HRT question

[sweetie87]

Hi girls,

As you may know I recently had SRS. After the SRS I stopped taking anti androgens and remained taking the estrogens in the same dose as when I was a pre-op.  As a pre-op I had a normal libido and the 2 months after SRS I still had libido (the first month it was especially high). Since recently my libido is significantly lower, almost zero. So I decided - together with my gyno/endo - to take only half of my normal dose of estrogen.

2 months ago, just after SRS and before adjusting HRT, I had bloodwork:

Estrogen 290
T or free T <2.0
FSH and LH not sure about it, but if I recall correctly around 20 or something

Now recently I had a blood test:

Estrogen 220
T or free T <0.7
FSH 86
LH 68

So my estrogen has been lower but still in the preferred range (above 200). Though both my FSH/LH increased (my endo said as a result of the absense of the testes and testosterone production) and my T has lowered even further.

I'm just curious if anyone knows if these results are normal, especially the testosterone and the FSH and LH. My endo is not really familiair with transsexuals, though eager to learn. As a young girl I just want to increase my libido to what is normal for females my age. And I would like to know if my results are in the 'normal' range.

[RhinoP]

I truly am not really educated when it comes to specific levels in hormones, but I think it's very important to retain a libido at a young age. Common-sense wise, it would seem that everything should be done in moderation, and while it may not work like this, it's possible that you do need lower dosages of everything.

This is also just speculation and guesswork, but I may try to keep on the Anti-Androgens if I were you, even if by a small amount. Overall, you want to be the prettiest girl you can be, and even if you have a lot of estrogen running through your veins, if certain Androgens find their way through your body too, it could mean that you'll age a bit faster than your female peers, or that you'll be a stockier woman than what you'd prefer. Some normal women do suffer from male Androgenic properties as they age, and quite frankly, I'd want to reverse this if possible.

I guess I'd say always figure that it's probably better to be on too many hormones and hormone reducers than not enough, but I'd still try to keep lowering things and balancing things until you get your libido back. Unless your asexual, a libido is something extremely important to the human mind, though a break from it all can do wonders too!

[Ann Onymous]

What the OP describes is why SOME post-op's are given a script for a low dose of T, just as some post-menopausal women are prescribed.  Treatment of a lot of hormonal issues will track that of post-menopausal (whether by age or by surgical procedure) women.  There are some other tweaks that can be done to restore libido without the T being administered though...

[paulault55]

When i had my total testosterone checked about 2 months after GCS it was less than 10 mg/dl, i had been quite fatigued, lacked energy, had trouble sleeping and no libido, Dr. Mcginn prescribed a low dose of testosterone cream that also had my estradiol included, i had to get it from a compounding pharmacy, within a few days my energy levels picked up, i am sleeping through the night and my libido picked up, i do not know if testosterone cream will help your libido issue so it is best to talk to your surgeon or hrt doctor.

Paula

[FairyGirl]

progesterone is sometimes given to increase libido.  It's what Dr. McGinn prescribed for me because I couldn't stand the thought of putting testosterone back in my body lol

[sweetie87]

Hiya all thanks for your help. I will talk things through with my hrt doctor, my next appoinment is scheduled for january though. I asked him about progesterone before but as a pre-op he then didn't want to adjust doses in anticipation of srs. I'm not sure if it can help normalizing my T levels. Does anyone have any experience in this regard? I consider adding T as well but it feels unnatural to add an hormone I used to combat for years using anti androgens. Or can T levels normalize by themselves and will I have to wait for the andrenal glands to kick in? I'm just unsure at the moment.

[Ann Onymous]

Hiya all thanks for your help. I will talk things through with my hrt doctor, my next appoinment is scheduled for january though. I asked him about progesterone before but as a pre-op he then didn't want to adjust doses in anticipation of srs. I'm not sure if it can help normalizing my T levels. Does anyone have any experience in this regard? I consider adding T as well but it feels unnatural to add an hormone I used to combat for years using anti androgens. Or can T levels normalize by themselves and will I have to wait for the andrenal glands to kick in? I'm just unsure at the moment.

all too often, people forget that the body naturally has BOTH estrogen and testosterone being produced. 

That being said, I have never added testosterone in the ~15 years I have been post-operative.  I don't remember the numbers from the period immediately after surgery (~90 days or so post) but recall that I was told they were within normal limits for a female my age.  My GYN recently reintroduced micronized progesterone to my daily mix...besides a slight change in libido, there was also a kickstart on some new breast growth (yes, it really can happen this many years down the road). 

[Lisbeth]

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

Estradiol (picograms per milliliter or pico-moles per liter)    
     Follicular phase    50 – 145 pg/ml (184 – 532 pmol/L)
     Midcycle peak    112 – 443 pg/ml (411 – 1626 pmol/L)
     Luteal phase    50 – 241 pg/ml (184 – 885 pmol/L)
     Postmenopausal    < 59 pg/ml (< 217 pmol/L)

Total testosterone - morning sample (nanograms per deciliter or nano-moles per liter)
     6 – 86 ng/dl ( 0.21 – 2.98 nmol/L)

Free testosterone - morning sample (picrograms per milliliter or pico-moles per liter)
     20 – 40 yr    0.6 – 3.1 pg/ml ( 20.8 – 107.5 pmol/L)
     41 – 60 yr    0.4 – 2.5 pg/ml ( 13.9 – 86.7 pmol/L)
     61 – 80 yr    0.2 – 2.0 pg/ml ( 6.9 – 69.3 pmol/L)

FSH (units per liter)
     Follicular phase    3.0 – 20.0 U/L
     Ovulatory phase    9.0 – 26.0 U/L
     Luteal phase    1.0 – 12.0 U/L
     Postmenopausal    18.0 – 153.0 U/L

LH (units per liter)
     Follicular phase    2.0 –15.0 U/L
     Ovulatory phase    22.0 – 105.0 U/L
     Luteal phase    0.6 – 19.0 U/L
     Postmenopausal    16.0 – 64.0 U/L

Estrogen 220
T or free T <0.7
FSH 86
LH 68

By "Estrogen" I assume you mean Estradiol. 220 is in the normal range for midcycle and Luteal phases.
For T and free T just saying <0.7 is not very informative. Is it less than 0.6, 0.4, or 0.2? Those are the bottom of the normal ranges.
FSH and LH are in the Postmenopausal range.

[sweetie87]

Just wanted to let you know that i feel it is going better lately. My libido is restoring (which is very nice and enjoyable) and so is my energy. I haven't changed hormones or doses so it just needed time i guess. I understand this topic is old already but thought the update may be of help to those having similar issues.