Question regarding Testosterone Levels

[jennystarcolonthree]

So, I've been on HRT since Aug 2012.
I was prescribed by my Endo and then switched to my general doctor to just keep me on it, as he is only 5 minutes away .
He always just TOLD me that my T levels were low, and my E levels were normal.
I asked for a physical copy today and I looked at it and it said my T levels were at 262 ng/dL  where the flag referance range is 241-827 (which he said would be the normal.)
I was astonished. I've been taking spiro for 2 years almost and it's that high? My breasts are very small for my time being on HRT, more pointy than anything, and barely rounded at the bottom. I hate it!
I have another appointment with my ENDO this time, in just about a week. Is there any other options to an anti androgen in the US?  Could I increase my dosage? I'm on  daily.
Thanks girls!


no dosages

[Just Ole Me]

Getting your estrogen levels higher will lower your T level I believe as E suppresses T.

[Mariah]

Try to avoid using terms like low and normal when working with a doctor, especially when it comes to HRT. My doctor called me up one day to say my testosterone was normal. So the next time I saw him I asked what was normal? He looked it up and went "oh" because the results were listed as normal male. The numbers really don't mean a whole lot though because spirnolactone and testosterone are like cars competing for the same parking spaces. If testosterone can't find a spot it just keeps driving around. What really matters is that you are satisfied with your transition. If your not, talk to you doctor and see if there is anything that you can try.

[KayXo]

I agree with Mariah but I find that your T levels are too high in my opinion (but I'm not a doctor) even if you are taking Spiro since it only weakly blocks androgen receptors. Your levels should be compared to females, not males, I think. There is however the issue of testosterone being bound to SHBG which is known to increase substantially with oral estrogen. Better test would be bio-identical and free T. This gives a more accurate picture.

But, the most important is results. Since you find that breasts are small, pointy, not rounded, I'm thinking two things.

First, I would discuss with the doctor and ask why he compares your levels to that of a male when you are transitioning to female. Female levels are much lower. Perhaps then, he will increase estrogen, spiro or add another anti-androgen or just switch anti-androgen.

Second, since breasts are pointy, progesterone (Prometrium) is known to help round them out and make them fuller. You could ask if he is ok with prescribing you bio-identical progesterone (which is different from other progestins in terms of side-effects and overall effects, much more positive according to studies and anecdotal evidence) on a daily basis. Taken with food, absorption is better and it's best to take it before going to bed as it makes you drowsy, at least the first few weeks to months as your body adjusts.

[Heather]

I suggest you find a new endo I was having a similar problem and at a friends suggestion I switched docs to her doc and I went from a 211 T level to a 18 in just over 3 months. I don't know what your dose is and I'm not asking but it sounds like you may need a higher dose.

[PrincessDayna]

This is why they say ymmv. Some peopke react better to lower, some mediocre, some hifher, doses. Everuone is different. Always get a hard copy of your labs for yourself, ahead of the appt., to look over possible concerns the doctor may miss, to bring up eith them. Doctors are always busy. It could be any range of factors from 17OHP to DHEA, which is why endos typically are a better choice for the field of hrt.
To me it sounds like spiro is too low with mediocre estrogen dose- or, that spiro is mediocre with low estrogen dose. It is wise to stay with the same endo for around two years, as it sometimes can take that long to find the dose that best "clicks", or the body to "get it"- which can take up to a year in some cases. Also note it takes cis females 5-10 years to complete puberty, it is not a short race, but rather one of long term stamina. Remember, your body was used to making one sex defining hormone primarily for years and years on end, and you are askibg it to please stop as it is time for the "right one" to take over. Definitely get a hard copy of that lab pre endo appt., and go over it. Check normal female levels for each chemical. LH and FSH should go down as well as SHBG, in order for T production to shut off. Sounds like low dose or middle dose spiro, with low dose oral e, to me. Females in puberty have extremely high levels of E. Hope this helped!

[Mirian]

This IMHO is one of those cases where simply trusting doctors may be the worst thing to do.
Never forget that they more than often know things less than us, expecially if they're not trained
to take care of tg patients. For me, a doctor stating that T 262 ng/dl is ok is a doctor to change.
Your T should be 26.2 instead.

[KayXo]

LH and FSH should go down as well as SHBG, in order for T production to shut off.

SHBG should actually go up, not down as estradiol increases its synthesis. SHBG strongly binds androgens and less strongly, estrogen. Binding androgens makes them unavailable to receptors. A good thing.

Females in puberty have extremely high levels of E. Hope this helped!

And high levels of Growth Hormone levels which we don't have. Their E levels actually still fluctuate during puberty from high to low (i.e. menstrual cycle). Being so young and having high Growth Hormone levels, they are especially sensitive to E and they also don't have to deal with prior masculinization like us.