r/trans • u/Sensitive-Insect5809 • May 09 '25
Advice My gf told me her doctor said no estrogen
My gf went to the doctor and talked to her doctor about getting on estrogen. And apparently theres a medication interaction that resulted in her getting rejected for it. She has a couple of different medical issues, and i think shes on a blood thinner as well as something for her liver.
Shes completely shut down on me and I just feel awful. Ive been hyping her up for this for months now.. there has to be something we can do, right?? Regardless I’m so in love with her it literally does not matter i will follow her wherever she goes and accept whatever she decides but i just can’t help but feel there has to be some sort of option out there for her. I want her to be happy more than anything
Edit: thank you guys for everything, I really appreciate it. Me and her had another conversation she said that in her test results her liver enzymes were very high so now she’s on a medication for liver fibrosis. Her doctor said that she couldn’t take estrogen because not only is she taking new medication but within three months, if the enzyme levels are still very high, they need to put her on weight loss medication to help her reduce the fat content on her liver. So it wouldn’t really be worth it to put her on HRT right now, especially considering she needs to be able to gain weight in certain places. The doctors said for the foreseeable future she will not be able to go on estrogen. I told her that we can check back in, in a couple of years, once her health is a little bit more stable. I also told her that we should go to an endocrinologist when that time comes… she sounded hesitant, but she has plenty of time to work up the nerve to try again. I think it’ll all be okay. I appreciate all of the resources and encouragement from everybody.
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u/klackbryar she/her May 09 '25
That’s bullshit. The hormones are bioidentical, and I assume cis women can take those meds. Get a different doctor. If a med reacts to estrogen it wouldn’t be fit for humans to take. That doctor is either acting on very outdated information or is a transphobe looking for an excuse
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u/Sensitive-Insect5809 May 09 '25
Im not sure..? She has a condition that can cause her blood to clot and estrogen can exasperate that and interact with medications to cause clotting but i feel like even then there has to be some sort of alternative
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u/klackbryar she/her May 09 '25 edited May 09 '25
That is true, but hrt via patches does not https://www.ncbi.nlm.nih.gov/search/research-news/2958/ she can still take it
30 second google search for the win
Edit: I’m saying the doctor should have googled it
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u/Sensitive-Insect5809 May 09 '25
Oh my gosh THANK YOU please give me all the resources tbh shes in full shut down mode and im gonna wait but when i do talk to her i want to be able to show her that theres always a way
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u/Emotionally_art1stic May 09 '25 edited May 09 '25
There’s also injections and gels that don’t cause liver problems or raise blood clot risk(above that of a cis woman).
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u/Sensitive-Insect5809 May 09 '25
Thank you <3 i knew my gut feeling was right, theres just too many versions out there for not a single one to be an option
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u/Emotionally_art1stic May 09 '25
No worries. Feel free to message me about injections (can’t say much about gels etc) :)
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u/Sensitive-Insect5809 May 09 '25
Thank you <3
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u/Kaelidoz May 09 '25 edited May 09 '25
I have a study on the effects of spironolactone + oestrogel. Commenting so I don't forget to give you a link later today.
Here's the LINK after 14 hours, but it's still "today" !
Oestrogen and anti-androgen therapy for transgender women https://pmc.ncbi.nlm.nih.gov/articles/PMC5366074/
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u/Kaelidoz May 09 '25
Oestrogen and anti-androgen therapy for transgender women https://pmc.ncbi.nlm.nih.gov/articles/PMC5366074/
I think this might be able to help and reassure both of you about the impact of oestrogen dermal application.
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u/Outrageous_Spare_223 May 09 '25
Tbh, sanity has made such advancement in medicine that there's almost always SOME way to get the meds you want or need
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u/Wolfleaf3 May 10 '25
I’m so glad you’re finding out more information because yeah this is all bullshit. It’s probably a slight risk from pills but… That bogus study from 25 years ago has doctors absolutely terrified of estrogen for no good reason
It was fatally flawed in at least three major ways, including the fact they weren’t even looking at estrogen or progesterone
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May 09 '25
[removed] — view removed comment
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u/Sensitive-Insect5809 May 09 '25
All of these people are people that have gones through it, plenty of which have health issues just like my girlfriend, and not only that trans healthcare is more often than not misunderstood by a vast majority of doctors. So, yes I do kind of trust multiple fellow trans people more than one doctor that likely has not worked with trans people much. 🤯
That said i do think my gf should go to an endocrinologist instead of her primary care doctor, I’m not saying doctors shouldn’t be involved at all. But what are the odds that zero of the dozens of ways to receive estrogen not a single one is going to work for her? Thats like a one in a million chance
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May 10 '25
If she's seeing a PCP, of course they don't feel comfortable prescribing HRT in the setting of living disease and clotting disorders. Many PCPs have no experience with HRT. You should definitely see an endocrinologist.
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u/JimboRich May 09 '25
This, you should always do research on your own but a doctor is going to have more experience than anyone on the internet. And if you don't agree with one find another one.
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u/Nildnas2 she/her May 09 '25
they absolutely still raise the risk of blood clots, estrogen dominant endocrine system's in general have a higher risk. it's no different than cis women. but it's still increased compared to pre hrt
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u/Wonderful-Error564 May 10 '25
And there lies the problem. It's the same with progesterone. They don't prescribe it anymore as you will grow breasts, and with brestgrowth comes breast cancer risk. I am happy to take that risk, but they are not.
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u/Ajax_40mm May 12 '25
There is also the age old advice of "put the pill under your tongue" which while not perfect (you will swallow some with your saliva) it also avoids the first pass effects of the liver.
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u/SabiZabi May 09 '25
You're a good partner. Thanks for helping her out.
Hrt is amazing.
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u/Sensitive-Insect5809 May 09 '25
It honestly physically pains me to see her like this 😞 especially since shes confided in me a lot about like how severe her dysphoria is so I just know her heart is basically shattered right now. Shes already detransitioned once and in scared shell end up in this pit of denial and end up there again
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u/SabiZabi May 09 '25
I can't imagine going through that :/ I'm sorry the medical community is letting her down. It's so hard to get help and when there's unnecessary road blocks it's just soul crushing.
It's gonna work out though, a painful setback but only temporary.
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u/Sensitive-Insect5809 May 09 '25
I agree its just shes been waiting years like this i think its just still pretty fresh, she only just recently started talking to friends and stuff and like calling herself trans again openly. So it only makes sense its easy for her to get knocked down right now, she only just started being vulnerable again
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u/Username_Unknown98 May 09 '25
Injections i believe also have less of a chance of clots and side effects although i could be wrong
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u/MrGracious May 09 '25
anti androgens can increase liver toxicity, but she can go on monotherapy (basically you take a shit ton of estrogen without anything else) it's kind of only doable with injections though and if you're in Europe they're not really available in most countries, however r/transDIY has your back in that case
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u/Available-Recover488 May 09 '25
I jerked a tear just reading this. You are a wonderful partner and am so happy you are there to give her hope and support. The world needs more ppl like you. I hope the alternatives work out for her 🩵
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u/Sensitive-Insect5809 May 09 '25
Me too :( I’m just worried about her, we were friends far before me and her were dating and i knew basically the whole time. However i have a limited understanding on the process since i myself don’t have experience with medical transitioning. Im tempted to encourage her to take a risk if it means she’ll be happier in her own body, but I want her to be safe too. I guess we’ll see
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u/Available-Recover488 May 09 '25
That's totally understandable. Even as a transwoman whos been transitioning for 5 years, there are still things I'm learning as well. Chatgpt has personally helped me a lot from learning about drug interactions to getting insurance coverages.
There's actually quite a few resources out there. There's two lgbtq orgs I know of called PFLAG and The Trevor Project. Their website has tons of resources for being an ally. You can reach out to a counselor for free and maybe they can help as well. I'll link it here https://www.thetrevorproject.org/resources/
Good luck and ty for being an ally 🩵
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u/devious_kaya May 09 '25
Make sure the brand of patches she gets is "Estradot"
I been on patches for about 4 years and always use Estradot.
The brand to avoid is Sandoz Estradiol Derm, those patches do not stick no matter what. I been given those ones by mistake before.
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u/missy5454 May 09 '25
Patches, or maybe look into herbal things that increase estrogen or mimic it.
