Hello, been on HRT for 16 months. I started at age 63. I will just mention negative side effects. Breast tenderness is actually a positive side affect. If your breast are tender they are growing.
Spiro-It is a diuretic and we use a side affect of it to lower Testosterone. It lowers blood pressure and it is processed in the kidneys. So you have to have good kidney function and blood pressure that is not hypostatic (low blood pressure). It works for most and the worst side affect is usually going to pee every hour; some less often. If you cannot use Spiro you have to have the testicles removed.
Estradiol – Patches, pills, or injections. It has the potential for several negative side affects. Deep vein thrombosis (DVT) (thrombosis-blood clot) may be a problem if you have other risk factors. If you get a DVT you have the potential of having a pulmonary embolism. Age, vein issues, estrogen and other items are risk factors. Sometimes Estradiol is blamed for a loss of muscle and fatigue. I did not have a loss of muscle strength but I experienced fatigue which was finally determined to be because Estradiol lowered my thyroid level. So the endocrinologist may monitor your thyroid level along with Estrogen level.
I had a DVT and it caused my lower left leg to swell and I had to keep it elevated several days until the blood thinner kicked in. The best blood thinner is Eliquis but it is expensive if you don’t have insurance and you will have to continue to take it. Taking Eliquis is not a bit deal; I have been told that it is the most prescribed medication in the country. The safest medication version is considered to be patches because it administers a continual dose and has less peaks.
The dose of both medications is determined through trial and error. You will have blood test before a dose is prescribed and then usually every 3 months.
Some primary care doctors can prescribe the medications but endocrinologist are the usual ones that have the experience to do it right.
Some trans girls take Progesterone but it is not prescribed often any more. Supposedly it allowed the breast to be rounder but the only ones that I know that take it are those girls that have been on HRT for a long time.