Stopping hormones before SRS
PTHolmes
Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
2-3 weeks prior to surgery. I believe this is due to the possibilty of
blood clotting. Do all doctors who do SRS recommend this? Could one reduce
her dose, but not completely stop before SRS? How critical is this?
thanks,
Tara
--
http://www.remoteview.com/holmes/trans.htm
Becky Allison
PTHolmes wrote:
>
> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
> 2-3 weeks prior to surgery. I believe this is due to the possibilty of
> blood clotting. Do all doctors who do SRS recommend this? Could one reduce
> her dose, but not completely stop before SRS? How critical is this?
>
thrombosis (blood clots). The risk may be small, but the fact that
after SRS you are at bed rest for several days further increases the
risk. All reputable surgeons do have this requirement.
When you compare the possibility of venous thrombosis or a blood clot to
the lungs with the minor inconvenience of being off estrogen for two or
three weeks, I would strongly suggest following the surgeons' request.
Becky Allison, MD
(yes, I stopped estrogen for three weeks too)
Laura Werner
On 9 Nov 1997 18:55:26 GMT, ptho...@aol.com wrote...
> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
> 2-3 weeks prior to surgery.
I talked to both of them about this. Dr. Schrang was adamant; he said to
stop taking any estrogen 3 weeks before surgery because it minimizes the
chance of blood clots after SRS. He didn't care what kind of estrogens I
was taking. Three weeks.
When I talked to Toby, he said the same thing at first. Then I told him
that my internist (Joy Shaffer) had said that I should stop the Premarin
3 weeks before SRS but could take estradiol until a week before. At that
point, he basically said "OK; she knows more about hormones than I do, so
listen to her advice." That's what I did, and I had no hormone-related
problems. I had a few minor hot/cold flashes when I started taking the
'mones again, but that might have been caused by something else.
--
Laura Werner
la...@goodkitty.com
Jennifer
Dr Biber requires it as well, the girl next to me didn't stop and had
complications with excessive bleeding. He flipped when she admitted to not
stopping.
PTHolmes <ptho...@aol.com> wrote in article
<19971109185...@ladder02.news.aol.com>...
> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
> 2-3 weeks prior to surgery. I believe this is due to the possibilty of
> blood clotting. Do all doctors who do SRS recommend this? Could one
reduce
> her dose, but not completely stop before SRS? How critical is this?
>
Rebecca Deerborne
PTHolmes wrote in message <19971109185...@ladder02.news.aol.com>...
>Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>2-3 weeks prior to surgery. I believe this is due to the possibilty of
>blood clotting. Do all doctors who do SRS recommend this? Could one reduce
>her dose, but not completely stop before SRS? How critical is this?
Last I heard, Menard required the same thing.
Although his instructions basically said "stop taking hormones", and I think
the time period was 3 weeks prior to surgery, I opted instead to gradually
reduce my dosage over the course of 4 weeks, being completely off HRT exactly
7 days before my surgery.
I wanted to avoid any hot flashes or other menopausal symptoms, and it seemed
to work.
Doctors recommend the hormone stoppage precisely because of the risk of
clotting -- and this isn't just for SRS, it's for nearly all surgeries. You
can develop a thrombosis, have the clot break free, and then it can travel to
a vital organ and do all kinds of damage.
They also say to avoid ansaids (things aspirin) because they prevent clotting
(the opposite problem).
How critical is stopping HRT before SRS? I dunno. Even the doctors can't
entirely seem to agree on it.
Rebecca
Dana Priesing
On 9 Nov 1997 18:55:26 GMT, ptho...@aol.com (PTHolmes) wrote:
>Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>2-3 weeks prior to surgery. I believe this is due to the possibilty of
>blood clotting. Do all doctors who do SRS recommend this? Could one reduce
>her dose, but not completely stop before SRS? How critical is this?
Michael Royle (in England), in addition to requiring 30 days off
hormones prior to surgery, has patients put on Jobst stockings
(compression stockings) before surgery, and they stay on for several
days thereafter, to reduce the risk of clots forming in the legs.
Dana
Grrlpetal
Menard sez no estrogens 3 weeks prior, "but you may continue taking
other hormones." I'm planning to do a testosterone blocker in a couple
of weeks.
dani richard
How critical? Life, death or lingering illness.
All the SRS surgons require stopping hormones before sugery!
The possiability of a clot and dying on the table is very very real!
I have heard that happend to one girl. She did no stop taking estorgen
before sugery. She died on the table due to a clot.
You could just have a small clot find its way to your brain. You could
be just partially parialized, blind, deminished mental capacity, or what
other brain dead combination that may happen.
These sugons have beeing doing surgeries (as well as SRS) for many
years. They have lots and lots of experience with "something going
wrong." They don't want it happing to you. They want to collect more
fees. Living patients make for good advertising. Dead ones don't come
back for more procedures! Dead ones drive away perspective customers.
Metzer say 3 weeks... I don't like either, but it is very necessary.
Remember the life you save may be your own!
Dani Richard
P.S. Reducing you dosage is like saying, "I am going to pull the tigger
gently. The bullet won't hit as hard that way."
PTHolmes wrote:
>
> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
> 2-3 weeks prior to surgery. I believe this is due to the possibilty of
> blood clotting. Do all doctors who do SRS recommend this? Could one reduce
> her dose, but not completely stop before SRS? How critical is this?
>
Natalie
In article <19971110191...@ladder02.news.aol.com>, SharonSchm
<sharo...@aol.com> writes
>I dunno what Mr. Royle recommends...but AFAIK Androcur isn愒 a risk
>factor. At least, blood clotting problems are not listed as a side effect,
>so I think it愀 safe.
That's not true. Androcur (Cyproterone acetate) _is_ a risk factor for
thrombo-embolic disease (source: British National Formulary, 09/97,
s8.3.4.2) and surgeons are therefore justified in their concern that you
should come off it before major surgery. Not to mention its
hepatotoxicity, which could be problematic in combination with other
drugs administered perioperatively.
Yours medically :)
Natalie.
=======================================================================
The Looking Glass Society, UK.
Mail: <lookin...@crystaleyes.demon.co.uk>
WWW: <http://www.crystaleyes.demon.co.uk>
=======================================================================
Dana Priesing
On Tue, 11 Nov 97 02:07:47 GMT, Meli...@Yamnix.com (Melissa) wrote:
>> Michael Royle (in England), in addition to requiring 30 days off
>>hormones prior to surgery, has patients put on Jobst stockings
>>(compression stockings) before surgery, and they stay on for several
>>days thereafter, to reduce the risk of clots forming in the legs.
>
>The ones they put on in Neenah were so loose, I doubt they would have prevented
>anything.
Mine were TIGHT, baby. I could barely get 'em on.
Gea van der Voort
Hi Tara,
PTHolmes <ptho...@aol.com> wrote in article
<19971109185...@ladder02.news.aol.com>...
> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
> 2-3 weeks prior to surgery. I believe this is due to the possibilty of
> . Do all doctors who do SRS recommend this? Could one reduce
> her dose, but not completely stop before SRS? How critical is this?
I had my SRS at the VU academic hospital in Amsterdam last year. They
urged me to stop hormones about 4 weeks before surgery, indeed due to the
risc of blood clotting. BTW I'm on estradiol-plasters. The surgeon involved
was Dr J.J.
Hage.
Hugs
Gea ( ... back, for a minute or two ...:)
--
Freedom is just another word for nothing left to lose......
Janis Joplin
SharonSchm
In article <QJrd3BAy...@npony.demon.co.uk>, Support
<Ni...@npony.demon.co.uk> writes:
>I have heard of one friend staying on Androcur for a lesser surgery. Can one
>continue androgen blockers before SRS or does this also increase the risk of
>blood clots? That at least would prevent masculization. What does Michael
>Royle recommend?
I dunno what Mr. Royle recommends...but AFAIK Androcur isn´t a risk
factor. At least, blood clotting problems are not listed as a side effect,
so I think it´s safe. And you won´t masculinize that much within 4 weeks,
even without taking it...
Bye
Sharon
Francine Smit
SharonSchm <sharo...@aol.com> wrote:
<snip>
> so I think it´s safe. And you won´t masculinize that much within 4 weeks,
> even without taking it...
Its better to stop using both hormones. And yes the change is already
made.
--
Francine.
Natalie
In article <QJrd3BAy...@npony.demon.co.uk>, Support
<Ni...@npony.demon.co.uk> writes
>I have heard of one friend staying on Androcur for a lesser surgery. Can one
>continue androgen blockers before SRS or does this also increase the risk of
>blood clots? That at least would prevent masculization. What does Michael Royle
>recommend?
The last time one of my clients went to him, just a few months ago, he
was insisting on no hormones or antiandrogens of any kind for a minimum
of six weeks prior to SRS. He also routinely uses TED (anti-embolitic)
stockings and heparin (an anticoagulant) while patients are confined to
bed.
He will accept patients using GnRH agonists such as goserelin or
nafarelin to limit reversion while off hormones -- but there have been
some questions over the safety of these.
With minor surgery it is often possible to stay on
hormones/antiandrogens but it is always prudent to ask the advice of the
surgeon and anaesthetist who are treating you. In some cases they may
take precautions such as anti-embolitic stockings and/or anticoagulants
but let you stay on hormones.
Hope this is useful,
Melissa
In article <34661B...@primenet.com>,
Becky Allison <beck...@primenet.com> wrote:
>PTHolmes wrote:
>>
>> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>> 2-3 weeks prior to surgery. I believe this is due to the possibilty of
>> her dose, but not completely stop before SRS? How critical is this?
>>
>thrombosis (blood clots). The risk may be small, but the fact that
>after SRS you are at bed rest for several days further increases the
>risk. All reputable surgeons do have this requirement.
>
>When you compare the possibility of venous thrombosis or a blood clot to
>the lungs with the minor inconvenience of being off estrogen for two or
>three weeks, I would strongly suggest following the surgeons' request.
>
>Becky Allison, MD
>(yes, I stopped estrogen for three weeks too)
I went to Schrang and stopped it for 3 weeks before AND after. Sure felt good
starting it up again & not having to be soaked in sweats all the time.
Of course that's just my opinion.
Anyone who doesn't agree with me is clearly wrong. :-)
- Melissa
To email me, remove X and Y spam proofing from my address. Abusive email may be posted.
Melissa
In article <645bl1$d...@dfw-ixnews9.ix.netcom.com>,
"Rebecca Deerborne" <Rebecca_...@bigfoot.com> wrote:
>
>PTHolmes wrote in message <19971109185...@ladder02.news.aol.com>...
>>2-3 weeks prior to surgery. I believe this is due to the possibilty of
>>blood clotting. Do all doctors who do SRS recommend this? Could one reduce
>>her dose, but not completely stop before SRS? How critical is this?
>
>
>Although his instructions basically said "stop taking hormones", and I think
>the time period was 3 weeks prior to surgery, I opted instead to gradually
>reduce my dosage over the course of 4 weeks, being completely off HRT exactly
>7 days before my surgery.
>
>I wanted to avoid any hot flashes or other menopausal symptoms, and it seemed
>to work.
Then you took a dangerous risk. If it wasn't out of your system enough to cause
hot flashes the day after srs ( assuming you hadn't had an orchiectomy before
srs ) then it was still in your system when you had srs and could have harmed
you.
>Doctors recommend the hormone stoppage precisely because of the risk of
>clotting -- and this isn't just for SRS, it's for nearly all surgeries. You
>can develop a thrombosis, have the clot break free, and then it can travel to
>a vital organ and do all kinds of damage.
Yeah, like a lung and kill you.
>They also say to avoid ansaids (things aspirin) because they prevent clotting
>(the opposite problem).
>
>How critical is stopping HRT before SRS? I dunno. Even the doctors can't
>entirely seem to agree on it.
It sounds like they pretty much agree.
Melissa
In article <MPG.ecfbc4d9...@nntp1.ba.best.com>,
la...@goodkitty.com (Laura Werner) wrote:
>On 9 Nov 1997 18:55:26 GMT, ptho...@aol.com wrote...
>> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>> 2-3 weeks prior to surgery.
>
>stop taking any estrogen 3 weeks before surgery because it minimizes the
>chance of blood clots after SRS. He didn't care what kind of estrogens I
>was taking. Three weeks.
>
>When I talked to Toby, he said the same thing at first. Then I told him
>that my internist (Joy Shaffer) had said that I should stop the Premarin
>3 weeks before SRS but could take estradiol until a week before. At that
>point, he basically said "OK; she knows more about hormones than I do, so
>listen to her advice." That's what I did, and I had no hormone-related
>problems. I had a few minor hot/cold flashes when I started taking the
>'mones again, but that might have been caused by something else.
