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Author Topic: Which Hormones Do You Have Tested  (Read 734 times)

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Offline ramilove

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Which Hormones Do You Have Tested
« on: January 19, 2021, 12:10:37 pm »
 Which tests other than E2 and total T do I need to have the good doctor order. At the minimum I think that I will also need to run my E1 to check my estrogen balance. Given a total T of 21ng/dL need I be at all concerned with my free T?
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Offline Northern Star Girl

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Re: Which Hormones Do You Have Tested
« Reply #1 on: January 19, 2021, 12:21:08 pm »
Quote from: ramilove on January 19, 2021, 12:10:37 pm
Which tests other than E2 and total T do I need to have the good doctor order. At the minimum I think that I will also need to run my E1 to check my estrogen balance. Given a total T of 21ng/dL need I be at all concerned with my free T?

@ramilove
Regarding the regular blood testing that you will undergo at the direction of your doctor...

In my own HRT experience, my doctor (endocrinologist) sometimes orders blood tests for more than just hormone levels... things like Potasium levels, Kidney function, Liver panel, etc.   
A HRT regimie of various meds can upset all of those things and more.

You can and should ask your doctor about the various tests and other testing that you may want done... and as always, follow your doctor's advice regarding dosages.

Wishing you well in your journey...
HUGS,
Danielle
« Last Edit: January 19, 2021, 04:01:12 pm by Northern Star Girl »
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Offline Rakel

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Re: Which Hormones Do You Have Tested
« Reply #2 on: January 19, 2021, 07:45:35 pm »
Danielle said it all.

HRT needs to monitored carefully because some of the consequences of not monitoring are terrible. Cardiac issues and cancer risks are the most troublesome.
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Offline Megan.

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Re: Which Hormones Do You Have Tested
« Reply #3 on: January 19, 2021, 10:47:17 pm »
The sad fact is I usually have to tell my doctor what to test for. In the UK we typically deal with GPs not Endos once we've had the green light to commence HRT.

But, I agree with the others, your tests should include a standard 'liver panel' among other things to ensure no damage is being done. X

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Online Rachel Montgomery

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Re: Which Hormones Do You Have Tested
« Reply #4 on: January 19, 2021, 11:32:11 pm »
I haven’t ever been on estrogen.  I am literally on male HRT (a metaphorical hard pill to swallow).  I take Clomiphene Citrate to replace my absent luteinizing hormone and Follicle Stimulating Hormone.  If I don’t take it, my T drops to zero, which causes all sorts of health problems and makes me feel terrible.  My cholesterol goes sky high, I have body cramps, headaches, high blood pressure, high blood sugar, I feel tired and spacey, I am irrationally irritable and I gain weight regardless of my diet.  I am not sure if estrogen would make the problems go away, but I am sure I wouldn’t need spiro if I transition. 

I asked me Endo if estrogen would relieve those symptoms if I stopped taking testosterone, and he said he had no idea.  If he doesn’t know, I sure don’t.

That said, I think the sorts of tests that you need run depend entirely on the medicine you are taking, including the delivery method.  I believe estrogen pills are processed by the liver, while estrogen injections and patches bypass the liver (but may affect the kidneys).  Spiro is a diuretic, so your electrolytes could get out of balance. 

Again, depending on what you take and how you get it into your body.  If your doctor doesn’t know and is incompetent enough to fail to educate himself, I would suggest finding another doctor.  I understand that isn’t always an option.
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Offline Rakel

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Re: Which Hormones Do You Have Tested
« Reply #5 on: January 20, 2021, 07:57:48 am »
Quote from: Rachel Montgomery on January 19, 2021, 11:32:11 pm
... including the delivery method.  I believe estrogen pills are processed by the liver, while estrogen injections and patches bypass the liver (but may affect the kidneys)... 

Actually all Estrogens are processed by the liver, eventually. If a tablet is swallowed and absorbed from the stomach, it goes straight to the liver. All other forms of Estrogens go first into the blood system and are distributed throughout the body. Then after once around the blood system, Estrogens  will eventually make it to the liver for metabolism.