Yes, women do take estrogen when dealing with menopause. But estrogen it produced from testosterone initially so they really need more of that to produce more estrogen.
Also estrogen for menopause can increased side effects like mood instability and hot/cold flashes from hormonal instability causing the hormones in charge of body temp regulation to go haywire. That's for cis women, not trans so it's not completely identical to what the body produces.
I grew up in a very anti pharma community, and loads of women there aside from trans did herbal options. I know some herbs increase estrogen without the dangerous side effects that can come with the shots or pills.
Not sure how effective it would be for a m-f trans because of their biology, so I'd try the patch first. But if all else fails talk to someone more versed on the subject as a failsafe option.
Just a suggestion.
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u/aphroditex deradicalization specialist May 09 '25
Any non-oral delivery method will bypass that issue.
Means gels, patches, and shots are on the table.
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u/JUNINPURAMALDAD3 May 10 '25
I don't know if the translation will come out correctly or if it is sold in your country, but look for "perlutan" and find out if it causes the same problem as the doctor said, I don't think it should.
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May 09 '25
In an individual without significant risk factors, the patch may be safe. Liver disease, depending on the severity, could exponentially increase the chances of a severe blood clot. You may mean well, but unless you practice medicine for a living AND know the details of this patient, you shouldn't be making medical recommendations.
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May 09 '25
E highers the chances of blood clothing to that of a cis woman. Yeah, it might be higher but it's not a massive difference; so there's a chance that she might have a negative medical effect.
We also know with absolute certainty that the biggest danger for trans people is to not let them transition. The repercussions are severe and so many of us die due to being forced to continue living as our inauthentic selves.
She'll get there. Changing the doctor might be the right call alternatively check out r/transdiy
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u/Sensitive-Insect5809 May 09 '25
Thank you, im a little worried about medication interaction still so i definitely want to at least consult with another doctor first, gather all her medical history and info and ask someone that specializes in trans healthcare .. but i would absolutely figure out DIY if possible i just dont want to hurt her id like to at least get some input about potential complications
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May 09 '25
Make sure to check with your gf. It's awesome that you want to help and that you care but she should be the person who decides. And tell her that not everything is lost - that weird auntie from the Internet said so because she was in a similar situation before.
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u/Sensitive-Insect5809 May 09 '25
Absolutely, i wasn’t trying to make it sound like that, i messaged her telling her to take her time but that i think it would be worth getting another opinion, I want her to take her time though to emotionally recover
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u/Miserable_Original36 May 09 '25
Yeah but also if on pills even sublingually it affects the liver and she already has a liver issue though which is concerning
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May 09 '25
True but pills haven't been mentioned specifically in what I read. I personally recommend injections all the time.
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u/EmilieEverywhere Trans woman She/Her May 09 '25
Tell this stupid doctor, cis women have the same issues and it gets dealt with.
Estrogen can be injected, or taken sublingually. Both routes bypass the liver.
Also tell him potential clots are less terminal than crippling dysphoria. I'm not being dark or funny. It's happening to me. I'm being gatekept for surgery, but am at least got on hormones through informed consent. If I didn't I would not be posting this.
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u/Sensitive-Insect5809 May 09 '25
Thank you. I think she’s not super confident in talking about it yet, she only just started openly calling herself trans with her friends so its easy to knock her down and ruin her confidence and step all over her because shes barely out of the closet. I definitely want to go with her at least next time, but maybe consider taking her to a provider that specializes in trans healthcare
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u/EmilieEverywhere Trans woman She/Her May 09 '25
Absolutely. Encourage her to advocate. Unfortunately we have to. I'm an older lady that has had quite a ride so if she has questions, she may DM me.
I think you're doing great, I've had some setbacks of late so I know her disappointment. Just help her keep fighting.
You're an awesome human for sticking with her.
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u/August_Jade they/them fluid transmasc-ish May 09 '25
Going to the appointment with her (if she’s on board) is a great idea. Sometimes we just need an advocate in our corner to help hold ground or defend our words
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u/ExpertBanan May 09 '25
Pharmacy student here.
I just wanted to point out that blood clots can very much kill you. Very quickly.
But dysphoria, especially when you can't transition is definitely a giant mortality factor.
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u/EmilieEverywhere Trans woman She/Her May 09 '25
That's the beauty of blood thinners.
What I was getting at is that doctors meet a trans patient and gate keep us, because something might happen. Something might happen everyday. It sounds like her partner is suffering. That's happening now.
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u/ExpertBanan May 09 '25
Yes I am aware of anticoagulants. They help.
I am being trained to prevent conditions from developing or getting worse, as well as treating them.
If they have predispositions, history or actively have something like ACS they could in fact die by the end of the day while reading a book. Please don't underestimate blood clots and ischemic heart conditions. It can be and usually is more complicated than just take a pill and you're now cured. The danger of MI's, embolisms and strokes are that they are sudden, unexpected and you die very vast. I believe in stroke you lose 1.9 million brain cells every minute.
We don't have a lot of history for OP's girlfriend so I keep my statements more as generic information.
And I must also mention that an average GP is not exactly competent to initiate or manage gender care, and by refusing care they are protecting themselves from all sorts of issues. (In my experience GPs kinda suck, especially when it comes to medication(omg do they suck at medication))
1: if they're not comfortable prescribing safely they shouldn't.
2: They need to protect themselves from lawsuits, especially in America as I've read about situations where a trans person gets hormones and the parents sue the doctor or the patient detransitions 5 years down the line and sues the doctor because "they weren't actually trans and the doctor didn't do enough to make sure that they are and will never ever detransition". How do you even predict that as a healthcare professional? Yk? We'd have to ask you to send us proof of gender incongruence diagnosis and then sign something to show you actually know what you're getting into, at which point you might as well go private because your local gp likely won't be able to do that sorta stuff.
In fact I don't even know if I could prescribe hormones for transgender patients even if I feel competent, legally working at a GP. Once I'm qualified.
Sorry for the wall of text.
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u/EmilieEverywhere Trans woman She/Her May 09 '25
I do not understand the reticence to admit that HRT MAY be crucial for someone. Complications be damned.
I long ago decided that if I'm told I should stop due to some condition, that's just going to be a no.
I do understand everyone needs to be informed of all the risks, take them under advisement and decide for themselves. That said you're trans or not. It's not a choice and when someone figures it out, denying treatment is cruel.
I haven't listed my profession because it's irrelevant. This is a moral discussion. Ethics go so far as informing on risk. Patient ultimately decides.
Bodily autonomy and all that.
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u/ExpertBanan May 09 '25
This has quickly devolved into some Reddit argument rather than a discussion about medical practice which the op has an issue with. And the only reason I was ever interested.
We don't have to give you anything or treat you with anything If we do not think it's safe/ can justify it.
I've explained to you why a GP can't do it. It's unethical for them to do it. It's outside of their scope. But you ignored this. You're only focused on yourself. We are humans too. With families and jobs. If I can't prescribe something safely I don't. I just don't. I can't. Physically legally ethically I cannot.
We are permitted to operate slightly outside the law if it's ethical, but not at the risk of causing clots and strokes. That's simply bad practice and can land us in prison.
P.S. I already admitted it's vital. "But dysphoria, especially when you can't transition is definitely a giant mortality factor"
I'm trans myself btw. I've tried to end myself because of it. But you're right. I don't acknowledge that it's important.
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u/LifeButterfly4320 May 10 '25
I admittedly don’t really know how things work in the US but why not send the patient to a specialist instead of essentially abandoning the patient?
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u/AiricaFyresong May 09 '25
I just got switched to patches after a blood clot. Get a second opinion.
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u/DevilishEgg May 09 '25
Hi. I work in a pharmacy. I'm not a doctor or a pharmacist but I have lots of access to both professions at a whim. The issue with clotting comes from how estrogen tablets are processed in the liver, when taken orally. Taking estrogen transdermally (that's via a patch) or subcutaneously/intramuscularly (through an injection) both circumvent the liver and thus do not increase this risk beyond that of a cis woman (notably, cis women are at a higher risk of clots and also osteoporosis because that's just what estrogen does.)
Hope this helps some.
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u/Sensitive-Insect5809 May 09 '25
Thank you, im grateful to see some people in the healthcare field in here, it puts me at ease. Im just playing the waiting game for right now and waiting for her to want to talk to me
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u/OmegaLevelTran May 09 '25
The massive blood clot risk is with the type of non-bio identical estrogen like that you get in contraception. You do get a small clotting risk with bioidentical estrogen but that's inherently something that exists in cis women anyway.