I thought it was 3 weeks before and after.
PTHolmes
In article <19971110191...@ladder02.news.aol.com>,
sharo...@aol.com (SharonSchm) writes:
And you won´t masculinize that much within 4 weeks,
>even without taking it...
I start masculinizing within 24 hrs. of stopping hormones, even with an
anti-androgen. In four weeks I've lost just about everything.
But this doesn't mean I'm going to go against my doctor's advice when my
time for SRS is here.
Tara
--
http://www.remoteview.com/holmes/trans.htm
Melissa
In article <19971111025...@ladder02.news.aol.com>,
ptho...@aol.com (PTHolmes) wrote:
>In article <19971110191...@ladder02.news.aol.com>,
>sharo...@aol.com (SharonSchm) writes:
>
> And you won´t masculinize that much within 4 weeks,
>>even without taking it...
>I start masculinizing within 24 hrs. of stopping hormones, even with an
>anti-androgen. In four weeks I've lost just about everything.
>
>But this doesn't mean I'm going to go against my doctor's advice when my
>time for SRS is here.
Even so, it gets much better after srs and just keeps on going.
Anne A. Lawrence
(PTHolmes) wrote:
>Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>2-3 weeks prior to surgery. I believe this is due to the possibility of
>blood clotting. Do all doctors who do SRS recommend this? Could one reduce
>her dose, but not completely stop before SRS? How critical is this?
Standard disclaimer: The following is medical talk, not medical
advice. Always consult your own physician. Now:
At the risk of offering a dissenting opinion, I believe that there is
no evidence of *any* kind to suggest that continuing to take estrogen
up to the time of SRS, or immediately afterward, leads to an increased
risk of complications (morbidity or mortality) after SRS. There are
simply *no data*.
I know that virtually all SRS surgeons will tell you that if you
continue to take estrogen, you increase your risk of venous thromboses
(blood clots), and therefore you are at increased risk for
complications, including death. And I understand their rationale --
estrogen increases blood coagulability, therefore there may be an
increased risk of clots. But has this been *demonstrated*? No -- it's
just one of those pieces of "logical" reasoning that doctors like to
indulge in. And an established practice, whether or not it is
supported by evidence, does tend to have a life of its own.
As an illustration of how complicated the issue is, consider this:
both blood clots *and* excessive bleeding can occur after SRS, whether
or not one is taking estrogen. Both are serious complications. So
let's assume for the moment that continuing to take estrogen *does*
increase your risk of symptomatic thrombosis. But isn't it possible
that it might also decrease your risk of post-operative bleeding --
maybe to a similar entent? How does the magnitude of that possible
benefit compare to the possible risk? Is estrogen beneficial, risky,
or neutral? Nobody knows, because nobody has done the study.
Surgeon Milton Edgerton, in his invited comments on a paper by Jan
Eldh concerning SRS, offered this tart question about Eldh's policy of
requiring the discontinuation of estrogen:
"It would be interesting to hear why the author recommends
discontinuing estrogen for 5 weeks in the perioperative period. Has he
seen complications or problems when this was not done?" (Plast.
Reconstr. Surg. 91: 901-902; April, 1993)
I've taken care of hundreds of women on hormone replacement having
pelvic surgery, and don't recall a single case where it was
discontinued preoperatively. And I've taken care of at least several
dozen men with prostate cancer who were receiving high-dose estrogen
therapy (much higher than we take), who also underwent a variety of
operations -- also without their estrogen being stopped. I have no
reason to think that SRS patients should be treated any differently
than these other patients.
My thought would be that transsexual women should weigh the possible
risks of continuing estrogen (maybe an increase in thrombosis; plus
the need to lie to one's surgeon in order to get SRS), vs. the
possible benefits of continuing estrogen (maybe a decrease in
perioperative bleeding, plus less discomfort from estrogen withdrawal)
and make their own decision.
I certainly feel that any transsexual woman who goes into SRS taking a
*low* replacement dose of estrogen (e.g., 0.625 mg Premarin), plus
enough spironolactone to reduce her testosterone to normal female
levels, would be entering surgery with the same hormone profile as
literally *thousands* of non-transsexual women on hormone replacement
therapy who undergo major surgery in the United States every day. And
they're not all dying.
One final caveat: no matter what you decide to do, tell your surgeon
what he wants to hear, i.e., that you were a good girl and *did* stop.
What did I do when I had SRS with Toby Meltzer on April 29, 1996?
Well, let's put it this way: I *told* him I had stopped....
Love and Sisterhood,
Anne
Melissa
RosePress
In article <3467c914....@news.mindspring.com>,
alaw...@mindspring.com (Anne A. Lawrence) writes:
>As an illustration of how complicated the issue is, consider this:
>both blood clots *and* excessive bleeding can occur after SRS, whether
>or not one is taking estrogen. Both are serious complications. So
>let's assume for the moment that continuing to take estrogen *does*
>increase your risk of symptomatic thrombosis. But isn't it possible
>that it might also decrease your risk of post-operative bleeding --
>maybe to a similar entent? How does the magnitude of that possible
>benefit compare to the possible risk? Is estrogen beneficial, risky,
>or neutral? Nobody knows, because nobody has done the study.
Dear Dr. Lawrence --
When I recently had liposuction, I brought this question up with the
surgeon. He said not to bother -- as far as he was concerned, the problem
was leaking, not coagulation. I had better not use NSAIDs for two weeks
before or after, but the estrogen was okay.
I think my compromise will be to go back on estrogen as soon as I am well
and properly ambulatory. I've never had a problem with thromboses.
Best -- Ellen Rose
If Cthulhu calls, don't answer.
(Another reason for Caller ID!)
beck...@primenet.com
In article <3467c914....@news.mindspring.com>,
alaw...@mindspring.com wrote:
> Standard disclaimer: The following is medical talk, not medical
> advice. Always consult your own physician. Now:
>
> At the risk of offering a dissenting opinion, I believe that there is
> no evidence of *any* kind to suggest that continuing to take estrogen
> up to the time of SRS, or immediately afterward, leads to an increased
> risk of complications (morbidity or mortality) after SRS. There are
> simply *no data*.
That is true. I suspect a prospective, randomized study comparing
persons who continued estrogen with persons who stopped might eventually
enroll enough people to reach statistical significance.
>
> I know that virtually all SRS surgeons will tell you that if you
> continue to take estrogen, you increase your risk of venous thromboses
> (blood clots), and therefore you are at increased risk for
> complications, including death. And I understand their rationale --
> estrogen increases blood coagulability, therefore there may be an
> increased risk of clots. But has this been *demonstrated*? No -- it's
> just one of those pieces of "logical" reasoning that doctors like to
> indulge in. And an established practice, whether or not it is
> supported by evidence, does tend to have a life of its own.
In October 1996, the Lancet published a huge study by Daly and colleagues
titled "The Risk of Venous Thromboembolism on Hormone Replacement
Therapy." They =did= find a small but significant increased risk of
venous clotting disorders in women taking low dose HRT. Do we disregard
this study because it was not done in male to female transsexuals? The
Coronary Drug Project, reported in 1975 and subsequently, found increased
risk of cardiac death and nonfatal myocardial infarction in males (with
heart disease) taking low and high dose Premarin.
Studies do demonstrate an increased risk of thrombosis with estrogen. Do
they demonstrate an increased risk of thrombosis with bedrest? I'm not
sure this study has been done. I know in my cardiology practice I see
pulmonary embolism in truck drivers who sit in one position for hours at
a time. This is surely more common than in the general population. Our
surgeons are considering the combination of risks from what data they do
have available.
>
> As an illustration of how complicated the issue is, consider this:
> both blood clots *and* excessive bleeding can occur after SRS, whether
> or not one is taking estrogen. Both are serious complications. So
> let's assume for the moment that continuing to take estrogen *does*
> increase your risk of symptomatic thrombosis. But isn't it possible
> that it might also decrease your risk of post-operative bleeding --
> maybe to a similar entent? How does the magnitude of that possible
> benefit compare to the possible risk? Is estrogen beneficial, risky,
> or neutral? Nobody knows, because nobody has done the study.
Postoperative bleeding has a variety of causes. Most common is surgical
technique: an artery or vein is not ligated or cauterized and continues
to bleed. Some people have taken aspirin prior to surgery and failed to
report this to the surgeon. How often would a person have a spontaneous
hemorrhagic tendency which is counteracted by estrogen? No, those data
don't exist either.
>
> Surgeon Milton Edgerton, in his invited comments on a paper by Jan
> Eldh concerning SRS, offered this tart question about Eldh's policy of
> requiring the discontinuation of estrogen:
>
> "It would be interesting to hear why the author recommends
> discontinuing estrogen for 5 weeks in the perioperative period. Has he
> seen complications or problems when this was not done?" (Plast.
> Reconstr. Surg. 91: 901-902; April, 1993)
Do we know Dr. Eldh's reply?
>
> I've taken care of hundreds of women on hormone replacement having
> pelvic surgery, and don't recall a single case where it was
> discontinued preoperatively. And I've taken care of at least several
> dozen men with prostate cancer who were receiving high-dose estrogen
> therapy (much higher than we take), who also underwent a variety of
> operations -- also without their estrogen being stopped. I have no
> reason to think that SRS patients should be treated any differently
> than these other patients.
Do you have postoperative in-hospital followup for these patients? Did
you see them two, three, four days postoperatively? I don't think
anesthesiologists follow their patients after 24 hours in most cases.
How do you know these patients did not have thromboembolic complications?
>
> My thought would be that transsexual women should weigh the possible
> risks of continuing estrogen (maybe an increase in thrombosis; plus
> the need to lie to one's surgeon in order to get SRS), vs. the
> possible benefits of continuing estrogen (maybe a decrease in
> perioperative bleeding, plus less discomfort from estrogen withdrawal)
> and make their own decision.
>
> I certainly feel that any transsexual woman who goes into SRS taking a
> *low* replacement dose of estrogen (e.g., 0.625 mg Premarin), plus
> enough spironolactone to reduce her testosterone to normal female
> levels, would be entering surgery with the same hormone profile as
> literally *thousands* of non-transsexual women on hormone replacement
> therapy who undergo major surgery in the United States every day. And
> they're not all dying.
No, they're not all dying. =Very few= of them are.
>
> One final caveat: no matter what you decide to do, tell your surgeon
> what he wants to hear, i.e., that you were a good girl and *did* stop.
>
> What did I do when I had SRS with Toby Meltzer on April 29, 1996?
> Well, let's put it this way: I *told* him I had stopped....
>
Okay, so Dr. Lawrence, who has a very good Web site called "Transsexual
Women's Resources," and is regarded by the online community as an expert
in medical matters, is "thinking" that you should make your own decision
whether to give serious consideration to continuing HRT against your
surgeon's instructions and then lie to your surgeon. And she begins by
saying it's medical talk but not medical advice, so ask you doctor.
"Doctor, what about me taking estrogen up until surgery against Dr.
Meltzer's instructions?" Okay.
Isn't it strange, the things we make an issue over. Five years after
SRS, we will never remember being off estrogen for a brief time. But
anyone who does experience a deep vein thrombosis with lasting results of
chronic leg edema will always have a reminder that she "beat the system".
Becky Allison
-------------------==== Posted via Deja News ====-----------------------
http://www.dejanews.com/ Search, Read, Post to Usenet
Melissa
In article <3465a464...@news.earthlink.net>,
dpri...@earthlink.net (Dana Priesing) wrote:
>On 9 Nov 1997 18:55:26 GMT, ptho...@aol.com (PTHolmes) wrote:
>
>>Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>>blood clotting. Do all doctors who do SRS recommend this? Could one reduce
>>her dose, but not completely stop before SRS? How critical is this?
>
>hormones prior to surgery, has patients put on Jobst stockings
>(compression stockings) before surgery, and they stay on for several
>days thereafter, to reduce the risk of clots forming in the legs.
The ones they put on in Neenah were so loose, I doubt they would have prevented
anything.
Melissa
In article <19971109185...@ladder02.news.aol.com>,
ptho...@aol.com (PTHolmes) wrote:
>Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>2-3 weeks prior to surgery. I believe this is due to the possibilty of
>blood clotting. Do all doctors who do SRS recommend this? Could one reduce
>her dose, but not completely stop before SRS? How critical is this?
It's like my therapist explained to me. There's not much point in doing all this
if you don't live through it. It's pretty critical. I wouldn't suggest cheating
because you'd only be cheating yourself if you had a stroke and they had to put
you in a pot near a window and water you once a week.
Yes, it's critical and follow the Dr.'s advice to the letter.
Besides, the day after srs you'll get to see what menopause feels like.
