Test Levels and Prescription

[kathy bottoms]

Two things happened today.  One that I'm real happy about and the other is just a flat out downer. 

First, an email from my Endocrinologist confirmed testosterone and estradiol levels that look pretty good.   Estrogen is 308 and the testosterone is 4.  I was real happy about this and actually would have been happier if the estrogen was even higher.  But then the endo called and said estrogen was way too high for the American Endocrinology standard.  He wants a maximum of 200, so he prescibed a patch that will result in a circulating estrogen level way below what I got from my current dose.  Then he said I may see some changes in feminizing effect and possibly mood swings.  The Spiro will also be lowered by one third, and that will cause my T level to go up.  This is going to kill me.

So what is this all going to do to me?  Has anyone else had this happen, and were you ever able to get the endo to raise the script to something equal to your previous estrogen use?  I'm stopping my self meds from Inhouse, and I promised my wife I wouldn't touch them when the prescription was filleded.  I intend to keep that promise, but this is a crushing hit that I didn't expect.  Not crying yet, but the day is only half over, and it's all building up inside.   Then this dreaded script is going to be ready around 2:30.

Kathy

[ashrock]

I know the effects will likely be slowed,  (sorry, no personal experience to speak from) but it is better to be safe.  Give it time, even A womans body has less E and more T than that, and they dont turn all manly overnight,  they stay femme.  HRT isnt meant to be an overnight "cure", better to be a woman in 10 years than the alternative.
Besides, feminization doesnt rely on huge levels of e and tiny levels of t.  Just give a balance toward the female side of hormones and the effects will happen all the same in time.

[ashrock]

Also remember, this is what your doctor is comfortable with.  If you are not, perhaps you should speak to your doctor and get the reasons.  Dont fret over this and certainly do not cry.  Levels will not be the same for everyone either, each is their own specific case.

[Ave]

300-400???

Mines are usually like 700-800, and my endo says "that's perfect!"

I'm confused. Does this doc know what he's doing?? lol

[Ave]

It should be noted that I took my blood test at around 9-10 am. I had to fast for well over 12 hours... i last ate , took my hormones, or drank anything at 5 pm the day before. My endo said that when I take my dosage, my numbers will probably be in the 1000s.
So, at my lowest, my e level is 330. Pretty good I think? He said the goal was to get it in a range between 300-400. I take a good dosage of E, which I obviously cant post here... I couldnt imagine "doubling" my dosage the mgs would be rediculous.

the last time I tested I was due for my E shot in the same day, I could actually have E levels in the 2000's after I inject!

So much moodiness has been explained!:P

[ashrock]

See, not the same for everyone.  This might turn into a bit of a dangerous topic if numbers are going to be compared...  Like I said, 200 is still higher than women with exception to the peak of the menstrual cycle (or pregnancy) when levels reach 200-300.  If thats the low end of your range, its way above the standard level for a genetic girl on an average basis.

[Padma]

Just a note of caution: if we're from different countries, our E measurements are in different units, which could cause confusion when comparing results.

In the UK, for example, E is usually quoted in pmol/L - to get the equivalent in the US unit (pg/ml), divide the UK measurement by 3.671.

See here for a useful conversion table (and of course, quote no dosages, please )

[Ave]

See, not the same for everyone.  This might turn into a bit of a dangerous topic if numbers are going to be compared...  Like I said, 200 is still higher than women with exception to the peak of the menstrual cycle (or pregnancy) when levels reach 200-300.  If thats the low end of your range, its way above the standard level for a genetic girl on an average basis.

yup, I agree. All my other test results seem good though, so maybe the good doctor knows what he's talking about?

Whowouldathunk.

[JoanneB]

Estrogen is 308 and the testosterone is 4.  I was real happy about this and actually would have been happier if the estrogen was even higher.  But then the endo called and said estrogen was way too high for the American Endocrinology standard.  He wants a maximum of 200,

There seems to be no firm fixed rule for E levels. I remember back in the day, endos were prescribing much higher dosages for E than they do today. I think a lot is lawyers and CYA. From what I read (and recently posted) the recomendation for maximum feminizing is around 600. Seems like most endos in the USA prefer 200 pg/mL territory.

My E hovers around 600 and at times was much higher. T is in the very low 20s which is waaaay lower then nomal male. A woman in my groups T is 12 last check. She didn't mention her E level. I doubt you have to worry about T going a bit higher. I do only a portion of an Androcur to maintain mine. I can also tell when I miss a day or two in a row. (I hate pills. Big PITA)

[kathy bottoms]

Here in California I assumed they would be flexible according to patient needs.  Especially since this state has such a large and vocal LGBT population.  Never thought the American Endo Std's. were so low, and that they would deliberately cut the estrogen so deeply.  Tried to calculate what % of my self med I'll be getting with this newly prescribed patch, and as near as I can tell it's about 25% with one patch per week.   Antiandrogen (Spiro) will be cut by one third, and I have no idea what that's going to do to my T levels either. 

