Osteoporosis diagnosis, where does this leave me?

[Danya (imported)]

Thanks much Bobbie for your additional comment, dev, MrT. I'll report tomorrow evening on what my doc says and what action I'll be taking.

MrT, its not inconceivable that I'd take some estrogen. I very seriously doubt that my family physician would prescribe this, though. I will not stop Androcur. If I needed to stop taking that to save my life, I'd stop it right away. That's not the case here.

It's likely I'll discuss something like a small dose of estrogen with the U endocrinolgist when I see her in February. I don't see it as a long-term solution for me. Short-term, to help with the osteoporosis would be fine. I'm basing this thought partly on the input of someone here who's opinion I value, namely plix.

I think I'd find it kind of interesting myself. Besides, I do feel androgynous and perhaps more on the feminine than masculine side of things.

As for you, MrT, don't knock it until you've tried it! Just kidding you, man. Don't worry, if I wind up taking any E, I'll report on it in more detail than you're ever likely to want to read. .

Again, my thanks to all of you for your input.

[BossTamsin (imported)]

Osteoporosis is nothing magical. Everyone loses bone density later in life. It is usually the ones who have the thinner bones to begin with that it shows up in sooner. If you notice that your wrists are thinner than your father or most of your brothers then you will be getting it that much sooner. It is generally because of lack of testosterone before puberty that causes thinner bones. I myself have thin wrists even though I am "male". After puberty testosterone does nothing for your bones. Just remember what your mother said, "Just eat your greens and shut up." (Greens have calcium and other minerals and vitamins for your bones.)

I'd really hate to disagree with most of this... wait, no I don't.

Eunuchs face special risks for osteoporosis, and testosterone actually does play a role in bone metabolism even after puberty. Calcium and vitamin supplements alone cannot guarantee you remain osteo-free.

While everyone may lose bone density later in life, a vanishingly small percentage of younger men develop it, and eunuchs on this board seem to be suffering from it at a much-increased rate, even if they have been taking calcium or other supplements.

(From someone who was diagnosed with osteo before they hit 30.)

[Danya (imported)]

From everything I've read, I've got to agree with IEunuch. Hormones are important in osteoporosis prevention and treatment. Perhaps what dev may be saying is that a

fter puberty testosterone does nothing for

bone growth, as in bone elongation, etc.

I haven't heard of a connection between thinner bones and the development of osteoporosis, but I guess that wouldn't surprise me. At any rate, I am thin-boned. I like to think of it as being lithe!

All this talk about diet, testosterone and metabolism is making me hungry. Time to go out for dinner! Probably a nice little, inexpensive Italian place that serves things with lots of cheese. Now that I'm back on a lower dose of that MAOI patch stuff, I can eat cheese again. It's got calcium, too.

[devi (imported)]

It is actually the estrogenic compounds that are derived from the testosterone complex that are believed to have something to do with bone preservation but have not as of yet been scientifically explained exactly how this happens. Certain societies have almost no incidences of osteoporosis with somewhat of a longer life span than in western societies. (Japan is one of them.) It is believed in these cases to be due to phytoestrogens in their diet which are derived from plants. Myself, I believe that the genus "amaranthus" which one variety is called pigweed or wild spinach (quelites in Spanish) which is abundant in Asian, Mexican and other traditional diets around the world has a lot to do with it. In England (and here too) they have varieties such as Joseph's Coat and Love-Lies-Bleeding. Before the industrial revolution English medical books had advocated their usage. And their described benefits turned out to be the same as Mexican lore. The UN had done some research into the health benefits and the viability of raising it as a crop. Turnip greens plus other such plants are probably just as good or better also. What they do is mine the minerals out of the soil and put them in the leaves which then after cooking the tenders the body is able to absorb along with other vitamins, nutrients, and phytoestrogens. But maybe one of those multiple vitamin plus greens pills might work just as well along with a little Black Cohosh, exercise and sunshine. Right now I hope so. But if you follow those little trails of who's advocating what you may find some pharmaceutical megacorporation lurking behind the bushes and especially with all of those hormones. And for all I know my supplements may be from some tired sales pitch and totally unnecessary but like Linus' blanket they do make you feel better anyway. C'est la vie.

[Danya (imported)]

Before I went out for dinner, I stopped by a bookstore to see what I could pick up on osteoporosis. I was about to give up as I looked in the regular medical/health section. There was nothing on osteoporosis. Then I thought to look in the women's health section and found several books. For some reason, there seemd to be no eunuch section Maybe if I'd asked?

I've known that men as they age are at risk of osteoporosis just as women are. It's just less common or perhaps it's less apparent until men are significantly older. At any rate, one book said more men will suffer an osteoporosis-related bone fracture than will die from prostate cancer. The sad truth for many men is that their physicians are unaware of the risk of bone problems in males as they age.

I purchased two books because I like to be as informed as possible when I'm discussing major issues like this with a physician. I read through much of one over dinner. This one in fact mentioned the role of phytoestrogens in helping fight osteoporosis. There was quite a long section on soy products.

I'm not at all clear that, for postmenopausal women, estrogen therapy is beneficial in treating osteoporosis. The book seemed to be indicating that estrogen would help ward off osteoporosis in premenopausal women and in older women who as yet had no symptoms. I didn't have time to read this section carefully but the conclusion seemed to be that estrogen replacement had little value in rebuilding lost bone mass. It apparently plays some role, though, in preventing fractures. This makes me question whether taking estrogen would help me much at all.