Heh, heh...
Melissa
In article <64598s$2e$1...@gte2.gte.net>, "Jennifer" <jjb...@gte.net> wrote:
>Dr Biber requires it as well, the girl next to me didn't stop and had
>complications with excessive bleeding. He flipped when she admitted to not
>stopping.
He probably would have refused the srs if she'd been honest with him and refused
to stop.
Sin lies only in hurting others unnecessarily.
All other "sins" are invented nonsense.
( Hurting yourself is not sinful-just stupid. )
- Lazarus Long ( paraphrased )
From the novel "Time Enough For Love"
By the late Robert A. Heinlein
Melissa
In article <346775d9...@news.earthlink.net>,
dpri...@earthlink.net (Dana Priesing) wrote:
>On Tue, 11 Nov 97 02:07:47 GMT, Meli...@Yamnix.com (Melissa) wrote:
>
>>>hormones prior to surgery, has patients put on Jobst stockings
>>>(compression stockings) before surgery, and they stay on for several
>>>days thereafter, to reduce the risk of clots forming in the legs.
>>
>>The ones they put on in Neenah were so loose, I doubt they would have
prevented
>>anything.
>
I musta just gotten lucky. Lucky I didn't need them.
Of course that's just my opinion.
Anyone who doesn't agree with me is clearly wrong. :-)
- Melissa
High Priestess, The Universal Planetary Pantheist Temple
http://www.amnix.com/~melissa/pantheis.htm
Founder - The Universal Planetary Alliance: http://www.amnix.com/~melissa
My personal web pages: http://www.amnix.com/~melissa/melissas.htm
Seeking new women friends in Denver area. See: personals newsgroup for
women-seeking-women at: http://www.amnix.com/~melissa/charter.htm
Kristin Rachael Hayward
In article <MPG.ecfbc4d9...@nntp1.ba.best.com>,
la...@goodkitty.com (Laura Werner) wrote:
>On 9 Nov 1997 18:55:26 GMT, ptho...@aol.com wrote...
>> Both Dr.'s Meltzer and Schrang want their SRS patients to stop hormones
>> 2-3 weeks prior to surgery.
>
>I talked to both of them about this. Dr. Schrang was adamant; he said to
>stop taking any estrogen 3 weeks before surgery because it minimizes the
>chance of blood clots after SRS. He didn't care what kind of estrogens I
>was taking. Three weeks.
>
>When I talked to Toby, he said the same thing at first. Then I told him
>that my internist (Joy Shaffer) had said that I should stop the Premarin
>3 weeks before SRS but could take estradiol until a week before. At that
>point, he basically said "OK; she knows more about hormones than I do, so
>listen to her advice." That's what I did, and I had no hormone-related
>problems. I had a few minor hot/cold flashes when I started taking the
>'mones again, but that might have been caused by something else.
Back in the "old" days, Schange didn't require such. Shortly before my
SRS in 1994, I heard he was requiring it. Since I had never been
formally informed of the change in policy, and not wanting to go
through the menopausal mood swings just prior to surgery, I stayed on
Premarin right through the entire period. In fact, I took my normal
dosage a day after surgery. Why didn't I want to go through the mood
swings? I was receiving absolutely terrible rejection from my family,
my lover, the few people at work, etc., about the surgery. They just
didn't understand.
I made the choice to keep my moods stable. Did I endanger my health?
Probably. Where their mitigating factors? Well, I was very fit
physically, running 5 times a week right up to surgery, my weight was
170, I didn't smoke. I figured since Gene had done surgery for years
wuthout requiring the patient to go off surgery, the risk factor was
low, and combined with the rejection from family and friends, I was
going to spin the wheel. Dr. Becky would probably take great exception
to this post, but for me, it was right. I just couldn't deal with
the swings.
Kristin Rachael Hayward
Rosalind Hengeveld
arb...@mindspring.com (Andrea Bennett) in
<34704a50...@news.mindspring.com>:
> Becky, I can understand coming off hormones as a precautionary measure
> since even though the risk may be small the studies seem to suggest
> some correlation. But do you guys think it is necessary to be off
> estrogens for many =weeks= pre and post-op? I don't know anything
> about it but wouldn't that stuff clear on out of the blood stream
> fairly quickly? [...]
No. Hormones do take weeks to get out of your system. Consequently,
after you stop hormones, it takes two to three weeks until you really
notice it, such as by feeling bad. I never had trouble with hormones
after I began taking them, but I hard trouble both times I had to stop
them for surgeries.
--
Rosalind Hengeveld
Laura Werner
On Tue, 11 Nov 1997 19:43:39 GMT, ell...@hooked.net wrote...
> Sorry for an annoying question, but I have to ask: do you think there
> is any possibility that your extended use of hormones prior to surgery
> is related in any way to the hematoma you endured 2 days post-op?
I doubt it. That hematoma happened because I started bleeding somewhere
behind my right labia. Toby said it might have been the inguinal vein.
The blood made that area swell up like a balloon, causing a *lot* of pain
and some surface tissue damage due to ischemic necrosis. It all healed
up nicely, though.
Some of the pooled blood did clot, forming a walnut-sized hematoma, but
that was just a side-effect of the bleeding. I probably would have been
better off if my blood had clotted more quickly -- it might have plugged
the leak before things got out of hand.
--
Laura
Anne A. Lawrence, M.D.
My friend Dr. Becky Allison, coincidentally the co-presenter of a
paper called "Research-Driven Standards of Care" at HBIGDA, wrote to
say that she agreed with me that:
>>there is
>> no evidence of *any* kind to suggest that continuing to take estrogen
>> up to the time of SRS, or immediately afterward, leads to an increased
>> risk of complications (morbidity or mortality) after SRS. There are
>> simply *no data*.
>
>That is true. I suspect a prospective, randomized study comparing
>persons who continued estrogen with persons who stopped might eventually
>enroll enough people to reach statistical significance.
But having conceded the point I was making, Dr. Allison went on to
explain why we should pretend otherwise:
>Studies do demonstrate an increased risk of thrombosis with estrogen. Do
>they demonstrate an increased risk of thrombosis with bedrest? I'm not
>sure this study has been done. I know in my cardiology practice I see
>pulmonary embolism in truck drivers who sit in one position for hours at
>a time. This is surely more common than in the general population. Our
>surgeons are considering the combination of risks from what data they do
>have available.
Becky, if our surgeons do indeed have data, they should publish it so
we can all take a look at it. My guess is that they have *opinions*,
but no data. That's all I'm saying.
>> Surgeon Milton Edgerton, in his invited comments on a paper by Jan
>> Eldh concerning SRS, offered this tart question about Eldh's policy of
>> requiring the discontinuation of estrogen:
>>
>> "It would be interesting to hear why the author recommends
>> discontinuing estrogen for 5 weeks in the perioperative period. Has he
>> seen complications or problems when this was not done?" (Plast.
>> Reconstr. Surg. 91: 901-902; April, 1993)
>Do we know Dr. Eldh's reply?
He *didn't* reply, Becky.
>> I've taken care of hundreds of women on hormone replacement having
>> pelvic surgery, and don't recall a single case where it was
>> discontinued preoperatively. And I've taken care of at least several
>> dozen men with prostate cancer who were receiving high-dose estrogen
>> therapy (much higher than we take), who also underwent a variety of
>> operations -- also without their estrogen being stopped. I have no
>> reason to think that SRS patients should be treated any differently
>> than these other patients.
>
>Do you have postoperative in-hospital followup for these patients? Did
>you see them two, three, four days postoperatively?
>How do you know these patients did not have thromboembolic complications?
I'm certainly not claiming that none of these patients had
thromboembolic complications -- such events are common enough
post-operatively that some of the patients undoubtedly did. They occur
in patients who don't take estrogen, too. My point is simply that
discontinuation of estrogen does not appear to be the standard of care
for non-transsexuals undergoing surgery.
What *does* seem to be the standard of care is getting patients out of
bed as soon as possible -- everywhere except in northern Wisconsin,
that is (grin).
>> One final caveat: no matter what you decide to do, tell your surgeon
>> what he wants to hear, i.e., that you were a good girl and *did* stop.
>Okay, so Dr. Lawrence, who has a very good Web site called "Transsexual
>Women's Resources," and is regarded by the online community as an expert
>in medical matters, is "thinking" that you should make your own decision
>whether to give serious consideration to continuing HRT against your
>surgeon's instructions and then lie to your surgeon. And she begins by
>saying it's medical talk but not medical advice, so ask your doctor.
>"Doctor, what about me taking estrogen up until surgery against Dr.
>Meltzer's instructions?" Okay.
My favorite children's story is "The Emperor's New Clothes." And if my
web site enjoys a certain popularity in some circles, I believe that
is due in part to my willingness to point out when our metaphoric
'emperors' are naked.
Many if not most of us have lied to our caregivers. Goddess knows that
I have. Until we transsexual women are treated with respect and
dignity, and until our rights to control our own bodies are secure, I
think that selective deception of caregivers is not only to be
condoned, it is sometimes to be recommended.
Unfortunately, the attitude of "Doctor Knows Best" doesn't seem to
have a very good track record of improving the care of transsexual
women. Case in point: until June of this year, about 90% of post-ops
left Neenah with disfiguring abdominal scars. Now that's a thing of
the past - and why? Because one brave transsexual woman named Jenni
McCloud refused to passively accept what her surgeon told her. I think
we can all learn from Jenni's example.
>Isn't it strange, the things we make an issue over. Five years after
>SRS, we will never remember being off estrogen for a brief time.
Actually, many people *do* seem to remember! Estrogen withdrawal is
very uncomfortable for many of us -- and that leaves an impression. I
suspect that most non-transsexual women wouldn't stand for what we're
being asked to do -- and *they're* not being asked to! On the other
hand, we, being mere transsexual gender trash, should meekly do
whatever we are told, and not presume to question our exalted
caregivers. No big deal if *we* suffer. Right, Dr. Allison?
And, yes, our suffering might be justified if there was evidence that
it was associated with improved outcomes. But I don't believe that
such evidence presently exists.
>Anyone who does experience a deep vein thrombosis with lasting results of
>chronic leg edema will always have a reminder that she "beat the system".
That comment is pathetic, and it *continues* to beg the question. If
we actually had *evidence* that "beating the system" contributed to
deep vein thrombosis after SRS, the statement above would be sobering.
In the absence of such evidence, it's merely emotional rhetoric.
Love and Sisterhood,
Anne
PTHolmes
In article <64bj4s$7ou$2...@news2.xs4all.nl>, rosa...@xs4all.nl (Rosalind
Hengeveld) writes:
>No. Hormones do take weeks to get out of your system. Consequently,
>after you stop hormones, it takes two to three weeks until you really
>notice it, such as by feeling bad. I never had trouble with hormones
>after I began taking them, but I hard trouble both times I had to stop
>them for surgeries.
I'm not a doctor, but I asked a urologist how long it would take
testosterone to work its way out of my system after an orchiectomy and he
said "3 or 4 days." I could be wrong, but I would assume it would be the
same for estrogen.
I know that I start feeling the withdrawl effects within 24 hrs. and
within a week I'm going crazy!
Melissa
In article <8793027...@dejanews.com>, beck...@primenet.com wrote:
>In article <3467c914....@news.mindspring.com>,
> alaw...@mindspring.com wrote:
>Isn't it strange, the things we make an issue over. Five years after
>SRS, we will never remember being off estrogen for a brief time. But
>anyone who does experience a deep vein thrombosis with lasting results of
>chronic leg edema will always have a reminder that she "beat the system".
>
>Becky Allison
Good points there Dr. Beckster. Leaves me glad I listened to Schrang.
That's the way I remember feeling about it at the time too. It may or may not
have cause me problems if I'd continued the estinyl but why find out?
Of course that's just my opinion.
Anyone who doesn't agree with me is clearly wrong. :-)
- Melissa
To email me, remove X and Y spam proofing from my address. Abusive email may be posted.
Melissa
In article <64bj4s$7ou$2...@news2.xs4all.nl>,
rosa...@xs4all.nl (Rosalind Hengeveld) wrote:
>arb...@mindspring.com (Andrea Bennett) in
><34704a50...@news.mindspring.com>:
>
>> Becky, I can understand coming off hormones as a precautionary measure
>> since even though the risk may be small the studies seem to suggest
>> some correlation. But do you guys think it is necessary to be off
>> estrogens for many =weeks= pre and post-op? I don't know anything
>> about it but wouldn't that stuff clear on out of the blood stream
>> fairly quickly? [...]
>
>after you stop hormones, it takes two to three weeks until you really
>notice it, such as by feeling bad. I never had trouble with hormones
>after I began taking them, but I hard trouble both times I had to stop
>them for surgeries.