Won't get another blood test until December, and the endo said he doesn't like to do any increase in E or AA until a 6 month run at the first dose. 

I hope they ralize that purposely limiting the medication  is counterproductive.  This type of medical response to patient needs just drives those patients to self medication.   And to keep this prescription, I'm going through with at least 6 months of gender therapy with a psychiatrist. 

Yeah, this is starting to sound like a rant, and I really don't want to do that.  But this sucks.  It really sucks and sucks and sucks. 

Kathy

[Devlyn]

JoanneB, have you tried a pill straw? They are for people who struggle swallowing pills. Makes it very easy. Hugs, Devlyn

[ashrock]

Again, it is safer this way. It does sound like the endo will likely increase the levels after 6 months. Dont rush this, those six months will not hurt you, especially since you have a t blocker. Your t will not go to male levels. 

[JennX]

Sounds like your endo is doing the right thing. I keep my E & T levels within those same ranges as well. E2 < 200 pg/ml & T < 40 ng/dl.

Here's some excellent info on MTF HRT levels: http://www.endo-society.org/guidelines/final/upload/endocrine-treatment-of-transsexual-persons.pdf

[A]

Don't worry.

If I convert, 300 pg/mL is 1101.3 pmol/mL in the international system, which, while not dangerous, are in the highest normal ranges for women. So a reduction wouldn't be a catastrophe.

Your endo is a bit conservative with his maximum of 200 pg/mL = 734.2 pmol/mL, but it's still well in the values that should allow feminisation, albeit maybe a little slower. But you know, sometimes, gradual is better and safer. If he went down to 100, that would be worrying, but 200 is fine. If I were him, I'd aim for 200, maybe a little higher, instead of setting it as a maximum, but: 1. I'm no endo and 2. I don't know your exact age, but you don't handle a 40-year-old like you do a 20-year-old, so perhaps it's all perfect.

As for your testosterone, don't even start to worry. Your levels right now, at 4 ng/dL = 0.14 pmol/L, are abyssally low. Lower than the lowest value of recommended range for women, 0.3 pmol/L. A reduction in your antiandrogen probably won't bring that anywhere higher than the recommended value for women, and will just reduce the amount of medication going through your system, which is good.

Unless your endo is way too aggressive with the estradiol reduction and brings your levels way below what he said, don't worry, much less cry. If effects are stalled, and they shouldn't, it's probably not impossible to increase the dose a little again.

PS: And gosh, US, change your units to the ones the rest of the world uses already! T_T

[JoanneB]

JoanneB, have you tried a pill straw? They are for people who struggle swallowing pills. Makes it very easy. Hugs, Devlyn

I have no problem geting the down. It's the remembering them part.   

[A]

JoanneB, how about daily alarms on your phone? You could also get something like this:


It's pretty straightforward. If you're not sure if you took your pill tonight, you look, and if they're there, you didn't. You can fill it yourself, or some pharmacies offer the service of filling them weekly for patients.

[Ave]

This is exactly what I use, but pink :p Sucha life saver

And now im a little bit confused. Is a T level of 1.3 too high? And an E level of 330 too low? All units in Canadia spec

you and A both live in quebec, so I think you use the same measurements.

[A]

This is exactly what I use, but pink :p Sucha life saver

And now im a little bit confused. Is a T level of 1.3 too high? And an E level of 330 too low? All units in Canadia spec

T: No. The female range is 0.3 - 4.2
E: Kind of. Not a super mega catastrophe like my 184 (which is, almost no changes), but it's pretty low, if you ask me, yeah. But I haven't had such levels, so I can't say for sure. Maybe it's ideal for older people (edit: lol, and then I remembered who I was addressing - someone younger than me). It's probably a pretty good starting dose. Again, I'm no endo, but I doubt optimal results are achieved with just that.

And yes, we have the same system. I don't know of any other country than the US that uses conventional units (like pg/mL) instead of international units (like pmol/mL).

[kathy bottoms]

Hey girls.   I had a chance to think and calm down while doing some work on the house.  I can accept the changes for now and as long as the patches will stick to me for a whole week things will be fine. 

The script didn't get filled today because the pharmacy at the clinic here ran low and had to order it from their hospital in Vallejo.  They said to pick it up after 12:00 Noon tomorrow.  It's a 3 month prescription so I can set up my next set of blood tests a couple weeks before it runs out.

Oh yes, that's good info about the differences between other systems and the US standards.  Seems like we are constantly rebelling over here.  Still use miles, feet and inches, plus,  pints, quarts, and gallons.  That metric stuff and other widely used measurements will just confuse us.   

Anyway.  Thanks again to all of you.

Kathy

[Stephe]

I try to follow the advice given to a menopausal female, take the smallest dose possible to get the results you are looking for. It sounds like to me you have a smart doctor who doesn't want to break your body in an attempt to get it feminized as fast as possible.