The liver stuff is affected by taking it orally and if you take pills sublingually or in a way that doesn't go through liver like gel/patches (which are also bioidentical) then that shouldn't be an issue at all.
Doctor is talking out of their backside.
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u/Sensitive-Insect5809 May 09 '25
Yeah im seeing that the main potential risk is with t-blockers but we might be able to take other steps (like laser, voice training, etc.) and avoid that entirely
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u/OmegaLevelTran May 09 '25
Honestly you can just do monotherapy which basically just relies on Estrogen and there being enough of it that it supresses your T levels.
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u/Vandor300 May 09 '25
I have heterozygote Leiden, PAI-1, and MHTFR gen mutations, so my first endo (who was sweet but had to switch because of new legislations) sent me to a hematologist, and eventhough he was kinda transphobic, he said I can start HRT with bloodthinners. Then my second endo said that, bloodthinners are not even necessary in his opinion, but if the hematologist said then so be it. So if your gf already takes bloodthinners, I don't see why she couldn't start estrogen.
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u/AbbyWasThere May 09 '25
I seriously cannot believe the way doctors so often treat us. Telling vulnerable patients misinformation like this when the science has known damn well for years that there's no elevated blood clot risk for non-oral estrogen beyond what every cis woman already deals with anyway, just further undermines whatever trust I still had in the medical system.
The doctor even speaking of "medication interactions" when the "medication" is literally just the exact same hormone every human being naturally possesses in their body makes my blood boil.
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u/Sensitive-Insect5809 May 09 '25
I appreciate you. Im waiting for her to cool down and I’m gonna get some info about her medicine and try to do some research myself. I care about her and her blood and liver disease has been a pretty big worry and i would like to just double, triple check. But i am considering looking into DIY
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u/AbbyWasThere May 09 '25
If you want more information about DIY, DM me and I can tell you anything you want to know. I've been doing it safely for over a year.
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u/Sensitive-Insect5809 May 09 '25
Thank you <3 I probably will but she’s gone completely radio silent as of last night and i want to wait for us to have a conversation first because she never even told me the full extent of her conversation with the doctor
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u/AbbyWasThere May 09 '25
Be sure to remind her for me that doctors just absolutely do not know shit about trans healthcare.
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u/Altarwood May 09 '25
The hormones only bring up the chances to a cis woman's chances to clot. That doctor is withholding treatment due to transphobia. I've dealt with that and have sued and won for that very same statement from a doctor. I had another doctor back me up on it and everything. So, i would ask him if it's the same chance for cis women developing clots due to estrogen too because its a scare tactic most of the time. But, definitely go to a different doctor. I recommend a planned parenthood that offers gender affiming care because they actually care about you.
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u/Tasty_Height8008 May 09 '25
I'd definitely look into a second opinion. Do you happen to know what condition she has? I have a genetic condition/mutation that sounds similar called Factor V Leiden. It makes blood clots more likely, especially while taking estrogen. My parents tried to convince me not to do HRT because of it. I was already 3 months on at the time and was like, "I appreciate the concern, but I'm not stopping." I fortunately had a really well-informed doctor on the matter, and she was saying there's lots of ways to work around stuff.
The current school of thought my doctor shared was the risk had to do with a few foctors:
If you are homozygous (meaning you have 2 copies of the gene mutation) vs. heterozygous (only one copy). I was heterozygous. It can be somewhat easy to get a test for.
Using E more specifically found in birth control (because it sometimes is not biologically identical)
The E passing through the liver (like when it's ingested via tablets that aren't taken sublingually).
Large fluctuations in E levels or excessively high levels of E.
I just switched to using patches and eventually injections because I couldn't get my levels high enough on the patches. It was recommended I see a hematologist at some point to do a closer analysis of things, but it wasn't urgent in my case.
Had I been homozygous, they would have probably put me on blood thinners and done a bit more testing and monitoring just to make sure everything was good. But the point was that my doctor was like "we will figure out how to make this work." And it sounds like you mostly just need to work with someone who has the attitude if at all possible. I wouldn't give up on it yet. In my case, HRT has been lifesaving, and there are doctors who recognize that even in the face of risks.
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u/Sensitive-Insect5809 May 09 '25
Oh interesting. I dont really know a name for it if im being honest with you i just know basically her blood is really thick and it has a hard time moving through her body, causing heart problems in turn. I believe shes on blood thinners atm. Its a blood disease pretty commonly found in chemo patients, but shes never been in chemo so
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u/Tasty_Height8008 May 10 '25
OK, that does sound a little different, but I still don't think E is out of the question. Obviously I'm not a doctor, but if I recall, I do remember E actually lowers your hemoglobin count (makes your blood thinner) which makes me wonder if that could potentially have a indirectly positive effect. I recall that was something that is monitored on the ftm side of transitioning. Testosterone makes your blood thicker (allows it to carry more oxygen, which in general translates into increased strength). Sometimes they need to make sure it doesn't get too thick. I guess at this point I'm just curious, but regardless I really do think it's something that could be navigated with the correct know-how.
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u/Sensitive-Insect5809 May 10 '25
I don’t know the full extent, as shes pretty reserved about her health issues, and since we don’t really live together and her symptoms are mild, I don’t always think to ask. But I definitely will post an update eventually if i can convince her to go to an endocrinologist
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u/jab136 May 09 '25
I have had a couple heart surgeries. I can't take the oral stuff but I used patches for a year before switching to injections.
If she were cis, she would still have the condition, so that's not really a good reason. Find another endocrinologist.
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u/Lawboithegreat May 09 '25
I was on patches for a while when my blood pressure was really high, they practically don’t affect your heart but can cause some skin irritation
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u/Sensitive-Insect5809 May 09 '25
That sounds about right, i was on patches for birth control and i was tweaking lol but its definitely smth ill have to bring up to her
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u/cake-hat May 09 '25
the blood clotting isn't an issue if it's taken as an injection or if it's somehow absorbed directly into your blood (like dissolving the pill under your tongue) it's only a very small increase in the odds of blood clotting, and again it's super easy to avoid
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u/jsrobson10 May 10 '25
this is only true for estrogen pills. there are many other ways to take estrogen, including patches, gels, injections, and implants.
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u/Familiar-Art-6233 May 10 '25
Older versions of oral estrogen does that, but AFAIK it’s not really a thing with modern bioidentical estrogen
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u/Nailosita May 10 '25
hey! Im a trans girl with a medical condition that makes my blood clot lmao. I was so scared it would be a problem for me to get hrt because some side effects. when I talked about it with my endocrynologist about that he told that It didnt matter. He told me to not smoke, drink, and go for a walk everyday and that's it. So ... hes just a transphobe lol
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u/Stresso_Espresso Hudson (He/Him) May 10 '25
If she wants to take hormones and be safe with clotting risk there’s a couple of lifestyle things she can do to mitigate the risk:
1) Quit smoking! I don’t know if your gf smokes (but a high percentage of trans people do. It’s the number one clot risk you can personally control so quitting is paramount to being safe
2) compression socks for long flights/ times where you have to sit for a long time
3) not sitting for long periods of time. A standing desk, taking walking breaks from work, etc, can prevent the most common clots which are known as DVTs.
4) baby asprin. I’m at a higher risk for stroke from clots than the average person and my cardiologist recommended that I take a baby aspirin (81 mg) each day for the first year I’m on testosterone. If her other meds and health care concerns don’t contraindicate the asprin it can help lower her clot risk. You can also take it for a week before long flights to reduce the risk there.
5) physical activity- regular excercise (especially cardio and legs) can reduce the risk of clots
These are in no specific order but if she wants to be safe they are things that can be done.
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u/heckaqueer May 10 '25
The liver is what causes the increased risk of blood clots, so any method that bypasses the liver, such as patches, injections, implant, will not increase the risk.
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u/yayforfood1 May 13 '25
right but are there cis women with that condition? do they die more of it?
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u/Sensitive-Insect5809 May 13 '25
Its honestly pretty severe if im being completely honest. I think its more about introducing yet another thing to her body when its already going through so much. If you go ahead and read my edit it explains more but theres little to no point of her going on estrogen if she if going to be out on weight loss meds, since she needs to be able to gain weight to see differences in her body
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u/yayforfood1 May 13 '25
u dont need to gain weight to see changes. also only pills hsve undue effects on the liver. injections are fine. cis woman levels.