In my case I didn't have an orchiectomy prior to srs, so it wasn't as noticable
for the 3 weeks before. But the day after! Whew! Soaking sweats all the time,
until 3 weeks after when I started them again. But I was pretty euphoric for a
couple of weeks after, anyway, having just finally gotten what I wanted and
needed for so long, so I didn't mind that much.
Aradia
Anne A. Lawrence, M.D. <alaw...@mindspring.com> wrote:
<Oh, you know, a bunch of stuff I snipped...>
: I'm certainly not claiming that none of these patients had
: thromboembolic complications -- such events are common enough
: post-operatively that some of the patients undoubtedly did. They occur
: in patients who don't take estrogen, too. My point is simply that
: discontinuation of estrogen does not appear to be the standard of care
: for non-transsexuals undergoing surgery.
<Yup, I snipped a bunch of stuff here, too...>
I'll grant everyone the fact that this started out to be a good thread.
The question of stopping hormones before SRS is certainly a good one to
ask, if not stopping can lead to such a variety of cardiovascular
problems. Now, I'm not a doctor or anything, just a deeply philosophical
person with a pretty high interest in psychology who happens to sometimes
be slightly too logic-oriented...
Assuming that a MTF TS on estrogen has an estrogen level similar to
that of a non-TS female, and assuming that a MTF TS really should stop
taking hormones because of the possibility of inconvenient blood clots,
then should non-TS females get rid of their estrogen due to the same
problem? If so, how? And do they?
If non-TS females don't get rid of their estrogen for a major operation,
then why should TS females get rid of their estrogen for a major
operation, if the levels of estrogen are similar to that of non-TS
females?
Perhaps someone can enlighten me...
By the way, very nice post, Anne. =)
--
"The true worth of a race must be measured by the character of its woman."
"...understand, it takes a woman to make a stronger man..."
Protect your freedom - Fight the government
---- finger ara...@teleport.com for pgp key ----
PTHolmes
I heard from a guy who said he used to work at a hospital that, "it's
critical to stop hormones. that's because of the anesthesia for the
surgery. they want "clean" blood gases."
Any comments?
Tara
--
http://www.remoteview.com/holmes/trans.htm
Rebecca Deerborne
PTHolmes wrote in message <19971112230...@ladder02.news.aol.com>...
>I heard from a guy who said he used to work at a hospital that, "it's
>critical to stop hormones. that's because of the anesthesia for the
>surgery. they want "clean" blood gases."
>
>Any comments?
Yeah, just my $0.02US, but this guy doesn't know what he's talking about.
As near as I can tell -- controversy or not -- the whole issue about whether
it is necessary to stop taking hormones (and by this, most references are to
estrogens only, not progesterone, nor testosterone blockers) has to do with
the risk of thrombosis. The reason for stopping for several weeks is because
estriols are dissolved in fatty tissues and it takes that long for most of it
to leech out and levels to drop.
I've become sufficiently confused to no longer be certain the risk is real,
but that's why many surgeons and anaesthesiologists have been telling women to
stop taking estrogen several weeks before major surgical procedures. They're
worried a clot will form in a vein or artery (either near the surgical site or
in legs left unused for days at a time post-surgery), break free, and then
travel to some vital organ where it'll do all kinds of damage -- can even
kill. Again, the controversy is over just how likely the thrombosis really
is.
Rebecca
Melissa
In article <64d4cu$ijq$1...@news1.teleport.com>,
Aradia <ara...@user2.teleport.com> wrote:
>Anne A. Lawrence, M.D. <alaw...@mindspring.com> wrote:
>
><Oh, you know, a bunch of stuff I snipped...>
>: thromboembolic complications -- such events are common enough
>: post-operatively that some of the patients undoubtedly did. They occur
>: in patients who don't take estrogen, too. My point is simply that
>: discontinuation of estrogen does not appear to be the standard of care
>: for non-transsexuals undergoing surgery.
>
>I'll grant everyone the fact that this started out to be a good thread.
>The question of stopping hormones before SRS is certainly a good one to
>ask, if not stopping can lead to such a variety of cardiovascular
>problems. Now, I'm not a doctor or anything, just a deeply philosophical
>person with a pretty high interest in psychology who happens to sometimes
>be slightly too logic-oriented...
>
>Assuming that a MTF TS on estrogen has an estrogen level similar to
>that of a non-TS female, and assuming that a MTF TS really should stop
>taking hormones because of the possibility of inconvenient blood clots,
>then should non-TS females get rid of their estrogen due to the same
>problem? If so, how? And do they?
>
>If non-TS females don't get rid of their estrogen for a major operation,
>then why should TS females get rid of their estrogen for a major
>operation, if the levels of estrogen are similar to that of non-TS
>females?
>
>Perhaps someone can enlighten me...
I'm no doc either but I wonder if the two equate. Is taking estrogen in pills
exactly the same as what genetically born females get from their own bodies?
- Melissa
Aradia
Melissa <Meli...@Yamnix.com> wrote:
: >If non-TS females don't get rid of their estrogen for a major operation,
: >then why should TS females get rid of their estrogen for a major
: >operation, if the levels of estrogen are similar to that of non-TS
: >females?
: >
: >Perhaps someone can enlighten me...
: I'm no doc either but I wonder if the two equate. Is taking estrogen in pills
: exactly the same as what genetically born females get from their own bodies?
Well, that depends upon what they're taking. Premarin isn't, as it's the
horse version. But Estradiol is supposed to be damn near close to what
chromosomal females have inside them. I still fail to see the rationale in
stopping HRT.
Karen Elizabeth A.
> explain why we should pretend otherwise:
>
> >Studies do demonstrate an increased risk of thrombosis with estrogen. Do
> >they demonstrate an increased risk of thrombosis with bedrest? I'm not
> >sure this study has been done. I know in my cardiology practice I see
> >pulmonary embolism in truck drivers who sit in one position for hours at
> >a time. This is surely more common than in the general population. Our
> >surgeons are considering the combination of risks from what data they do
> >have available.
> Becky, if our surgeons do indeed have data, they should publish it so
> we can all take a look at it. My guess is that they have *opinions*,
> but no data. That's all I'm saying.
In the absence of hard data one has to extend know information and take
into account anecdotal evidence such as Becky presents above to make the
best decision possible. HRT hase been shown to increase clotting in GG's
as well if memory serves. That combined with the *LOGICAL* (makes sense
- less activity less flow more chance for clot formation) connection
between physical inactivitty and the problems Becky has observed with
the truck drivers indicates to me (I'm a physical scientist BTW) that
stopping HRT is REASONABLE precaution. After all though temporary
menopause may be uncomfortable it's not life threatening. You played the
odds and won but for most is the risk really worth the gain? Not for me.
I will stop before and resume once I become reasonable moble and active.
> My favorite children's story is "The Emperor's New Clothes." And if my
> web site enjoys a certain popularity in some circles, I believe that
> is due in part to my willingness to point out when our metaphoric
> 'emperors' are naked.
It appears you are the one with no clothes here. Are you trying to tell
people what they want to hear to increse your popularity in the
community? Are you in competion with Becky in some way? Sounds like it
to me!
> Many if not most of us have lied to our caregivers. Goddess knows that
> I have. Until we transsexual women are treated with respect and
> dignity, and until our rights to control our own bodies are secure, I
> think that selective deception of caregivers is not only to be
> condoned, it is sometimes to be recommended.
An argument can be made for it (though I don't really agree with it) for
the case of psychological care providers. When it comes to the physical
realm common sense says that is higly unwise. A blanket statement such
as that is simply irresposible IMO.
> Unfortunately, the attitude of "Doctor Knows Best" doesn't seem to
> have a very good track record of improving the care of transsexual
> women. Case in point: until June of this year, about 90% of post-ops
> left Neenah with disfiguring abdominal scars. Now that's a thing of
> the past - and why? Because one brave transsexual woman named Jenni
> McCloud refused to passively accept what her surgeon told her. I think
> we can all learn from Jenni's example.
An open honest arument/discussion is much different then deception. I
had that with my endo and convinced her. Happens every day BTW. Because
of my scientific training I don't accept what and MD says to me blindly.
Many do not these days and physians learn for that. They don't learn
from deception. That's what Jenni's experience shows.
Somehow that paragraph above sound like a politician running for offce
to me.
> And, yes, our suffering might be justified if there was evidence that
> it was associated with improved outcomes. But I don't believe that
> such evidence presently exists.
No hard evidence exists ***EITHER*** way but their are INDICATIONS that
stopping is a reasonable precaution and is an ethically justifiable
request.
> >Anyone who does experience a deep vein thrombosis with lasting results of
> >chronic leg edema will always have a reminder that she "beat the system".
>
> That comment is pathetic, and it *continues* to beg the question. If
> we actually had *evidence* that "beating the system" contributed to
> deep vein thrombosis after SRS, the statement above would be sobering.
> In the absence of such evidence, it's merely emotional rhetoric.
Becky presented reasonable - though not conclusive - arguments which you
do nothing to refute in your statements yet you attack her. IMO you are
not serving the community in this but your own ego.
-Karen A.
Anne A. Lawrence, M.D.
Dear Ms. Haugh:
I regret that my last post left you feeling so uncomfortable that you
felt the need to respond as you did.
Let me be clear that I do not intend to practice medicine via the
Internet. What I hope to do is to provide information. Anyone is free
to do what she likes with that information -- use it, consider it,
reject it, or ignore it. I hope that everyone will evaluate what I say
critically, and not regard it as "truth," for it is not -- it is
simply my opinion.
And my point is that that is not a bad posture to take with the
pronouncements of *any* physician, including one's surgeon.
I have practiced medicine for over 20 years, spending most of that
time in the company of surgeons; and it is my opinion that what we
call "medical practice" is a rich stew consisting of some knowledge,
some conjecture, some received tradition, and some outright nonsense.
And that includes *my* practice, too.
Perhaps you come from a background in science or engineering, where
ideas of predictability and testable hypotheses are accepted. Medicine
is not like that, and that is an uncomfortable truth for some. Most of
us would like to think that our caregivers always do what they do
based on solid evidence; and we would also like to believe that if we
put ourselves in their hands, and do what they tell us, we will
predictably have the best outcomes. Goddess knows that that is what
*I* would like to believe, too. But I can't -- I've simply seen too
much evidence to the contrary.
As a result, I've become an "informed consumer," otherwise known as a
"bad" patient. I personally believe that "bad" patients get the best
healthcare, but that's just my opinion. And I cautiously recommend
that anyone who thinks she can stand to, consider becoming a "bad"
patient as well. My friend Jenni McCloud is another example of a "bad"
patient -- though apparently this preceded her association with me!
The stated purpose of my web site is to "empower transsexual women ...
by providing factual information, informed opinion, and personal
narrative." And that is also the purpose of my posts to
alt.support.srs.. If I have made an error, I think it is in not
realizing that too much information is *disempowering* to some women,
particularly when comfortable "truths" are called into question. The
result may be anxiety for some women; perhaps it was so for you. If
that was the case, I apologize.
Nevertheless, I do believe that in medical care, as in other aspects
of life, we nearly always have choices, and that those choices have
consequences. Some of those consequences are relatively predictable;
others are effectively unpredictable.
Thromboembolic complications are not frequent after surgery, but they
do occur. Some women will have them, whether they are taking estrogen
or not; the vast majority will not have them, whether they are taking
estrogen or not. I think that both continuing estrogen and
discontinuing it fall well within the realm of "accepted practice."
Your surgeon will likely advise you to discontinue if he is an SRS
surgeon; likely not if he performs any other type of surgery. The
point is that there *is* a choice here, on his part, and on yours.
Discontinuing estrogen commonly produces withdrawal effects; often
these are mild, but sometimes they are not. Some doctors will minimize
their importance, especially if they are male SRS surgeons; others may
not. One can choose to endure withdrawal, or not; but one *does* have
a choice.
And likewise, one can choose to have a relationship with one's
physician that involves total honesty and total compliance; possibly
that is what most people want. Or one can choose selective honesty,
and selective compliance -- that is the way *I* prefer to deal with
*my* caregivers. Neither one is "better;" nor, in my opinion, does my
choice imply that I have a "poor relationship" with my caregivers -- I
just have a *different* relationship than what you would choose. The
point again is simply that there *is* a choice.
At the risk of seeming too cute: whenever you become a "patient," you
metaphorically enter a Baskin-Robbins -- there are *many* choices
available to you, sometimes more than thirty-one! You can pretend, if
you wish, that there is *only* vanilla; or you can pretend that only
the person behind the counter knows what flavor is best. Perhaps he
often does. But there are actually a lot of flavors available, and
perforce you *will* be choosing one -- even if your choice is only to
pretend that there is *no* choice, or that it is a choice that only
*someone else* can make for you. And your choice *will* have
consequences.
