Hey ! My girlfriend is having GRS soon and she's been told to stop taking HRT 10 weeks before the operation. This seems like a lot to me, is it usually that long ?
I can't speak for how long it usually is, but a lot of doctors tell you to stop taking estrogen before any major surgery, not just GRS. Estradiol has a risk of blood clots and they want to minimize that.
There's no data showing modern bioidentical estradiol increases risks enough to be a concern prior to surgery. It's an outdated practice that dates back to the days of Premarin and ethinylestradiol, which have a much greater risk of clots (and which is why they fell out of favor for HRT use!)
With that said, even the surgeons who do still require HRT cessation generally want patients to stop a couple weeks prior to surgery. 10 weeks is ridiculously unnecessary (and frankly if it were me, I wouldn't stop HRT even close to that far out from surgery. I wouldn't want to feel like total shit for two and a half months leading up to major surgery.)
I certainly don't agree with it. I'm just saying why doctors do it.
My therapist and I had a laugh about it too. I pointed out it’s still less risk than cis women, she just shook her head because she’s had to put up with it for years too.
I'm fortunate in that my surgeon didn't require it at all -- they even brought me my full dose every day while I was in the hospital. For some higher-risk patients they may put them on a low dose shortly prior to and after surgery, but they don't see any good reason to make anyone stop completely. Marci Bowers is the same way now, and I hope more surgeons will start following her lead.
I’m in the U.K. so unless I save up a fuck tonne of money in the next two years I’ll be going the NHS route, which is free, but means I don’t really get a choice in the surgeon etc, which means I won’t get a choice on this either I don’t think.
But as a 23 year old in good healthy, good BMI etc, I would be a good candidate for not stopping HRT.
10 weeks?! JFC
I wouldn’t stop it because I think the data on the risks is severely outdated and doctors just don’t have new data to know any better.
I just had an Orchiectomy and I never stopped my dosages before surgery. But this is what I did and I’m not saying that she should follow my advice
But 10 weeks is an absurd length of time. Most doctors say to stop taking anywhere from 2-4 weeks out.
10 weeks is insane, 2 weeks is standard and tbh I think even that is a stupid holdover from the Premarin days. Just cut it to a super low dose two weeks before, I've done that for two surgeries now and it's been fine
My doctor told me it was outdated and transphobic to require patients to stop HRT before surgery. Obviously that’s one end of the spectrum, but on the other, the longest required time off hormones that I know of was 3 weeks.
Nope. I was instructed to cut my estrogen dose to 1mg/day two weeks out from surgery. Didn't even have to stop taking it.
For FFS I think I went to half a dose a month before. Stopping cold turkey for ten weeks sounds extremely excessive -- I don't think the half life of estradiol in the body is more than a couple days
For FFS I've been told not to go or cut my dose at all :o
Do they use pellet implants ? With other methods it may be a few weeks.
And it may be possible to discuss if it is necessary. A number of surgeons only want a lower dose, like half of a dose. Amongst those to my knowledge is Bowers for example.
This is a standard many endos use and it may be possible to point there :
"There is no evidence to suggest that transgender women who lack specific risk factors (smoking, personal or family history, excessive doses or use of synthetic estrogens) must cease estrogen therapy before and after surgical procedures, in particular with appropriate use of prophylaxis and an informed consent discussion of the pros and cons of discontinuing hormone therapy during this time. Possible alternatives include using a lower dose of estrogen, and/or changing to a transdermal route if not already in use.[62]"
That seems extremely conservative. Several surgeons don't require you to discontinue at all these days...
My surgeon required me to discontinue 2 weeks before, though I could keep taking my AA up until the night before. I felt so flat for those two weeks, I can't imagine what 10 weeks would have been like.
Depends mainly on your Gf's risk factors for VTE (venous thromboembolism)/blood clots/stroke. If she is taking a long flight the stasis/immobility factor just before surgery should be considered. 10 weeks sounds like a lot to me, but if she has a lot of additive risk factors it might make sense in her case?
Risk factors: (Source: https://www.heart.org/en/health-topics/venous-thromboembolism/risk-factors-for-venous-thromboembolism-vte )
- Major general surgery
- Major orthopedic surgery
- Lower-extremity paralysis due to spinal cord injury
- Fracture of the pelvis, hip or long bones
- Multiple trauma
- Cancer — all cancers increase the risk, especially if the cancer has spread widely, and if it is cancer of the lung, brain, lymphoma, gynecologic system (like ovary or uterus), or gastrointestinal tract (like pancreas or stomach). In patients with cancer, chemotherapy and surgery for cancer further increase the risk.
"Additional risk factors" (lesser impact)
- Prior VTE— Patients with a previous episode of VTE have a high chance of recurrence.
- Age— Patients older than 40 years are at higher risk, and that risk doubles with each subsequent decade.
- Obesity--- people with obesity have 2 times the risk of VTE as people with normal weight, and the higher the weight, the higher the risk.
- Immobility— Prolonged immobility, such as during long travel , combined with other major risk factors increases the likelihood of VTE.
- Oral Contraceptives or estrogen treatment for menopause symptom (**or HRT**)
- Family history of VTE--- especially if this is in a first-degree relative (parent, sibling, child)
- Physical inactivity
- Genetic blood conditions that affect clotting
Hi! I had to stop it 2 weeks before going to meet my surgeon... Not so much... Good luck to her :)
I was not required to stop HRT prior to surgery, and Dr. Bowers is at least one other surgeon who doesn't require it either. There's no evidence that shows any benefit, and all it does is make the patient (who is already likely anxious about upcoming surgery) feel like shit due to basically inducing menopause.
I had to stop everything two months prior. Ten weeks doesn’t sound that abnormal.
It was only two weeks for me.
It sounds like you're in the UK which is overly cautious. 2 weeks is what Chettawut requires which is conservative.
Do what the Dr says
Have another meeting with the Dr about concerns and possibly shortening the time or going on a light dose
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