Post op hormone levels

[JessicaR]

  According to my post-op instructions, my surgeon states that the vast majority of women need not resume anti androgens after SRS.
He also states that, in some, removal of the testes can cause the adrenal gland to compensate for the loss and produce more T on its
own and it can take up to a year for everything to level out. The risk of this problem diminishes for women who have been on HRT
longer. I'm just over one month post-op and had been on HRT for almost 6 years before SRS; I'm hoping that this won't be an issue for
me but I have a few concerns...

   --Since SRS I've been having what I can only describe as "inner erectile activity." It's not consistent nor does it last long but it's caught
me off guard because, before SRS, I hadn't had any erectile activity to speak of in a few years. Is this activity typical for my recovery period?
As per Suporn's instructions, I'm avoiding sexual thoughts for the first two months; the sensations I'm getting just seem to happen on their
own. Even though I've been on anti androgens for years, I'm concerned that my body is producing T right now.

   --My mom's side of the family, as well as me and my two siblings, seem to have a sensitivity to DHT or maybe androgens alltogether; I
was very fuzzy before HRT and still have a few problem areas; my mom and sister both have deeply receding hairlines and have always been
rather hirsute... I've noticed that my sister, in particular, is developing more, coarse hair on her arms and face now that she's done with
menopause.

   --I just had my first follow up visit with my GP; We agreed that testing my levels now wouldn't make much sense seeing I has SRS so
recently. I resumed E and P 3 weeks after SRS but never resumed Spiro; I've felt so much better without having to pee all the time and
feeling the leg cramps in the morning. I really don't want to have to go back on it but I am very concerned about the possible post-op T surge.
We talked a bit about Avodart as something we might try in the future and decided to have my levels checked one month from now and
include the DHT level test. I have one refill left for spiro and I'm thinking of filling it but cutting the dose in half and taking it for 2 months
to give myself a little peace of mind.

   HRT was so effective for me; I feel fortunate to have has such favorable results for being 40. I am very afraid of T and especially of DHT.
I'm watching my temples daily and the very idea of any of the body hair I've lost growing back makes my skin crawl. Am I being reasonably
cautious or am I worrying too much? Has anyone had experience with these issues post-op? Any thoughts on the matter would be
appreciated :-)

[Dinky_Di]

I wouldn't go getting myself worried at this stage, wait and see what the result of your tests show.  You may be concerned for no reason.  I was on HRT for about 5 yrs before surgery and upon being tested several months after my T was virtually zero and still is some 18 mths later.   

[girl_ashley]

If you're that worried about your T levels, the only real true way to tell is to go get labs performed.  What I can tell you is that the adrenal gland doesn't always pick up the slack.  Yes, there are post-op trans women who go on fine with their lives, but there are plenty that have too low of testosterone.  There really is no concern for "post-op T surge", it just doesn't exist.  Don't go back on Spiro, get your levels checked, and stop being such a worry wort!

I'll be getting my levels checked next week and am concerned about my T being too low.  If it is, then I will be talking to my doctor about adding some T back in to get back to a normal female target range.

[juliemac]

I had a surgeon say IO needed T, but the endocrinologist said I had perfect levels for a woman my age.
I just take one pill of E per day. So much for the breakfast of pills I took over the last 20 years....

A year and 5 days later and I am feeling more energetic, sleeping better than before.

[FairyGirl]

The "inner erectile activity" is normal according to Dr. McGinn and does go away after a while.

I was only on AA's for 15 months before my surgery.  A year later my T level is practically non-existent, even with taking progesterone regularly.  I mention that because Dr. McGinn also wrote in some of her literature that some excess P metabolizes into T, and that is why she sometimes recommends it for increased libido after surgery.

the very idea of any of the body hair I've lost growing back makes my skin crawl.

I totally agree!

[FairyGirl]

Valerie, when my doctor increased my E and P dosages it made a BIG difference in how I felt, all for the better.  I was taking my E sublingually however and was supposed to be just swallowing the pills- this caused my last E reading to be over 3 times maximum! After a chastising by my doc I'm now taking them correctly so hopefully my next reading will be okay.

It's funny when it was lower I could really tell, but when it was too high I didn't notice any difference.

