My life

[Danya (imported)]

A few more citations for normal estrogen dosage.

http://www.drugs.com/pro/delestrogen.html

This is a straight copy of the Delestrogen package insert.

http://women.emedtv.com/estradiol-valer ... osage.html

Note that you are taking 10 times the recommended dose for advanced prostate cancer which is considered a very large dose. Also

Transward

Thank you for persisting in this matter. Your last post made me wonder how we could be in such disagreement.

This was my error and it's important that I let readers know the actual dose of estradiol valerate I am taking. Once I realized my mistake, I had to issue a correction. Not to do so would be inexcusable. One of my biggest complaints about some TS support sites is inaccurate information. There is no way I want to contribute to that kind of thing. I apologize for any confusion I may have caused readers.

Sometimes, particularly when I am writing late in the evening - as I am now and when I wrote about my estradiol injection volume - I make mistakes. If I make more spelling errors late in the evening that's not a big deal. Providing incorrect medically-related information is an entirely different matter.

I am doing weekly

intramuscular injections of estradiol valerate

and the vial does show the concentration of estradiol valerate is 40mg/ml.

My error was in stating that I use 7 ml in each weekly injection. That's a hell of a lot, you are absolutely right.

The correct volume I inject once a week 0.7 ml, not the ten times higher dose of 7 ml I had reported. So one injection provides 28 mg of estradiol valerate, not 280 mg.

Again, Transward, I appreciate your persistence.

I am still concerned that, even taking the volume correction into account, I am putting myself at risk for depression at a time when I do not want to chance it.

The 0.7 ml/week injection is giving me, averaged over a week, nearly 3 times the estrogen from the sublingual pills.

I have always been concerned about clotting risks, too. Particularly the danger if I should ever need emergency surgery. I will discuss this once again with my HRT doctor when I see him Monday.

[transward (imported)]

Thank you for persisting in this matter. Your last post made me wonder how we could be in such disagreement.

This was my error and it's important that I let readers know the actual dose of estradiol valerate I am taking. Once I realized my mistake, I had to issue a correction. Not to do so would be inexcusable. One of my biggest complaints about some TS support sites is inaccurate information. There is no way I want to contribute to that kind of thing. I apologize for any confusion I may have caused readers.

Sometimes, particularly when I am writing late in the evening - as I am now and when I wrote about my estradiol injection volume - I make mistakes. If I make more spelling errors late in the evening that's not a big deal. Providing incorrect medically-related information is an entirely different matter.

I am doing weekly

int

ramuscular injections of estradiol valerate

and the vial does show the concentration of estradiol valerate is 40mg/ml.

My error was in stating that I use 7 ml in each weekly injection. That's a hell of a lot, you are absolutely right.

The correct volume I inject once a week 0.7 ml, not the ten times higher dose of 7 ml I had reported. So one injection provides 28 mg of estradiol valerate, not 280 mg.

Again, Transward, I appreciate your persistence.

I am still concerned that, even taking the volume correction into account, I am putting myself at risk for depression at a time when I do not want to chance it.

The 0.7 ml/week injection is giving me, averaged over a week, nearly 3 times the estrogen from the sublingual pills.

I have always been concerned about clotting risks, too. Particularly the danger if I should ever need emergency surgery. I will discuss this

once again with my HRT doctor when I see him Monday.

Thank you. Before I replied the first time I debated with myself whether to reply on the board or on PM. I decided since you had posted your regimine on the board, the right dosage should be there too, so I did it on the board.

I wondered how painful it would be to inject 7 mg, as viscous as the estrogen is. It would take forever to load the syringe and inject it. Even with the volume correction, I note that you are still taking about two and a half time the dose prescribed to any of the trans woman I know;(I take .4 ml, 16 mg, every two weeks.) On the other hand it probably won't hurt you in the short run. I know a trans woman that transitioned in the mid seventies, and who, believing that a little, being good, a lot is better, has been taking about three times the prescribed dose for about 35 years and she is still raising hell. Still a conversation with your doctor would be indicated. Had you health insurance, I would recommend a second opinion. You could probably do quite well on a much lower dose. The best breast development of any trans woman i know is on a woman who has been taking 20 mg biweekly for about seven years. (She is an aspiring porn star and doesn't need implants.) I wish you great happiness in the upcoming months.

