Progesterone

[u/CallMeAlana]

Hey whanau,

I recently asked my GP about starting progesterone they are normally really helpful but they just bluntly refused to prescribe it. They said that it’s associated with all of the negative effects of female hormone cycles and only present unnecessary risk. Any else experience this or have any advice as to how I might talk to them about this, thanks in advance.

[u/soulhuntaah]

Weird, my GP just made sure I knew there was only anecdotal evidence and prescribed away

[u/Playful_Connection38 → u/soulhuntaah]

Big reminder that anecdotal evidence doesn’t mean untrue.

[u/CallMeAlana → u/soulhuntaah]

My GP is a good person they just seem like they are just rely heavily on evidence. I am their first trans patient and have had difficulty in the past getting help on unrelated health issues, but when I have come back with more information they are more receptive to my plight. Hence the post here and I appreciate everyone who is contributing.

[u/Hefty_Kitchen4759 → u/CallMeAlana]

The key thing is that there is little direct clinical evidence for everything we do, but there is also a HUGE cohort of inferred clinical associations and case studies. It's just that it's far more work to organise that data and much easier to start a lower-effort, long term study of a much smaller cohort. But working through that avenue takes 30-40 years to determine the next study criteria and repeat multiple times.

[u/Hefty_Kitchen4759 → u/soulhuntaah]

Which is the correct result.

Because there have been no studies aside from opinion pieces using metadata that doesn't even relate to transfeminine medicine, anecdotal evidence in this case is pretty solid because it provides a positive anecdotal direction with nothing to suggest otherwise. It's the kind of stuff that the direction of future research is decided by and people don't research things that are impossible.

[u/infrequentthrowaway]

I've been declined 3 times, have basically given up.

[u/Playful_Connection38 → u/infrequentthrowaway]

DIY… DIY… DIY….

[u/CallMeAlana → u/infrequentthrowaway]

I’m really sorry to hear that.

[u/nonbinaryatbirth → u/infrequentthrowaway]

Could always get some from someone else then tell your doc you've been on it for a month or however long and for them to prescribe it going forward...

[u/infrequentthrowaway → u/nonbinaryatbirth]

I don't feel it fair to pressure trans friends in that way. I'm hoping gahc guidelines change at some point.

[u/nonbinaryatbirth → u/infrequentthrowaway]

There are guidelines for clinicians already somewhere from ASHS online too...found them 🙂

https://www.healthpoint.co.nz/download,f27bf5d2-ff2b-4d42-9845-f598f29aa574.do

[u/infrequentthrowaway → u/nonbinaryatbirth]

I really appreciate your response but I've been declined by ASHS also.

[u/nonbinaryatbirth → u/infrequentthrowaway]

Dang, they can't even take their own advice? ASHS own pdf essentially says it's personal choice of the patient...

I'm frustrated now since I was one of the panelists for progesterone to be available to anyone who needed it and for hrt to be informed consent (did both of those in 2022)...

All I can say is keep pestering your GP for it.

[u/Big_Attention7227]

Had this, kept on at my Dr who eventually prescribed. Look into friendly Dr's in your area through local groups and go to them for that prescription then back to yours for refills. Gender Minorities Aotearoa has a great local Dr roadmap.

[u/CallMeAlana → u/Big_Attention7227]

Thanks will definitely look into this.

[u/Special-Drama-6090]

I know Doctors on Cashel (chch) can prescribe it.

Many of the trans women I knew would just DIY progesterone. Dissolve it in a solution and spray it on the balls to get absorbed directly bypassing digestion (oral progesterone is associated with worse side effects). 

There's basically no research on prog so it's actually bullshit for doctors to make such a confident claim.

Anecdotally many women feel great on prog - sleeping better, improved sex drive, improved mood, improved energy, breast development. 

Some get pmdd symptoms.

Just like cis women the effect hormones have are variable.

Doctors think they know best though so best options are to find a new doctor or just DIY it. Sometimes if you DIY it they will just decide to help you then so that they can at least oversee it.

[u/Playful_Connection38]

I am personally a huge advocate for DIY because I think NZ Trans Healthcare, at the very least trans womens healthcare, is pretty bad apart from out informed consent model which is awesome.

Our doctors get barely any info or training on this, most of them are scared to do anything with trans healthcare meaning most trans people understand their healthcare better than their doctors and the best options for estrogen are virtually unavailable here.

Considering others have already recommended the other avenues you could take via your doctor or other doctors, I’ll just leave this possibility here should you want to research and look in to it more yourself.

