E Levels

[Joanna]

Hi everyone,
I havent been on here for a while, but I needed a little advice.

I had my 6 month hormone levels checked the other week and picked up the results today and was surprised.
Normally my T levels hover around 1.5 - 1.7 nmol and my E is always on the lower side at around 250-280 pmol.  I have questioned the low E levles and was told that yes it was low but obviously was enough to feminise me.

Today my T was 0.7 and by E was 1143!! I dont know why that would be? Is that dangerous?  I have been on HRT since Oct 2011 and the highest my E has ever been was 500 and that was shortly after I had started treatment.

I have recently started an anti-depressant and wondered if that would be having a unexpected effect on my sex hormones?  Anyone have experience of this ?

Any advice ladies and gents or opinions would be greatly received.

Jo

[JLT1]

What antidepressant?  Check out rxlist.com and look for interactions.

[KayCeeDee]

If you take pills, when you take them can have an effect on your level when they draw the blood.

[JennX]

Did you take any E within 12 hours of getting your blood drawn? If yes... the high E level could be caused by that.

Also it could be a mistake at the lab. It happens. I've had it happen once myself.

[Joanna Dark]

yes the anti-depressant could definitely be the culprit for the high E level. It is a well established fact that certain medications inhibit or induce other medications and raise the blood level (or AUC) of other drugs. A lot of it prob depends on when your take the AD. I wouldn't be worried and the effect is usually temporary. There are all kinds of interactions between meds. Progesterone is a PGP inhibitor and could cause certain meds to cross the BBB in a greater number. Hope this helps.

[Joanna]

Thank you very much for your replies.  Fortunatley I have an appointment with my Doc next week so I will deff ask him about this.  I did a check online to look at the possible interactions between Mirtazapine (Ad) and my Estradiaol Valerate (Patches) and the only thing I found was flatulance!   Thankfully I dont suffer with that .....yet

Jo x

[A]

First thing, 250 pmol/L is definitely NOT enough if you're anything like me. That's pretty much what I have right now, and I haaaaaave... slight hip growth, and sensitive nipples. >1 year of HRT, mind you. No, 400-600 are commonly cited target values.

Now, for the high levels... It's most likely an error. Lab analysis errors do happen. If that's not it, then it could be that you'd taken your pill recently. My ex-girlfriend got values of like 2000 pmol/L because of that, once, and she certainly wasn't taking huge doses.

It could also be a transdermal product problem. Dunno how patches work, but while my actual levels were ~170 pmol/L at the time, I had results of 1000 and 450 (on the same dose!) because I had put my estradiol gel on my arms (same arms blood was gonna be taken from) about 3 hours before the blood test, twice.

Whatever the cause for the error is, take care of it fast. I've been on a ridiculously low dose of hormones ever since I started HRT because of these erroneous tests. The doctor thinks they are true, (even though a technician wrote TO BE REJECTED on one of them, lolol), ignored my next blood test done 24 hours after the last dose as instructed by another specialized endo to his patients, because he didn't seem to have the same conception of "gradual release over 24 hours" as I, and either didn't receive or acted as if he didn't receive the last blood test, done after going back on Estrace pills, and wrote me in a letter (because yes, that annoying man replies to his phone messages through freaking mail) he "did not allow me to call him with impunity" as I was desperately trying to have him understand, through the bad communication channel, that I wasn't blindly requesting for a dose increase like a fool, but that I was encouraging him to look at my results and see my levels weren't 45t0 or 1000, but in the 250 range, and act appropriately.

So, eh, ranting aside, if you want to avoid a horror story like mine, don't trust your endo's confident an reassuring smile; take matters in hand.

Finally, 1100 pmol/L is high, but I doubt it's dangerous. I think it's reached in pregnancy and even during puberty.

[Megan S]

I wouldn't be too concerned about the higher Estrogen level. It could be due to you being overly sensitive to the release from the transdermal patch, meaning you got all of it from the patch quickly, or right away, rather than it slowly entering your system. This can and does vary greatly from patch to patch, similar to absorption from pills taken orally (not sublingually) can vary greatly dependent on several factors as well. There is no interaction between Remeron (mirtazapine) and transdermal estrogen. Remeron could effect oral estrogen somewhat because it does slow gastric emptying some due to increasing histamine. Was there a particular reason Remeron was chosen? I usually only prescribe it for those with depression, anxiety, and sleep difficulties. It also tends to cause some weight gain, so you should exercise and watch what you eat.

[Joanna]

Thank you Megan and A
That was just the advice I was looking for.  I did see my specialist yesterday and he has suggested I change my patch twice weekly and not every three days as I have been doing. He also recommended. I alter my dose slightly every other week to a lower dose to help even things out a bit. Of course I am dubious about that like we all would be if asked to lower our E. I guess he knows best.

Megan, thanks for the advice on Mirtazapine and E. You have put my mind at rest. I was feeling like the Mirt was affecting the uptake of E. it was most likely all in my mind.

X

[Nicolette]

My E level has been around 850 and may have been so since 1996. Spiking briefly to 1143 shouldn't harm you.