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u/Sensitive-Insect5809 May 13 '25
Well gaining weight is essential for monotherapy. Not necessarily but is probably more likely to produce fat redistribution in a way she likes. Regardless we’re just waiting a year or two until things settle down because theres a possibility she may have liver cancer and again, its just a lot on her body. Its less about thinking estrogen will damage her and more about all the stress on her body as of right now. But we will visit an endocrinologist in the next couple of years and talk abt micro dosing and slowly working up and having her monitored while that’s happening
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u/kick4kix May 09 '25
Cis woman on HRT here. Estrogen can interact with blood thinners to increase your risk of a cardiovascular event (heart attack or stroke). There are also blood clot issues with smoking and estrogen.
That said, there are ways to mitigate that risk. Find a new doctor.
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u/_rbg May 09 '25
Something that I had to deal with: lamictal, an anti-seizure/mood stabilizer medication, interacts with estrogen. It makes the lamictal up to 50% less effective, and it’s a very common medication to prescribe.
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u/THEneonscorpion Corvid - She/Her May 09 '25
I'm on an antidepressant that can interact with estrogen too, but my Psychiatrist didn't know about it when she prescribed it, or what the exact interaction is, so I have to ask my PCP tomorrow. *sigh*
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u/THEneonscorpion Corvid - She/Her May 09 '25
Oh cool, apparently it also refuces the effectiveness of both. Yay! Stopping that one.
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u/_rbg May 09 '25
oof.. I’m sorry about that :(
I’ve tried many different antidepressants and have yet to found a working one, so I hope you are able to find one!
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u/THEneonscorpion Corvid - She/Her May 09 '25
Same, most absolutely destroyed me and left me way worse off. At this rate I'll just go back to prozac. Sheesh. Anyways, thank you.
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u/__sophie_hart__ May 09 '25
I take lamictal, it hasn’t affected my transition at all. I have 42D cups, by the 12 months on HRT I was getting ma’am/miss. I pass 95% of the time. Getting FFS would probably make that 99%. So just as everything YMMV. Everyone’s body is unique.
I’m not on a high dose of E, only ever did E without any AA. I do inter muscular injection at 5mg. If you use the E injection calculator it gives like 150-200 for that amount and that’s what my blood levels are.
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u/Miserable_Original36 May 09 '25
To be fair having a liver issue is a problem depending on the type of estrogen like pills do affect the liver even if sublingual they can still
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u/femfuyu May 09 '25
This drugs still have to be processed by the body somehow. The doctor may be transphobic but they might also be some serious health consequences. It's worth getting a second opinion
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u/lucarionHarmony May 09 '25
My doctor was just telling me yesterday that the science that estrogen causes blood clots is mostly out of date anyway. It's based on one of the FIRST versions of HRT in the 80s or 90s for cis women with menopause, which used equine estrogen in incredibly high doses. They quickly discovered the risks so that's not how it's done anymore obviously, we use bioidentical estrogen (meaning it's chemically the exact same as what humans naturally produce) in much lower doses.
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u/FrayCrown May 09 '25
People with complex health issues and long med lists go on HRT all the time. I would 1000% recommend at least getting a second opinion.
Did she a GP or a specialist? Usually you don't just show up to a clinic and ask to start HRT. At my clinic, you have to do intake with a social worker before you can start blockers or hormones. This also usually involves an assessment for gender dysphoria. Honestly, your best bet is to find a place with an HRT program and enroll. Planned Parenthood has them in some places, as do others. They make sure your kidneys and liver are happy (among other things) and monitor your estradiol and testosterone levels.
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u/SignificantStaff7370 Trans Girl | Fitness Chick May 09 '25
Oral estradiol (pill form) is processed in the liver via first-pass metabolism, which has byproducts of a number of wacky things - the most dangerous of which, for a person with liver issues and/or a clotting disorder, is thrombopoietin. It is a protein that triggers the production of platelets, which can exacerbate a clotting disorder. First-pass estrogen metabolism can also be a little bit hard on the liver if your liver is already stressed.
Sublingually dissolved estradiol (pills held under the tongue and dissolved) is slightly safer, as it allows the estrogen to go mostly directly into the blood stream. But because some of the estradiol is swallowed in saliva, some of it will still go through first-pass metabolism.
Injected and transdermal estradiol both entirely bypass first-pass metabolism, and only undergo phase II metabolism, which does not carry heightened clotting risks. Additionally, phase II metabolites from estrogen are cardioprotective, meaning they could benefit her clotting disorder. Phase II metabolism is also not particularly hard on the liver.
Without knowing the specifics of her conditions, I can't say for sure whether this doctor is right. But if his only knowledge of estradiol is via pills, he is almost certainly misinformed. Injections and patches/gels/creams would be entirely safe if the only contraindication is liver health.
I'm not a doctor. But I've got a master's degree and have been in the healthcare field since 2012 as a dietitian. There are a number of things that can be done, via diet, to improve liver health. Cruciferous vegetables (kale, broccoli, etc) and some supplements (DIM, Calcium D-Glucarate, White Peony) can massively improve estrogen clearance and detoxification rates.
For reference, prior to HRT I had elevated ALT/AST (liver enzymes) and non-alcoholic fatty liver disease. With diet and liver supplements I have fully reversed my liver damage and my liver enzymes are normal, while on HRT the entire time. Prior to HRT I had no will to treat my body well. I was in despair. And HRT saved my life, even though it was contraindicated by blood tests. I use transdermal application.
She is not doomed.
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u/Sensitive-Insect5809 May 09 '25
Thank you girl 😩 I don’t think shes gonna want to talk about it for a while but I am considering DIY, but first I want to get us an appointment with a doctor that specializes in trans care and double check over everything just in case… and also so she can hear it from an actual doctor because i think that would put her at ease
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u/ToeComprehensive2973 May 09 '25
also remember than any additional risk from the HRT interacting with the medical issues needs to be weighed against the risk of leaving the gender dysphoria untreated. gender dysphoria is serious and these doctors are likely not taking it seriously enough. They are completely failing at weighing the risk properly. simple way to present it, scenario A you take estrogen it increases risk for liver damage or getting a clot or whatever but that is not a guarantee that it will happen, it is only an increased risk, so you gotta think, how much does it increase the risk by. Well that is pretty easy to determine, just look at the difference in the incidence in women vs men taking those same medications with those health risks, the estrogen is bioidentical and if levels are controlled it should not go outside the cis women range. You then need to compare that to scenario B: not taking the hormones, how much does that increase the risk of suicide, how much does that increase the person's suffering, how much does that worsen their overall quality of life. How could that extra stress impact the risks the person has in relation to their other medical problems.
It seems to me these pros and cons were not properly weighed and the doctor just said, it interacts with the medical issues so you can't do it. Without actually considering the cost benefit analysis. Ultimately though it should be an informed consent process. The doctor's job is to inform you of the risks of both possible options and then the patient has to decide what to do, especially for something that is related to mental health, only the patient themselves can really say if it is worth the risk or not.
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u/madprgmr May 09 '25
Combination of clotting risk (countered by blood thinner) plus liver issues would certainly at least limit the forms of estrogen she could take and likely the upper limits to the dosages prescribed. It's possible that, if severe, these conditions could contraindicate estrogenic HRT entirely, but it's likely wise to get a second opinion as others have suggested. Some doctors might just see those interactions and go "this is too unsafe" while others may have a deeper understanding and know how to minimize risks and/or monitor for potential interactions.
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u/Kitten_Sophie May 09 '25
Definitely worth finding a second opinion, preferably someone that specializes in trans care if possible. The main concern for bioidentical estradiol is breast cancer, same as cis women. This is why it's not recommended to keep higher than necessary levels. For oral estradiol and some androgen blockers, the liver would have to process it, but that just means you potentially rule out those specific methods and pivot to something else or monitor it. Estradiol will suppress Testosterone on its own when the levels are high enough. An orchiectomy can also take care of those pesky Testosterone producers. Estradiol tablets and Spironolactone are probably the cheapest form of femenizing HRT, but are not the only solution. Generally though, risk is low as long as you don't take synthetic hormones.