That's all I'm saying.
And if you think that constitutes "the grossest form of professional
misconduct possible" -- well, I guess I'll just have to endure your
displeasure.
Love and Sisterhood,
Anne
Karen Ross
Melissa <Meli...@Yamnix.com> wrote in article
> >Although his instructions basically said "stop taking hormones", and I
think
> >the time period was 3 weeks prior to surgery, I opted instead to
gradually
> >reduce my dosage over the course of 4 weeks, being completely off HRT
exactly
> >7 days before my surgery.
> >
> >I wanted to avoid any hot flashes or other menopausal symptoms, and it
seemed
> >to work.
>
> Then you took a dangerous risk. If it wasn't out of your system enough to
cause
> hot flashes the day after srs ( assuming you hadn't had an orchiectomy
before
> srs ) then it was still in your system when you had srs and could have
harmed
> you.
Actually, probably not true. The three week "rule" is based upon some of
the long lasting estrogens like estinyl. Premarin also is fairly
persistant. Estradiol, on the hand has a *very* short serum half-life.
For proper serum levels it's best to take it in two divided evenly spaced
doses each day, for example. The effective estrogen level is a minimum
after a week without estradiol or three without estinyl. Hot flashes and
other menopausal symptoms are *not* useful indicators of the hormone
levels. They are sympotoms that arise later and are *quite* variable.
Your estrogen level can be at the castrate level for some time before the
body reacts with any symptoms. Surgeons would probably test estrogen blood
levels before surgery except that estinyl and Premarin don't show accurate
levels with conventional estradiol tests.
Surgeons use a simple "three weeks" answer because they mostly deal with
patients who take Premarin and estinyl. The use of estradiol is rare
enough that they simply don't distinguish between them. Toby took Doctor
Shaffer's word for it because she knows what she's talking about. She
prescribes estradiol and progesterone USP and she understands the medicine
part quite well. Her specialty is internal medicine. As a post-op TS,
she's about as knowledgable as they come. On an issue of hormones that
there effects, she's a more knowledgeable source. Toby knows her well
enough to respect her opinions and accept them.
--
Kare (Karen Ross)
A faint heart does not become a fair lady.
email: kr...@gis.net
RosePress
In article <64dvgk$g04...@dialup1.den.amnix.com>, Meli...@Yamnix.com
(Melissa) writes:
>>If non-TS females don't get rid of their estrogen for a major operation,
>>then why should TS females get rid of their estrogen for a major
>>operation, if the levels of estrogen are similar to that of non-TS
>>females?
>>
>>Perhaps someone can enlighten me...
>
>I'm no doc either but I wonder if the two equate. Is taking estrogen in pills
>exactly the same as what genetically born females get from their own
>bodies?
---------
You do what you can -- you try not to worry if you cannot. If a young
genetic woman needs surgery, she probably can't wait until menopause.
Taking estrogen in pill form can easily be stopped. It may not be
enjoyable, but it can be done. If you know about the surgery ahead of time
(as we do) and if a slight margin of safety is available (it is) why not
take it? Genetic women cannot stop their estrogen production, though if
they are older, they CAN stop taking pills.
Question is, do they expect postmenopausal women to stop taking pills?
Hugs -- Ellen Rose
Karen Ross
beck...@primenet.com wrote in article <8793027...@dejanews.com>...
> In October 1996, the Lancet published a huge study by Daly and colleagues
> titled "The Risk of Venous Thromboembolism on Hormone Replacement
> Therapy." They =did= find a small but significant increased risk of
> venous clotting disorders in women taking low dose HRT. Do we disregard
> this study because it was not done in male to female transsexuals? The
> Coronary Drug Project, reported in 1975 and subsequently, found increased
> risk of cardiac death and nonfatal myocardial infarction in males (with
> heart disease) taking low and high dose Premarin.
Which actually raises some interesting questions. One I find most
interesting is the question of what types of hormones were taken? Some
took Premarin - what about the others? Did some take estinyl? What about
progestins? What about the combination of progestins and estinyl?
Progestins and conjugated estrogens? Etc. Has anyone studied whether
natural estradiol, for example, behaves differently? What about estrogens
without progestins? I have a hunch that these equine and artificial
estrogens have effects that natural estradiol may not possess. I suspect
that synthetic progestins may multiply that effect. You'd think that this
sort of information would be considered as vital to women's health and
actually studied. But, once again, women's health issues don't seem to
inspire much research effort. I suspect that if men had similar issues,
we'd have had all the data we needed long ago.
In any case, it is still seems arbitrary and hard to defend requiring
someone to by "off hormones" for the same interval whether they have been
on a long half-life estrogen like estinyl or a short half-live med like
estradiol.
Hugs and happy hormones,
Kare
Natalie
In article <19971113234...@ladder01.news.aol.com>, RosePress
<rose...@aol.com> writes
>You do what you can -- you try not to worry if you cannot. If a young
>genetic woman needs surgery, she probably can't wait until menopause.
>
>Taking estrogen in pill form can easily be stopped. It may not be
>enjoyable, but it can be done. If you know about the surgery ahead of time
>(as we do) and if a slight margin of safety is available (it is) why not
>take it? Genetic women cannot stop their estrogen production, though if
>they are older, they CAN stop taking pills.
>
>Question is, do they expect postmenopausal women to stop taking pills?
Ok, here's another opinion, if it's worth anything at all. The usual
disclaimers apply, i.e. this is medical talk and not advice...
There is a significant difference between endogenous oestrogen levels in
a natural-born woman, and the supraphysiological doses used in pre-op
transsexual women. To a lesser extent there is likewise a difference
between a woman on HRT and a woman on a combined oral contraceptive
(COC).
- Natural physiological oestrogen levels do not present a problem, which
is why no-one would seriously suggest administering an anti-oestrogen
prophylactically to a natural-born woman before surgery.
- Modern approaches to HRT for postmenopausal women aim to provide a
quasi-natural level of hormones; enough to avoid vasomotor disturbances
and oesteoporosis but no more. For this reason, ethinyloestradiol (which
is very potent) is now regarded as non-optimal for HRT (in *natural-
born* women, I must emphasise!). Such HRT carries *some* (little) risk
of thromboembolism:
"Recent studies show an increased risk of DVT and PE in women currently
taking HRT. The view of the CSM is that the new data do not change the
overall positive balance between benefits and risks of treatment for
most women. The CSM has advised that there is no good reason for women
without predisposing factors (such as personal or family history of DVT
or PE, severe varicose veins, obesity, *surgery*, trauma or prolonged
*bed-rest*) it may be prudent to review the need for HRT as in some
cases the risks of HRT may be expected to exceed the benefits.
...
Surgery is a predisposing factor for venous thromboembolism and it may
be prudent to review the need for HRT."
(Source: UK Committee on the Safety of Medicines (CSM), 1997)
- BUT... the doses typically used in pre-op TS women are much higher
than normal HRT, being in most cases stronger even than the doses used
for oral contraception. There have been numerous reports to the effect
that COCs *do* constitute a significant DVT/PE risk factor and should be
discontinued before major surgery:
"Oestrogen-containing oral contraceptives should be discontinued (and
adequate alternative contraceptive arrangements made) 4 weeks before
major elective surgery and all surgery to the legs; they should normally
be recommenced at the first menses occurring at least 2 weeks after full
mobilisation. When discontinuation is not possible, e.g. after trauma or
if, by oversight, a patient admitted for an elective procedure is still
on an oestrogen-containing contraceptive, some consideration should be
given to subcutaneous heparin prophylaxis. These recommendations do not
apply to minor surgery with short duration of anaesthesia, e.g.
laparoscopic sterilisation or tooth extraction, or to women taking
oestrogen-free hormonal contraceptives."
(Source: UK CSM, 1997)
So it seems to me that there *is* good reason for the surgeons'
insistence on hormone withdrawal. Indeed at least one prominent UK
surgeon also uses heparin routinely in SRS patients, in accordance with
the above guidelines. So while it may be true that there is little data
specific to TS women, data *does* exist for natural-born women both on
HRT and COCs and I can see no reason why these results cannot be
extrapolated to the TS population.
Certainly I would advise any of my clients coming up to their SRS to
heed their surgeon's advice on discontinuing hormones.
Hope this is some use...
Natalie.
=======================================================================
The Looking Glass Society, UK.
Mail: <lookin...@crystaleyes.demon.co.uk>
WWW: <http://www.crystaleyes.demon.co.uk>
=======================================================================
Aradia
Natalie <nat...@crystaleyes.demon.co.uk> wrote:
: Ok, here's another opinion, if it's worth anything at all. The usual
: disclaimers apply, i.e. this is medical talk and not advice...
: There is a significant difference between endogenous oestrogen levels in
: a natural-born woman, and the supraphysiological doses used in pre-op
: transsexual women. To a lesser extent there is likewise a difference
: between a woman on HRT and a woman on a combined oral contraceptive
: (COC).
<blahblahblah>
I asked for someone to enlighten me, and Natalie made this nice little
post. Now was that so hard? In light of she said, I certainly feel more
inclined to pause HRT for a few weeks. If natural-born women are
recommended to stop oral contraceptives, which have an extremely minimal
amount of estrogen, and thus raises their natural estrogen levels by such
a small amount, it seems logical that TS women, with a generally slightly
higher amount of estrogen than natural women, should stop their hormones.
Or, perhaps, at least cut back if not stop completely...
Melissa
In article <19971113234...@ladder01.news.aol.com>,
rose...@aol.com (RosePress) wrote:
>In article <64dvgk$g04...@dialup1.den.amnix.com>, Meli...@Yamnix.com
>(Melissa) writes:
>
>>>If non-TS females don't get rid of their estrogen for a major operation,
>>>then why should TS females get rid of their estrogen for a major
>>>operation, if the levels of estrogen are similar to that of non-TS
>>>females?
>>>
>>>Perhaps someone can enlighten me...
>>
>>I'm no doc either but I wonder if the two equate. Is taking estrogen in pills
>>exactly the same as what genetically born females get from their own
>>bodies?
>
>---------
>
>genetic woman needs surgery, she probably can't wait until menopause.
>
>Taking estrogen in pill form can easily be stopped. It may not be
>enjoyable, but it can be done. If you know about the surgery ahead of time
>(as we do) and if a slight margin of safety is available (it is) why not
>take it? Genetic women cannot stop their estrogen production, though if
>they are older, they CAN stop taking pills.
>
>Question is, do they expect postmenopausal women to stop taking pills?
Not all even take pills, only some. And the ones who don't still have some
natural estrogen production unless they had hysterectomies. It's complicated all
right. I see Dr. Anne's point too, that medicine is an art as much as a science.
Becky Allison
Karen Ross wrote:
>
> > In October 1996, the Lancet published a huge study by Daly and colleagues
> > titled "The Risk of Venous Thromboembolism on Hormone Replacement
> > Therapy." They =did= find a small but significant increased risk of
> > venous clotting disorders in women taking low dose HRT.
>
> interesting is the question of what types of hormones were taken? Some
> took Premarin - what about the others? Did some take estinyl? What about
> progestins? What about the combination of progestins and estinyl?
> Progestins and conjugated estrogens?
The study wasn't controlled for progestin usage, so we don't have data
for low dose HRT. What we do have are the studies on oral
contraceptives, which up until a few years ago had significantly higher
doses of estrogen and progestins than they do now. Several studies
showed increased risk of thromboembolic complications, including stroke,
in women taking the high dose combinations.
> Etc. Has anyone studied whether
> natural estradiol, for example, behaves differently? What about estrogens
> without progestins? I have a hunch that these equine and artificial
> estrogens have effects that natural estradiol may not possess. I suspect
> that synthetic progestins may multiply that effect. You'd think that this
> sort of information would be considered as vital to women's health and
> actually studied. But, once again, women's health issues don't seem to
> inspire much research effort. I suspect that if men had similar issues,
> we'd have had all the data we needed long ago.
Amen to that.
>
> In any case, it is still seems arbitrary and hard to defend requiring
> someone to by "off hormones" for the same interval whether they have been
> on a long half-life estrogen like estinyl or a short half-live med like
> estradiol.
While I agree that estradiol is cleared from the blood more rapidly than
ethinyl estradiol, I believe that estradiol is transported into the
cells where it continues to have an effect long past its serum
half-life. I know some people, including yourself, have recommended
that estradiol be taken twice a day because of the short half-life, and
I don't think there's anything wrong with that but I'm not sure it is
necessary because of the continuing tissue effect.
