More on estrogen, spironolactone and doctors.

[Sadie]

I won't speak directly of any dosages.

So the last couple threads about estrogen has me thinking of my last results and my endocrinologist.  First off my endocrinologist is extremely conservative, extremely. She makes me wonder though if she is agressive enough to really feminize t-girls. I've heard many of the other girls going to her talk of how they don't think she is agressive enough and are self-medicating in addition to what she gives. I have never done this but it shows I am not alone thinking she is too conservative.  The problem is she is one of the only games in town. She has been treating t-girls a long time and is a member of WPATH and such so she is fairly active in the trans community.  The one thing I really like about her is she spends a lot of time with you, she will spend a good hour talking with you, she actually enquires how things are going in your life and such so I never feel like she just rushes me out the door.

So she started me off on a very low dose patch (think starting dose). The patch however did not agree with my sensitive skin after a month or two so I switched to pills. Also think very low starting dose.  She will not graduate me to a higher dosage.  I am now 1.5 years into HRT and still am on what most would consider a starting dose. She states my levels are within normal female range and I don't need anymore. Also she will not consider any form of estrogen other than patch or pill. So I can't even get shots if I want them, I did and I asked and was told no.

My last test reults were in April 2012 I had: Estradiol: 121.1 pg/ml; Testosterone, Serum: 16 ng/dl; Testosterone, Free+Weakly Bound: 1.5 ng/dl

I haven't been able to get any further tests since then because I currently don't have insurance and can't afford to get 500+ dollars worth of lab tests run.

So do you think she sounds too conservative? Should I seek another Endocrinologist?

Oh and one other thing: Can sprironolactone seriosuly dry your skin out? I used to have oily skin and hair and now I am the exact opposite, extremely dry skin, I have to moisturize all the time and have very dry hair. I can go days without washing it and it does not get greasy. I used to have to wash my hair everyday.

[Carbon]

Yes, testosterone can make your skin more oily, so less of it means less of that.

. I'm trying to use this thing on wikipedia:
http://upload.wikimedia.org/wikipedia/commons/c/cb/Blood_values_sorted_by_mass_and_molar_concentration.png

It looks like your testosterone levels are below the average levels for women (low average is 70 ng/dl, but yours is 16) and your estradiol  is in the male range but tending towards the high end that overlaps with the low end of female levels, also around where post menopausal women are.

If you're not happy with your results I guess it couldn't hurt to get a second opinion. I'm not sure exactly where estradiol levels "should" be for trans women. edit: where do doctors put post menopausol women doing HRT or younger women with hormone imbalances? it's kind of a different thing for it to be stable

[Brooke777]

My endo is very conservative as well. He still has me on a starting dose but, he is taking an approach to ensure I stay healthy. He too has treated quite a few trans people so he does know what he is doing. I think you should trust her. If your levels are where they should be then she is doing a good job. However, it never hurts to get a second opinion if you can afford it.

[Sadie]

That is the thing I don't really feel the estradiol is where it should be.  It seems low but she insists its fine. I have argued over this point with her.  Plus it took 10 months to reach that level the test I had 4 months earlier was only 80.6 pg/ml. She didn't increase my dosage and just let it slowly build.  I just hear about girls going to other doctors that are more aggressive and they seem to be getting better results.  The only thing she has done is add progesterone because I asked if we could try it to help with breast growth. It hasn't.

[Carbon]

That is the thing I don't really feel the estradiol is where it should be.  It seems low but she insists its fine. I have argued over this point with her.  Plus it took 10 months to reach that level the test I had 4 months earlier was only 80.6 ng/pl. She didn't increase my dosage and just let it slowly build.  I just hear about girls going to other doctors that are more aggressive and they seem to be getting better results.  The only thing she has done is add progesterone because I asked if we could try it to help with breast growth. It hasn't.

It wouldn't hurt to see someone else, then, and get their opinion. It sounds like the estradiol might be too low.

[JennX]

Your lab results sound fine. Just where they should be for a MTF trans person on HRT in fact. Most docs I've talked with like to keep MTF pre-op E levels between 100-200 pg/ml and total T below 40ng/dl. You are right there as far as E & T levels go. The lack of T and increased E level is what is drying out your skin. Which is why there are so many women around the world spending a small fortune on all sorts of moisturizers. Hang in there, HRT takes a while to see results, and then it will differ from person to person. HRT is not a magic pill and may not give you all the physical changes you hope for all on it's own.

[Tammy M]

The Endocrine society recomends estrogen levels of less than 200 pg/ml and testosterone levels of less than 55 ng/dl.  The average female level of estrogen is somewhere around 150 pg/ml, and that seems to be a level many doctors liek to see their ts patients.  Some doctors are more conservative than yours and like to keep levels or transitioning ts patients under 100.  It sounds like your levels are within the norm, the E could be a little higher and the T seems just fine.  Given time the E will likely go up even more so it sounds like patience is in order.  Transition takes time as much as we would like to rush it along.
 
here is the link to the hormone level chart
http://jcem.endojournals.org/content/94/9/3132/T15.expansion.html

and the link to the entire document: Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline
http://jcem.endojournals.org/content/94/9/3132.full

[Carbon]

Thanks to Jenn and Tammy. I know this isn't my topic but I'm glad to have this information.

Sadie mentions that she's heard of people self medicating... one thing I've noticed when I've been on sites where self medicating is more accepted than here is that trans women who self medicate seem to start on and take higher doses than trans women who go through a doctor. I think there's definitely a place for self medicating, it's the only way some people are going to get treatment and with a little knowledge you can get your blood tested on your own (making it a lot safer), but it also seems like we aren't always the best judge of how this stuff works. Not that doctors always are, either...

Those of us with competent doctors are really lucky, probably.

[Sadie]

I know girls who self-medicate in addition to what they are prescribed by the doctor.  Doesn't seem smart, but at least they are still being monitored.

[delia_dunno]

I'm so happy I found this thread. I just had my first followup with my doctor, and my E level seemed really low, but she said that was just fine, especially since I was experiencing such positive effects from the E/spiro. My E was 63, T was 12 and free T was 0.3. Doc was very happy (surprised?) with T level. She bumped the E dose a little, and I go back in eight weeks.

I guess that's all good with me. I am lucky, though, to have a doctor I trust a great deal.

[Meshi]

Sounds like she is very conservative.  There are ways of finding the standards for MTF.  I can not go into detail, cuz we cant talk about dosages, but from what you have said I myself you not go to her.

[Cindy]

One of the comments I have had from my gynaecologist/endocrinologist is how careful natal woman are about taking hormonal therapy for menopause, wanting know all the risks etc.
Her TG patients just want the hormones, 'pour them into me' "But they can kill you?" 'So what'. And I think self medicationers have to be careful about that. I went on low dose E under supervision and my liver enzymes went ballistic very quickly - within two weeks. If I had continued I would be very seriously ill, as in 'I hope you have made a Will?"

[delia_dunno]

Sounds like she is very conservative.  There are ways of finding the standards for MTF.  I can not go into detail, cuz we cant talk about dosages, but from what you have said I myself you not go to her.

To each her own. I trust my my doc. If it takes her a while to get my chubby, smoking,35-year-old self up to the right E level, I can live with that. Besides, she's kind,well-respected, and informative. I don't intend to leave my care to a quack or to myself.

[Carbon]

Her TG patients just want the hormones, 'pour them into me' "But they can kill you?" 'So what'.

This is true isn't it. 

[Rita]

Mines wasn't but in truth, as much as I care about the consequences.  I care more about living my life.  Rather live a shorter more fulfilling life~

Self medicating is almost suicide though.  I would never do it~