Too low testosterone is listed as a risk factor for men. I've already stated that I won't go off Androcur. I'm certain my doctor will feel he needs to suggest this, and I won't blame him. I also think he'll understand where I'm at when I say I can't do that. We've already had the transgender discussion.

The book mentioned reduced stature as a symptom of osteoporosis. I used to be 1 1/2" taller than now. Sometime in the mid 90's or earlier, I lost that. So I may have had osteo even longer than I'd earlier suggested. The book very definitely listed small bone structure as a risk factor. That's me. It also listed a body mass index of 19 or lower as a risk. Right now I'm not too far above that but the at risk BMI may be significantly lower for men than women.

So, there's lots to think about. I've got to say one of my major concerns is will it be wise for me to continue inline skating (i.e. 'rollerblading')? Yes, folks, this small-boned, chemically castrated eunuch really enjoys inline skating. [I even purchased 'faster' skates last year so I could more easily keep up with the hot, shirtless guys skating in front of me!] Until asthma forced me inside for most of last summer, I was skating up to 25 miles. I don't expect to have much problem continuing my weight-training and aerobic exercises. I'll just need to keep to a more regular schedule.

I definitely need to work on my diet. In this cold, cloudy northern clime, there's little sunlight even on the occasional sunny winter day. I need to get more vitamin D. More green, leafy veggies, etc.

I'll be perfectly willing to take a bisphosphonate drug to help treat this, too. It seems this is the only class of drugs approved for treating osteoporosis in men.

So, there are a number of reasons to be optimistic about this. I'll let you know tomorrow evening how things went with my doctor.

[Danya (imported)]

I usually feel no anxiety at all when seeing any doctor. Today I am. The visit should be over in less than 3 hours so I hope my anxiety level will go down at that point!

I typically have no problem asking questions or closely questioning and even disagreeing with the doctor's advice. Today won't be any different. I suspect that once I get into my usual bantering, joking conversational mode with 'Charlie', I'll settle down.

[mrt (imported)]

You have to watch the label close when it comes to calcium. Most times the dose that is on the front of the jar is when you take two tablets. You need to be taking at least 1000mg a day.

Thanks Bobby:

I will double check that. It's one of those things we have to do now to avoid issues later and thanks for the tip on doing it right.

- MrT

[mrt (imported)]

I usually feel no anxiety at all when seeing any doctor. Today I am. The visit should be over in less than 3 hours so I hope my anxiety level will go down at that point!

I typically have no problem asking questions or closely questioning and even disagreeing with the doctor's advice. Today won't be any different. I suspect that once I get into my usual bantering, joking conversational mode with 'Charlie', I'll settle down.

Good luck with the Doctor. For what its worth my new sexual "status" has not changed my good relationship with my Doctor. I hope it goes great for you and ahh... I'll have to pass on that test flight with Estrogen. Hell if I liked it (as others have suggested) who would be there to throw snickers bars at soccer players pretending to be hurt?!?!

[Danya (imported)]

I'm really worn out tonight so this may not come out as clearly written as other posts. OTOH, maybe it's just wishful thinking that my other posts are generally clear!

I don't want to wait until the morning to update you on my appointment this morning.

As many of you know, one measure or bone density is the T score. Values at or below -2.5 are considered indicative of osteoporosis. My lowest T score, for an area of my right hip, is -3.2. Only one of the four measured was as 'good' as -2.5.

Tomorrow morning, I'll start the once a week dosage of Actonel. This is one of the bisphosphonate class of drugs approved for treating males with osteoporosis. With insurance, my copay for this came to $90 for a one month supply of 4 tablets. Despite the really steep price, I feel fortunate. I have no idea how people with no insurance and/or less money can afford proper medical care. Truth is, they can't. That's one of the great injustices of life in the US. Even my pharamacist has unkind comments for the profits of the pharmaceutical companies.

As it is for me, a pretty hefty chunk of my monthly salary goes for drugs. I don't like it and it would be nice to have some of the money to spend on other things. At least for the time being, though, I'm able to pay for the meds. A lot of people aren't nearly as fortunate.

I'll be making changes to my diet, including eating more leafy green veggies, downing more milk, drastically reducing my caffeine intake, etc. While I've been exercising more or less regularly, I now need to make sure I exercise on a very regular routine that I skip only if I'm ill. I'll be taking a calcium supplement to make up the difference between what I get from milk, other dairy products and veggies and the 1500 mg/day my doc says I should be getting. I want to be careful to get enough calcium. Too much of the supplement, though, can cause kidney stones. I'll err on the side of kidney stones, though, if I'm in doubt . There will be other changes, too.

In one year, we'll redo the bone density scan. I'm optomistic that these lifestyle changes, combined with the drug therpay, will result in a large improvement in bone density.

BTW, my doctor never suggested I stopped taking Androcur. He fully accepts where I'm at with being transgendered.

I want to thank all of you for taking the time to provide lots of useful information and emotional support. It helped me get through a difficult week.

[bobbie (imported)]

Sounds like you will be hit with some heavy prisctiption bills for Actonel. May I suggest going out of the country and ordering online for the meds. It will be far more cost effective. Here is a link to one for Actonel. http://www.masters-uk.com/medicines/sea ... rch&page=1 You just put in the drug name in the search for the price and dose information. This site is used by many from this site. Good and fast service. Great place to get androcur.

I am on fosamax for my osteoporosis. It is a once a week pill. My insurance covers all but $30.00 of the price. So for me it is cheaper to get local.