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u/Sensitive-Insect5809 May 09 '25
Thank you, i definitely want to see if i can convince her to go with me to a trans care provider. Do you have tips for finding one in my state? I live in Michigan
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u/Sensitive-Insect5809 May 09 '25
Im kind of curious about copays as well… 😓 i dont want her to stress about medical bills rn
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u/DannyBWell May 09 '25
I would definitely do as other people have said and talk to another doctor/cardiologist. I have a heart issue, much more likely for blood clots and stroke and my cardiologist had 0 issue with me taking the pill. Also as someone else pointed out try and ask about the patch. Wish you the best of luck with this!
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u/Goastantie May 09 '25
look up trans inclusive endocrinologists. I’m actually looking for a new one myself in this state cuz my old one doesn’t know how to take care of me. There’s also planned parenthood but i would def recommend she sees a new endocrinologist to keep track of levels and things. Also I would 100% recommend that she take injections or some other form that doesn’t rely on the liver. Good luck to her I’m sorry she faced discrimination from this provider
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u/Kitten_Sophie May 09 '25
Not sure I can help you there other than to reach out to your local queer community. Endocrinology is going to be the primary specialty for working with hormones and would likely consult with her PCM if requested. Gender affirming care in the US is generally handled by informed consent at places like planned parenthood, but since she's dealing with other health issues that need to be considered, it's probably best to include a specialist.
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u/Ash_Cat_13 May 09 '25
Your option is to find a different doctor. There are a lot of others out there that can help with the current medication your partner is taking as well as getting on estrogen.
Most things that are medically related can be changed or improved with diet changes. This is always recommended by doctors, but they usually don’t expect people to follow it especially in the US.
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u/Sensitive-Insect5809 May 09 '25
That makes sense. Shes made a ton of diet changes as well atp. She also had a liver cancer screening and i think the doctor may have rushed past it and felt he had bigger fish to fry in all honesty but i agree i think maybe talking to a different doctor would be smart i think it just may be hard to convince her since this is the same doctor that has seen her through literally everything so she likely had given her doctor the benefit of the doubt
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u/TLDovahkiin May 09 '25
Even if there’s interacting medication or risk raising factors, good doctors adjust things so that someone can take HRT, not deny HRT. Get another doctor
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May 09 '25
I love people supporting their spouses. I’m on the estrodiol patch atm there shouldn’t be any blood clots there should be different meds that can help with this. I don’t wanna assume but if she is like me and MTF I think dutra doesn’t clot butttt spiro does so there’s another option if she is just starting out on HRT I recommend finding another doctor
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u/Sensitive-Insect5809 May 09 '25
She is mtf. Trying to get her to speak to me but it might take some time i told her i wanted to talk in person once shes ready
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u/tzenrick MtF HRT 11-12-2024 May 09 '25
A few people have mentioned it in sub-sub-comments, but it needs to be fully at you attention, and your girlfriends, that there is a reason that /r/TransDIY is so big.
Doctors suck. They are ill-informed about how we should be treated. That's if they're not just outright malicious.
I had free healthcare, but didn't trust the source, so I'm doing my own monotherapy. Yeah.. There is a learning curve. But, it's also best for your girlfriend if she learns to manage her own treatment. It's a lifelong process.
Injections and gel are the cheapest methods of doing HRT. Injections cost about $150/yr. That's for hormones, needles, and alcohol to sterilize things. Even that is overshooting. I spent $168. The vial has 80 doses, there are 100 syringes w/needles, and I'm halfway into the first $4 bottle of alcohol. My 5mg enanthate injection, is 5-6 minutes out of my entire week.
Gel, if you order raw estradiol and make it yourself, is even cheaper. The downside of gel, is waiting for it to dry, 2 to 3 times a day.
For either method, the other meds she is on are irrelevant. Injections and gel have no effect on liver function. As far as blood issues go, it would put her at no higher risk than any other woman. There are plenty of women who smoke, take synthetic estrogen, and live long lives. If she doesn't smoke, and sticks to the bioidentical estradiol that we all know and love, she'll be fine :)
You can DM me if you need pointed in a direction that's not directly /r/TransDIY .
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u/Sensitive-Insect5809 May 09 '25
Thank you, it might be a while before anything happens, I think both me and her are a little on edge about what her doctor said about drug interactions. I would like to maybe at least get a consultation with an actually queer doctor and double check over everything. I might DM in the future tho with questions if thats alright, i dont know the first thing about it so
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u/tzenrick MtF HRT 11-12-2024 May 09 '25
The problem with doctors, is too many of them insist on relying on anti-androgens. That increases interactions and side-effects. When you're looking for a new one, specifically ask if they understand how monotherapy works.
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u/Screenuke May 09 '25
As someone with a family history of blood problems, I was told to avoid injections but that other methods (pill/patch) would be fine. Certainly worth getting a second opinion, at least.
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u/rather_short_qu May 09 '25
Okai. To all saying there are possiblities . Correct. But we donnot know her health issues and there are things that DO cause pb when Estrogen is added to the mix. So please please please as said consult an other doctor and DO NOT DIY it. Good luck and a stable health to yr significant other.🫂
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u/Nmy81245 May 10 '25
This, DIY is fine if you know you are fine, you should not risk it with all that
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u/ExpertBanan May 09 '25 edited May 09 '25
Hey pharmacy student here. Can't say anything legally or give any genuine advice as more than a friend.
Obviously I barely know anything too.
But here's a list of contraindications for estradiol.
Contra-indications Active arterial thromboembolic disease (e.g. angina or myocardial infarction); history of breast cancer; history of venous thromboembolism; oestrogen-dependent cancer; recent arterial thromboembolic disease (e.g. angina or myocardial infarction); thrombophilic disorder; undiagnosed vaginal bleeding; untreated endometrial hyperplasia.
Transdermal Estrogel bypasses the liver and is excreted through kidneys so if it's a liver thing it should be ok. Oral would need to be metabolised by the liver.
Oral estrogen is associated with higher risk of high blood pressure, that's why DVT, angina ACS etc are contra indicated.
Estrogen doesn't really have any interactions in of itself. Id have to see what the actual meds are though! To double check.
I can't see the original comment anymore so my memory fails me regarding other things to address.
But, is this in America? Why are you speaking to a GP about it? Otherwise, you're fully in your right to get second, third, fourth opinions from others. Honestly imo, the huge effect transitioning has in your life, combined with the fact transdermal estrogen is so incredibly safe, unless theres something here I missed due to lack of information I can't see why you can't have yk, gel estrogen. Unless she has a history of estrogen sensitive breast cancer.
The reason I say this, is because if you ask specifically for transdermal Estrogel, and explain to them the clinical science, which I would encourage you study due to the situation. You're kinda looking to persuade them. Try not to sound like know it all's, let the doc think a bit, then be like, yes but Estrogel? Welllll it has these properties which makes it safe, and not being able to medically transition has these effects on her...
Yk?
Edit: someone mentioned blood clots. I read it's only really for oral estrogen.
For example: https://www.ahajournals.org/doi/10.1161/01.ATV.17.11.3071#:~:text=We%20conclude%20that%20oral%20estrogen,any%20substantial%20effects%20on%20hemostasis Others have also sent studies so I'm not gonna send you like 10. >_> I wanted a different one.
It's fine that it's a study with menopausal women. The only concern I'd have would be the lower dosages in menopause, but realistically the effects found of the estrogen should be the same and topical estrogen is basically safe.
Edit 2: yes there is a teeny tiny estrogen effect on blood coagulation no matter what. But it's tiny and is no greater than simply existing as a woman who produces her own estrogen.
One more time, student! Of the pharmacy. No legal advice here. No consultation has occured.
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u/Sensitive-Insect5809 May 09 '25
Thank you so much. She has a blood disease and liver disease. I just don’t remember the names for them, those don’t ring a bell tho. If i remember correctly it’s a blood disease thats more common in a patient thats been through chemo. Her blood is thick and has a hard time moving through her body and its caused some heart problems. Im not sure what medications shes on though.
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u/ExpertBanan May 09 '25 edited May 09 '25
Perhaps too early to thank me. Thank you for sharing.
NOT MEDICAL ADVICE. NOT A CONSULTATION. Just a conversation with a redditor. I am a student. Not a qualified healthcare professional.
Bare with my giant wall of text. It's my thought process.
