My life

[Danya (imported)]

I think of this sort of thing as lessons that could not be had for any money - although the price paid can be high in other ways. --FLO--

Thanks, Flo, for your thoughtful observations. It helps to know that someone recognizes that many people go through this type of thing. Over the last few days I have felt like an idiot for not accepting the reality of who this man is far sooner.

I hope I am far wiser for this experience.

Hugs,

Danya

[Danya (imported)]

To move beyond 'X,' for the last time, I have deleted his phone number from my cell phone and removed his email address from my list of contacts. I am also taking steps that have worked before, including visiting places alone that we used to jointly explore.

Tonight, I went to a movie alone for the first time in months. I saw the fairly light-weight "No Strings Attached." I was crying at the end, as I frequently do at movies whatever the genre. This was good for me.

A call from a friend earlier this evening helped a lot, too. We have known each other for several years, going back to the time before I transitioned. I felt very calm after we spoke about many things. This confirmed that I really need to get into action to form a local network of friends. Not that they will ever replace the friends I already have.

Tonight, I received an email from a woman friend who is a trainer at the Minnesota Workforce Center I relied on, a lot, when I was laid off. We became friends. I was always quite open with her about who I am. I needed to be as I wanted feedback then about how to handle job applications as a trans woman.

In her note, she was responding to my request for suggestions on my life direction. Taking into account her knowledge of me and where my passions lie. She offered some very keen insights and ideas, too. She is a sweetheart.

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[transward (imported)]

I am sorry for all the stress in your life. Breakups, even when it is the only thing to do, still are painfull. Take care of yourself.

Regarding your antidepressant, I have a lot of empathy for your situation. But I am having a hard time figuring out your plans. Your scheduled SRS is in about 8 week. In that time you are talking about tapering off one antidepressant, then tapering up to full dose on another, then immediately turning around and tapering back off the second. Since every antidepressant I know of warns of going on or off too quickly, and it usually takes two to three weeks to taper off or on, that's cutting it a bit close and almost guaranttes 8 weeks of emotional upheaval. Since your insurance is going to continue till your SRS, and since you have to taper off for your SRS, it would seem to make more sense to continue the expensive one till you have to go off for SRS, then to go on the new one after the surgery.

I am curious about your link between the estrogen and the depression. I also (like many trans folk) have battled depression my whole life. I have been suicidal at least since age twelve; that I am still hanging around at my age is a testament to the power of positive cowardice. In my case I have found that I get quite depressed shortly before I am due for a new shot, and that my mood improves considerably after a shot. Does the estrogen induce your depression of is it linked to the drop in blood levels just before the shot? (I take 20 mg every two to three weeks.)

Should you ever get up to the NW corner of the country I would love to meet you sometimes.

Transward

[butterflyjack (imported)]

Hi sweety...I like what Transward had to say...and the way you're talking, it's almost as though you're forecasting gloom and doom...If you follow Transward's advice, the surgery may just enhance your mood to the point that, upon restarting with the less miraculous drug , you just may have a full recovery...

Sounds feasible to me... And, it looks like winter's worst is behind us...and you have springtime in Montreal to look forward to in about 2 months...

Big smooches dragonfly

[transward (imported)]

Are you also taking progesterone? Serious problems with depression are much more common as side effects of it than of estrogen. This is especially true of those taking synthetic progestins, which are notorious for causing serious depression. The sudden drop in blood estrogen levels at childbirth, and the corresponding rise of progesterone levels is one of the main causes of postpartum depression in genetic women.

Transward

[Danya (imported)]

I am sorry for all the stress in your life. Breakups, even when it is the only thing to do, still are painfull. Take care of yourself.

Hi Transward,

Thanks for writing, for expressing your understanding and for caring.

Regarding your antidepressant, I have a lot of empathy for your situation. But I am having a hard time figuring out your plans. Your scheduled SRS is in about 8 week. In that time you are talking about tapering off one antidepressant, then tapering up to full dose on another, then immediately turning around and tapering back off the second. Since every antidepressant I know of warns of going on or off too quickly, and it usually takes two to three weeks to taper off or on, that's cutting it a bit close and almost guaranttes 8 weeks of emotional upheaval.