Transward

[Danya (imported)]

I wondered how painful it would be to inject 7 mg, as viscous as the estrogen is. It would take forever to load the syringe and inject it.

Pulling just 0.7 ml into the syringe seems to take forever. It is thick. I cannot imagine ever injecting 7 ml.

Even with the volume correction, I note that you are still taking about two and a half time the dose prescribed to any of the trans woman I know;(I take .4 ml, 16 mg, every two weeks.)

My dose is similar to several trans women I know in the Chicago area and my measured estrogen level is 135 pg/ml. This is not considered a high test result.

On the other hand it probably won't hurt you in the short run. I know a trans woman that transitioned in the mid seventies, and who, believing that a little, being good, a lot is better, has been taking about three times the prescribed dose for about 35 years and she is still raising hell. Still a conversation with your doctor would be indicated.

Just to be sure people are aware of this, I am not taking more estradiol valerate than the dose prescribed by my physician. He has several decades of experience treating over 200 transsexual persons, including prescribing hormones.

I agree that more estrogen is not better, beyond a certain point as determined by a health care provide.

I have never taken more than the prescribed dose since I started estrogen HRT in June, 2008.

Had you health insurance, I would recommend a second opinion.

I have opinions from three physicians who regularly treat transsexual persons.

What I find frustrating is that, to my knowledge, there is no consensus on the best delivery method, dose or 'type' of estrogen for HRT in male-to-female transsexual persons.

You cite DonFL's report (

http://www.eunuch.org/vbulletin/showthread.php?t=12114

) on HRT for male-to-female transsexuals. I know he was a careful researcher who worked in the medical field.

He recommends injectable estradiol valerate as one method for feminization:

To Feminize:

2-8mg of Estrofem sublingualy as tolerated by your liver

Oral estrogens can cause significantly more hepatic and cardiac impairment than injected, and is only recommended if shots can not be tolerated weekly.

OR

20mg-40mg Bi Weekly Progynon Depot (Estradiol Valerate, Oestradiol Valerate) Deep IM Injection, must be dosed per the individual person. Blood tests indicating E levels should be dont to assure you do not exceed maximum safe levels. Average dose for a fit individual is 20mg bi-weekly.

OPTIONAL when using Estradiol Valerate : 2mg Daily Estrofem sublingualy (only if needed for constant feed of E from the up/down cycle of the injected estrogen, estrofem has the lowest emotional liability of all the oral estrogens, if your body is sensitive or you dont need it, you can leave out the oral estrogen. Injected is the safest method of delivery and best for your liver.)

Contrary to DonFL's advice, the Anne Lawrence page (http://www.annelawrence.com/regimens.html) you cited does not recommend injectable estradiol for pre-operative transsexuals. Dr. Lawrence discusses this treatment under a title with a warning. I am pointing this out only as a small bit of evidence that there is no consensus view, in this case on hormone delivery method:

Injectable (intramuscular) estrogen

(NOT RECOMMENDED):

estradiol valerate (e.g., Delestrogen®), 20 mg IM every two weeks.

Occasionally half the suggested dosage may be sufficient. Sometimes the dosage will need to be increased, rarely even doubled. Beyond a certain point, larger dosages will not increase tissue response, but will only cause more side effects.

In the Twin Cities, to my knowledge there were no physicians who would prescribe anything but the patch to male-to-female transsexuals over the age of 40. Two gender therapists also told me that all of their over-40 patients were using the patch.

One of the Twin Cities physicians I worked with for HRT told me that medical views on best hormone treatment options for transsexuals varied around the US.

I agree with transward's cautions and appreciate her input. It is wise to educate yourself on the risks and benefits of HRT, to proceed only under the care of a physician and to assertively question providers about their experience and philosophy. We all need to make informed decisions on how to proceed with all medical treatment.