[Re: Joyce]

Surgery apparently substantially changed my chemistry.  I was told to cut my E in half as a starting point post-op, so we started back at about 65%.  After 2 weeks, blood tests showed I was low, so we went back to the same as my pre-op level.  I had always registered on the low side.  After a few months, we re-tested and showed that I was  *double* normal!  Holy hormones!   

      I went back to 65% and we'll be re-testing soon.  My T barely registered as being there at all and it's below normal.  We'll have to do something with that.  I'm leaning toward asking for some Progesterone.  I have little bittie titties and they've been content to sit in neutral as far as development goes for a few months.

      This next blood test will make 3 tests in about 4 months.  It takes time (for me) to get it all right.  I just have to be patient.  Any comments on the P?  I have no sex drive, which has been the norm since starting HRT.  I guess I'm supposed to be getting that back, but I'd expect that's low T levels.  I'm still losing body hair and don't want that back.  Any ideas?

[AbraCadabra]

Hi Joyce,
I'm pre-op but my T also barely registers (numbers not allowed for that either?). Ok, about 3 mmol/l total free T and being well below normal female levels.
Let's see if that passes as I'm NOT talking about HRT dosages, right?

My question on these yo-yo E levels I do experience too, are you taking oral E?
And if so, are you taking it sub-lingual?
BTW I decided to stop sub-lingual, it seems to produce quite an E peak in place of having a few goes through the liver - the way those E pills seems to have been designed.

I currently think, after plenty of testing, that MAYBE if T is that low with some of us, a VERY even E delivery is required?

I'm noticeably roller-coasting even during the day. Get cold, ears ringing, taking more E (gel in this case) and woopsy I get warm again.
Tinnitus always seems to tell me something is running low.
In short: an *even delivery* would mean patches, yes?
(BTW injections also produce quite a peak initially, and also I don't like my butt perforated)

So can you share some more that might help me here as well?

Thanks,
Axelle

[girl_ashley]

Hi Joyce,
I'm pre-op but my T also barely registers (numbers not allowed for that either?). Ok, about 3 mmol/l total free T and being well below normal female levels.
Let's see if that passes as I'm NOT talking about HRT dosages, right?

For the time being I think that is okay.  We'll see though if they decide to to change the TOS in the future that we won't even be able to talk about our lab results/levels.

[girl_ashley]

Any comments on the P?  I have no sex drive, which has been the norm since starting HRT.  I guess I'm supposed to be getting that back, but I'd expect that's low T levels.  I'm still losing body hair and don't want that back.  Any ideas?

Don't be afraid to go on P if you think it'll help you and you have no contra-indications for it.  A little bit of T isn't going to re-masculinize you at all.  All post-op trans women should get their T levels checked and maintained to normal female range if it registers too low or not even at all.  When I talk about going on T being post-op, I'm certainly not talking about going on as much as the trans guys go on.  We're only talking a lil bit here, only enough to put you back up in the normal female range.

[paulault55]

Jessica, i am 2 months post-op still on my pre-op E but no Spiro, as you are i am also curious about the adrenal gland causing more hair growth, especially facial hair, i went for my first electrolysis session last week and the tech mentioned there seemed to be new facial hair growth, i noticed this too about three weeks after surgery, it is probably just my body adjusting to the new hormone levels after surgery which i understand can take up to a year to stabilize, i see my endo in a week and Dr. Mcginn wants the free testosterone level checked, she said if it too low she was talking about adding a little T to help with libido and help boost energy levels, i could do with a bit higher energy level, libido at this point i do not care about for a few more months as i continue to have silver nitrate treatments about every 10-14 days to get rid of granulation,  i am extremely sore and quite a bit of discharge for around four days afterwords.

Paula

[Re: Joyce]

To answer that question, I'm on patches and always have been.  Once my dosage got correct, I couldn't tell any peaks and valleys from varying levels, even when I changed the patches twice a week.

     When my levels tested waaaay high, I could not have told you that, because I felt no symptoms at all.  I did feel all sorts of symptoms when I went off of it, cold turkey. 

     I hope this helps answer your questions.  I am taking estrogen by patch because it seems to be the least stressful on my liver and also because the delivered dosage is the most consistent over time.  There are fewer peaks and valleys.

[Muffins]

I'm back up to my pre-op dosage level and instead of lowering in the future I'm just going to just keep going up to at least 2/3rds of what I'm on now. When I change my brand of P I'll be doubling that as well.

