[Coldwine]

Hi everyone I'm a MtF trans in my 40s(I'm also in the closet) and am interested in taking PM for breast growth and any other potential feminisation effects. I know that herbs are weaker than prescription hormones, but does anyone know if they carry similar risks in terms of blood clots? I've read the info on Ainterol's UK website but it doesn't mention anything about it. I'm interested in buying some R1 but I thought I'd ask about this first.

Also, is PM sufficiently strong that it should be taken under medical supervision? I mean, I guess no-one's going to say don't take it under medical supervision, but do people usually tell their doctors about it or not bother? I haven't told my doctor yet about being trans.

[AbiDrew85]

I have found nothing to indicate that it has any increased risk for blood clots, and in fact the only solid evidence for that at all only applies to a single particular source which is hardly used by anyone with any sense anymore: premarin. As of right now all other estrogens are merely supposed to increase that risk because they KNOW premarin did.

That doesn't mean it isn't true of other estrogens, only that no one's bothered to prove it.

As for medical supervision... most of us, both men, and women, who use PM do so without consulting their doctors, I would suspect.

Of course, if you have a doctor who's OK with holistic medicine, then, by all means, get supervised... If you're also OK with coming out to them...

You do have to be aware that this stuff IS sufficiently strong enough that you will eventually begin to show. Your changes will become indisguisable. So if you go down this path, you will eventually be forced to come out at least a little. Maybe not completely, but at least some.

Granted, I would never ever have been able to "only come out some". LOL. I was out completely before even starting on PM.

[julie_txcd]

ahh, I was going to post something about drs myself. I was wondering how many actually told their doctors they were taking PM or other NBE stuff? If so, how did they react?

I have my regular dr and I'm seeing a urologist for BPH. I'm sure neither would have a clue that I might do something like this.
I wonder if they should know what I'm taking but am really leery of telling them for fear of their reaction, how to explain why, what if they say they won't be my dr anymore, etc.!

julie

[SarahSchilling]

I'm betting your doctor won't care, I told mine I was taking PM and SP for hair loss, and he just wanted to know about prescription drugs. It's all they are taught about lol.

Not that I'd call the lack of knowledge/interest a good thing.

[jamie88]

Coldwine you raise a very important concern. Something that everyone should seriously consider before starting PM. AbiDrew notes (perhaps in a slightly dismissive manner) that there is little evidence to suggest that estrogens other than conjugated estrogens are likley to raise cardiovascular risk. This is true although Ethinyl estradiol has also been shown to be associated with increased cardiovascular risk (Toorians et al. 2003; Van Kesteren et al. 1997). What both conjugated estrogens and ethinyl estradiol have in common is that accurate serum blood levels are not measurable in a meaningful way and this means that it is difficult to be certain that a MTF transsexual is ranging at the mean levels of biological females.

What needs to be understood here is that estrogens above biological norms can be very dangerous. Indeed, it could be the case that the increased cardiovascular risk of conjugated estrogens and ethinyl estradiol are less a result of inherent properties of the drugs and more a case of the inability to monitor sex steroid levels and therefore maintain them within biologically normal ranges. What I am saying here is that increasing your estrogen levels above the biological normal for a woman is likely to raise cardiovascular risk factors. It could also alter the functioning of your liver (Hembree et al. 2009). PM taken in excess is in my view likely to cause the same increases in cardiovascular risk along with god-alone knows what else. What is excess in relation to PM? Nobody knows. Nobody has done any experiments on humans that are taking the amounts that biological males on this forum are doing so on a daily basis, to do so would be unethical. Recently my friend, taking PM at the time, developed a pulmonary embolism - at the age of 20 i might add!! whilst this is proof of nothing, I have stopped taking PM myself and would strongly advise that others exercise caution. Blood tests and GP monitoring are a good idea but in common with conjugated estrogens, i suspect accurate monitoring would not really be possible.

[AbiDrew85]

I've got to say I wasn't familiar with the research on EE. But it doesn't surprise me. Though from what I understand of the paper it seems the risks do reduce significantly when dissolved sublingually.

The problems mostly seem to come in with the liver with EE. Which again doesn't surprise me. Ethinyl is an alcohol molecule, EE is estradiol bonded to a small amount of alcohol.

I don't think this shows anything in regards to PM though and I can't believe that your friend actually experienced such a problem from JUST PM. Or really even that PM contributed at all.

Unless it was extracted in a really nasty form of alcohol... Like the form EE is bonded with. Ethinyl's really quite nasty.

Most of it isn't though...

[chrishoney]

As far as any of us has been able to determine, there are no studies regarding use of PM by human males. However, there are a few studies with post-menopausal human females as well as a fair number of studies using animal models, ie animals as test subjects, including trying to establish an LD50 for PM.

