Frustrated with Low Dosage... Should I Be?

[itsxandrea]

Hey everyone,

First let me start off by saying, I ended up doing the preliminary therapy (standards of care) and then I've started going to an endocrinologist, one of the best in Boston who works with transsexuals specifically, all the time. Also, when I visited, I was told that my testosterone baseline was 290, so, lower than the norm (by the way I'm mid 20s). I don't drink, I don't smoke, all my labs were with-in normal ranges.

My issue is, from what I've been researching compared to other girls, I was given a low dosage of estradiol and spironolactone (not sure if I can disclose the amounts on here, let me know if that's okay?).  At any rate, it's fairly low.  And I have to go back in 3 months for them to review more blood work for it to be doubled (which would be what people usually get at the start, in my research).  And from there, after those 3 months, I go back again and they will double that dosage, if needed.

So here's the question then: did they do this because of what they found in the blood work?  Or are they just being overly cautious?  I don't doubt that the doctor knows exactly what he's doing, but I'm really curious why my dosage would be so low... has anyone else had a low dosage? 

[Brooke777]

I am on a rather low dose as well. My endo is going the cautious safe route. Since I will be taking hrt for the rest of my life, he wants to ensure he does it right the first time. I strongly recommend not deviating from what the doctor prescribes you. Instead, talk to them and see what their reasoning is.

[MaidofOrleans]

I'm currently on half the normal medicating dose of estrogen. My endo is well known in the area for working with trans patients so I trust he has an idea of what hes doing.

He never took preliminary blood work and told me to get tested at 3 months and come back. Honestly I think he is trying to ease me into the hormones rather than slamming me. Probably for my own safety as well as his protection. It's probably not a good idea to introduce mass amounts of new hormones into your system anyways as it may react adversely or even the opposite of what you want.

I think patience and caution is the key, even though we may feel otherwise. There is a lot of risk involved in what we are doing and being dead is a lot worse than a slower transition.

[Ms. OBrien CVT]

Doctors always start a patient on a low dose of anything.  They are monitoring how the patient tolerates the medication.  As you go along, they will judge how you are tolerating the medication.  Generally they will raise it if you ask.

[Alainaluvsu]

Honestly I agree with Tessa. But you know your body and comfort zone. From my experience talking with transsexuals, doctors are too cautious sometimes. A couple of my friends were going through the same thing... very very low doses for 3 months at first and by the second month they knew they needed it raised. One of them called the doctor and the doctor raised it for her. The other called the doctor and wouldn't raise it for her... so I told her take what you want and when the levels come back  ... at least the doctor can have something to go by, while she feels better about her dose and it skips all the experimental time of upping it every 3 months.

[Catherine Sarah]

Hi itsxandrea ,

A big Aussie welcome to Susan's family. It's good of you to drop in and say "Hi". Hope you like it here, and you stay for a while.

There is a mountain of information, resources and friendship waiting for you here, you just need to jump in start talking and ask any question you like. You're quite safe here and we are very accepting.

It is a standard practice for Endos to do start on a lower dosage and monitor its progress over the next few months. The hormones prescribed can have adverse reactions and can and do cause life threatening damage to vital organs.

Although there have been some suggestions that you should take what you want, I know of no transgendered person who "knows" what dosage they should be on, through apparent instinct. After all this is why you consulted the Endo in the first place. To take primary care of you.

You must remember everybody's reaction to the same drugs will be completely different. that's why they have to be monitored. Blood tests requested by Endos not only give details of hormone levels, but give indicators on other proteins, enzymes and hormones that regulate critical organs.

With all respect, I'd be inclined to leave the complex matter of HRT and the serious implications it has on your health and wellbeing to professionals who can understand what's going on; in favour of leaving it to "personal feeling."

Looking forward to hearing more of your story in time to come, but in the meantime, be safe, well and happy.

Lotsa huggs
Catherine

[Cindy]

Can I totally state that you should not take 'what you want'. Every persons reaction to going on E can be different. I remember well that I caused all sorts of panics when I went on the initial low dose my T dropped to zero and my E went through the roof. It wasn't and hasn't been explained why and how. We don't know. BUT if I had continued on that or gone to higher doses I could have suffered irreparable liver damage before anyone could have said stop.

There is a reason we go to Drs to monitor this, it's because they do know what they are doing.

[Misato]

My endo started me off on low dose Spiro only with E coming next month.  I had a choice of which one to start first and I think I made the right choice with the Spiro.  I just don't know if the low dose limit will come off next month or in Feb.

It's a lesson in patience but I'd rather be careful too.  I finally got the courage to be myself in life, I wanna make sure I get the chance to live and not gum it up by disrespecting the power of the pills that are trying to help me.

[Carbon]

Hey everyone,

First let me start off by saying, I ended up doing the preliminary therapy (standards of care) and then I've started going to an endocrinologist, one of the best in Boston who works with transsexuals specifically, all the time. Also, when I visited, I was told that my testosterone baseline was 290, so, lower than the norm (by the way I'm mid 20s). I don't drink, I don't smoke, all my labs were with-in normal ranges.

That isn't that far from my pre-spiro levels. 

I'm one month into HRT. Right now my spiro dose is a little low (it's below a normal "full" starting dose) but I'm going to have to stay on it for two more months before my next appointment. But since my T levels were lower than average (but very definitely in the "male range") it's probably not too bad. I'm hoping they'll raise it at the end of the three months. Starting on a low dose and working it up is okay, perpetually keeping your hormone levels in the male range is not.

"I remember well that I caused all sorts of panics when I went on the initial low dose my T dropped to zero and my E went through the roof. It wasn't and hasn't been explained why and how. We don't know. BUT if I had continued on that or gone to higher doses I could have suffered irreparable liver damage before anyone could have said stop."

This kind of thing is pretty uncommon, but it does happen. The conventional wisdom is to use the lowest possible effective dose and IMO this is a good tactic, but it can provide cover for stallers or people who don't know what they're doing.

[itsxandrea]

Thanks everyone. That actually makes me feel a little better that other girls were given similar lower dosages and, yes the explanation of monitoring things with my blood does make sense.

I guess I'm just frustrated, of course, I'm so ready mentally for higher levels.

Thank-youuu

[Stephe]

The other reason is you body needs to adjust. Remember a natal females e levels don't go from nothing to sky high in a week, it takes months to years to "ramp up".  I know everyone is in a huge hurry but be patient.