Did you experience symptoms toward the end of a twenty-four hour
interval between doses of estradiol? I think that would be important
information if enough people reported this.
Becky
Jennifer McCloud
Stefani Banerian wrote:
> To this point, I have not heard this story, of Jenni McCloud in particular,
> nor of the "abdominal scars".
>
> I would appreciate it if someone filled me (and others) in.
Hello Stefani,
A friend told me that Dr. Anne Lawrence had recently mentioned my name and
situation on the alt.support.srs newsgroup. I read the thread and saw your request
for info.
Below are some posts that I think will answer your questions.
If you have any other questions, do let me know.
With love,
Jenni
PS - If you haven't done so already, I suggest you visit Dr. Anne Lawrence's web
site. I believe it is one of the most informative sites for transsexual women on
the web. Find it at: http://www.mindspring.com/~alawrence/
----------------
Subject: Re: I've set the date!
Date: Thu, 13 Mar 1997 18:25:00 -0500
From: Jennifer McCloud <Jenn...@llc.net>
Organization: Lightning Link Communications
To: Michelle Steiner <ste...@antispam.best.com>
Newsgroups: alt.support.sexreassign
References: 1 , 2
Michelle Steiner wrote:
>
> Congratulations, Jenni. Why Schrang? (I would have asked this question
> regardless of whom you chose.)
Hi Michelle,
OK, I'll explain my experiences, and reasons, but I want to ensure that
everyone clearly understands that this was MY choice, based on MY
experiences and considerations, and that my choice may not be the right
one for anyone else. (This probably doesn't need to be said, but just
the same, I'm a bit sensitive to this issue, and wanted it
communicated.)
Also, at the outset, I want to communicate that this was a terribly
tough choice. By that, I mean that these two surgeons are so comparable
in skill and result, that you just can't go wrong with either one (just
as Becky Allison says in her charming Alabama accent). But, obviously, I
had to make a choice, and my choice was Schrang (arrived at, you
understand, with no small amount of gut feelings and intuition, as these
guys were just so closely balanced by my estimations.)
Several weeks ago, I had the wonderful good fortune to have Dr. Anne
Lawrence accompany me on my interviews with, and examinations by, Drs.
Meltzer and Schrang. Additionally, she was able to observe Dr. Meltzer's
vaginoplasty procedure (again, as she had observed him last year) and
Dr. Schrang's, and I was afforded the benefit of receiving hours of
discussion and explanation on the differences between these two
surgeon's techniques.
Also, by visiting the hospitals involved, and spending hours with each
doctor's patients, I was able to get a good feel for the aftercare that
is provided to transsexuals after surgery at Eastmoreland Hospital and
Theda Clark Medical Center (this one was a no-brainer).
Here's what I interpreted from my experience (and again, this is my
interpretation and understanding, whether right or wrong).
Dr. Toby Meltzer is a wonderful person and a superb surgeon. He is very
approachable, genuinely likes his patients and what he does, and may
very well be the most skilled (technically speaking) of any surgeon
performing SRS in the world. And ALL his patients just love him (if you
don't believe this, check out Michelle Wallace's latest "The Surgical
Results Information Page"
(http://www.pacificnet.net/~mwallace/surgery_info.html).
His most attractive "feature" to me is his technique in creating the
neo-clitoris. In this state-of-the-art procedure (as reported upon by
Dr. J Joris Hage of the Free University in Amsterdam), he utilized a
portion of the glans penis to construct the clitoris. The nerve bundle
and blood vessels that supply the glans are left intact, so that by all
reports I was able receive, this ensures a very sensate clit.
Another attractive "feature" of his technique is the careful "thinning"
of the penile tissue, thereby ensuring maximum elasticity of the penile
sheath, which, in most cases, results in the avoidance of skin grafts.
According to Anne, he definitely knows what he’s doing with a scalpel
(for those of you who don’t know, Anne is an anesthesiologist, and has
seen many surgeons at work in the operating room).
Not having been in many hospitals in my life (but enough for me) I would
characterize Eastmoreland Hospital as a fairly small, regular private
hospital. Nothing extraordinary. The staff there that care for us
trannies seem nice enough, although I did receive complaints from one
patient about noisy intrusions near the entrance of her room, where a
supply closet was accessed at all times of day, keeping her awake. She
requested, and was granted, a change of rooms. Also, I have read in this
newsgroup some complaints about the attitudes of the nursing staff at
Eastmoreland.
I addressed this with Dr. Meltzer, and he acknowledged that he was in
the process of training the staff of Eastmoreland that deal with
transsexuals, and since he had just moved there several months ago, this
was something still in process. I understand that he has direct access
to the senior management of the hospital, and has their total support
for ensuring that the care afforded his patients is of the highest
order. They’re not there yet, in my opinion. But on the other hand, I do
believe things are improving.
Dr. Eugene Schrang is also a superb surgeon, but different from Dr. Toby
in his presentation and demeanor. He seems very strong minded, stern
some might say, and came across at first as sort of patronizing and
paternalistic. (Frankly, he IS paternalistic and somewhat chauvinistic,
as well. He kept calling Anne and I girls - "Come on, girls, I’ll take
you to lunch." Of course Anne hated it, being a staunch feminist, and
I... well, I thought he was kinda cute, in a sort of elfish way. BTW,
both these guys are smaller than probably 90% of us!)
Dr. Schrang is very proud of his surgical skill, and strikes me as the
consummate perfectionist, as well. He speaks of himself as a
"craftsman", and I think he is just that, a master craftsman at SRS.
His surgical technique significantly differs from Meltzer’s, in that he
does not use the glans penis to construct the neo-clitoris. Instead,
according to Anne, he "sandwiches" spongy tissue (corpus spongiosum),
nerves, and urethral tissue to create the clit. In a way he creates a
sort of "mini penis" of tissue coming up from the urethral opening
(urethral meatus). At the meatus he splits the urethra lengthwise,
thereby exposing its mucosal lining, and terminating it at the clitoris.
This creates the nice pink tissue that is apparent in most of the
photographs of his work. This technique also results in the swelling of
the clitoris during sexual excitement, and according to the reports of
the boyfriends of Schrang’s patients, quite naturally so. And for our
benefit, the nerves incorporated into the sandwich ensure good sensation
there, as well.
He does something else that is attractive and important to me. Because
he more often than not utilizes skin grafts, he has more penile tissue
to deal with, and I believe he puts it to good use. He creates a
"tunnel" , or bridge of penile skin between the urethral meatus and the
clitoris. Because it doesn’t fuse, while healing, with the mucosa
tissue underneath it, he is later able, during his labiaplasty
procedure, to split this bridge and fashion it into labia minora. Nice
touch, and very attractive and anatomically approximate. Anne thought
this was quite ingenious.
Perhaps most important (as this would have nixed him off my list) is
that I will not have to have an abdominal skin graft. Instead, since I
am fairly small and need a graft, he will take the needed tissue from my
scrotum - tissue that he would normally discard.
I told him point blank, in no uncertain terms, that I have seen those
scars, I consider them ugly, and I refuse to have them on my body. To my
amazement, and appreciation for his flexibility, he acquiesced. I will
have to depilate a major portion of my scrotum (OUCH!) but it’s what I
want, and I’ll endure it.
Theda Clark Medical Center is simply an A+ facility. Large, spotless,
modern, it is by far the superior medical facility. I don’t know, but it
may be the best facility in the world to receive SRS. I can’t imagine a
hospital being any better. And the staff are absolutely wonderful. All
the good stories you have heard about Theda Clark are true.
While I was visiting a new friend, Jennifer Lynn Martin (what a
coincidence, she’s got my first two names, and we share monograms!),
over the course of an hour or so, a nurse came in at least 3 times
inquiring if she was OK, and if she needed anything. The nursing staff
is absolutely supportive, super friendly, and well-experienced with
caring for the transsexual patients of Dr. Schrang.
Earlier, while considering where to go, I did not put too much
importance on the medical facility. I thought, what the heck, I’ll only
be there for a week or so, and I really am most concerned with the skill
of the surgeon. Well, my viewpoint on this changed. I looked at the fact
that I will be undergoing major surgery, and I realize that
complications can occur. Clearly, I would prefer to be at Theda Clark if
something goes wrong, as I am confident that they would be best able to
respond quickly with equipment and medical expertise in any emergency.
So there you have it. Meltzer’s a great guy and he makes a better clit.
Schrang’s a perfectionist who, I believe, gets a more consistently
aesthetic result, with an adequately sensate clit, and operates out of a
clearly superior facility.
I should add, so that no one may assume otherwise, that despite her
appreciation of the skill and techniques of Dr. Schrang, it was Anne’s
final recommendation to me to go to Dr. Meltzer. She continues to
believe, unless she’s re-evaluated her data, that Dr. Meltzer is the
preferred SRS surgeon in the US.
Also, I would like to publicly thank Dr. Anne Lawrence for her ceaseless
and unbounded concern for the transsexual community, and her kindness
and concern for me personally. She does care about each and every one of
us, and her continuous efforts to empower us through the dissemination
of information on her Web site (http://www.mindspring.com/~alawrence/)
and her participation in our forums, is admirable beyond measure. Being
with her for 8 days was an experience in and of itself, one that has
matured and enriched me, and one that I will never forget.
Thank you, Anne.
Hope I haven’t bored you guys.
Jenni
----------------
Subject: Re: Another SRS surgeon?
Date: Sun, 01 Jun 1997 11:39:59 -0400
From: Jennifer McCloud <Jenn...@llc.net>
Organization: Lightning Link Communications
To: cmm...@ibm.net
Newsgroups:.support.srs
References: 1 , 2 , 3
Caitlyn M. Martin wrote:
>
> I'm most likely to see Dr. Meltzer for another reason. I am *very*
> small below the waist, and he seems likely to be the only one that might
> just avoid a skin graft. Still, I've got a while to decide yet.
Hi Katy,
I'm glad I took a few minutes this morning to take a look at what's up
on our groups. There is something important that I'd like to share and
which I'm sure will be of interest to a lot of us.
A week from this Wed. I will undergo Dr. Schrang's vaginoplasty
procedure. I will have a skin graft which will NOT be visible, as the
skin used to extend the depth of my neo-vagina will come from excess
scrotal tissue, NOT the abdomen.
Some of you may recall my posts in March where I presented the results
of my interviews with Drs. Meltzer and Schrang. I was very fortunate to
have had Dr. Anne Lawrence accompany me on my interviews and
examinations by both surgeons. (Dr. Lawrence also observed both
surgeons’ procedures during our trip to Portland and Neenah.) An
important element of my decision to go with Schrang was his acceptance
of my request to use my excess scrotal tissue, instead of abdominal
skin, for the graft.
I don't know, but I may be the first patient to undergo this alteration
(advancement?) in his grafting procedure. I must admit that this does
make me a bit nervous, but I’m confident in a positive outcome, as I
don’t believe this change in his procedure presents any significant
technical challenge. (I can tell you, though, that it sure did present
some significant discomfort in clearing the hair from down there!)
My consideration is that the skin graft part of this is no big deal on
his part, but it IS a big deal to me, as I will get the depth I’m
looking for without any scars.
I have been waiting for Dr. Lawrence to present her observations on this
issue in her excellent web site <http://www.mindspring.com/~alawrence/>.
She assures me this is forthcoming, having been delayed by her busy
schedule and her important presentations in the upcoming gender
conference in Philadelphia.
My observations (from a post in March) can be found in the gender
section of Andrea Bennett’s cool web site
<http://www.mindspring.com/~arblaw/>. My report is at
<http://www.mindspring.com/~arblaw/comp.htm>.
Anyway, I believe this represents an important advancement in Dr.
Schrang’s procedure, and significant information for those evaluating
SRS surgeons.
Jenni
----------------
Subject: Schrang's Improved SRS Procedure
Date: Thu, 26 Jun 1997 15:00:21 -0400
From: Jennifer McCloud <Jenn...@llc.net>
Organization: Lightning Link Communications
Newsgroups: alt.support.srs
Hi All,
As many of you are aware, I was away recently seeing Dr. Schrang
(actually, he saw a lot more of me than I saw of him!).
Well, I’m back home, happy as a lark and feeling better daily.
Before I say anything else, I want to say thank you to all of my friends
and family who have been so incredibly supportive, and especially my
transgendered friends who I have met on these newsgroups. The love and
support has been overwhelming. Truly, in my wildest dreams, I never
imagined I could receive so much support and be so happy.
While I was in the hospital, someone (I believe it was Andrea Bennett)
posted a short memo about my recent SRS with Dr. Schrang, specifically
commenting on the use of my scrotal tissue to extend the depth of the
vagina, leaving NO visible skin graft scars.
