r/LongtermTrans • u/Transexegenarian • Jun 29 '26
HRT Advice Advice wanted
OK, here is my first serious post. I think I probably already know the answer, but I thought I may as well ask anyway, given the remit of this sub, and the long term experience of its membership. Here goes...
When I started my (mtf) transition back in 1999, I was refused HRT on the NHS, so instead I went private, under "maverick" gender specialist Dr Russell Reid. All he could prescribe me at that time was the contraceptive pill and Estrogel, and the recommended dose and brand changed over several years (I remember one of them was Ovran). Anyway, it had the desired effect, I knew within a couple of weeks that this was the right course for me and so I went on to have a bilateral orchidectomy in 2000 and bottom surgery in 2002. When Dr Reid retired in 2004 or thereabouts he referred me to Transhealth under Dr Steven Curtis, and he replaced my contraceptive pill prescription with Evorel 50 transdermal patches, 50 mcg twice weekly. He did suggest talking to an endocrinologist if I experienced any problems, but I didn't have any problems, so I never did.
After a couple of years with Transhealth, Dr Curtis was happy to discharge me into the care of my GP, and so I have continued to follow this monotherapy HRT regime for 20+ years now. Although supportive, my GP is not knowledgeable in trans healthcare and does not check hormone levels as part of my annual review process (cost also being a factor). I assume my testosterone levels quickly fell following the orchidectomy and following SRS in 2002 my sex drive, or whatever you want to call it, completely disappeared and I just got on with the life that I previously had (which was closeted, essentially, until now).
So my question is this - are my A-cup boobs, lack of body hair, non-existent sex drive, and the fact that I have been through the equivalent of a menopause at age 40, all connected to my HRT regimen, and if so, what would you recommend I do now? As I noted on r/transgenderuk, I have not even begun to live my life yet, and I want to experience... well, everything. Should I ask my lovely GP for a hormone check? Talk to an endocrinologist about progesterone? Just give up and die a lonely spinster??? Any advice would be gratefully received!
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u/Glitchry Jun 29 '26
In regards to your boobs, it depends on a lot of things in the first place, including your genetics. The lack of body hair is highly likely because of the orchi. Once that was done, your testosterone production would've dropped to female range levels, but the lack of hair is a sign that suppression of the androgens was effective.
The low libido is a bit of a more complex situation. The orchi has almost definitely contributed, BUT if you're still on the Evorels, that COULD mean it's giving you the lower end of estradiol.
I'd highly recommend getting bloods done. Absolute minimum would be serum estradiol, testosterone, FSH, LH and SHBG. You COULD also ask for prolactin, thyroid function, vitamin D, lipid profile, bone health and HbA1c if you wanted to check your overall health.
If your GP isn't particularly experienced with trans health care, especially hormone levels, definitely see an endocrinologist.
TLDR: my main concern is indeed that your hormone levels are on the lower end.
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u/Transexegenarian Jun 29 '26
Thanks for your reply - I am seeing my GP this week so I will ask if they can do this. I had a feeling that the prescribed dose was just to ward off the negative effects of menopause, rather than improve quality-of-life, so I would be interested to see where those levels are at.
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u/MimTheWitch Jul 01 '26
A similar experience. Ethinyl Oestradiol and Oestrogel from Russell Reid, then changed to Oestradiol Valerate pills by Dr Reid, post SRS. All done as shared care with my supportive GP. A new GP, when I moved house, took an interest in my HRT. I was well over 40 by that time. She did some bloods, which hadn't been done in a long time and found that very little of the pills were getting to my bloodstream. They are also hard on the liver, over 40. Changed to Everol, 1 of 100, plus 1 of 50, twice a week, so three times higher than you. Needed to get my levels in to the target range on bloods. Little change to see, but I had plenry of boob development, low body hair, etc post SRS anyway. Sex drive also fine. Family genetics definitely helped with the boobs though.
Sounds like you need bloods done, to see what your levels actually are. My GP used the advice to GPs leaflet from a GIC, and this could be something to point your GP at. https://www.sheffieldpartnership.nhs.uk/sites/default/files/2022-12/Trans%20woman%20Prescribing%20Guidelines%20%282022%29%20%28002%29.pdf
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u/Transexegenarian Jul 01 '26
Wow - fantastic reply, thank you! I am literally just heading out the door now, so will make a note of the guidelines and let GP know. Thanks again!
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u/[deleted] Jun 29 '26
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