Date: 2012-04-04 23:43 Security: Public xpost http://soph.livejournal.com/230094.html Mood: intrigued Tags: dr james barrett, gender identity, gender identity clinic, gender identity: hormones Subject: Hello, world!

I'm so sorry for seemingly dropping off the face of the Earth. (Or at least Dreamwidth; I've been pretty active elsewhere, but still.)

Lots of things have happened since the last time I posted. Let's go through them!

1. Firstly, I got copied on this letter from Dr James Barrett to my GP (a transcription of which is below for those who need it), asking my GP to prescribe me estradiol valerate (a form of oestrogen), along with an anti-androgen in the form of a gonadotropin-releasing hormone analogue called Decapeptyl (yes, that is the correct link; Decapeptyl is a brand name for Triptorelin). Finally, it asks for a two-week prescription of cyproterone acetate to prevent the so-called "flare effect" associated with using GnRH agonists; namely, at the start of treatment, testosterone levels will actually go *up* before they go down. The cyproterone acts as a testosterone blocker, but is pretty harsh on the body, which is why it's only ever prescribed for a short period of time.
   
   Here's a transcription of the letter:
   
   

   Dear [my doctor],
   
   Re: Sophie HAMILTON -- DOB: [my date of birth]
   
   I write regarding the above named patient having discussed her with my Consultant Endocrinologist colleague, Dr Seal.
   
   She is somebody who would be appropriate to treat according to our clinic protocol and accordingly I would be grateful if you could prescribe her Estradiol Valerate at a dose of 2mg a day, rising after 3 months to 2mg twice a day. In concert with this she would need to have her native androgen production suppressed and to this end, I would be grateful if she could be given a gonadotrophin releasing hormone analogue, any would do, but we usually suggest Decapeptyl at a dose of 11.25mg every 12 weeks, which is to say precisely the formulation used in prostate cancer. [ed: I'm assuming that he meant to say the formulation used in treating prostate cancer...]
   
   As ever with the use of gonadotrophin releasing hormone analogues, for the first 2 weeks after the first injection only, there is a brief but marked rise in androgens and so for that 2 week period only, she will need additional dosing with Cyproterone Acetate at 50mg a day. This can stop after the first 2 weeks and need not ever be used again. This treatment is decidedly safe as you will see from the information I have included with this letter. If there is any problem with you prescribing it, please do not hesitate to get back to me as quickly as possible.
   
   Yours sincerely
   
   [signature]
   
   James Barret. BSc MSc FRCPsych
   Consultant Psychiatrist/Lead Clinician
   
   cc: Ms Sophie Hamilton
   [my address]

   
   
   This is all what I was expecting to get the first time round when I went to my GP to collect the prescriptions, but didn't get at the time. (There was a small change; I was expecting Zoladex (goserelin acetate) as the GnRH analogue because I knew that's what some trans friends of mine were on. Instead, I'm on Decapeptyl, which I hadn't heard about before now.)


2. With an actual letter having been sent, this time I managed to get the prescriptions easily. Getting the actual medications, though, proved to be a bit more difficult, because I was just about to have a five-day break with cxcvi in Cardiff, which involved driving there and then back, taking three hours each way. I didn't want to risk not being able to do that, and besides, there really wasn't any time. Because of that, I decided to take the prescriptions with me, get the medications in Cardiff, and then drive home and see what I could do with them.


3. I didn't have any problems in getting the medications, but one thing that I discovered was that rather than the Progynova (estradiol valerate) I was expecting, I got Estelle Solo (estradiol hemihydrate) instead. It turned out that my GP had put just "estradiol" on the prescription, rather than specifically saying "estradiol valerate" as they had done the last time. From everything I can see, however, they should be interchangeable. I think I'll ask the GIC about it just in case though.


4. I knew that the Decapeptyl was going to have to be injected, and when I had asked the GP to write the prescriptions, my GP (or rather, the GP I was seeing - my own GP wasn't working that day) said that it would probably be a good idea to have the first injection done at the local hospital, and have them show me how it was done so that subsequent injections could be done by myself. That seemed logical to me.
   
   So, on my way back from Cardiff, I stopped by at the hospital and tried to find out what I could. To cut a (very) long story short, I was told that the GP had got it wrong for two reasons. Firstly, the hospital didn't do this sort of thing; it'd need to be done by the nurse at my surgery. Secondly, Decapeptyl is an intramuscular injection, meaning an injection directly into a muscle. In this case, it's normally done in the patient's bottom, and as such it wasn't something I would be able to do myself at all; I'd always have to have it administered by someone else. So I called my GP back and have made an appointment to have that done.

And that's about everything regarding my transition so far! My appointment to be injected is on the 13th of April - just over a week from now. From that point is what I'll consider to be my true beginning of hormones, since the estradiol on its own won't be doing a lot without an anti-androgen!

(In fact, to put a frame of reference on it - today I noticed that my nipples are getting sore. This is a normal part of the process, but it normally happens in 2-3 days after starting, assuming an anti-androgen is in place. For me, though, it's been 2-3 months instead. Things should drastically speed up once I'm on the anti-androgen though!)

I've been slacking with taking pictures a bit since I wasn't actually going anywhere fast, but once I start the new meds I'll definitely start again. (And no, nobody's missed anything; I haven't posted any to my journal yet.)

Again, apologies for falling off Dreamwidth! I hope this update was enough to assure you that things are happening. :D

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