Estrogen levels going down and no change in medication - Help

[Rebecca Perez]

I cannot find a solution to this issue and I am hoping someone may have come across weird hormonal issue at some point. My estrogen levels have been declining and my testosterone levels have been increasing.

A little background.
I have been on HRT for 4 years under the care of a physician. Simple HRT protocol of estrogen and anti-androgens and there were no complications or problems. I had a bilateral orchiectomy 2 years ago and the anti-androgen was stopped. The same dosage level of estrodial was continued.

I get blood tests every 3 months and have been tracking my estrogen and testosterone levels this whole time. I have been having the weirdest thing happen.

Unknown Reason for Changes in Estrogen and Testosterone Levels
My estrogen levels have been dropping quickly. In the last six months (since December at least) I have seen significant decreases, as in, from 220-260 pg/ml to my most current test which has it now at 92 pg/ml. My dosage was decreased for the last 3 months due to the idea that maybe there was no too much estrogen in the system, but there were no changes in estrogen levels.

Estrogen levels are still declining. Testosterone levels went from less than 1 to 16 pg/ml. I have no idea why T is going up.

There were no medication changes over this time. The E and T levels had been constant for 3 years until about December.

A recent blood test showed DHT levels to be low 6 ng/dl with a range of 5-46 being normal so the estrogen is not being converted into DHT. Certainly, the estrogen is not being converted into Testosterone.

One Possible Issue
I had been showing symptoms of hypothyroidism and tested positive for ANA (more than likely Hashimoto's) and was diagnosed with hypothyroidism. I did start Levothyroxine but that had no effect on hormone levels. Last blood test showed TSH and T3 levels as normal (though lab results are not always the best source.)

Any Possible Answers?
This issue concerns me. Estrogen levels have dropped significantly even though my medication dosage has not. My testosterone levels have been increasing even though I have no testes. This all started in December (probably earlier) and there has been no other changes other than hypothyroidism, but even with medications the numbers are still reversing.

Help.

[JLT1]

Hi Tara,

Long time no hear....

How are you taking your E?  What specific E (brand) are you taking?  Dosage unimportant so don't mention....

What lab is doing your tests? (It should be on the result sheet.)  Has the laboratory changed from what it used to be?  Have you changed diet, vitamins or any prescriptions lately?  Have you changed the way you are taking the medication or have you changed the time of day you are getting the tests done?

Do you have valid measurements of your T3/T4 ratio?  Other thyroid tests???

That's it for now, PM if necessary......

Hugs,

Jen

[Ms Grace]

Are you on oral, injection, topical, implant? Maybe a different delivery method would help?

[Rebecca Perez]

Estrogen is orally and it is estradiol ethanyl. I only dosing changes were 3 month intervals as the doctor was trying to figure out why the changes. Regardless of dosage, the levels still dropped.

The lab is through the Veteran's Affairs, same lab, same location and I get it drawn at the same time, each time. As far as I know there wer no changes in collection methods or labs.

There have been no prescription changes other than the thyroid med but the numbers were changing before I started that med.
I do have blood test results of for TSH and Total T3. After being on the thyroid medication for 3 months my TSH is in the middle normal and Total T3 is in the middle normal.

No real changes since December.

Tomorrow, I have another blood test to look at T3/T4 and free T3 levels as well as some other thyroid tests.

Is there a mechanism in which the thyroid would disrupt the conversion of androgens into estrogen? What would explain my testosterone levels going from below 1 to 16?

I talked to my doctor abut different delivery systems but I think I want to understand the need for it before I do it. In other words, what is my body doing with all of that estrogen, why did it seem to start only a few months ago, why is testosterone going up when the only production would be from the adrenal glands?

Oh, kidney and liver functioning is fine, glucose levels are fine, cholesterol levels are fine.

BTW, I hate losing my hair due to hypothyroidism

Thank you for helping me

[JLT1]

Hi Tara,
High levels of T3 can decrease aromatase function leading to lower E and higher T.  You need to look at both free T3 and bound T3 for the whole picture.  Also, if T4 is down, you can hit E as well.  As weird as this sounds, you might actually be able lower E and fix the thyroid and that is what your body is doing.

Sometimes, one type of a medication will just stop working.  This is most often due to "induced" metabolism or when one enzyme becomes much more active than it had been previously.   The CYP450 enzymes are very prone to this and the CYP3A4 is where estrogen is metabolized.  This would lower E and your body starts making slightly more T as part of a very odd feedback mechanism.  Changing the type of E for a while can reset everything if this happens.   

The endocrine system is nightmarishly complex.  The medications you are taking for your thyroid could very easily impact E levels and there isn't any data out there to know for sure but I would not be surprised at all.

It sounds like you have a good endo.  I find that surprising.   If it were me, I would discuss the possibility of switching the type of E with the endo, going to injections or patch (estradiol) for a few months then possibly going back to your pills...

Hugs Tara,

Jen

MODS:  If I went to far, just delete post and slap me.  Just trying.....

[KayXo]

Estrogen is orally and it is estradiol ethanyl.

If you mean to say Ethinyl Estradiol, then I find it strange that this form of estrogen is still being given to transsexual women as there are far safer alternatives like bio-identical estrogen which don't affect DVT risk nearly as much.

Orally, there could also be an interaction with thyroid medications you are taking but you stated that taking this medication did not change levels.

Also, there is no use in measuring estradiol levels when taking this form as the most active estrogen is ethinyl estradiol and is not measured by labs.

I think the important thing, more than levels, is your feminization and well-being. If these are going well, then personally, I wouldn't be concerned. But that's just me and how my doctors see things.

Good luck!

[Rebecca Perez]

This is immensely helpful. Thank you.

It is very important for me to identify any changes out of the ordinary. My system is a bit messed up, always has been (thanks DES). Early identification can be a life saver for me. I do have some info from my last blood test, but will keep you all updated.

It is interesting about the different ways of E delivery. I hadn't heard that, but will look into that as well. Funny enough, these tests were ordered by my psychiatrist after we talked about it. We both realize how hypo and hyper thyroidism can significantly impact the effectiveness of psychiatric meds. Though his intial plan was to augment with T3, which seems to be in the normal range as it has some research to support anti-depressants. Though I don't take anything that really touches serotonin because of extreme sensitivity to serotonin syndrome. Seriously, like melatonin can induce it!

Hi Tara,
High levels of T3 can decrease aromatase function leading to lower E and higher T.  You need to look at both free T3 and bound T3 for the whole picture.  Also, if T4 is down, you can hit E as well.  As weird as this sounds, you might actually be able lower E and fix the thyroid and that is what your body is doing.

Sometimes, one type of a medication will just stop working.  This is most often due to "induced" metabolism or when one enzyme becomes much more active than it had been previously.   The CYP450 enzymes are very prone to this and the CYP3A4 is where estrogen is metabolized.  This would lower E and your body starts making slightly more T as part of a very odd feedback mechanism.  Changing the type of E for a while can reset everything if this happens.   

The endocrine system is nightmarishly complex.  The medications you are taking for your thyroid could very easily impact E levels and there isn't any data out there to know for sure but I would not be surprised at all.

It sounds like you have a good endo.  I find that surprising.   If it were me, I would discuss the possibility of switching the type of E with the endo, going to injections or patch (estradiol) for a few months then possibly going back to your pills...

Hugs Tara,

Jen

MODS:  If I went to far, just delete post and slap me.  Just trying.....