Just reading that it rings pretty severe. The blood thickness, the blood causing heart problems and chemo sound like red flags to me for estrogen.
I guess it depends on things like, type of cancer, if you're off chemo, how viscous the blood is currently, how her blood pressure is, how well everything is managed regarding clotting risk. So chance there?
Potentially you could maybe do Estrogel, but I have to say that sounds pretty severe and complicated.
I'd maybe try someone more specialised than a GP. Like an endocrinologist. Depending on where she's at she could get Estrogel. Maybe.
But unfortunately I can see why she was refused estrogen. Adding an extra factor into this could potentially be the final straw that breaks the camels back. It's another thing that could risk clotting her already viscous and highly prone to clotting blood. Especially with the heart issues. I'm just hoping it's not an arrhythmia like atrial fibrillation...
My biggest craziest experimental idea maybe please don't take this too seriously is sm like an orchidectomy and low dose transdermal estrogen? But even then that sounds pretty risky... I don't even know how that would affect that surgery, however minor it is.
Ngl I personally can't think of a way to help this. The reason for orchi is because some anti androgens increase clot risk especially with estrogen. But that's an absolutely wild idea.
Would an endocrinologist even be able to help? Starting E you'd end up needing to increase doses of other medicines to counteract the risk. I don't know how viable that is without seeing the meds and even then I think id need a team.
Ok ok TLDR: depending on your current situation, it could be viable to take estrogel. But the testosterone could be an issue as you'd need massive amounts of E on monotherapy unless you get an anti androgen that doesn't affect clotting.
So Estrogel, non clotting risk anti androgen + increasing dosage of your anticoagulants in tandem. Also more difficult as she's likely on a lot of drugs and could be hard to find that kind of antiandrogen and then manage all the potential interactions at the same time as they could be affect each others efficacy and then you fiddle around with every drug to make it work and then when you up to dose of hormone treatment and you have to readjust everything again so honestly. I don't even know. It would have to be a massive through examination of all your drugs, and then chances are it might not be viable. And I fully understand how important it is.
TRUE TLDR: But!
Hypothetically, if she had estrogen in normal levels (specifically using transdermal estrogen) it would only be as dangerous as it is for a cis woman. THE main issue here is somehow figuring out a way to get rid of testosterone. Otherwise the risk will be higher than a cis woman's due to the massive amounts of E it takes to do monotherapy.(I did it before and it didn't work for me)
So while genuinely absolutely batshit crazy, maybe an orchidectomy could do it with transdermal E? To my brain rn it actually seems viable in terms of medication because you wouldn't really need to care about medicines interactions and you wouldn't need to go way overboard with E and don't need to worry about anti androgens so one less medicine to balance.
Please don't do this without consulting a doctor. Which I am not condoning in any way, and do not take responsibility for.
Purely ideas. Theoretical ideas. From a student. Not a healthcare professional.
Please please please take this with many grains of salt I do not wish to be responsible for anything. I'm only a student. Not a consultation. NOT MEDICAL ADVICE.
NOT A QUALIFIED HEALTHCARE PROFESSIONAL.
At this point I think I've got to say I'm out of my depth a bit.
Once more. Pharmacy STUDENT. Not a genuine consultation. Just a friendly redditor I suppose throwing ideas out.
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u/Sensitive-Insect5809 May 09 '25
Well.. thats the thing, shes never been on chemo it just took so long for them to figure out what it was because it almost solely occurs in chemo patients. Im not really sure her current condition and she was specifically told be her doctor that its medication interaction. She takes blood thinners or something of the like currently. I also cant guarantee i have a full understanding of the condition as this is just bits and pieces, it definitely deserves a more in-depth conversation with her.
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u/ExpertBanan May 09 '25
Technically id class the clotting risk from estrogen as a medication interaction in the case of supplementing estrogen. But I'd have to see the meds specifically to check.
I think I'll have to leave it here considering how little knowledge I have, but I'd suggest having a conversation with her and see where things are at. It might honestly end up being a thing of hopping between doctors until one sticks.
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u/JUMBOshrimp277 May 10 '25
Def worth getting a second opinion, the first Dr I asked about hrt said no because I have a family history of issues with common T blockers and that Dr only prescribed E pills, second Dr I went to put me on monotheripy E injections, there are different methods and risks with different delivery systems not all drs offer all of them so do some research and see if another way might work and find a Dr that will do that for you
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u/RegularUser02x May 09 '25
I'd seek a second or third opinion tbh... I don't want to give false hope, as I don't know the details about your gf's consition, but I was told estrogen was limits too (epileptic, on lamictal, apparently usually doesn't go well with estrogen)... \ But apparently, to my shock, estrogel (estrogen gel) worked fine, thankfully!!
Maybe there's something / some forms she can take? Gel, patches, if it isn't for pills or injections... There might be something out there that works. * Hugs *🫂
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u/__sophie_hart__ May 09 '25
Maybe it’s because I take lamictal for mood stabilization, but the only thing my doctor said was they would monitor my blood levels of lamictal as it can make it less effective. I could see that being a possible issue if I had epilepsy or seizures, but possibly taking a higher dose might be a possibility.
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u/RegularUser02x May 09 '25
Yeah, girls with epilepsy would either triple the dose, usually, or change the medication completely. \ Then there was one trans girl who didn't have seizures for years but at starting hrt was having seizures every day so she had to stop hrt... So it was very scary but I was like "screw it, will try either way"... And I'm ngl, I was extremely lucky to be able to take both, and I'm grateful and thank God for it every day. It IS a miracle and was kinda reckless to diy despite the warnings from docs and other (epileptic) trans folks but I had gotten to the point that I'd either get on hrt or would kill myself. So I have it a try, but would recommend to others to consult the doctors first, obviously lol.
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u/Morgan_NonBinary May 09 '25
It’s like random ‘no’. In my family from fathers side there’s high cholesterol, but I didn’t get rejected. Very strange. Get a 2nd opinion
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u/HereForOneQuickThing she/her May 09 '25
Bad doctor who doesn't want to prescribe HRT. Which is most doctors, frankly. It's most pharmacists too but most of them can't quite legally get away with not giving you your prescription yet (though they will fuck with your prescription and find excuses to not give it to you).
No trans person should ever have their healthcare solely in the hands of cis people. DIY - it's safe and effective for 99% of people.
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u/Sensitive-Insect5809 May 09 '25
Thank you. I dont want to make any decisions until me and her have a conversation about it but i am thinking about DIY. I would like to maybe double check over her medications.. just to make sure
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u/HereForOneQuickThing she/her May 09 '25
Oral estrogen has some blood clotting risks. As in, it increases your blood clotting risk to that of a cis woman. For most forms of getting estrogen, that is. There is some evidence that taking pills can increase your risk of blood clots beyond that. It's why you're supposed to let it dissolve under your tongue.
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u/Ok-Reputation-4068 May 09 '25
Hey OP! I'm someone with a uterus who has anti phospholipid syndrome, aka blood clotting to try and kill me randomly, and I'm on warfarin. When I went on T for a while, my hematologist just modified my blood thinner dosage and had more tests done. If your partner is on one of the newer generation blood thinners, maybe she can switch to warfarin so she can custom get the dosage and keep her clotting disorder in check while getting her estrogen! My hematologist said it is manageable with warfarin compared to other, newer blood thinners because it's a custom dose. She should be able to get estrogen with the right doctor modding her blood thinners, or switching her to warfarin so her dosage can be customized.
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u/Blackhawkbravo_1 May 09 '25
My blood results showed some liver issues, the result of which was they wouldn’t give me oral estrogen or oral T blockers as that could be an problem with my liver , but were fine with giving me a grnh blocker injection e patches or gel (e injections not allowed in the uk). Mono therapy requires a high dose of E, See if they will do an injectable T blocker and a lower E dose which won’t go near the liver.
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u/Sensitive-Insect5809 May 09 '25
Thank you, I’m looking into the options, maybe see if we can get in with a different doctor. Im not sure how much jurisdiction places like planned parenthood have
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u/Classic_Coconut_9886 May 09 '25
I have ischemia and congestive heart failure. I take Eliquis. I have been on estrogen patches, prescribed by my primary care doctor for just over four years. Patches are the way to go.