[Danya (imported)]

Once I start investigating a topic, it can be hard to stop. When a medically-related or scientific subject has my interest, I prefer to read published articles to form my own opinion. This will be my last foray into this topic. I don't have time to do more investigating. I really do need to get a life. Besides, all of this analytical thinking goes against my personality preference for feeling versus thinking (although by a smaller margin than before I transitioned, which is very interesting to me, but way off-topic.) I may need to play the piano, with passion, for awhile to 'feel' back to my regular self.

Using the web site PubMed (http://www.ncbi.nlm.nih.gov/pubmed), run by the US National Library of Medicine, National Institutes of Health, I ran a search to include the words 'transsexual hormone therapy' and, voila, all kinds of interesting and recent studies were returned.

This government site provides abstracts and, at times, further details of published studies of all kinds. Generally, one can obtain the entire article only by paying for it. What most interested me was this recently published study, because it describes consensus treatment guidelines. What follows is only a small fraction of the published article (at the end of this post, I will explain how you can download the entire publication at no cost.):

J Clin Endocrinol Metab. 2009 Sep;94(9):3132-54. Epub 2009 Jun 9.

Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. (http://www.ncbi.nlm.nih.gov/pubmed/19509099)

Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM; Endocrine Society.

The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, Maryland, USA.

Abstract

OBJECTIVE: The aim was to formulate practice guidelines for endocrine treatment of transsexual persons.

EVIDENCE: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence, which was low or very low.

CONSENSUS PROCESS: Committees and members of The Endocrine Society, European Society of Endocrinology, European Society for Paediatric Endocrinology, Lawson Wilkins Pediatric Endocrine Society, and

World Professional Association for Transgender Health

commented on preliminary drafts of these guidelines.

CONCLUSIONS: Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person's genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person's desired gender. A mental health professional (MHP) must recommend endocrine treatment and participate in ongoing care throughout the endocrine transition and decision for surgical sex reassignment. The endocrinologist must confirm the diagnostic criteria the MHP used to make these recommendations. Because a diagnosis of transsexualism in a prepubertal child cannot be made with certainty, we do not recommend endocrine treatment of prepubertal children. We recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. We suggest suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks in adult transsexual persons.

PMID: 19509099 [PubMed - indexed for MEDLINE]Free Article

Because I am not quoting anything from the full article text, I will adhere to the quite reasonable EA site guidelines: I will not post the link to the full article. I will simply state that the complete article gives me information I feel I can trust to make more fully informed decisions about my own treatment with cross-gender hormones.

Most peer-reviewed publication abstracts/summaries are not available without payment. This one is an exception.

Anyone wishing to view the published article, at no cost, can find it by using the Advanced Search function of Google Scholar at http://scholar.google.com/advanced_scholar_search. Enter the title of the article or the first few words of the title (Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline) in the field labeled: "Find Articles with the Exact Phrase."

[transward (imported)]

Anyone wishing to view the published article, at no cost, can find it by using the Advanced Search function of Google Scholar at http://scholar.google.com/advanced_scholar_search. Enter the title of the article or the first few words of the title (Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline) in the field labeled: "Find Articles with the Exact Phrase."

The article is available on Anne Lawrence's web site http://www.annelawrence.com/ Click on Hormone Therapy then on "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline"

Transward

[Danya (imported)]

I relearned something important when I was laid off in mid-2009. At such a time, you can feel overwhelmed by worries about the future. It helps to allow a limited time each day to worry, rather than trying to repress legitimate life issues. A productive method is to write out your concerns for up to 30 minutes or so. Then you put your writing aside and proceed with what you need to accomplish that day.

This technique was reinforced by my friends at the Workforce Center. With some practice, it works reasonably well.

I want to be sure people understand this is what I often do here on EA. By writing about my worries about changing medications, a continuing unstable career situation and other things, I am committing my concerns to 'paper.' I am then able to put those worries aside, for a day and sometimes for a much longer period and proceed with my everyday activities unburdened by these concerns.

anya (importe
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About a yea

r ago at this time, I traveled from Minnesota to Illinoi

s to loca

te a roommate. Time has flown since then.