I agree with you and I used the same line of reasoning. What I did not mention is that, once I am off my current antidepressant for two weeks, I will start yet another medicine to help me get through the adjustment period to the new antidepressant. Both my psychiatrist and my HRT physician recommended that I take a prescription amphetamine (e.g., ritilin) to boost my energy level during the transition time. I'm not convinced this is wise, and I will research it further. If I follow my doctors' advice, though, I may not start the new antidepressant at all until after surgery.

Since the end of January, I have been without health insurance. That's when my 18-months of COBRA coverage ran out. I will be covered under my contract agency's policy by next week. Whether or not the new plan covers my antidepressant, I can no longer afford the co-payment. I have to stop taking very expensive medicine unless I have no option.

The lack of affordable health insurance for contract workers is one reason I am considering career options.

I am curious about your link between the estrogen and the depression. I also (like many trans folk) have battled depression my whole life. I have been suicidal at least since age twelve; that I am still hanging around at my age is a testament to the power of positive cowardice. In my case I have found that I get quite depressed shortly before I am due for a new shot, and that my mood improves considerably after a shot. Does the estrogen induce your depression of is it linked to the drop in blood levels just before the shot? (I take 20 mg every two to three weeks.)

I suspect you are positively a courageous 'coward,' at the very least. Having dealt with major depression since the age of 4 or so, I know first hand how difficult this makes life. That you have gotten this far is a testament to your courage.

The folks at the University of Minnesota gender clinic warned me of the danger for estrogen to exacerbate depression. They did not consider it to be an absolute contraindication to treatment with estrogen, but urged caution. I have done a literature search of my own which confirms this connection for some people, not all.

As far as the estrogen goes, for weeks I felt extremely low for a several days after an injection. Supplemental testosterone solved that problem. I may feel a little down the day before an injection.

The estradiol content in my weekly 7 cc injection is roughly 280 mg, or an average of 40mg/day. My doctor would like to see my blood plasma estrogen level in the 200 - 400 (whatever units ) range. When I was using the sublingual pills, I was taking 10 mg/day (70 mg/week).

I'm sure this final break-up with 'X' is contributing to my down mood, which really is not so bad now.

I can handle 10 mg/day of estrogen as I change medications. I still think it's too risky to be on 280 mg/week during this time. Anyway, several weeks before surgery I will need to stop all estrogen HRT. This may make things more difficult.

I apologize for my rambling reply.

Just saw your latest question. No, I am not taking prog

esterone.

Should you ever get up to the NW corner of the country I would love to meet

you sometimes.

Transward

I would love to meet you, too, my friend.

Hugs,

Danya

Hi sweety...I like what Transward had to say...and the way you're talking, it's almost as though you're forecasting gloom and doom...

Hi Dragonfly,

I've dealt with changing antidepressant medications numerous times over the last 3 1/2 decades. My forecast comes from experience. I'm simply being realistic. If things are dif

ferent this time, no one will be happier than me.

If you follow Transward's advice, the surgery may just enhance your mood to the point that, upon restarting with the less miraculous drug , you just may have a full recovery...

I am hopeful that after surgery, and when my life becomes more stable, I won't need any antidepressant. That would be truly wonderful. In general, my post-transition

life has far exceeded my expectations. I never dreamed I could be so happy on a regular basis.

Until things are more stable for me, though, I am just as hopeful that the less ex

pensive antidepressant will be more than adequate.

Sounds feasible to me... And, it looks like winter's worst is behind us...and you have springtime in Montreal to look forward to in about 2 months...

Big smooches dragonfly

The temperature here in Chicagoland reached at least the mid-50s today. I loved it. Things will cool down again but Spring is not far off.

Hugs,

Danya

[Danya (imported)]

This is a very difficult time for me. Overall, and conveniently ignoring some large bumps along the way , I am pleased with the way I have handled my life in the time since I was laid off.