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Online Rachel Montgomery

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Re: Which Hormones Do You Have Tested
« Reply #6 on: January 20, 2021, 11:52:59 am »
Quote from: Rakel on January 20, 2021, 07:57:48 am
Actually all Estrogens are processed by the liver, eventually. If a tablet is swallowed and absorbed from the stomach, it goes straight to the liver. All other forms of Estrogens go first into the blood system and are distributed throughout the body. Then after once around the blood system, Estrogens  will eventually make it to the liver for metabolism.
So, was I right about the idea that pills would probably be more likely to cause liver function problems than other delivery platforms?
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Offline ramilove

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Re: Which Hormones Do You Have Tested
« Reply #7 on: January 20, 2021, 05:26:40 pm »
Met with the endo today. It went well he was very friendly. He was honest when he told me that transgender care was not his area of expertise. He does have access to an endo whose area of expertise is transgender care. (Denver VA)   I had to explain to him why I wanted to test both E1 and E2. We discussed testing for Testosterone, given that my total testosterone was 21 ng/dL the week prior we did not need to  test. Now looking at my test results E2<20pg/mL undetectable after being off estradiol sublingual for a week, was curious as to how much my testosterone recovered in a week.

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Offline Rakel

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Re: Which Hormones Do You Have Tested
« Reply #8 on: January 20, 2021, 07:42:47 pm »
Quote from: Rachel Montgomery on January 20, 2021, 11:52:59 am
So, was I right about the idea that pills would probably be more likely to cause liver function problems than other delivery platforms?

No, not at all. The delivery method has little effect on liver function problems. It does have an influence on side effects such as blood clot issues, not liver function issues. If you are of advanced age and have a family history of cardiac issues, most doctors stay away from oral Estradiol and prefer Estradiol Patches to minimize the cardiac issues.

Swallowed tablets are going to have lower blood levels compared to sublingual tablets. Patches and injections have their own absorption profile. We call this Pharmacokinetics. This is not an issue because your individual dose will be adjusted based on blood levels.
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Offline ChrissyRyan

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Re: Which Hormones Do You Have Tested
« Reply #9 on: January 20, 2021, 08:04:16 pm »
Quote from: Rakel on January 20, 2021, 07:42:47 pm
No, not at all. The delivery method has little effect on liver function problems. It does have an influence on side effects such as blood clot issues, not liver function issues. If you are of advanced age and have a family history of cardiac issues, most doctors stay away from oral Estradiol and prefer Estradiol Patches to minimize the cardiac issues.

Swallowed tablets are going to have lower blood levels compared to sublingual tablets. Patches and injections have their own absorption profile. We call this Pharmacokinetics. This is not an issue because your individual dose will be adjusted based on blood levels.


Very good, very informative post Rakel.  We are lucky to have you here.

Christine
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Online Rachel Montgomery

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Re: Which Hormones Do You Have Tested
« Reply #10 on: January 20, 2021, 08:13:01 pm »
That is important to understand.  What are the health risks regarding the liver?  Do most people tolerate HRT without complications?  If I transition, and I can’t take estrogen, I will be quite unhappy.  The idea of blowing up my life for nothing (no dysphoria relief) is disturbing.
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Offline Rakel

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Re: Which Hormones Do You Have Tested
« Reply #11 on: January 20, 2021, 08:44:52 pm »
Quote from: Rachel Montgomery on January 20, 2021, 08:13:01 pm
That is important to understand.  What are the health risks regarding the liver?  Do most people tolerate HRT without complications?  If I transition, and I can’t take estrogen, I will be quite unhappy.  The idea of blowing up my life for nothing (no dysphoria relief) is disturbing.

Rachel,

Please do not obsess about this. Estradiol in normal doses, does not poison your liver. If you are a heavy drinker, the alcohol will poison your liver and you will have problems metabolizing the Estradiol, if you take any.

You really need a through physical evaluation by your doctor before you start any hormone regimen.
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Offline sandrauk

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Re: Which Hormones Do You Have Tested
« Reply #12 on: January 20, 2021, 09:23:16 pm »
What are the blood clot issues? I know that EE was in birth control pills and was found to cause problems for women taking it, but I haven't seen any studies for bio-identical.I asked my doctor about this and he didn't have a clue.
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Online Rachel Montgomery

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Re: Which Hormones Do You Have Tested
« Reply #13 on: January 20, 2021, 10:32:56 pm »
Thanks.  I am overly emotional right now because of frustrations and concerns about health.  I suddenly did get scared that the thing I am told might  help might also be unavailable to me because of my body not being able to handle it. 