[quo

te="Danya (imported)" time=1292968260]
__________________________________________________
[/

quote]
___________

With my GRS date now slightly less

than two months away, I am getting more excited. Of course, I'm not looking forward to the surgery itself

, but the results. I do not expect surgery to dramtically change

my life. I already know who I am. Rather, surgery will widen my life options as a trans woman.

__________________________________________________

____________

My career: what am I do to with it?? I've written about potential career options ad nauseum. I'm tiring of the whole thing so I can only imagine how boring this must be for others. It helps me to write it down.

I decided that it's time to make some decisions both for my career and how I can make my life more satisfying. These are subject to revision as time passes, but I doubt I will make major modifications later.

I will stay with my current career as a business analyst. I can do the work and there are, after all, a number of aspects of this role that match my temperament. In the right organization, I can thrive in this role.

I will be open to other interesting and well-paying opportunities

I may find that fit my background in science and IT.

At this late point in my career, I cannot justify switching to to a path that pays significantly less than I now make, even if it would prove more satisfying

on an emotional level. Not being able to save enough fo

r retirement would add to my stress. This would not help my emotional well-being.

I will take action to improve my prospects for more responsible business a

nalyst roles, including becoming a certified Project

Management Professional. I enjoy greater responsibility and I would also likely get a higher salary. I need to rebuild savings seriously depleted by transiti

on expenses.

I am considering additional strategies to i

ncrease my marketable skills, including learning Spanish and slowly building a side business in technical writing. Bilingual skills, particularly English/Sp

anish, are increasingly in demand for all types of jobs

including some Business Analyst positions.

I will expand my social network through activities like dance lessons. This is something I've wanted to do for ye

ars. Having a number of local friends will make life

much more pleasant. I want to have more fun, too. This will improve how I view my work life. It's all about work/life balance. I have always been weak in this

area. Throughout my life, I have tended to neglect havi

ng fun in favor of studying, working and similar things. I need to stop doing living my life this way.

I will seek out a volunteer opportunity. When I was a

college Freshman, I volunteered Monday evenings at a

state home for mentally handicapped children. As each Monday evening approached, I usually felt like I could better use my time by studying. Once I arrived at

the state home and interacted with the children, my

mood improved a lot. I was then able to study more effectively when I got back to my work.

The hard part for me is balancing social activities with solo passi

ons such as playing the piano/organ and photography. Th

e issue here is the 'solo' part; I am not interacting with people when I pursue these interests. Still, playing music is great therapy and I am a fairly acco[q

uote="Danya (imported)" time=1295182380]
mplished musician. I considered giving up photograph

y
[/quote]
to concentrate solely on music, but I enjoy that too much.

Update after 45 minutes playing the piano, which I still love. My need for friends and socializi[qu

ote="Danya (imported)" time=1294649040]
ng may now far surpass any desire and pleasure I get f

rom
[/quote]
playing the piano or ogran. I've had a growing suspicion this might be true since I purchased the digital keyboard a few weeks ago. I am very surprised by [qu

ote="Danya (imported)" time=1294472940]
this. I may yet give up playing music entirely so I h

a
[/quote]
ve more time for socializing and relationships. It may be too early to be certain, but this possibility saddens me. Playing music has been an important and rew[

quote="Danya (imported)" time=1294139640]
arding part of most of my life. My needs continue to

ev
[/quote]
olve as I travel down this transition path.

With photography, I am at least out among people. It's not such an isolating activity as intense music practice.

__________________________________________________

__

In a few months, it will help me to look back at this. For everyone else, this is probably totally boring. I am continuing to evaluate several metropolitan

areas that I might move to, after GRS, should Chicagoland not offer continuing employment op

portunities of the right caliber and in sufficient number. Or if I am unable to find a job soon enough following surgery. For now, I'm limiting my research to:

Number of p

osted openings for Business Analysts by metro area on a per capita basis.

