Hormone Therapy as advocated by Dr William Powers in the USA

[Adrian]

A link to the presentation perhaps?????

[Catherine]

Finally, someone who knows his stuff.
The health and well-being of many of the TG community would be so enhanced with some one of his ilk here in Australia.

I sadly noticed the recent forced resignation of Australia’s’ one and only research Endocronoligist who worked extensively in the field of TG health, Dr Jon Hayes. He leaves a very large hole in the field of endocrinology which goes well beyond testosterone and estrogen.

There is a lesson to be learnt from this act by the Medical Council. If you think TG Heath is going to be available to you in the future, I’d think again. It’s going backwards at an alarming rate.

If anyone is interested in hearing/seeing Dr Power here in Australia, leave your comments below and I’ll see what can be done.

With Love and Respect

[Deleted User]

Id be delighted if I knew that Australian Doctors were adopting treatment regimes that are contemporary with Best World Practice. Most seem to adopt WPATH or its Local version ANZPATH and Ive read enough now to think that perhaps ? there IS something better not yet taken up by WPATH.

[Adrian]

Dr Powers is indeed a good guy. Rather than following rules he seems to be devoted to getting the best outcomes for those who seek his help. I was also impressed to see the wealth of information he provides to other GPs to inform them.

We shouldn’t loose sight though of the difference between empirical observations and clinical studies. Dr Powers is describing his observations about the transwomen he is seeing. In many cases he correctly points out that he can’t say anything about treatments he doesn’t use, only the results from the treatments he has tried. As such his findings are immensely valuable (probably because many other doctors don’t seem to show enough interest in outcomes). BUT you can’t expect the WPATH guidelines to be shaped by results from a very limited “convenience sample” with largely homogeneous treatment pathways.

In contrast clinical studies attempt to compare different treatments in a more scientifically rigorous way. They are very difficult to design (largely due to the problems recruiting a representative cohort of transgender subjects) and often the results are contradictory. I trust that it is this body of peer reviewed data that WPATH uses to create its guidelines, and that would explain why they seem to lag behind the work of intelligent guys like Dr Powers.

So remember the environment that Dr Powers works in is very different from Australia. The influence of medical insurance schedules alone distorts what a Dr can economically suggest in the USA. That means his solutions may not be the only ones that are efficacious in Australia.

[Lisa_W]

I have a couple of points to make about this topic and an off topic point that was raised.
Firstly no one knows why Jon Hayes resigned. Both APHRA and the medical board deny any restrictions put on his practice of medicine. Also he is not the only research endocrinologist in Australia. I agree his retirement left a temporary but very large hole in TG care in Sydney. But that has largely been resolved now.
I had a look at Dr Powers presentation. At one point he was advocating cross sex hormones for pre-pubertal people. That does not happen anywhere else in the world and WPATH does not advocate it. Injectable oestradiol is only used in the US &A. Have you ever wondered why? Do you think it might be dangerous and also give widely fluctuating E levels. Americans are smart people but not all the time.
I agree with Adrian, anecdotes do not make valid research.
I admire Dr Powers compassion but be aware of messianic zeal.

[Deleted User]

I can answer Lisa’s question. In Australia oral and injectible estrogen regimes involve the liver, with the addition toxicity issues implicated. Skin patches are therefore favoured here by most Endocronologists. That’s how mine explained it to me.

[dee88]

After having and still having Implants. They are so much safer and easier..In time they last a very long time before another visit. They are not mentioned in the talk by Powers.

[Deleted User]

I agree entirely Dee
It seems the US FDA has not approved tthem.
Just another case of the USA being diferent to the rest of the world .

[Catherine]

Hi Dee,
Good to hear you’re having good results from your implants.
Dr Powers does reference them in his discussion, only very briefly, as it appears to him they are not available in the States. Whereas in fact they are. There is a manufacturer in Colorado.
Best wishes

[Adrian]

dee88 wrote:

They are not mentioned in the talk by Powers.

In the pdf of Dr Power’s guidance he says:

Quote:

So what about transdermal estrogen or implants?
>I rarely use transdermal estrogen patches or gel except in patients who have poor e1:e2 ratios but cannot or refuse to tolerate injectable estrogen. When I do prescribe them, I tend to use the week duration patches at 0.1mg per patch, typically 2-3 patches simultaneously to achieve injection level effects.
>Estrogen pellets are a kind of implant (similar to testosterone testopel) which can be obtained from compounding pharmacies and placed in the gluteal area in a small surgery done in the office. They last 4-6 months on average. I rarely do them as these patients have to be maintained on HRT for life, and over 30 years that’s almost 100 surgical procedures. However, some patients do really want them and I am willing to do it in certain cases.

As I read it his reluctance doesn’t rest on availability but the number of surgical procedures required over one’s lifetime.

[Catherine]

Thank you Adrian for clarifying this matter. Dr Powers was speaking quite quickly and this transcript helps immensely. I appreciate your efforts in clarification.
Best wishes

[dee88]

Sorry I missed that bit. I watched it over a few days and not as a block. I can only speak from my own experience but the implants I have been receiving have lasted 10-11 months. They are only a nick and inserted with a trocar. I get blood test done on a regular basis.