Epilepsy: How would you check my hypothesis?
Another epileptic concerned about epilepsy medication and HRT. I've written a couple of posts about epilepsy already. TLDR: I'm skeptical that the HORMONES are really the PROBLEM.
So IF a physician wanted to check my hypothesis, this is MY "professional opinion" as a loser with no life on that topic:
You're looking for cholesterol deficiency, B5 deficiency, electrolyte imbalance.
My understanding is that CURRENTLY the hypothesis is that hormones are the issue, so if you have an anemic menstruating cis female epileptic AND learn she's anemic, you need to figure out WHY.
Is it iron deficiency? Or B5 deficiency?
I'm guessing you can recommend B5 supplements to treat anemia without anyone going "Hold up, she's epileptic. That's a problem. You can't do that safely."
You can just do your usual due diligence as a GP and go "Hey, girl, you're a tad anemic. I'm going to prescribe B5 supplements as the conservative treatment because it could be B5 or it could be iron and you can't really poison yourself with B vitamins. IF that doesn't work, we'll try iron."
And if you're a GOOD doctor, you should note that in the chart and then if what you see is gals who stop being anemic because they got B5 supplements ALSO see a reduction in seizures, now you have valuable data supporting my hypothesis.
If you have ethics, you credit me as the person you got the idea from. If you are an Earthbound human, I'm not holding my breath but that's what SHOULD happen.
Anyway, if you document that B5 deficiency correlates to more seizures and improving B5 status correlates to reduced seizures, THEN you can start laying out tentative non hormonal treatments for your trans patients. AND write up a tentative study outline and get it approved for this hypothesis that HRT in trans individuals shouldn't impact epilepsy and improved B5 or cholesterol or whatever is the way to bet.
If you get the data and you have evidence this works, you can start by checking the B5, cholesterol and electrolyte status of your epileptic trans patients and address any issues in those areas first to get them as stable as possible BEFORE you do your HRT study to test the idea that HRT in trans individuals isn't a problem for epileptics.
Footnote
On the off off off chance someone other than ME actually reads this:
If you prescribe B5 to treat anemia and the anemia resolves, this is evidence the anemia was caused by a B5 deficiency and ALSO evidence that deficiency is now resolved. So IF you also see a reduction in seizures, if this is the ONLY change, you can fairly confidently conclude that the reduction in seizure activity is due to resolving the B5 deficiency.
That's why I mentioned "if the anemia resolves": because it would be affirmative evidence of improved B5 status.
B5 is a precursor for cholesterol, so you could track BOTH. Odds are good resolving the B5 deficiency would increase cholesterol built in house, such as happens for 95 percent of the cholesterol in the brain.
Also also: Blood draws are a common means to get data on stuff in the body and can be useful, BUT:
In people with CF, the body STRIPS the bones of calcium, causing osteoporosis at extremely young ages, in a desperate attempt to combat acidosis.
It's common knowledge people with CF are too acid but rest assured I'm officially a LOON for thinking this is medically significant and NEVER MIND that if you are diagnosed with ketoacidosis due to diabetes, they promptly hospitalize you because you can be dead within 72 hours.
So point being that if it were ME, I would consider resolved anemia to be stronger evidence of nutrient status within the tissues than blood draws.
Keep that in mind if you see blood draws that say "She's fine. The numbers are normal."
The body jumps through hoops to keep the blood stable and strips other tissues of nutrients to do it.
You are trying to establish norms for inferring BRAIN status without cutting into the skull. This is likely to be a tad tricky.