Back in March, I was excited to let everyone know that I had set a
surgery date with Dr. Schrang. Michelle Steiner asked me why I selected
Schrang and I responded with a rather long post, explaining the results
of my trip with Dr. Anne Lawrence to visit Drs. Meltzer and Schrang, and
my resultant decision to select Dr. Schrang as my surgeon. (For those
interested, this report may be found on Andrea Bennett's web site at
<http://www.mindspring.com/~arblaw/comp.htm>.) I mention this now as my
opening comments in my report in March are appropriate to this
discussion and still hold true. I repeat them here:
> Hi Michelle,
> OK, I'll explain my experiences, and reasons, but I want to ensure that
> everyone clearly understands that this was MY choice, based on MY
> experiences and considerations, and that my choice may not be the right
> one for anyone else. (This probably doesn't need to be said, but just
> the same, I'm a bit sensitive to this issue, and wanted it
> communicated.)
> Also, at the outset, I want to communicate that this was a terribly
> tough choice. By that, I mean that these two surgeons are so comparable
> in skill and result, that you just can't go wrong with either one (just
> as Becky Allison says in her charming Alabama accent). But, obviously, I
> had to make a choice, and my choice was Schrang (arrived at, you
> understand, with no small amount of gut feelings and intuition, as these
> guys were just so closely balanced by my estimations.)
My purpose for this communication is to provide what I feel is very
important data for pre-operative transsexual women. I have felt this way
since my visit with Dr. Schrang in early March (hence my rather long
post that I hoped would provide some useful information). I recently
popped backed into alt.s.srs to provide this info to Katy Martin (and
any others that had an interest), and I do so again as I have now
successfully undergone Dr. Schrang’s modified vaginoplasty procedure,
leaving me with more than adequate vaginal depth without any visible
scarring. Frankly, I think people should know about this.
I should also mention that each surgeon that performs SRS has their own
techniques and nuances that make their procedure somewhat different from
their peers, although they may all be performing penile inversion
vaginoplasty. As I learned during my trip with Dr. Anne Lawrence,
Meltzer and Schrang do things a bit differently, with the efficacy of
the results of these differences being very subjective to various
observers in many cases. I believe that this is the case with the use of
scrotal tissue. Every surgeon’s use of scrotal skin is probably a bit
different. I say this because some may comment that this is nothing new,
that other surgeons have been doing this for some time. This may be so,
but what I think is important is that Dr. Eugene Schrang, clearly
recognized as one of the leading surgeons performing SRS in the world
today, is now utilizing scrotal tissue effectively. He is excited about
this positive advancement in his result. Again, I believe this is
important information for any TS who is in the process of considering a
surgeon.
In addition, I thought it would be most appropriate if the readers of
these newsgroups could get the data straight from the horse’s mouth. So,
I have asked Dr. Schrang if he would forward me some information about
this development so I might provide it to our community. At the end of
this memo is his response to me.
Thanks again for your wonderful support and friendship.
With Love,
Jenni
___
Subject: Laser depilation of the scrotum
Date: 97-06-23 20:07:43 EDT
From: ESchrang
To: Jennifer McCloud <Jenn...@llc.net>
Dear Jennifer,
This is to answer your inquiry regarding the latest exciting advance
in M/F SRS. As you know, one of the goals we wish to achieve
when doing the operation is adequate neo-vaginal depth. The
greatest obstacle to attaining good functional depth is lack of
sufficient penile skin for lining of the new vagina. With
insufficient penile skin, we must turn to skin grafts of various
kinds to overcome the lack of lining material. In the past, split
thickness grafts - usually from the lower abdomen - were used but
their drawback was the unsightly donor site scar which took a long
time to heal. Full thickness grafts are excellent sources of lining
material and can be obtained from various places such as from
across the lower abdomen (if enough hairless skin is present)
leaving a transverse scar which resembles a Hysterectomy scar or
the bilateral flanks which leave oblique scars of varying length and
width that can often be covered with even scanty attire - but scars
result all the same!
In our never ending quest for lining material that leaves no telltale
scars, an exciting technological advance has been made using the
Long Pulsed Ruby Laser to depilate the hair from the scrotum.
Actually, this laser can remove unwanted hair from any part of the
body (works best in light skinned people) in far less time and with
less pain and expense than other currently used methods. For years
my objection to the use of scrotal skin as a source of graft material
was the fact that it contains hair and has a rough texture. With the
advent of a fast and relatively easy (and less expensive) method of
removing scrotal hair, it was discovered that, once the hair was
removed, the texture of the scrotal skin was no longer
objectionable for use as a neo-vaginal graft. Not only that, but it
was discovered that the tissue is distensible and a little goes quite a
way. If scrotal skin proves out to be a practical source of skin graft
material, many more patients will no longer have to endure the use
of the abdomen as a full thickness skin graft donor area.
HOWEVER, THIS METHOD IS NOT FOR EVERYONE. For
those patients with a small penis and little scrotal skin, abdominal
grafts (split thickness or full thickness) must still be used.
I plan to begin using this technique as soon as I obtain my own
laser equipment within the next few weeks. There are some
unanswered questions however; costs have to be worked out and
the time lapse between laser treatment and SRS must be
determined. Also, we need experience to root out any bugs.
I hope the above clarifies things and please feel free to disseminate
this information as I know that it will be welcome news to the
Transgender community. The scrotal, full thickness skin graft
operation has now been done on several patients who had previous
electrolysis of their scrotums. With your permission I am calling it
the "McCloud Procedure" - after you, of course, because it was you
who first had the operation done in this particular way.
As things develop further, I will pass the information on to you.
Sincerely,
Dr. Schrang
----------------
Subject:: Dilation and vagina applicator fors
Date: Sun, 29 Jun 1997 12:55:18 -0400
From: Jennifer McCloud <Jenn...@llc.net>
Organization: Lightning Link Communications
Newsgroups:.support.srs
References: 1
Susan Thomas wrote:
>
> I was talking with some recent 'graduates' on the phone and discovered
> that they hadn't picked up on a key technique for dilation: ...
Hi Susan,
You are absolutely right, they help out immensely! It's good that you're
presenting this data for us. Thanks so much.
> ... but you might read my experiences, below, if you had a scrotal
> cap (such as what Toby and possibly now Schrang does) ...
And from your other post (Re: Schrang's Improved SRS Procedure):
> It is really a shame that Schrang waited so long and required so
> much pressure from Jenni and Anne in order to follow the lead of
> others like Meltzer and Menard.
It appears that you have come to the conclusion that Schrang's new
procedure is nothing more than an imitation of what Meltzer and Menard
have been doing all along. This is not my understanding (and I've spent
a LOT of time with Anne Lawrence, Meltzer and Schrang discussing this).
Toby uses the scrotum to "cap" the vaginal vault (is this what Menard
does? I don't know as he was not on my "short list"). When Toby needs to
extend the depth of the vagina, my understanding is he uses skin from
the body (his regular use of the very distensible scrotum is probably
why he rarely needs to use grafts, however). Schrang has used my scrotal
tissue to extend the depth of the vagina (not just cap it), which at the
present (and without the preferred dilators from Laura Harris) is at 6"
with a larger diameter stent than given to me by Schrang (#3 from Intel.
Eng. - 1 1/4"). With diligent (but not unduly vigorous, I would imagine)
dilation, I expect to pass the 7" mark with a 1 1/2" dilator. More than
sufficient for accommodating all but the largest men, I would think.
I believe this is remarkable with no visible skin graft, and would be
surprised to learn that Meltzer or Menard have accomplished this with
someone so small as myself (we’re obviously never going to know now,
though, are we!?). Also, because it's Schrang, I also have a very well
constructed, and anatomically correct, vulva (from the mouth of Jessy
Xavier, who has seen her fair share of them, I'm sure!). After Schrang's
labiaplasty, which Anne Lawrence has said is very clever and novel, I
would expect an overall fabulous result. I am EXTREMELY happy with my
result so far.
Remember, each surgeons' technique differs, and although all the best
current surgeons use the penile inversion technique, there are
differences, and each gets a different result. And although all three
major North American surgeons now use the scrotum, HOW they use it
differs. And all three have very good reputations, get repetitively
great results, and have overwhelming supportive patients. Much of this
decision on our part involves other criteria such as location, cost,
reputation of the hospital, etc. I believe any of the top surgeons may
be the correct choice for an individual, based on their preferences and
needs.
Also, although this is rarely spoken of, I should add that perhaps each
of us who has made our selection feels ours was correct, and we wish to
defend, support and justify our decision. I am no different, so factor
that in while reading my praises of Dr. Schrang. This was MY decision,
and I think he's the best. Others my not think so. Fine. I understand.
Anyway, thanks again for sending along the applicators, and thanks for
sharing this vital info with our community. You're a dear.
Love,
Jenni
PS - And let me not forget your kind attention and concern for me over
these months and especially recently during my surgery and recovery. You
set a high standard and example for all of us to follow, Susan. I am
very grateful for your help and support.
----------------
Subject: Re: Schrang's Improved SRS Procedure
Date: Wed, 02 Jul 1997 22:27:19 -0400
From: Jennifer McCloud <Jenn...@llc.net>
Organization: Lightning Link Communications
Newsgroups: alt.support.srs
References: 1 , 2 , 3 , 4 , 5 , 6
Michelle Steiner wrote:
> ...
>
> Nope; this procedure is to use scrotal tissue as a graft at the front of
> the vagina, where it meets the labia--the same thing that Dr. Schrang is
> doing now.
Hi Michelle,
Dr. Schrang confirmed for me today that all of his grafts are at the end
of the penile sheath, extending the end of the vaginal vault, including
the scrotal skin graft he performed on me (this was a freely removed
graft of scrotal skin, not a flap, if that's perhaps what you were
thinking). A little tactile investigation has confirmed this fact!
> >nor did Schrang with Jenni (his
> >first and only use of a free scrotal graft),
Again, this is correct, however, I’m not alone. I met a beautiful 15
year old girl who was number 2. I found this out as Dr. Schrang blew
into my room the day after my surgery, stating, "Well, I just performed
the McCloud procedure again this morning." I didn't know what the hell
he was talking about (the morphine didn’t help matters), and was
incredulous, until he assured me he was serious. Explaining himself, he
proceeded to excitedly tell me how great my operation went, and asked me
if it would be OK to name his altered procedure after me. I must admit,
I was relieved to no end to learn of the success of my surgery, and
could hardly deny the man his desires, could I! (As my head blew up big
enough to fill a 10 gallon hat! Huh, Sallyanne?)
This young woman was absolutely precious. I was completely blown away by
her and her loving parents, and look forward to the day when our
condition is recognized and accepted early on, with appropriate and
loving care. (She had not even sprouted a single hair on her face yet!)
I was so proud of her and her parents, and now I've got a little sister
(I should be so young... niece?) to keep tabs on.
Jenni
Melissa
In article <64f3gg$t3h$1...@news1.teleport.com>,
Aradia <ara...@user2.teleport.com> wrote:
>Melissa <Meli...@Yamnix.com> wrote:
>: >If non-TS females don't get rid of their estrogen for a major operation,
>: >then why should TS females get rid of their estrogen for a major
>: >operation, if the levels of estrogen are similar to that of non-TS
>: >females?
>: >
>: >Perhaps someone can enlighten me...
>
>: I'm no doc either but I wonder if the two equate. Is taking estrogen in pills
>: exactly the same as what genetically born females get from their own bodies?
>
>horse version. But Estradiol is supposed to be damn near close to what
>chromosomal females have inside them. I still fail to see the rationale in
>stopping HRT.
Whether it was a hard core proven fact or not, I personally had no problems with
stopping them per my Dr.'s orders for those 6 weeks and it still seems like a
good precaution. I had nothing to lose but a few blood clots and no loss of
feminization, and it really did get way better after srs, so I don't see
anything to worry about from stopping for those few weeks.
But hey, it's a free country and you pay your money and take your chances,
either way.
Melissa
In article <EJH2G...@midway.uchicago.edu>,
hay...@cs.uchicago.edu (Kristin Rachael Hayward) wrote:
>
>
>In article <MPG.ecfbc4d9...@nntp1.ba.best.com>,
> la...@goodkitty.com (Laura Werner) wrote:
>>On 9 Nov 1997 18:55:26 GMT, ptho...@aol.com wrote...
