Correct est levels for transgender?

[Danielle Sherry]

Hi ladies, and thank you for your input.

Does anyone have an idea of the correct estrogen levels for a trans woman after an orchiectomy? I'm googling it and I'm getting normal levels for women ranging from 25 to 400 pg/ml (400 at puberty, 25 and below for postmenopausal). I'm doing a search specifically for us but I'm not getting any straight answers.

I'm also wondering how well daily supplements of ground flaxseeds and DHEA would help (again, after an orchi).

Thank you

[sam79]

Estrogen levels with or without an orchie should be fairly similar. There's no real reason for them to be different, although dosage may change ( not E levels ) after an orchie.

Normal E levels for a cis & non post menopausal woman range greatly. A MTF's estrogen levels are generally far more consistent. My endo likes to keep me above 200 pmol/L.

[Danielle Sherry]

Thank you Sammy.

I'm seeing pg/ml (picograms per mililiter). You're saying "pmol/L" .. same thing?

Sorry, arts major here. I ran screaming out of my chemistry class at the end of the semester.

[sam79]

Oh sorry

I'm using the default units that seem to be used in Australia. For some reason we just have to be different. Or is your country different ?

There is a handy calculator here: http://www.endmemo.com/medical/unitconvert/Estradiol.php

So the minimum my endo aims for is 200 pmol/L, which is about 55 pg/ml.

[Danielle Sherry]

Got it Sammy, thank you again.

I'm an American living and working in South Korea (been here for 8 years). Metric system here    .

Any thought on flax and/or DHEA? Bio-indentical hormone replacement is made from soy (most soy is now GMO world-wide). Flax is actually higher in phyto-estrogens. Also, DHEA converts to estrogen in the liver when swallowed. I'm wondering what levels can be achieved with just those two alone. I was going to experiment with this after the orchi. I have a distrust of doctors and I never take medications unless there is no way around them (I won't even take antibiotics). If I have to take monthly shots I'll do so holding my nose. This is the one area of what I'm doing that bothers me: dependance on the medical/industrial complex.

Any thoughts?

[Ginny]

So you'll want your post castration in the healthy female range. As you are not menopausal, you probably do not want to go lower than 100pg/mL.  Even menopausal women take different forms of estrogen boosters to help them.  Normal women have about 25-95ng/mL testosterone (i forget if that's free or total). This helps with different functions in the body specifically libido and bone health.

*If I am wrong in regards to any of this, please correct me as I only started deep research about 4 months ago.

EDIT: Changed Estrogen (post-castration) lower end range to match information supplied later on in thread.
EDIT2: Removed ranges as they were called into question due to concerns about upper level dosing and toxicity.

[Hikari]

I personally have had experiences with plant based estrogens not from proper pills and I can only say I wouldn't recommend it at all. It isn't in my view a viable or safe route.

Those "Bioidentical" hormones in pills, are synthetically derived from plants, it doesn't mean that soy itself contains bioidentical estrogen; and while humans can metabolize nonhuman estrogens (after all look at Premarin) it just doesn't seem to have the same outcomes as hormones close or identical to that found in the human body.

Even after an orchi, or SRS I would consult with an Endo to find the right dosage to maintain E levels and just get that, I mean I know you don't like the system of medicine, but I haven't really heard of anyone successfully transitioning with using herbal supplements or diet, etc to maintain hormone levels. I am not clear on your exact reasons but for the best outcome, perhaps it  is best for outcomes to find a way to be at peace with medicine related to transition.

[Missy~rmdlm]

I have posted this before, this lab snippet has good info right on it.

[Danielle Sherry]

Got it Jennifer, thank you very much!

Any insight into the types of HRT to look for? I've started reading Suzanne Sommers and listening to Dr. Mercola. They both recommends bio-identical only. I've also been reading the pros and cons of delivery methods: Injections, pills, creams, gels etc. All this is leading to confusion. Any recommendations here?

I don't mind going slowly. I want the minimum amount a medication to get the desired effect. My desired effect is mild feminization (small boobs, subtle shifts in body fat, no voice change).

[Ginny]

Danielle,
I would definitely stay away from synthetics if you can. Bio-identical is a poor label but often used it should be labeled Bio-mimetic.

Pills (take sublingually if able to)
Pro: Cheap, many people use it
Con: Spurts of hormonal spikes, overworks/toxifies liver over time (this varies person to person on when harmful to liver), most medical complications with regards to blood clotting factors, remember to take 1-3 times daily.

Creams/Gels
Pro: Absorbs into bloodstream, fast acting, bypasses first pass on liver, less complications with blood clotting factors.
Con: Remember to take 1-3 times daily, not high enough concentration for my purposes (pre-SRS), but may be viable option for you, hormone spikes.

Patches
Pro: See Cream/Gel, also only change every 3 or so days, more steady hormone levels.
Con: Not high enough concentration for pre-SRS or if skinny, may be a very viable option for you.

Injections:
Pro: Only need to do every 2-3 weeks I think, goes into bloodstream, bypass first pass of liver, very safe in terms of blood clotting factors
Con: Cost, hormone spike and fade away effect,
*Note: I haven't really looked into this much, don't like needles so I didn't consider it an option for me.