[FairyGirl]

I can definitely tell when my progesterone is low because then I just want to die... 

I think around 100 is a normal level for us since we dont have a menstrual cycle (age 53)?

There's a good list of what the normal female ranges are here, which corresponds pretty closely with what my doctor told me:

http://www.keratin.com/ab/ab012.shtml

[Debra]

I was on the low dose of E after surgery for probably at least 3 weeks and then I went back on injections.

At that time, my T had gone down to < 10ng/ml and my E was dropping down to 25pg/ml.

I went back on injections at just a slightly lower dosage from what I was at pre-op and 3 months later, I saw the doc again. My T was up to 30ng/ml (which is still pretty healthy but not crazy) and my E was bottoming out at 75pg/ml at the end of the week.

My doc also said my platelettes (clotting #s) were the lowest they've ever been.

All in all, feeling pretty good about where things are at right now but my doc was even amenable to upping the dosage again. For now I figured I'd let things continue to stabilize out.

[AbraCadabra]

Hi Val,
am a bit curious about all of this since my T is apparently VERY low. Yet I can't say that I have no libido as such. Far from it. Yes, YMMV as we know.

Some is obviously in the mind here too, and not just down-yonder as the saying goes.

YEEEEEEES, it takes me a good while to get into the "spirit" but I'm mostly rewarded with a nice "resolution" (shivering my timbers).
Not sure if I'd be with a partner (as I'd had) that wants to stifle me, clamping her hand over my mouth and such, eh.
Right now I'm having sex with someone that loves me at least --- and that person being me? And so why not?!
My advise? Rely less on a partner and get yourself tuned in first --- rest should follow.
If you get frustrated guess what your company must feel like? Much the same I guess. As you know guys get a real high for getting their lady going --- and preferably first!

Hope I'm not too far of the OP here, but hormones alone will not do all the magic IMHO.
My total T being as low as 0.7 pmol/l, I'm told that is way low and a total "shut-down" of my gonads was suggested i.e. that's as close to bi-lateral orchie as it gets.

:-)
Axelle

[Debra]

They were unsympathetic and don't want to prescribe a testosterone cream. They said, welcome to womanhood...

Ugh I hate doctors that are so closed minded like that. My doc is very open to just about anything really. He makes suggestions for me but it's really up to me in a lot of ways.

Have you been able to try progesterone, Val?

Also the "Welcome to womanhood" answer for every little problem gets old quick.

[Northern Jane]

I am 37 years post and my endo keeps my serum oestrogen levels in the normal female range with the patch. My T level is WAY lower than normal female but my libido is off-scale high. When I asked my doctor about it, she laughed hysterically ..... love sympathetic doctors! She said libido is more strong related to being in good health and feeling good about myself. Obviously, in my case, it isn't driven by testosterone or I wouldn't have this problem! 

[wendy]

I am 37 years post and my endo keeps my serum oestrogen levels in the normal female range with the patch. My T level is WAY lower than normal female but my libido is off-scale high. When I asked my doctor about it, she laughed hysterically ..... love sympathetic doctors! She said libido is more strong related to being in good health and feeling good about myself. Obviously, in my case, it isn't driven by testosterone or I wouldn't have this problem! 

Well I have good physical health.  I always felt a libido is something weighted in the produce section of a supermarket.

T did not increase after removal of extraneous parts.   E was taken for several years prior.

L-arginine seems to have some influence on mood.  DHEA seems to increase T a little naturally.

Hair growth had no influence from hormones.  I was rather hairless to start and did not become less hairless.  Also no hair regrew on my head.
....

Actually a little libido might be nice but I turned the tables and laughed at the endo when she suggested "just a small shot."

...................
My endo left e alone but I think she wanted to lower it.  (She kept dose too low prior so that it is O.K. now.)  I do not need any T blockers.  I do not trust doctors so that I had T tested by two different doctors and it is gone.

.................

I wonder if Progesterone helps control your appetite and or weight?  I always enjoyed food but I feel whatever I lack in libido I make up with in appetite. 

[Rosa]

Can someone better describe this inner erectile issue?  Are we talking about the part of the clitoris under the skin?  I've read that a substantial part of the clitoris is under the skin where we can not see.  Does SRS duplicate this for us as well?