[Pink.Chiffon]

Hi, Dianna!

I would strongly recommend having a hormone panel (bloodwork) done for her. Unwanted hair growth and underdevelopement can be caused by estrogen dominance rather than a high testosterone problem. I think having hormone levels done will be the best way to figure out how to move forward. Estrogen dominance is actually a huge problem for women today because there are so many hormone disruptors in the environment that tend to cause estrogen dominance more than any other hormone imbalance.

Hope this helps!

Thank you, Pink Chiffon.
We had a blood panel done to diagnose the PCOS. Need to get an updated one, but we're doing one thing at a time...  This week was the woman's knee replacement. NExt week I take a "vacation" to help her convalesce.

We know she needs estrogen, but I don't have the numbers at work. And they didn't do a fractional E or T workup, either. Nor SHBG, so far as I know.
But if the EE (which I understand is hard on the liver, per MTF guidelines, and then oral administration? Something doesn't gel here.) is working, then it's likely this is correct, since this is script from the doc, not an overseas pharmacy where we're guessing and hoping and adjusting, though those steps would come during the process.

She's got a nice figure overall, she wants to look like a girl, though, unmistakably. She's usually a t-shirt and jeans girl, with some hirsutism and cystic acne problems (sounds worse than it is, mostly, but she'll dig out the cysts...) 
But if she dresses in good (fitted) clothes, with a good bra, she's definitely a girl. (Who now is facing the problems of cortisol and bad food choices - mac'n'cheese, candy.)
I think we need to supplement a LOT more, and use more E for the early phase (Luteal, I think?) and then add progesterone cream at the follicular (?) stage. See how it goes for a cycle.
BO might make the use of PM or pharma E unnecessary (great option given exogenous E's ties to breast cancer), and if it can turn the T levels down, even better.

What has me concerned the most is, she said sometimes she feels like a guy, so I'm nervous about her maybe being transgendered, but she doesn't show a lot of drive or aggression normally - just, she'll spike on the aggressiveness out of nowhere (like an unruly teenage boy might). That signals DHT to me, which means too much T, and it's going the wrong way. Her mother has male pattern baldness, for comparison, and is 260 pounds...  Oily hair if she doesn't wash it every day.
So BO seems best option to start.
Then using some routine scanning of hormones, make sure we're going the right direction, and then refine based on how she feels (E.G., progesterone might go away early on, because her mom reacted badly to it - angry, aggressive, moody. That's at 51, basically menopausal.)

I'll look for the information when I get home, and try to post them here.
Doctors in MA aren't necessarily great...  Ask for X, they say you don't need it. Insurance denies that you need it. And the rents and food costs, it's not like you can go private too easily.
But I'm planning to hit Fenway health anyway (TG friendly) - and that might enable better medical monitoring for both of us.

-Dianna

Hi, Dianna!

To be honest, she sounds a lot like me when I was a teenager. I had a lot of the same problems: unwanted hair growth, PCOS, very oily skin, severe cystic acne, I was also very boyish. I had high testosterone in my teenage years, was put on birth control for this which I later came off of when I learned birth control can actually make things worse and cause infertility. This is what made me switch to bioidentical hormone therapy (BHT) when I could afford it. Insurance doesnt help pay for doctors visits but I get progesterone prescribed through my OBGYN and this is covered by insurance.

Interestingly, my high testosterone was gone by the time I started BHT at 28. I have a theory as to why that is. But anyway, once I got my hormones sorted (I had high estrogen and low progesterone), I started BO and my PCOS symptoms have since gone away. It took about 9 months of working with my BHT doctor to get my hormones right but it changed everything for me. Like you, I had to go to a BHT specialist to get any help in this department. Regular doctors were useless.