Q:Hello, I was curious as to if you know why most doctors don't prescribe progesterone along with estrogen? I'm on estrogen and I was talking to one of my trans friends and her doctor put her on progesterone too and she said it feminized her more and added a half cup more and the same was true to another of her friends who is also trans. Thank you!
Fox says:
I mean, I feel like that’s a conversation that you should take up with your doctor…?
Ren says:
Hey, I didn’t see this when it was posted, or I would’ve dumped some endocrine knowledge all over the place! Here is your daily dose of way too much medical information. (Hey, you were curious!)
Thing is, progesterone…really does not have any function for folks without uteruses. Studies don’t show any conclusive evidence that it increases boop size (your friend’s anecdote could just have easily been caused by the estrogen she continued to take alongside the prog!), not even in cis women.
Progesterone increases the size of your mammary ducts, yes, but that’s not noticeable in your boop size! (For reference, mammary ducts make up about 20% of boop size, and fat distribution makes up 80%. Progesterone is more likely to make your boops slightly tender than, like, actually grow.) It just helps you to lactate, which is possible as a trans woman / transfeminine individual, but is a whole ‘nother endocrine mess entirely! It’s estrogen that causes boop growth, and that’s pretty much it.
Prog does increase your chances of both breast cancer and thrombosis (blood clots), which is, yanno, no good. There’s also other major medical warnings, like if you have asthma, diabetes, migraine, depression…and on and on. (Also, it causes PMS symptoms. Screw that noise, seriously.)
Doctors used to think that prog was required for trans women because folks with uteruses produced it…but they only produce it because of the uterus! It prepares the uterus for implantation and does some stuff for pregnancy. When it's prescribed to AFAB folks, it’s only as birth control, to handle menorrhagia, or to prevent uterine cancer - none of that applies if you don’t have a uterus. :P
To summarize: progesterone is dangerous, and it doesn’t do anything to make you more feminine, because that’s the job of estrogen and anti-androgens. No feminizing benefits, but tons of health risks - if a doctor doesn’t prescribe progesterone, it means they’re caught up with the current medical research. :)
(Full disclosure: progestins - synthetic progs, usually prescribed in the form of Depo-Provera - are sometimes prescribed as less-expensive alternatives to GnRH analogues, AKA hormone blockers like Lupron, Vantas, or Synarel. Problem is, they aren’t nearly as effective as GnRH analogues at what they do, and can mess with thyroid function and bone development at the dose that’s required for hormone blocking! Also, progestins are pretty bad for any body when compared to natural progesterone.)
Here is my major source for this information! Darn good resource. Also note that the Endocrine Society’s guidelines for hormonal transition do not recommend progesterone (and don’t speak fondly of progestins for hormone blocking, either).
I’m not a doctor and Fox is right - ask your doctor about their thoughts on progesterone! But this, at the moment, is the general consensus of the endocrine community.
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- thedisc0urse said: it’s because there isn’t a lot of data on what’s most effective for most people, as well as what’s more likely to increase the risk of breast cancer.
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