Since the procedure for determining the LD50 involves megadosing of the substance or drug in question, it seems reasonable to assume that any deaths resulting from cardiovascular complications would form part of the 50% of the test subjects that succumbed when given excessive PM. Since the studies specifically designed to determine the LD50 actually failed in their purpose (NO LD50 has been established for PM because 50% of test subjects did NOT die, despite being given extremely high doses of PM to the point they could not practically give the animals any more PM), it is safe to assume that even extremely high doses pose little if any cardiovascular risk, at least to those animals. (To head off the spurious argument that just because something didn't happen in a study, doesn't mean it can't happen, this is simple set theory. The subset of deaths due to cardiovascular events is part of the larger set of all deaths due to ingesting PM. If the set of all deaths is so low, NO LD50 could be established, then the subset of deaths due to cardiovascular events is equally low if not lower.)

Add to that the prolonged use (spanning several generations at least and without reported cardiovascular complications) of PM in areas of Thailand and the far east, and the risks from taking PM seem low indeed.

I do understand all the vagaries of experimental design and the danger of inferring or generalizing results for a specific subset of test subjects, to the population at large as well as extrapolating results using animal models to humans, but we have to base a judgement call on something. In my opinion, based on the research I have been able to read, PM is as safe, if not safer than current formulations of bio-identical estradiol.

And just to set the record straight, the danger inherent in Premarin and ethinyl-estradiol are NOT because serum estradiol levels cannot be measured accurately. Please read the research if you don't believe me. Part of the problem with Premarin is that it unnaturally elevates serum estrone and estriol levels which throws things severely out of wack. The other part of the problem is the large number of unknown substances in Premarin that throw off dangerous metabolites as it is being metabolized by the liver in combination with the relatively high doses necessary to be effective since Premarin has relatively low amounts of estradiol, the most effective naturally occurring estrogen.

Premarin was used with and without synthetic progestins (formulated as depot medroxyprogesterone acetate and marketed as Depot Provera) in a longitudinal study of post-menopausal women. The study was called the Women's Health Initiative, so please google it and see why it was HALTED prematurely because of the relatively high number of women who experienced severe health complications, including death! Realize, in a study like this, the goal is NOT to elevate serum estradiol levels to that of pre-menopausal women, but just enough to alleviate the undesirable effects of menopause. The test subjects (over 160,000, so sample size ISN'T an issue) were taking Premarin at levels to sustain serum estradiol BELOW normal levels for pre-menopausal women, and they STILL had severe health complications. Premarin is INHERENTLY dangerous and in combination with medroxyprogesterone, actually, really and truly lethal. It has nothing to do with measuring serum estradiol, estrone and estriol levels.

Ethinyl-estradiol is an extremely potent estradiol analogue (more estrogenic than 17-beta estradiol) that unfortunately forms deadly metabolites as it is slowly being processed by the liver. Again, do the research. The deadly nature of ethinyl-estradiol has nothing to do with how serum estradiol is measured.

Accurate monitoring of serum estradiol levels is possible even if prohibitively expensive for for all but a few. But this begs the question of whether there actually is a link between bio-identical estradiol administration and blood clots. None has been established by any studies I have been able to find. As Abi pointed out, the (flawed) assumption of the medical establishment and big pharma is that all estrogen replacement drugs are equal, in effect as well as risks. This is just false on many many levels.

Finally, all of this is complicated by the fact that PM is NOT an estrogen, it is NOT estradiol, nor estrone nor estriol, the three naturally occurring estrogens found in biological females. The purported active ingredients in PM (deoxymiroestrol and miroestrol) are estradiol MIMICS. That is, they mimic many of the effects of estradiol. This does NOT mean they mimic ALL of the effects of estradiol as evidenced by the studies (using animal models or in vitro cell cultures) showing PM has a PROTECTIVE effect with regard to certain types of cancer, including estrogen sensitive cancer cell lines. This is seemingly illogical if we assume PM has ALL the properties of estradiol since certain cancers are known to be estrogen sensitive, that is estrogen accelerates their growth and development. It is NOT illogical if we remember that just because PM mimics some of the effects of estradiol, it is NOT estradiol, and therefore does NOT necessarily have the same risks.

I do agree that everyone considering taking PM should be very cautious when they start in order to determine how it affects their particular system. Everyone reacts somewhat differently to every drug or herb. That is part of the reason there are numerous drugs in any class of medications, such as NSAIDs, statins, diuretics, antianxiolytics and so on. It is entirely conceivable that PM precipitated the event of the 20 year old that threw a clot to the lungs. But then there are folks that develop deadly clots which are ideopathic. He may be genetically prone to excessive arterial plaque build-up too. Estradiol has a heart protective function, but it is NOT a given that PM has the same effect, and even if it does, it would not eliminate the occurrence of clots. Some folks form clots easily, and some don't. It is equally conceivable that his taking PM and throwing a clot are completely unrelated except for their proximity in time.

Taking PM is NOT risk free and each person has to assess the level of risk tolerance they are comfortable with. In order to do that, we need to consider facts, not just what we read on some forum (YES! including this polemic--DO THE RESEARCH FOR YOURSELF.) However, in my opinion the preponderance of evidence indicates that PM is as safe, if not safer than most if not all of the common drugs many of my patients currently take, including ibuprofen (if you're the type to stay up at night worrying, DON'T read the possible side effects and complications from this common OTC drug), celebrex, coumarin, oxycodone, and even nicotine (check out the LD50 of nicotine, which is more toxic than pure cocaine!)