Data derived from

US Bureau of Labor statistics for each metro regios on the number of unemployed people per job posting. This ratio is an average for all job postings, not just IT-related j

obs. Therefore, as with everything else I use in making a decision, I need to use this inform

ation cautiously. As an example, in a metro area there may be one unemployed computer engineer for every 5 openings while there are 15 unemployed people for every sales man

ager opening. This information, by itself, may be useless.

Projected economic outlook for me

tro regions.

Metro regional outlooks for IT-related jobs.

I will continue to track these over the next few months, every week to ten days, to separate trends from tempora

ry fluctuations. I realize that, even taken together, the trends I am tracking cannot offer a

definitive guide. I am not trained in this type of analysis, either.

Since mid-January, it looks like these areas offer much better prospects than Chicago for my career (

the picture may change down the road, mid-January to late February is a short time frame):

Chicago unemployed persons per job posting: 3:1. In Chicagoland, relevant job postings have remained fairly constant over the last year.

Seattle metro region - initially I

thought the Seattle metro region was not significantly better than Chicago. In Seattle, prosp

ects are improving (as business journals have predicted) and there are now twice the openings over what Chicago can offer.

Seattle unemployed persons per job posting: 2:

1 (expected to improve quite a bit over the coming months)

New York metro region: relevant job

posting are 3 times greater than Chicago for my career role.

New York region unemployed persons per job posting: 1:1

San Francisco metro region: relevant job postings co

ntinue to track over twice what Chicago can offer.

San Francisco region unemployed persons p

er job posting: 1:1

Boston metro region: results similar to San Francisco

For my career role, Portland, OR and Washington, DC are not performing as well as they had been.

__________________________________________________ ________________________________________

[Danya (imported)]

I ran into my boss today as we both were taking our laptop computers to the lab for an upgrade. He surprised me when he said "it's hard for me to decide whether to spend time on work or life problems." I thought he was talking about work and life balance and responded with a brief statement of understanding. He went on to tell me a little more, including a strong hint that his family was falling apart. He then added that maybe all he could do is allow things to happen, when everything is beyond his control.

At this point, I knew I needed to use caution. With just a few words, I think I let him know that I was sensitive to what he was sharing. It would have been inappropriate for me to say more.

Danya ([

quote="Danya (imported)" time=1296559920]
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__________________________________________________
[/quote]
______

I am often a slow learner. I finally realized today that

I am putting too much pressure on myself.

Duh! In these continuing difficult economic times, though, I need to anticipate what I may need to do for my life and career over the next few months and longer, too. As I do that, I need to set realistic goals. Finally, I do not need to write out all of my thought processes here, particularly when it is late and I should be in bed.

[butterflyjack (imported)]

Hi sweety..Nice to hear you...smooches dragonfly

[Danya (imported)]

Hi Dragonfly,

It's always good to hear from you. :

)

I spent 4 hours playing the piano this evening, including working my way through major sections of Beethoven's last paino sonata, #32. As with much of his late output, some complain that this, to me, impossibly beautiful and finely constructed work just doesn't sound like Beethoven. Therefore, these people view these late works as somehow deficient. It some ways, they are right. This piece doesn't sound like what people expect from Beethoven. Late in his life, he was exploring entirely new ways of putting music together. Some thought he was losing it. The results are astonishing in their originality and anticipate techniques not used by most other composers until much later. The second movement is a set of variations. The third variation sounds shockingly modern and anticipates jazz and, perhaps, boogie-woogie.

Unlike the classical sonata and most later sonatas, that are written with three and sometimes four movements, Beethoven's #32 has but two sections. A friend supposedly asked him why the work lacked a middle movement. One report has Beethoven responding "I forgot to write one." Beethoven was not often patient with those who asked him what he viewed as irrelevant, if not downright ignorant, questions. He may well have given a much more scathing reply.

Despite #32's 'reduction' to two movements, this is considered by many to be one of his most perfect creations. It's extremely difficult to play and, although I play parts of it well, I don't have the time to learn the entire piece to play at a recital. Even if I had the time, I doubt that I could ever do this masterwork justice. I have done very well at the few recitals I have given, but I have never publicly played a piece this challenging on so many levels. When I play through it, though, it speaks to my soul.

