and my skin got softer and w less acne , but then a masculinization has come going further and further, my Adam’s apple have gotten bigger , I’ve grown hairs on my chest, hands and legs , also my facial hair went back after almost eliminating it w laser, got acne on my cheeks and chin I have a strong body odor, my libido came back as well , all this usually happens after I begin to feel like tingle on my scrotal area , the more it’s there, the more are the androgen if effects Also I had ultrasound and blood test and doctor checking to discard a possible testicular cancer, and fortunately it is not at all

Took my test 8 hours after my last lenzetto dosage, the levels are Total Test: 0.150 ng/mL Estradiol: 350 pg/mL Prolactin: 67.10 ng/mL DHEAs: 421 ug/dL GCH: <0.200 mUI/mL (This one was for checking possible testicular cancer, already discarded)

Also usually I sleep like 5-8 hours everyday and even if I try to not be I get stressed easily , I’m 1.76 cm and 62 kg.

I wonder if it’s maybe a problem w dht, I’ve been taking dutasteride 0.5 every day for three weeks

Or a problem w DHEAs in my case I’ve been two weeks w dexa 0.5 mg everyday for two weeks but haven’t seen any change yet, actually I’d say it have gotten worse

Also I’m wondering if it’s a problem w SHGB and I should lower my dose or go back to arms lenzetto pumps or if just is a problem with Estrogen Insensitivity Syndrome

Would love any of your help or advice it’s been really sad and frustrating see how this have gotten worse so fast

I hope this is okay to ask here. I used to find a lot of information and knowledgeable people when I started my transition about six years ago, so I thought this would be a good place to ask. Also because I've seen u/Drwillpowers mention that he has some methods for this, so would love to hear what he thinks.

In short I started hormones six years ago and had an orchiectomy four years ago, but I've since changed my mind. I have been socially detransioning for a while now and have been slowly lowering my EV injection dose since a couple of months (E still in female range). My next endocrinologist appointment is in a month and I would like to be prepared in the likely case that he's never dealt with this before.

I know that to hormonally detransition the only option for me is to take testosterone for the rest of my life, and I'm okay with that. I'm just wondering what's the best way/if there is a best way to go about this (slowly introduce T while still on E, stop E when tapered down and start T at the same time, etc.)

Curious to hear everyone's opinion!

Doing the same with rectal progesterone 200mg. I’m on 6mg of EV weekly injections. Is this a good idea? I’m coming off of just doing everything every night and for the past three months i’ve noticed little difference. If I’m to cycle both what’s the best way to do it?

Hi everyone, here's my story, and I could really use your thoughts:

I started HRT at 19, and it's been 3 years now. Initially, I was on oral cyproterone acetate (50mg), which I lowered to half after 9 months. For almost two years, my testosterone was completely shut down, leading to no libido and other effects. At the two-year mark, I reduced my cypro dose to a quarter of the original amount and switched to injectable Enanthate (4mg a week).

Since I was on injectable estrogen, I decided to stop using cypro altogether, as I hated taking it and knew it wasn’t the healthiest option. However, when I tried to taper off cypro, I experienced a heavy rebound effect—things like sudden body hair growth, thickening of vellus hair, very oily skin, feeling overheated, extremely high libido, and fat distribution in more masculine patterns. It was overwhelming, so after two months, I went back to cypro.

I’ve tried to get off cypro two more times since then. One attempt involved switching to bicalutamide, but I discontinued it because it wasn’t effective enough.

Around the two-year mark, I began considering orchiectomy, and I had the procedure two months ago. The goal was to eliminate the need for cypro. I tapered off cypro and went completely off it after two weeks. But once again, I'm experiencing the same issues as before—body hair growth, increased libido, skin changes, nausea, and bloating.

I’m currently waiting for my bloodwork results, which will include DHT and SHBG levels. I’m struggling right now, and it's frustrating to see these changes happening again. Literally i'm growing hair all over my face and lost so money as my laser treatment was for nothing.

My guess is that it might be related to adrenal issues or possibly some weird androgen receptor upregulation, especially since my testosterone levels were in the lower female range last times I went through this.

Has anyone here experienced something similar? Any advice or insights would be greatly appreciated!

PD: My doctor told me every time that this is impossible if my T is at femenine levels

I recently started using the compounded Anti Aging cream and last night was my 4th use. No negative skin side effects but each of the 4 times I've used it I've had very realistic vivid wild dreams.

I really don't dream and when I do they are always unremarkable and these have been intense world building dreams.

Anyone have any thoughts on this? Or maybe my brain is just dreaming of smoother younger skin :P

For reference it's this one: Alpha Lipoic Acid 1% Aloe Vera .05 Azelaic Acid 5% BIEST .05% DMAE 4% Melatonin .05% Progesterone 1% Tretinoin .05% Vitamin E 5%

The below attached mass message was sent via the portal and to every PFM registered email account this morning about upcoming changes to the practice.

Without getting too much into the weeds, even me working 60-70 hours a week for free is no longer sufficient to keep the practice solvent. Reimbursement has been cut continually since 2019, inflation is brutal, we see Medicaid patients at a loss, and commercially insured patients currently owe us hundreds of thousands of dollars in bad medical debt we haven't written off yet (LGBTQ people are not better off for the past 4 years of post-pandemic economy). We've written off more than a million dollars in medical debt over 5 years.

I have been faced with very difficult choices.

1. Cast all our Medicaid patients out, and also discharge all commercially insured patients who are behind on their balance. (thousands of people instantly lose care access)

2. Shut down PFM entirely. Go work for a hospital clinic and maybe some people could follow me there? (Maybe not as bad as #1, but all out of state/telehealth patients are screwed, and few clinics are likely to tolerate much less welcome the kind of medicine I do in our current political climate).