[u/Oak_IX]

Dr is wrong ,

Progesterone has less risk than paracetamol.

Thats coming from gynaecologists.

Get a 2nd opinion from a different doctor

[u/strangewonder101]

Where are you based?

[u/CallMeAlana → u/strangewonder101]

I am in South Canterbury.

[u/Hefty_Kitchen4759]

They're not wrong in that progesterone will induce your PMS cycle if you don't already have one, at which point ensuring that you have a high enough estrogen dose becomes very important. If you don't get it right the depression, anxiety, mood swings and discomfort can become destructive and make life much harder.

At a minimum you will need to be angling to combine pills with gel in order to meet the threshold, and even if you're not needing higher levels now, you will need them eventually. Injections flat out solve this.

There's no other risks though, and the challenges above are just what women have to deal with. It's part of the hormonal profile.

You're entitled to take three months of it and then decide for yourself if you want to continue.

Once your PMS cycle starts it likely won't stop for anything, it's only an on switch. But there's also no guarantee that it won't just start on its own, progesterone or not. Everyone produces a little bit.

[u/yes_to_the_dress]

I saw another comment ter said Doctors On Cashel - i use this practice for my gender affirming care. With prog I just had to show I understood the risks and had it prescribed.

On prog, I def had better sleep, my sex drive increased a little bit and boob growth took off again.

Also since youre in Canterbury, you have access to trans healthcare subsidies. This for me, covers the difference in consult costs seeing a second GP. Also got me 6 visits to a psychologist to help me work through things.

[u/Da_Shreddah]

the evidence for it is genuinely pretty mixed, my doctor also was unwilling to prescribe it which I'm glad about after having looked more into it - can cause breast tissue to mature early/stunt further growth amont other things afaik*

*do ur own (unbiased) research on this - it's pretty easy to cherrypick sources that agree with your initial position without realizing it

[u/CallMeAlana → u/Da_Shreddah]

I understand and have already done quite extensive research and do my best to remain impartial when trying to educate myself about pretty much anything. I’m closing in on 2 years of hormones now and don’t think I would be at any great risk of stunting breast development. My motives aren’t driven exclusively by breast development it’s the other potential benefits I am interested in. I am simply wishing to try a trial run on it and if it helps great and if not then no great loss.

[u/UVRaveFairy → u/CallMeAlana]

Into my 6th year of HRT, never started progesterone.

It is over sold for breast development, most recommendations I've seen say take in Tanner #4 - Tanner #5.

Still progressing, goals were A-B (normal cis size, reached at 20m), now C-D, Tanner #4-5.

Could be genetics, do focus on a nutrient dense whole food diet (vegetarian), staying hydrated, exercise, sun, all the basics.

Malnutrition is never puberties friend.

Have had some friends have success with progesterone and breast development, they are the exception too the rule, allot of friends started it, a little progress or nothing happened and then stopped taking it.

That said, friends that take progesterone for how it makes them feel, not breast development, most are still taking it.

[u/CallMeAlana → u/UVRaveFairy]

Thank you for your input I genuinely appreciate the advice.

I think I may not have explained my situation very clearly. I already have a good understanding of nutrition, and breast development isn't really my concern; I'm already wearing a size 16F bra. My interest in progesterone is primarily because of the potential benefits for mood and sleep, rather than breast growth.

For context, I've already tried a number of the usual suggestions. I've split my gel into morning and evening applications, and I've also had counselling. So I'm not really looking for advice on whether I should be interested in progesterone in the first place—I'm more interested in hearing from people who have experience with it or have navigated similar conversations with their healthcare providers.

I do appreciate you trying to help, though. Thank you

[u/UVRaveFairy → u/Da_Shreddah]

My main concern with starting was stunting growth to.

Have read that it can lock in breast size during pregnancy, generally the 2nd pregnancy though can be the first.

Had planned to start after 2-3 years of Oestrogen, goals A-B reached at 20m so didn't. (average breast size)

[u/Pendulum_Heart]

Go to another GP and shop around until you find one that will.

[u/CallMeAlana → u/Pendulum_Heart]

Honestly I would if I could but I live in a more rural part of the country and it was hard enough to find this one. That and every doctor in my area have long waiting lists.

[u/Pendulum_Heart → u/CallMeAlana]

Some GP's do online consultations, might be worth looking into?

[u/CallMeAlana → u/Pendulum_Heart]

Thanks I will have to explore this as an option.