Still, #32 and I have had an ongoing relationship for many years. I fell in love with this work when I heard Rudolf Serkin perform it at Carnegie Hall. That was my first trip there and I went with several grad school friends. I cannot adequately describe how this performance affected me. Composer, music and performer came together as a perfect whole.

After struggling with 32 this evening, and enjoying every minute of it, I realized I am pushing myself too hard, for the moment, in trying to play this. I need to spend more time getting my fingers back in shape. I tend to be inpatient, though. I doubt that anyone has picked up on this.

Finally, after struggling through Chopin's wonderful Ballade #4, I admitted defeat, but only for awhile. There was a time when I could play through this entire piece with some ease. People used to stop and listen to me play it and other pieces when I practiced in college. That was nearly a lifetime ago. Things are different now, and I need to compensate for some arthritis. I can manage that if I first practice sensibly.

I decided to switch to simpler music that I've carted all over the country but never played. This was a set of blues, jazz and boogie-woogie short pieces. I did not have to struggle at all with these. Although they do not speak to me in the same way as works like Beethoven's late piano sonatas, they have their own charms.

They have another advantage. These are the types of things I could play from memory in public. They are more accessible for many listeners, too. So they may yet serve as con[[

quote="Dan

ya (imported)" time=1297843140]
[

quote="Danya

(imported)" time=1296559920]
quote="Dany

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v[

[Danya (imported)]

My job, and those of a number of other contractors and some permanent employees, is dependent on certain things happening so that projects can continue. I cannot be more specific than this, because the information is proprietary.

Corporate management expected that what needs to happen would have been done deals weeks before now. They were wrong, although they continue to predict that just about any day, everything will fall into place. Based on how things have played out so far, it is entirely possible they will be wrong again.

When I accepted this contract, the stated length was 3 - 6 months. On March 21, it will be 3 months since I started working. So when my recruiter confirmed that management had informed him my contract might end in a few weeks, I was not surprised. In fact, I was not bothered at all. I wondered again, though, how long I might have to continue moving from one short-term job to another.

It is this kind of uncertainty, and lack of continuous reasonably priced benefits, that keeps drawing me back to reconsider career options. For now, I'm sticking with the career decision I posted a night or two ago.

There may come a point when I feel I must pursue other options that offer some permanence with good benefits. I'll be 60 at the end of the year. As I get older, the likelihood of health problems will increase. I'm not losing sleep over this, but I consider it for long-term career planning.

I will not cancel GRS if this contract ends in a few weeks. By the time I learn if it will be extended, it would cost me thousands in non-refundable dollars to cancel.

Of course, I'd prefer that my contract be extended, with the possibility of continuing work for this company after my surgery. When I budgeted for the late March early July time frame, I allowed for the possibility that I might not be working at the end of this month and into early or even mid-July.

I will start looking for other work now. If I am offered another contract job or even a permanent job I will take it. If I am without work at surgery time, I will start my search again as soon as I return home.

If necessary after GRS, I will

move [quote="Danya (imported)" time=1290

409200]
to another part of the country
[/quote]
for contract work. Preferably to one of the areas that show the most long-term potential for on-going career opportunities.

I continue to rent a room with a private bath, on a month to month basis, for two reasons: to save money and because I accept that I may need, or want, to move away from Chicago at any time. I'd prefer to have my own apartment. That would be more expensive and could tie me down with a lease.

If I move out of state, it will add more stress to my life. Even if I move to a location I consider very attractive.

For now, at least, I a

m not bothered by any of this.

When I am down about the continuing uncertainty in my life, I write about it. Then I feel back to normal.

When I was laid off in mid-2009, I expected that I might not have an easy time of it. I never expected this continuing uncertainty nearly two years later. I've learned a lot about myself and what I can do. I have also learned that life can, and does, continue to be wonderful despite the ongoing turmoil. Whatever my external circumstances, I feel incredibly fortunate. I know wh[

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