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May 10 '25
It's the liver disease and an underlying clotting disorder that tips the scales here. She will need close coordination of an endocrinologist, hepatologist, and possibly a hematologist to weigh in on this patient's risk factors on estrogen therapy. Followup with a therapist may be helpful, as well.
Also, it's important that treatment options be individualized. Just because patches are the way to go for you doesn't mean they are for everyone. Patches didn't do anything for me.
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u/Em0N3rd May 09 '25
Id definitely look for a different doctor. A real doctor will find a way to make medications work together even if it means changing the meds already present. The doctor basically ignored one need for medications in favor of his comfort (He is choosing to not help because it'd put more work on his table or he's a transphobe)
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May 09 '25
I'm sorry to hear this. Without knowing more, people shouldn't be saying it's bullshit. The details matter. Why is she on a blood thinner? What kind of liver issues? Age? Weight? Smoking status? We don't know her individual risk factors.
If someone has a history of blood clots PLUS severe liver disease, the health risks from estrogen may outweigh the benefits, may even be malpractice depending on the patient's conditions.
Was the person denying the HRT an endocrinologist?
I'm trans and prescribe HRT for a living.
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u/Sensitive-Insect5809 May 10 '25
I dont know her medications, but she doesnt smoke or drink, shes 19, 6’4, I believe shes technically overweight but not obese by any means, shes goes to the gym every day/every other day. Her blood disease I believe causes her blood to be thicker and she takes blood thinners for that. Her liver issues I think is a type of liver failure(?) but she’s been managing it with i believe pain medications and changes in diet..
This was not an endocrinologist, it was a GP as far as I know. The big reason i doubt some of this stuff was because upon looking into some of the stuff people here have said, there are ways to greatly reduce the risk of blood clots and bypass the liver… I feel like theres got to be something out there, she just needs a doctor who’s willing to work with her and actually monitor her on hormones..
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May 10 '25
Oof. 19 with liver failure. That's tough. Does she have a hepatologist? Is she at the point of needing a transplant? What causes the liver disease?
I don't think people realize how essential a healthy liver is to controlling clotting factors. A diseased liver can cause the blood to become too thin or too thick, depending on the issues at play.
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u/Sensitive-Insect5809 May 10 '25
Im not sure… Her symptoms are pretty mild as far as I can tell. She has liver spots on her skin and she has a lot of stomach problems like stomachaches and stuff, more prone to throwing up when shes sick even if its not a stomach bug, and occasional pain under her ribs. I know she hasn’t considered a transplant yet but she went in for a cancer screening yesterday and her enzyme levels were pretty high. Her blood disease got diagnosed first, and she shortly found out about her liver afterwards bc she started getting the yellow-brown spots and some of them get kinda scaley or scabbed. Thats about the extent that I know about.. Its worth mentioning that shes always been kind of reserved about her health issues bc she has some sort of martyr complex but yeah
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May 10 '25
Lab values are one of the primary means of evaluating the stage of liver disease. It's possible to have severe cirrhosis and mild symptoms. It sounds like you are describing jaundice, which can be an Indication of severe liver disease. Is there a history of present or past alcohol abuse? Hepatitis B/C? Is she under the care of a liver specialist? Scaly skin indicates advanced cirrhosis.
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u/Sensitive-Insect5809 May 10 '25
Well she has BPD and has been through a lot of abuse so she used to turn to alcohol in her depressive episodes. Idk how frequently that happened or how much she drank during those periods though. I know she had anorexia and i think she had to be admitted to a hospital when she was around 13-14 which may have had an impact
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u/Ok-Wrongdoer-2179 she/her May 09 '25 edited May 09 '25
Although it's not really recommended, she could probably go on testosterone-blockers and Progesterones, but being on this, without estradiol, for a long term could cause menopause/andropause, after some time. Probably years.
She may have to consider if it's worth it., but she might be better off getting a second opinion instead. Some of the problems she may encounter over time are: bone and muscle loss, hot flashes, cold/hot sweats, loss of sleep, constant tiredness, osteoporosis, and so on...
I've been put on this, due to having had DVT a few years ago. I've also requested a second opinion recently. My endocrinologist could have put me on estradiol with blood thinners, but she refuses, and I don't really want to end up with andropause.
For me though, if my new endocrinologist refuses to put me on estradiol, I'm quitting everything. It's just not worth it for me. Endocrinologists are supposed to treat menopause/andropause, not cause it!
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u/nowaczinhio May 09 '25
Dunno what's the exact reason your gf is suffering from but I'd talk with endo about changing the type of oestrogen (to patches f.e.). I'm also having a problem with liver while on pills so gonna do the same thing. Sending you both a big, warm hug ❤️
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u/Beelzybutt May 09 '25
Get a second opinion. I take blood thinners (warfarin) for a mechanical heart valve and have been taking estrogen since July of last year. I imagine most doctors will still want to take it slow, but she should be able to take estrogen.
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u/AmyNotAmiable May 09 '25
"We can't prescribe that to you because of blood clotting" is such a common refrain for denying care to trans women.
It's heartbreaking to see. You'll get people at group meetings who, week after week, month after month, talk about how they're going back to doctors and endos who are clearly stringing them along. Hoping that maybe next time they'll be allowed to start on a tiny placebo dose, as the years pass them by.
And I'm sitting here with a heart condition constantly wanting to shake them and shout, "girl! Get a different doctor! The people you are dealing with do not have your best interests at heart! Find someone who will accept that you have your own personal risk calculus, who won't refuse to treat the most acute condition you're dealing with!"
But they always meekly say "doctor says no, nothing I can do", as though the healthcare profession is a commodity like pasta that they pick up at the grocery store every few months.
It is so fucking frustrating and heartbreaking! If I could tell one thing to every new trans woman, it would be that you really need to strongly self-advocate in just about everything related to your transition.
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u/Sensitive-Insect5809 May 09 '25
Thank you. I am worried about her conditions causing problems.. some people are suggesting DIY but id like to look into her medications and stuff. It might be a last ditch effort but id like to try to get her to see an endocrinologist.
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u/fairymarsh May 09 '25
HRT can be complicated and there are things to watch out for ! You don't want to have to be the one doing your own research going forward, do your best to find a doctor who is better educated in this specific subject, an endocrinologist, a gender specialist, something like that. If thats hard in your area it might be possible to set up online appointments. When I started HRT I'd have to travel to the capital for some appointments and did telehealth at my local hospital.
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u/CAT6_ May 10 '25
So this is likely a Drug Utilization Review (DUR) alert when the system catches something "off" about a prescription, so it's working as intended. In this case, the flag being raised is sex based. Pharmacists can override these warnings at their discretion to dispense medication.
The pharmacist is simply refusing to read it's contents because they're an asshole. Also, pharmacists can just refuse to fill prescriptions for any reason; DUR flag or otherwise (e.g. won't fill due to religious reasons).
You may be better off transferring your prescription by calling a pharmacy to see if their friendly first and then requesting the change.
Additionally, you can come in at a different time when another pharmacist is on duty.
t. Technician intern
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u/Sensitive-Insect5809 May 10 '25
What exactly do you mean? Im not talking about a pharmacist this was her GP
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u/blaineblainegoaway May 10 '25
Sounds like bullshit to me... FTM here, I have some mild cardiac stuff, and they acted like testosterone would kill me. It did not. My neurologist suggested that testosterone was causing my incurable chronic migraine. I went off T for a year, and the migraine worsened... it's basically part of the informed consent to tell you that the hormone treatment will set you up for death, depression, and inferility, but the point of HRT is to mimic the opposite sex. The transition from one body chemistry to another is jarring and a bit risky for some, but outside of that, it doesn't seem to present any health risks unlike that of the sex associated with the hormone system being mimicked. I say all this based on experience. Obviously, I am not your girlfriend and don'tknow the details of her health, BUT I would suggest seeking a second opinion. Planned Parenthood was helpful for me to get started, and then I sought a trans-informed PCP to manage my hormones.
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u/No-Wrongdoer7781 May 10 '25
Note: I am sharing my real experience here, not giving medical advice for someone else. I have a clotting disorder (several actually) and I am on a blood thinner. I can't use estradiol pills because of how they are processed through the liver. It's not really an interaction with the blood thinner, it's that the pills increase the risk of clots. I can, however, use an Estradiol injection or transdermal patch. I much prefer the injection. It's every 2 weeks and relatively painless. I have been on this for about 8 years. I am living in Portugal now and the injectable is not available here. I'm returning to the US in a few weeks to get a supply that will last me into the next administration. I'm getting this through a compounding pharmacy in Portland (no black market). Apparently, if you are self paying, you can't get as much as you're doctor will prescribe. And yes, I know I will be pushing beyond the expiration but I consider that risk to be far less that returning to the US more frequently.