Pellets:
Pro: Only need to change 2-4 times per year, absorbs to bloodstream, bypass first pass of liver, virtually no complications due to blood clotting factors, very steady level of hormones.
Cons: Costly (insurance most likely will not cover, though in long term about as same as injections), bruising around incision, careful of bathing for 2-3days after incision, can't exercise for at least a week after insertion, if performed by someone with little-no experience can have protrusion or rejection.
*Note: Method I've chosen to go with, have had no complications thus far.

[sam79]

On Jennifer's post, my endo and I don't agree that E levels should change pre & post orchi. So I don't understand the reasoning for that. As mentioned, dosages may change, but you should still maintain a healthy hormone level for a woman of your age.

And those high figures ( 400+ pg/ml ) could almost be lethal if taking and non bio-identical E, with the risk of DVT and other risks! Please consider removing that information. I'd hate to think that some DIY-er might try to aim for that kind of level and kill themselves.

I don't have any experience with the bio-identical forms of E, but my endo doesn't like them. He says they're too weak and are less effective. I don't know any more than that about it. Delivery though, there's certainly some variety . Don't forget pellets ( which I hope to swap to ). I've only heard that patches are used with older women, and that oral is the norm for younger women.

[Ginny]

Sammy,
I removed the entire section on hormone concentrations due to your concerns on high level toxicity.  Like I had initially stated, I had not jotted down the source and had wanted clarification to make certain.

Also I definitely agree that E levels don't need to drop post-orchi/SRS, as a lot of people here are healthy young people and should have levels congruent with their age. Always consult your endo when adjusting hormones. 

As for bio-identical/mimetic, in my opinion they are more effective than synthetics based on all the research papers I've looked at.  From what I have found they have less complications, bind more readily to the body's hormone receptors, and have greater efficacy. You may want to converse with your endo on why he thinks bio forms are less effective as they more readily bind to receptors, and I haven't come across pellets that were synthetic yet.

[Danielle Sherry]

Ladies, thank you for all the great input! Wonderful advice!!

I haven't yet heard of pellets. Jennifer, do you have a link or a favorite brand?

Did we agree on a proper est level? (rereading now) I've come away with around 100 pg/ml. This seems to be the correct range when I google it.

[Ginny]

I looked at a medical sheet when I went to get my pellets, but don't remember the specific manufacturer.  You will need to go to a endocrinologist for this because it involves an incision in either left or right upper buttock or somewhere in the abdominal region depending on the doctor. The doctor will numb the area, make the incision, insert a determined amount and type of hormonal pellets based on what they and you feel is safe, close the incision, and bandage the area.  The area for me was tender for about 12-14 days and I had it in my left inner upper buttock. The first day you will want to avoid sitting for long durations of time and won't be able to submerse the area for usually 2-3 days. Do a search on pellets in the forums if you are interested, there is some good information other girls have posted. Just a for-mention though, they are not cheap.

As for levels, Missy posted a lab result form, which has the ranges from the hospital, so I'd probably go with those. We don't do hormone levels at our hospital but that result layout looks similar to what we give to patients.
~Jen

[Just Shelly]

I don't know if I should be concerned or not?? for the last 2 years I have an average between 650 pg/ml up to my last test 2 days ago which was 739.6 pg/ml. My primary physician was a bit worried last year but my hrt doctor wasn't too concerned since all other things looked well....even though he does agree its high.

I would like to get it down a bit to see if maybe my health would be better....even though there's nothing concerning me other than just average crap. I am on injections and wonder if maybe the last tests were all close to when I had my shot....but I can't believe all three tests would have been on the same time frame. I'm also afraid of lowering my dose since I don't want it to affect me negatively.

Oh my T is at 2.5 ng/dl this I can tell is definitely low....don't have as much energy as I once did!!

[Ginny]

Shelly,
I would suggest that if you are concerned about when the levels were, ask for records of when you got the shots and when you had your hormone levels taken. 
I'm not sure what health effects an overload of hormones may cause, but you'll want to monitor different clotting factors and thyroid tests. These would be things like thyroid (T3, T4, TSH) and clotting (INR, PTT, D-Dimber, Fibrinogen, Factor V Assay). I think there may be a few others but can't recall what they are called.  Your CBC and BMP/CMP results should not really change.

Also, for energy, you may want to try a patch or cream with a minor amount of testosterone. What you are trying to get is a steady stream of testosterone as possible. You so not want your testosterone spiking constantly.

[Just Shelly]

Oh everything else is fine! I have a complete test run along with levels for E and T checked. All is in range, except the T if I was a man  LOL and the E is a little high even for a women. The only other thing that is a little high but not out of range is my potassium....this is to be expected with taking spiro and my doctor isn't too worried.

Even though he is not an Endo he has been prescribing cross HRT for many years now....the thing is no one is an expert on what dosages and what types work the best....especially when its prescribed off label. Heck even HRT for menopausal women isn't down to a science yet!  The best thing is to be monitored....which I am every 6 months!

[Violet Bloom]

  I am pre-SRS and a little over four months on HRT.  At my last checkup my doctor said my E level was a bit over 200 (I don't know the unit format) and she considered this to be comfortably within the normal female range.  Once my T is suppressed further by an increase to my Spiro dose, she is expecting to raise my Estrace dose again anyway, so the target is higher than I'm at now.  Both meds are oral and the Spiro is now being taken in the morning and evening instead of just in the morning.  Everything's felt perfect all the way through and all of my blood tests and blood pressure readings have been completely normal.