This is another bump time. I need to keep in mind what my close friend Erica Ann has told me. "You've made it through some difficult times in your life, you can make it through this." She is right and I will make it through my current life complications.

My woman friend at the Minnesota Workforce Center wrote to me Tuesday. She, and a male colleague who was my dislocated worker counselor, continue to have seemingly unlimited faith in my ability to get to where I want and need to be.

[It still saddens me that so many, through no fault of their own of for lack of trying, still struggle to find work. People should be able to earn a living, regardless of their social status, race, gender of educational level.]

Her note reminded me that I have, so far, never failed to achieve what I have gone after in my life. This does not mean that what I have pursued, and gained, was always in my best interest. I just don't know when to give up.

Some months ago, I reached the point of fully believing what people like this friend were telling me. I think I'm still mostly there, taking into account a quite natural feeling of discouragement. Being discouraged does not mean I do not believe in myself, my worth and the contributions I can make to others.

Years ago, a wise therapist told me that it is possible to be depressed and also at peace. As in simultaneously. I agree, although this can be challenging.

Although I do not feel quite as on top of things as I prefer, I still find great joy and reassurance in music.

At times like this, it helps if I leave inspirational quotes lying about to read from time to time. These are a few I just found. Many refer to relationships that have ended. Some could easily apply to many of life's disappointments:

Anonymous

Relationships are like glass. Sometimes it's better to leave them broken than try to hurt yourself putting it back together.

Victoria Holt

Never regret. If it's good, it's wonderful. If it's bad, it's experience.

Larry Miller

I broke up with someone, and she said, "You'll never find anyone like me again." And I'm thinking, 'I hope not!'

Margaret Mitchell

I was never one to patiently pick up broken fragments and glue them together again and tell myself that the mended whole was as good as new. What is broken is broken, and I'd rather remember it as it was at its best than mend it and see the broken pieces as long as I lived.

Nicole Kidman

I refuse to let what happened to me make me bitter. I still completely believe in love and I'm open to anything that will happen to me.

Usher

Breaking up is a natural evolution when you try to figure out what you want in life. If you're with an individual who isn't moving in the same direction and at the same rate that you are, it ain't going to work.

Alexander Graham Bell

When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us.

Nicole Kidman

I'm not sure what the future holds but I do know that I'm going to be positive and not wake up feeling desperate. As my dad said "Nic, it is what it is, it's not what it should have been, not what it could have been, it is what it is."

[transward (imported)]

...

As far as the estrogen goes, for weeks I felt extremely low for a several days after an injection. Supplemental testosterone solved that problem. I may feel a little down the day before an injection.

The estradiol content in my weekly 7 cc injection is roughly 280 mg, or an average of 40mg/day. My doctor would like to see my blood plasma estrogen level in the 200 - 400 (whatever units ) range. When I was using the sublingual pills, I was taking 10 mg/day (70 mg/week).I

I can handle 10 mg/day of estrogen as I change medications. I still think it's too risky to be on 280 mg/week during this time. Anyway, several weeks before surgery I will need to stop all estrogen HRT. This may make things more difficult.

Hugs,

Danya

I am concerned about this. Perhaps I misunderstand you or maybe you are taking some other form of estrogen than I am aware of. I am assuming when you speak of injectable estrogen, you are talking about estradiol valerate in oil, Delestrogen or its compounded equivalent, usually 20 or 40 mg per ml. You say you take 7 ml for 280 mg per week. That is over 1120 mg a month. If that is Delestrogen, that is a massive and dangerous over dose. I give shots to myself and four other needlephobic transsexuals, with prescriptions from three different doctors. The largest dose is 20 mg per shot taken every other week for a total of around 40 mg per month. Your dose is almost 30 times the recommend dose for a pre-op transsexual.

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

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.

http://www.annelawrence.com/regimens.html

Injectable (intramuscular) estrogen

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.

