Response to Lowdown on Progesterone.

GIRES is a well respected organisation and papers that they publish are taken, most seriously. Being published gives credence to Dr. Curtis's paper.

In my opinion, this paper, incomplete, poorly researched and shows Dr Curtis’s well known prejudice against the use of progesterone.

I agree that much of what is on the internet, is of dubious origin but there is also masses of information that is accurate and well researched. My experience is researching hormones, for m-f use, since early 2003 before starting to use them since March 2004.

He gives a table of synthetic progesterins, with the possible side effects but does not include natural progesterones, such a Cyclogest Utrogestan and as used by many who self prescribe, microgest.

I know it is only anecdotal evidence but those that take progesterone the vast majority experienced improved breast growth, especially in the development/enlargement of the nipple-areola, milk duct complex. Richard says that the difference would only be up to about 20%, the remainder being fat tissues. Ask most transsexuals, another 20%, yes please. Also, believe you me, proper development of the whole breast, including. nipple-areola, milk duct complex is extremely important to us. The breast is far more than just fat tissue.

Richard’s statement: "Therefore the same effect in feminisation can be gained by exercising less, and a modest degree of caloric over-consumption. For those who wish bigger breasts, save your money, reduce the side effects and longer term risk and just eat more pies. Without making yourself obese, feminisation is greatly dependent on the oestrogen assisted accumulation of body fat which does not come out of the either."

I strongly disagree with recommending that m-f transsexuals reduce their exercise and "eat more pies" in order to grow bigger breasts. I feel that it is not appropriate for a GP authored article, published by GIRES and one running his own Gender Practice to recommend actions that threaten long term overall health. Even if his comments were intended as humour, self-acceptance of m-f transsexuals bodies is certainly not a joke.

There are several apparent benefits that may be derived with the addition of progesterone to at least the initial 2 years of cross-gender hormone treatment for m-f’s, and if the hormone delivery is NOT oral (and there is good evidence that if these studies would have been done with alternate delivery systems [such as trans-dermal and IM] and with a better choice of hormones and selection criteria), then benefits may in fact far outweigh the risks. I see no reason not to extend the period for far longer.

Transgender women are interested in far more than breast development; Holistic whole-body balance is certainly higher on the priority list for many of my M-F patients than just breast size. In some cases, progesterone has been the missing piece of the puzzle for these women. Placebo effect or not, when natural bio-identical progesterone (i.e. Cyclogest, Utrogestan, etc) is used it is safe and effective in most cases.

He cites many side effects and risks. However, these refer to natal women, synthetic progestins and any side effects as regards to m-f transsexuals are not known, have not be researched and based on assumptions. He uses as an examples, breast cancer risks. However, the statistics relate to natal females; numbers for transsexuals are not known but thought to be low, not much higher than that for men. Transsexual women, particularly after issue of your Gender Recognition Certificate, I would suggest that their breast cancer is likely to get recorded along with natal women. However, I do accept that there may be a very small, increased risk and I am breast aware. I regularly, ‘self examine’ and also have mammograms, when invited. I had one three years ago and just recently, another.

Abstract from different published articles, with thanks.

These articles disagree with Richard Curtis's claim that 'progesterone is not involved in breast development'.

Published by Ingenta, Ingenta, a division of Publishing Technology plc.
Progesterone is an ovarian steroid hormone that is essential for normal breast development during puberty and in preparation for lactation and breastfeeding. The actions of progesterone are primarily mediated by its high-affinity receptors, which include the classical progesterone receptor (PR)-A and -B isoforms, located in diverse tissues, including the brain, where progesterone controls reproductive behavior, and the breast and reproductive organs. Progestins are frequently prescribed for contraception or during postmenopausal hormone replacement therapy, in which progestins are combined with estrogen as a means to block estrogen-induced endometrial growth. The role of estrogen as a potent breast mitogen is undisputed, and inhibitors of the estrogen receptor and estrogen-producing enzymes (aromatases) are effective first-line cancer therapies. However, PR action in breast cancer is grossly understudied and remains controversial. Herein, we review existing evidence and discuss the challenges to defining a role for progesterone in breast cancer.

The Institute for Optimum Nutrition
Progesterone is a hormone from a corpus luteum, formed by the cyclical rupture of an ovarian follicle. Progesterone is necessary for proper uterine and breast development and function.

Where is it found?
Progesterone is produced in the female body in the ovaries. Progesterone production is high during the luteal phase (second portion) of the menstrual cycle and low during the follicular phase (first portion), as well as being low before puberty and after menopause.

EAST LANSING, Mich. — Scientists at Michigan State University have found exposure to the hormone progesterone activates genes that trigger inflammation in the mammary gland.
Exposure to progesterone in normal amounts and in normal circumstances causes inflammation, which promotes breast development. However, exposure to progesterone in menopausal hormone therapy is known to increase breast cancer risk.

Published by Elsevier BV on behalf of the Federation of European Biochemical Societies
The effects of progesterone derivatives on breast cancer development are still controversial, probably accounting for their biphasic, opposed effects on mammary cell-cycle regulation. Here, we demonstrate in vitro that the growth-inhibitory effects of progesterone on breast cancer T-47D cells require the transcriptional upregulation of the cyclin-dependent kinase inhibitor p27Kip1 (p27) gene. A statistical analysis of human tumor biopsies further indicates that p27 mRNA levels correlate to progesterone receptor (PR) levels. Moreover, p27 gene expression is inversely associated with tumor aggressiveness, and is a prognostic factor of favorable disease outcome. Thus, progesterone derivatives selectively activating the p27 gene promoter could be promising drugs against breast cancer progression.

Articles from Breast Cancer Research : BCR are provided here courtesy of BioMed Central
Estrogen and progesterone play leading roles in orchestrating proper development and function of breast tissue. High levels of these hormones are associated with pregnancy and appear to be responsible for the diminished risk for breast cancer among women following a full-term pregnancy.

In Conclusion
There are risks in any medications that we take, even paracetamol, aspirin, etc. everything we do there are risks. You must weigh up those risks and decide for yourself if the benefits outweigh any risk. In my opinion the risks from female hormones, bio-identical oestrogen and progesterone is absolutely minimal. It is my risk and not for anyone else to deny me taking that risk. I can chose to smoke, drink, overeat, or not to; nobody can stop me. That is my choice. Yet something that is much, much safer, others can deprive me of it. No wonder so many self prescribe.

I feel that Richard Curtis and other clinics are wrong to refuse progesterone and they have not really given any really well thought out reason not to. Certainly Richards Paper does not go anywhere near explaining.

If you have researched female hormones and understand their effects and possible risks then you should be prescribed an adequate and well balanced regime, at your own risk. The Doctors responsibility stops at ensuring that the patient understands any possible risk.

There are essential surgeries that we have to undergo; the risks posed by these are infinitely higher.

 

Paper researched by Michelle Dibble, in response to ‘The Lowdown on Progesterone’ by Dr. Richard Curtis (updated 03-04-'10).

Michelle Dibble MASC FASC CCCreg.

As a balance, the full paper by Richard Curtis 'The Lowdown on Progesterone can be accessed on: 

http://www.gires.org.uk/assets/Medpro-Assets/Progesterone.pdf 

You must make your own judgement on which is more appropriate for our regimes.