[snip]
>Back in the "old" days, Schange didn't require such. Shortly before my
>SRS in 1994, I heard he was requiring it. Since I had never been
>formally informed of the change in policy, and not wanting to go
>through the menopausal mood swings just prior to surgery, I stayed on
>Premarin right through the entire period. In fact, I took my normal
>dosage a day after surgery. Why didn't I want to go through the mood
>swings? I was receiving absolutely terrible rejection from my family,
>my lover, the few people at work, etc., about the surgery. They just
>didn't understand.
Sorry to hear that Kristen. Has that improved for you since then?
>I made the choice to keep my moods stable. Did I endanger my health?
>Probably. Where their mitigating factors? Well, I was very fit
>physically, running 5 times a week right up to surgery, my weight was
>170, I didn't smoke. I figured since Gene had done surgery for years
>wuthout requiring the patient to go off surgery, the risk factor was
>low, and combined with the rejection from family and friends, I was
>going to spin the wheel. Dr. Becky would probably take great exception
>to this post, but for me, it was right. I just couldn't deal with
>the swings.
Like I mentioned, despite the sweats the day after srs, I was eupohoric for
weeks after. My roomie in Neenah had some severe problems from mood swings
though, ripped up one of the food servers and threatened to complain to Schrang
about her because she accidentally slipped a pronoun ( I mean the kitchen woman
was very nice and we were talking about getting my roomie a birthday cake from
the kitchen when it happened ) , and chased her parents away one day, who had
come from overseas to be with her and had paid for her srs by mortgaging their
home, we heard.
Definitely YMMV.
But the bottom line is that all's well that ends well. Glad you did well.
SharonSchm
In article <346E2A...@primenet.com>, Becky Allison
<beck...@primenet.com> writes:
>Did you experience symptoms toward the end of a twenty-four hour
>interval between doses of estradiol? I think that would be important
>information if enough people reported this.
On 2 mg Progynova (estradiol valerate) taken once a day in the morning I
experienced severe night sweats on a regular basis. I upped the dose to 4mg
a day (2 mg in the morning, 2 mg in the evening) 4 weeks ago. Since then, I
only had 2 night sweats in the whole period of time. Mmh, seems there is a
correlation...
BTW, 2 mg seemed a bit low to me, anyway.
Nice n´ dry
Sharon
Melissa
In article <346E3563...@llc.net>,
Jennifer McCloud <Jenn...@llc.net> wrote:
>Stefani Banerian wrote:
>
[snip]
>
>His most attractive "feature" to me is his technique in creating the
>neo-clitoris. In this state-of-the-art procedure (as reported upon by
>Dr. J Joris Hage of the Free University in Amsterdam), he utilized a
>portion of the glans penis to construct the clitoris. The nerve bundle
>and blood vessels that supply the glans are left intact, so that by all
>reports I was able receive, this ensures a very sensate clit.
As far as I can tell, that's what Schrang did with me too.
[snip]
>Dr. Eugene Schrang is also a superb surgeon, but different from Dr. Toby
>in his presentation and demeanor. He seems very strong minded, stern
>some might say, and came across at first as sort of patronizing and
>paternalistic.
IMO, very! I also wrote him about being overweight, in email, months before my
srs and he assured me it was no problem, told me to just do the best I could
with it. Then when I got out there, after spending over $1000 on plane tickets
and hotel for me & Jennifer, he nearly refused to do my srs when he saw that I
was overweight, and totally freaked on me in his office, before finally agreeing
to do it. He took my blood pressure after freaking on me and freaked even more
when he saw that it had gone up to 185/something! Not like it wasn't caused by
him freaking on me & saying he might not do my srs! I didn't come there for fun
& games! I needed srs! ( my blood pressure went down to perfectly normal, btw,
while I was in bed recovering from srs, I'm sure that spike was caused by him
freaking on me in his office! ) If he has that kind of a problem with it, he
should require nude frontal and side photos in advance of saying he'll do the
srs. IMO what he did was not right, having someone schdule srs & look forward to
it & fly out there at that expense, and then freaking on them like that.
>(Frankly, he IS paternalistic and somewhat chauvinistic,
>as well.
Not to mention arrogant and elitist( IMO ).
> He kept calling Anne and I girls - "Come on, girls, I’ll take
>you to lunch." Of course Anne hated it, being a staunch feminist,
I'm a feminist too but was willing to allow for that, as long as I was treated
decently. I didn't feel like I was.
>and
>I... well, I thought he was kinda cute, in a sort of elfish way. BTW,
>both these guys are smaller than probably 90% of us!)
Yeah, I thought he bore a remote similarity to Kirk Douglas, but Kirk is getting
kinda old too. They're probably the same age.
>Dr. Schrang is very proud of his surgical skill, and strikes me as the
>consummate perfectionist, as well. He speaks of himself as a
>"craftsman", and I think he is just that, a master craftsman at SRS.
That's fine with me, but Jennifer & I thought he was very abusive to me the
whole time I was under his care, because I was overweight. He wouldn't stop
hassling me about it in the hospital and kept telling me that the reason I'm
overweight is because I eat too much! Duh-uh! And it wouldn't happen to have
anything with an abnormal set point or body metabolism, I suppose. But he
wouldn't let go of it and hassled me about it constantly, even though I was
trying to be pleasant to him. One of the nurses confided in us that she thought
he definitely considered himself an artist, and his patients were his canvas,
and that if a TS woman was the slightest bit overweight or unattractive, he
would hassle them mercilessly! This was confirmed to me by someone else I know
who lives in Denver, who went to him a few months later, and while she was not
one ounce overweight, but perhaps not the most attractive woman in the world,
she said he told her she was "too fat".
I think the doc needs therapy for that himself, and that he's probably too
arrogant to ever get it.
So I'd recommend that if anyone considering going to him is the slightest bit
overweight or unattractive, they not bother. It wasn't worth the abuse, to me,
and if I had it to do over again, I would have gone to Dr. Meltzer, who I've
heard is a very kind doctor.
I won't go back to Schrang for part 2 when I can afford it, I'd rather not have
it than go back to that kind of abuse. I'll try to have it done with the good
Dr. Meltzer, if he can fit me in, I understand he's now booked past February of
1999! Wonder why? Could it be that he's not only the best but the nicest?
>His surgical technique significantly differs from Meltzer’s, in that he
>does not use the glans penis to construct the neo-clitoris.
That may have changed by 3/96 because he sure seems to have, with me. But I
still wouldn't go to him if I had it to do over again.
[snip]
>Perhaps most important (as this would have nixed him off my list) is
>that I will not have to have an abdominal skin graft. Instead, since I
>am fairly small and need a graft, he will take the needed tissue from my
>scrotum - tissue that he would normally discard.
I now have big long purple scars on each side of my waist from Schrang, which
itched for a long time after srs. I suppose he didn't care what I looked like
afterwards because I was overweight and so unworthy.
[snip]
>Theda Clark Medical Center is simply an A+ facility. Large, spotless,
>modern, it is by far the superior medical facility. I don’t know, but it
>may be the best facility in the world to receive SRS.
The nursing staff were certainly super.
>So there you have it. Meltzer’s a great guy and he makes a better clit.
>Schrang’s a perfectionist who, I believe, gets a more consistently
>aesthetic result, with an adequately sensate clit, and operates out of a
>clearly superior facility.
I'd still recommend Meltzer, unless you're a raving beauty, then I think
Schrang will treat you fine.
>I should add, so that no one may assume otherwise, that despite her
>appreciation of the skill and techniques of Dr. Schrang, it was Anne’s
>final recommendation to me to go to Dr. Meltzer. She continues to
>believe, unless she’s re-evaluated her data, that Dr. Meltzer is the
>preferred SRS surgeon in the US.
[snip]
I think the fact that he's booked almost to the year 2000 speaks for itself.
Wish I had a time machine and could go back and change my mind to Meltzer, but
..
Becky Allison
Michelle Steiner wrote:
>
> In article <64nhci$f5c...@dialup1.den.amnix.com>, Meli...@Yamnix.com (Melissa) wrote:
>
> >I won't go back to Schrang for part 2 when I can afford it, I'd rather not have
> >it than go back to that kind of abuse. I'll try to have it done with the good
> >Dr. Meltzer, if he can fit me in, I understand he's now booked past February of
> >1999! Wonder why? Could it be that he's not only the best but the nicest?
>
>
I'll say this about labiaplasty. Dr. Schrang does the traditional "Z"
technique which leaves a Z-shaped scar on each side. Dr. Meltzer uses
the inverted-Y technique, and the small midline scar is easily hidden in
the pubic hair.
I was impressed enough that although I had my SRS with Dr. Schrang, I
went to Dr. Meltzer for my labiaplasty, and I'm still glad I did on both
counts.
> >I now have big long purple scars on each side of my waist from Schrang, which
> >itched for a long time after srs. I suppose he didn't care what I looked like
> >afterwards because I was overweight and so unworthy.
>
> Everyone I've seen who has gone to Schrang for SRS before he started to use the "McCloud" procedure has scars on the abdomen; he uses grafts in about 90% of his patients. At least you didn't get the half-thickness skin graft which left a rather large rectangular scar on the middle of the abdomen.
>
Michelle, I'm gonna call you on two points on that one.
You've seen me. And I went to Dr. Schrang before the McCloud procedure,
and I don't have skin grafts. And he does not use a midline donor
site. He takes grafts from both inguinal areas so under best
circumstance it looks like you've had hernia repairs.
I do agree with you that both surgeons are excellent and one's chances
of a good result are very good with either one.
Becky
Grrlpetal
Julie Haugh wrote:
>
> Shrang's literature is clear on the point that he doesn't like to
> perform SRS on anyone who is over 200 lbs. At the time you had SRS
> you were significantly over 200lbs, as well as being overweight for
> your frame.
>
And she also wrote:
>Another issue is an entirely different form of "getting read"
>which seems to create more depression than the usual form of
>getting clocked. It is when you are having a discussion with
>another woman and she goes "You mean your mother never told you
>about <X>?" and =every= woman your age is already supposed to
>know that.
Okay, Julie. As a fully integrated, assimilated woman I think it's time
you have a lesson in female socialization. Every woman your age is
supposed to know *not*
to speak about another woman's weight problem in public. Especially the
way you've just done. Unless you *hate* her, of course. This is *not*
the way to keep friends, at least among women. And it's no sexist
cliche. My xspouse is a former board member for the National
Organization for Women, and she says that she'd slit your throat for
doing this- it tends to be *very* humiliating. Melissa can think, say or
do whatever she wants about this...in a million years I'd *never* do
this to another woman...unless she was going after my boyfriend ;). At
the very least, who needs the headache of a cat fight?
Now I don't do this to embarras you. You've done a good job of it
yourself, here.
If I was playing one-upsmanship I'd also quote your line (from another
post) about taking too little time for transition before SRS.
No, what i really mean to do here is something supportive, for you and
the ng. And
that is to tell you to calm down, take it easy, *chill* 'cause it's
gonna be okay, ya' know? It seems like your anxiety about impending SRS
has overtaken your good sense. And before you start rolling over newbies
someone has to trip you up. And better it be me because I think you can
be a cool person. And there ain't nothin' you can say about me that
would keep me from slicing you up for dinner, if I had to. I think
you're very out-of-sorts, now. That's all. :)
Don't be so defensive about your man in Neenah. He's just a guy with a
technique and your paying lot's of money for him to employ it on you.
BTW, I'm truely impressed with your knowledge about SRS techniques-
makes for very informative reading.
Ciao bella,
Cindissima
Cynthia E. Dumville
> : thromboembolic complications -- such events are common enough
> : post-operatively that some of the patients undoubtedly did. They occur
> : in patients who don't take estrogen, too. My point is simply that
> : discontinuation of estrogen does not appear to be the standard of care
> : for non-transsexuals undergoing surgery.
>
> I'll grant everyone the fact that this started out to be a good thread.
> The question of stopping hormones before SRS is certainly a good one to
> ask, if not stopping can lead to such a variety of cardiovascular
> problems. Now, I'm not a doctor or anything, just a deeply philosophical
> person with a pretty high interest in psychology who happens to sometimes
> be slightly too logic-oriented...
>
> Assuming that a MTF TS on estrogen has an estrogen level similar to
> that of a non-TS female, and assuming that a MTF TS really should stop
> taking hormones because of the possibility of inconvenient blood clots,
> then should non-TS females get rid of their estrogen due to the same
> problem? If so, how? And do they?
>
> then why should TS females get rid of their estrogen for a major
> operation, if the levels of estrogen are similar to that of non-TS
> females?
>
> Perhaps someone can enlighten me...
>
that comes to mind.
What are the hormones level in the TS? I bet that the levels are much
higher then any GG sees in her life time, other then prubity.
One last comment. In my own research I have found that in one way or the
other all of the surgins who work with the Transgender community require
that the thirty days off hormones a must.
Cynthia D