Your last response makes me feel less afraid.  Thanks Rakel.
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Offline Rakel

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Re: Which Hormones Do You Have Tested
« Reply #14 on: January 21, 2021, 06:15:37 am »
Quote from: sandrauk on January 20, 2021, 09:23:16 pm
What are the blood clot issues? I know that EE was in birth control pills and was found to cause problems for women taking it, but I haven't seen any studies for bio-identical.I asked my doctor about this and he didn't have a clue.

Let's take a few moments for a little history lesson.  :-\

Many years ago, in the 1950's, when oral contraception was first used by millions of women, it became appearant that more women were suffering medical issues such as phlebitis, pulmonary embolism and cardiac issues, all related to blood clots forming in the veins. The studies at the time reported that for women who were smokers and over the age of 35 had a much higher likelihood of having these adverse complications. High doses were also a factor in an increase of the issues.

In the 1970's drug companies promoted low dose oral contraception and this helped some.  The FDA issued a black box warning about smoking and contraception. Synthetic hormones seemed to be more involved that natural products. Premarin is a natural product extracted from a pregnant mare's urine, hence the name. At one time, this was the most prescribed medication in the US. Being a natural product, it had limited supply availability and we looked to synthetic products. Bio-identical Estradiol does not have the issues that the older Ethynyl Estradiol had.

Today, we use bio-identical Estradiol, which is the most active of all the female hormones and it is very safe, but we still recommend using the lowest dose needed to get the results we desire, whether it is for post menopausal issues or transition. The doses for each individual person is adjusted based on blood levels, which is why we insist on doctor prescribing and monitoring of all body processes involved in the absorption and elimination of hormones.

Because of these measures, there is very little problems with hormone therapy, but hormone therapy is not 100% harmless. We need to evaluate the risks versus the benefits of every medication we take.



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Offline sandrauk

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Re: Which Hormones Do You Have Tested
« Reply #15 on: January 21, 2021, 02:33:59 pm »
Thank you for replying Rakel.

As you say, bio-identicals are thought to be very safe, and if I understood you right Premarin is almost as safe.

My concern is that when I go to my GP surgery,  the immediate response from both of the doctors I have seen so far is to warn me of the dangers because of increased DVT risks even though I had no history and it appears to be on no studies that I know of apart from studies in the 1990's. When I asked one about it the she replied that I probably knew more about it than she did, and the other doctor denied any knowledge.

If they were not giving advice against hormones, that would be understandable, but it appears  they are still giving 1995 advice, today.

From the Guardian:

"A health scare in the UK in 1995 over thrombosis caused a drop in usage, and an increase in pregnancies and abortions. However, in 2000, a report in the British Medical Journal said the scare was unfounded.

On the positive side, the pill has been shown to protect against cancer of the ovaries and the womb lining, and against pelvic inflammatory disease, a major cause of infertility in women.

It can make periods more regular, but is not recommended for women over 35 who smoke heavily, the obese, or those with high blood pressure, a history of heart disease, blood clots or other specific illnesses such as breast cancer."

And that's without mentioning Osteoperosis

My own wife went through the menopause in the 1990's and started on hormones but stopped and still refuses to take them, because they are still giving the same advice. 
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Offline ramilove

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Re: Which Hormones Do You Have Tested
« Reply #16 on: January 25, 2021, 11:40:52 am »
They did not get everything wrong,  smoking at any age increase your odds of having a DVT. The risks under 35 are less than over 35 but still exist. I would hate to be one of the hundred that dies from a DVT induced by HRT and smoking.
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Offline Wendi

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Re: Which Hormones Do You Have Tested
« Reply #17 on: January 31, 2021, 03:10:43 pm »
My endocrinologist will not prescribe me anything but patches. I had a pulmonary embolism in 2013 add she's afraid of me having another if I used pills or injections.

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Offline pamelatransuk

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Re: Which Hormones Do You Have Tested
« Reply #18 on: February 01, 2021, 09:00:15 am »
Quote from: ramilove on January 19, 2021, 12:10:37 pm
Which tests other than E2 and total T do I need to have the good doctor order.

Hello again Ramilove

Every 3 months along with Blood Test for E&T, I have several other BTs similar to those suggested by Danielle plus also Full Blood Count

Wishing you every success.

Hugs

Pamela xx
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