3. Make the below change. Hope that the program is successful, and that the revenue from it will cover our overhead, allow us to see Medicaid and underinsured patients at a loss without closing our doors. Maybe I'll even get to break minimum wage!

I chose option three.

This was an impossible situation, I've done everything I possibly could do for years now to make this work, but no amount of trips into the dunk tank and patient assistance fundraisers could make up for the deficits.

I apologize to the patients who have been loyally seeing me for many years who now will be shifted to other providers if they do not join the DPC membership. I didn't want to have to do this, I tried everything I could, but at least this way, you're not totally cast into the street, and PFM will continue to exist and be accessible for those who need us.

Thank you for your understanding and forgiveness.

- Dr Powers

Ps: Just for the sake of simplicity before everybody goes and has to browse all the links to find it, it's $1,200 a year for 12 appointments and two free laser sessions and a $200 discount on pellets for in-state patients and $1,600 out of state.

This is the fee regardless of whether or not you have insurance. So if you are completely uninsured, you can see us once a month every month for 12 straight months for $1,600 if you say live in Arizona and want us to manage your stuff remotely. Or, if you live in Detroit, and you want to have me stitch you up after BDSM sessions once a month for $1200 a year and get some free laser cosmetic sessions with it as well.

We are trying to make it as affordable as possible, but simultaneously, remain financially solvent so that we can continue to exist for you. Getting paid $22 an appointment for Medicaid was just no longer sustainable when the practice cost $200 an hour to run and even the commercially insured patients aren't paying their bills anymore. With no income, we were soon to cease to exist.

. . . . . . . .

Patient Update (Important): Powers Family Medicine

Dear Patients,

We are writing to inform you of an important update that will go into effect on January 1, 2025. To improve patient care, reduce unpaid medical bills, and simply be able to remain in business we unfortunately have to make changes. In order to continue to serve the community and in particular, our Medicaid patients, we are making changes to our insurance protocols and Dr. Powers (only) will be switching to a direct primary care model.

The changes are detailed below and outlined in our FAQs available at www.powersfamilymedicine.com/update-faqs

What's Changing:
(1) Michigan Meridian Medicaid and Michigan Meridian Complete Medicare-Medicaid (Meridian) will be the only Medicaid programs accepted by Powers Family Medicine.
(2) Dr. Powers will be shifting exclusively to a Direct Primary Care model. Whether you have Meridian, Commercial (Private) Insurance, or are uninsured and self-pay, all patients will pay a flat quarterly or yearly fee for all necessary appointments. Other former cash services (cosmetic laser / pellets) will be offered at significant discounts for members. You can learn about the fees and services included in the Powers Family Medicine Direct Primary Care Membership via the Membership Guide linked further below.

(3) There will be an upper limit to the DPC program membership, with enrollment offered
preferentially to current patients first. If we reach capacity, a wait list will be implemented similarly to how we did in 2019.

What's Not Changing:
(1) Patients currently seeing other providers, including Dayna Niewolak, Sommer Shefferly, and Damian Gerkman will experience no change in their care plan. Patients who currently have Meridian, Commercial (Private) Insurance, or are uninsured and who self-pay will not experience any changes to their care or access to their provider if they are not currently seeing Dr. Powers.

(2) If you choose to remain a patient of Dr. Powers and have a Direct Primary Care
Membership, you can still use your Meridian or Commercial (Private) insurance for labs,
imaging and diagnostics, referrals, medication and other services.

(3) If you elect not to join the DPC program with Dr. Powers, we would be happy to transfer your care to one of our other providers.

Why We're Making These Changes:
(1) We remain committed to supporting the community and our patients. If we continue on our current financial path, we simply won't be able to do that.
(2) Revenues received by the Powers Family Medicine Direct Primary Care Membership will
offset the financial losses caused by our acceptance of Meridian Medicaid and unpaid
medical debt. By remaining a patient of Dr. Powers and joining the Powers Family Medicine Direct Primary Care Membership, you are enabling us to keep accepting Meridian and directly supporting a patient in need.

Resources:
We understand you may have questions or concerns about these changes and how they will affect your ongoing care or insurance coverage. Our primary goal is to ensure a smooth transition and to continue offering you the best possible care. To help you navigate this upcoming change and answer any questions you might have about your care options moving forward, we have developed detailed FAQs:

FAQs for all Patients: www.powersfamilymedicine.com/update-faqs
Powers Family Medicine Direct Primary Care Membership Guide:
https://powersfamilymedicine.com/update-faqs/#DPC-membership

Please refer to the FAQs before calling the practice, emailing reception, or sending a message in your patient portal. If your questions are still not answered by the FAQs, please email us at

Questions@PowersFamilyMedicine.com

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Hi everyone, as the title says, I've just turned 18 today. I don't live in a safe environment and am still on parents insurance, meaning I cannot get access to HRT without DIY. Immediately beginning with estradiol esters would become too obvious within the few months due to breast development and facial changes. I am still in an unsafe environment for transition, so I have concerns starting that aspect immediately. I plan to use bicalutamide for at least a few months to suppress whatever remaining development can occur naturally from androgenic effects of testosterone (even though I am so late into development). Is there anything I should know going into this? Will this have any effect on when I eventually am able to utilize estradiol esters, or is it largely too late for any meaningful preventative measures of bicalutamide to take place? Any other things I should be aware of when taking bical at the normal dose for a few months before truly starting HRT? Thank you.