I assume I am mistaken,(I am not a doctor) but in the off chance I am right, please talk to your doctor immediatly and your SRS surgeon. That level of estrogen would put you at huge risk for blood clots in surgery (or at any other time for that matter.) I hope I am being silly, but that big an overdose would cause the other problems.

Transward

[Danya (imported)]

I am concerned about this. Perhaps I misunderstand you or maybe you are taking some other form of estrogen than I am aware of. I am assuming when you speak of injectable estrogen, you are talking about estradiol valerate in oil, Delestrogen or its compounded equivalent, usually 20 or 40 mg per ml.

I am taking the intramuscular injections of estradiol valerate in cottonseed oil. The bottle shows that this is 40 mg per cc (i.e., ml).

You say you take 7 ml for 280 mg per week.

This is exactly what I take.

That is over 1120 mg a month. If that is Delestrogen, that is a massive and dangerous over dose. I give shots to myself and four other needlephobic transsexuals, with prescriptions from three different doctors. The largest dose is 20 mg per shot taken every other week for a total of around 40 mg per month. Your dose is almost 30 times the recommend dose for a pre-op transsexual.

For references;http://www.eunuch.org/vbulletin/showthread.php?

http://www.annelawrence.com/regimens.html

I just did a quick search that I certainly do not consider exhaustive or authoritative. I need to get ready for work.

Sites I looked at included those covering use of IM estradiol valerate in natal and transsexual women.

Many of these sites listed depression as a possible side effect in both natal and transsexual women susceptible to depression.

I will investigate further tonight. For now, it looks like the dose I am taking is not out of line with that prescribed by some doctors to both natal women (who may have had ovaries removed or be experiencing other problemscausing an estrogen deficit) and transsexual women.

What many providers, including the HRT doctor I saw in Minnesota, tend to look for is the resulting estrogen blood level while being somehwat less concerned about the dose. When I was taking a lower injection dose of 140 mg/week, my tested estrogen level was no higher than the roughly 130 I was getting from sublingual pills.

I assume I am mistaken,(I am not a doctor) but in the off chance I am right, please talk to your doctor immediatly and your SRS surgeon. That level of estrogen would put you at huge risk for blood clots in surgery (or at any other time for that matter.) I hope I am being silly, but that big an overdose would cause the other problems.

Transward

My surgeon insists that all estrogen therapy by stopped 3 weeks before surgery.

I have discussed this dose of estradiol valerate with my physician several times. I'm aware of the potentail for blood clots and other problems. This is a problem with all forms of estrogen administration, although it is likely a higher risk on the dose I am on. Right now, I am getting blood work done every 3 months to follow what's happening. All of my test results remain well within the normal range.

He has treated over 200 transsexual women without problems, most with injectable estradiol valerate.

I'll try to write more on this tonight.

Transward, I very much appreciate your concern. Got to finish dressing for work.

[transward (imported)]

A few more citations for normal estrogen dosage.

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

For treatment of moderate to severe vasomotor symptoms, vulvar and vaginal atrophy associated with the menopause, the lowest dose and regimen that will control symptoms should be chosen and medication should be discontinued as promptly as possible.The usual dosage is 10 to 20 mg Delestrogen every four weeks. ...For treatment of female hypoestrogenism due to hypogonadism, castration, or primary ovarian failure.The usual dosage is 10 to 20 mg Delestrogen every four weeks. ... For treatment of advanced androgen-dependent carcinoma of the prostate, for palliation only. ...The usual dosage is 30 mg or more administered every one or two weeks. ...

This is a straight copy of the Delestrogen package insert.

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

The recommended estradiol valerate dose is 10 mg to 20 mg injected once every a month. If you still have a uterus (if you have not had a hysterectomy), it is recommended that you take a progestin medication along with estradiol valerate, in order to help prevent cancer of the lining of the uterus....For prostate cancer, the recommended estradiol valerate dosage is 30 mg (or more) injected once every one or two weeks. This is a very high estradiol valerate dosage (much higher than recommended for other uses).

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

Beyond a certain point, larger dosages will not increase tissue response, but will only cause more side effects.

Transward