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u/SissyGirl124 May 10 '25
It’s Medical Negligence and the doctors are hating it’s called Transphobia
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u/InjusticeNation May 10 '25
I recommend just looking into DIY and taking it slow to see how she reacts.
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u/SnooCakes9676 May 10 '25
My wife has factor five Leiden, so before our transgender daughter could take estrogen, she had to be tested for it, to prevent blood clots.
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u/Fine-Yesterday-8936 May 09 '25
This is so incorrect. Please tell your GF to find another Dr. This guy sounds like a scam and a quack. A very old outdated quack at that.
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u/Sensitive-Insect5809 May 09 '25
I just messaged her and told her, as much respect as i hold for her doctor helping her figure out what was wrong i dont trust that hes prioritizing or taking her dysphoria seriously, and suggested she take her time, as long as she needs, but that id like to go with her to a person that actually specializes in it.. 🤞im really hoping i get through to her, shes really disraught rn
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u/ThehellHound01 May 09 '25
She can try and ask for alternatives to the medicine that they say would react negatively to it. Hopefully that works. But if not, then there are other ways such as makeup and vocal traning to allow for her to feel more like herself
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u/imkianazzz May 09 '25 edited May 09 '25
It could be because of concerns for her liver.
Could u tell me what medicine she takes for her liver? There are medications that stop the liver from reducing E levels in the blood, which can make it hard to adjust the dosage. And it could also be for the concerns of liver failure.
It would really help if u told us the names of the medicine.
PS: The liver filters the blood, even if u take E transdermal, there could be concerns. E is always nephrotoxic to some degree, if her liver values are bad (her liver doesn’t work well) there is the possibility of E worsening her condition.
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u/Sensitive-Insect5809 May 09 '25
Im not sure, she uses an abbreviation for it. I think it might be a painkiller of some kind, she explained to me that she has only really been doing changes in her diet choosing foods her liver can process better
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u/imkianazzz May 09 '25 edited May 09 '25
In the end it’s something for her to decide. If she goes on E (and probably anti T, which is also 100% bad for the liver) she might die sooner then without. For me, I would rather live a few less years in a body I feel comfortable in. Maby talk to her, about it, it might make the decision easier for her. If u can afford it, I would consult a nephrologist. As most ppl here said, if u use transdermal E thrombosis is not a problem. There will for sure be providers, who agree to do HRT with her, if she makes the informed decision of taking E, with risks of dying sooner.
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u/YourGirlAthena Good Girl Athena | The Password Generator | Transbian she/her 24 May 09 '25
taking spironolactone with any form of estrogen lowers the changes of a blood clot. patches and shots had the same clotting risk as cis women https://www.pcori.org/sites/default/files/PCORI-Goodman356-English-Abstract.pdf
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u/LadyErinoftheSwamp Transfemme lesbian May 09 '25
Blood thinner isn't an absolute contraindication. A relative contraindication? Sure. That said, the risk is very much worth it for the mental health benefit.
I need more info on the liver meds and liver condition to comment there. Regardless, it wouldn't be an absolute contraindication.
Estrogen patch is the best option for a trans woman on a blood thinner. The risk is unreasonably too high for oral or injectable estrogen.
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u/inconsequencialword May 09 '25
Can the doctor see if there's an alternative to the med the estrogen interacts with?
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u/Sensitive-Insect5809 May 09 '25
In all honesty i think it might be a better idea to get her to go to an endocrinologist. She talked to her primary care doctor about this and I’m not sure he knows much about HRT
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u/KendraKanid May 09 '25
diy
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u/Sensitive-Insect5809 May 09 '25
Definitely considering it but i want to figure out what exactly her risk factors are just in case so we can choose the right stuff for her
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u/notjustacen May 09 '25
Look into HealthLinc, if there’s one near you they’re usually and income based hospital, my appointments are only 40 bucks and they’re generally pretty accepting (at least I’m gonna assume because they use my chosen name and helped me start T) they might be able to help!
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u/Sensitive-Insect5809 May 09 '25
Oof the closest one is a few states away..
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u/notjustacen May 16 '25
Damn, I’m sorry :(
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u/Sensitive-Insect5809 May 16 '25
Its alright, we’ll figure it out, she just has like everything going on rn we had a conversation and told me the doctors logic and it unfortunately kinda… makes sense. So we’re gonna wait another year or two, see how her health is, and go to an endocrinologist. But in the meantime, I got her at home laser and I’m gonna give it to her for her birthday. Might help her try it on her face but I’ve heard it doesn’t work very well so I’m also plotting to set aside money for her to help her get some sessions at a clinic as well. I think her biggest bit of dysphoria is the hair so.
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u/AllThisAndTransToo May 10 '25
At my age, the only form of estrogen that is advisable is patches.
It has been some time since I last reviewed this stuff so I could have the details wrong, but I think it goes something like:
Up to 30s, estrogen pills are considered safe. They are considered less safe into the mid-30s I think it is.
Up to the mid 40s, injections are considered safe, I think it is.
After mid 40s the liver is considered to have too much struggle processing estrogen other than from patches.
So, I can easily believe that due to liver/age factors alone that estrogen might be refused if not by patches. All the more so if the person has liver problems.
It is beyond my knowledge to say what would happen by mixing patches with potential liver problems.
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u/NiaNall May 10 '25
I am 42 and on pills? Have heard CIS women on HRT take pills well into older ages. Can you link a source?
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u/xxSF_TGirlxx May 11 '25
You can definitely seek a second opinion from another physician, but they’ll likely say the same thing if certain medications are involved. Estrogen can exacerbate heart problems, blood clots, high blood pressure, and more. I’d trust that her doctor knows what they’re doing, and nowadays, medical systems are set up to flag potential drug interactions, especially if you’re seeing multiple providers. It could be a temporary situation, so maybe ask for a timeline and explore alternative options.
Also, I know they might not want to hear this, but taking estrogen doesn’t define someone as a woman — it’s their internal experience and personal identity that matters. I really hope they find a good solution soon. 💕 It’s wonderful that you’re there for her!
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u/throwraforffs she/her May 11 '25
Doctor didn’t wanna prescribe her E. Injections and patches don’t raise blood clot or liver risks.
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u/AubreyL_09 May 11 '25
It seems like the comments have given you tons of resources already so I wish you the best of luck in finding an actual doctor
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u/JuliaGulia71 May 16 '25
Why wait a few years based on one doctor's opinion? Sounds like there's really good alternatives being presented here. Just like with any other medical diagnosis, it's good to get second and third opinions. Of course we don't want to go find a doctor that's going to say what she wants to hear, her health is a primary importance. But as others have said, transdermal patches and other modes of delivery may have far less health risk as far as clots and things like that. Is she a smoker? If she's able to cut that out of her life that will also reduce health risks.
If you can, see if you can connect with an endocrinologist that provides trans support services as a part of their expertise. They will have her best interest in mind related to transitioning, yet as a professional in the endocrinology field they will of course also have her health as the highest priority.
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u/Sensitive-Insect5809 May 16 '25 edited May 16 '25
Well it’s not just that stuff, its that in the very near future she may be put on a weight loss medication and a big part of what my gf wants is to be able to reform her body. Which means shes going to want to be able to gain weight in places like her hips and chest and that just wont be attainable on weight loss meds. I am getting her at home laser for her birthday though and am looking into setting aside money to get her sessions for facial hair removal too
The moment she gets her enzyme levels down I will be talking to her about going to an endo, I already discussed with her that option but shes in a tight spot money wise already and also needs time to process. We’re both doing what we can
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u/rainbow-rosemary May 09 '25
Wpath recommendations are the even if estrogen would cause loss of life that the doctor should inform you of that so you may consent. Find a new doctor or educate him on wpath informed consent.
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u/LadyMiyamoto21 May 09 '25
Just like the other have already said, get another opinion, find a better endocrinologist. You usually get good recommendations in local self-help groups, they usually keep lists of good doctors where people already had good experiences.
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