Wondering About Free-T Value

[Wynternight]

When I had my T levels drawn in Nov. it was 22 and the Free T was 0.3. I had them drawn this month and the T was 12 and free T 8.8. What could account for the dramatic rise?

[iKate]

Could be your pituitary gland making it in response to some outside factor like stress?

[Wynternight]

I've certainly had some stress the past few months between being sick and having an emotional meltdown one night, pretty much at the same time as well as dealing with chronic fatigue.

[KayXo]

Typo? Or did you change anything in your HRT?

[Wynternight]

Typo? Or did you change anything in your HRT?

No typo. My estradiol was increased and I went on Celexa and Wellbutrin. No other changes to HRT meds.

[Wynternight]

Hmm...methinks I need to have my PCP look at my serum estradiol. I'm thinking 1181 PG/ML is a wee bit too high.

[iKate]

Hmm...methinks I need to have my PCP look at my serum estradiol. I'm thinking 1181 PG/ML is a wee bit too high.

That is pretty high. Are you on injections or pills?

[Wynternight]

That is pretty high. Are you on injections or pills?

Injection and Vivelle Dots to keep a constant serum level. The troughs when my levels drop are very, very bad.

[iKate]

Injection and Vivelle Dots to keep a constant serum level. The troughs when my levels drop are very, very bad.

That's probably why.

[KayXo]

Ok, I think I know why. You were probably on pills back in Nov and then switched to injections, right? Estradiol, when taken orally, STRONGLY stimulates the production of SHBG which strongly binds T and decreases significantly free T. Whereas, when taken non-orally (injections), SHBG is MUCH less stimulated, therefore the increase in free T.

The reason why oral estradiol increases SHBG to a far greater extent is because, taken this way, much more of it circulates it through the portal vein on its way to the liver, where SHBG production is triggered by estradiol. Taken parenterally (injections), a far lesser amount goes to the liver so SHBG production is weakly affected.

In the end, I think what matters most is how you feel and physical results. If those are good, then you needn't worry.

I've had my levels tested on injectables where up to 3,800-3,900 pg/ml was shown. I've been on the same dose for 1 yr + and I feel good and all other health parameters are fine. Do realize that pregnant women have levels ranging from a little less than 1,000 pg/ml to up to 75,000 pg/ml. You're in the VERY low range of that.

The doctor should decide whether these levels are appropriate for you or not. I'm just throwing ideas at ya. 😉

[Wynternight]

Ok, I think I know why. You were probably on pills back in Nov and then switched to injections, right? Estradiol, when taken orally, STRONGLY stimulates the production of SHBG which strongly binds T and decreases significantly free T. Whereas, when taken non-orally (injections), SHBG is MUCH less stimulated, therefore the increase in free T.

The reason why oral estradiol increases SHBG to a far greater extent is because, taken this way, much more of it circulates it through the portal vein on its way to the liver, where SHBG production is triggered by estradiol. Taken parenterally (injections), a far lesser amount goes to the liver so SHBG production is weakly affected.

In the end, I think what matters most is how you feel and physical results. If those are good, then you needn't worry.

I've had my levels tested on injectables where up to 3,800-3,900 pg/ml was shown. I've been on the same dose for 1 yr + and I feel good and all other health parameters are fine. Do realize that pregnant women have levels ranging from a little less than 1,000 pg/ml to up to 75,000 pg/ml. You're in the VERY low range of that.

The doctor should decide whether these levels are appropriate for you or not. I'm just throwing ideas at ya.

I was on patches until I started the injectable and I maintain one patch for a constant serum level along with the IM. My concern about the estradiol level is twofold: I'm at an increased risk for DVT and there's no evidence to suggest that supraphysiological levels are any more efficacious that what the Endocrine Society recommends. 

[KayXo]

My concern about the estradiol level is twofold: I'm at an increased risk for DVT and there's no evidence to suggest that supraphysiological levels are any more efficacious that what the Endocrine Society recommends.

1) Pregnancy levels range from a little less than 1,000 pg/ml to up to 75,000 pg/ml, therefore not supraphysiological levels as they occur naturally in the body of women, during the course of pregnancy. Risk of DVT during pregnancy is 0.05-0.2%. I have scientific sources for both these figures.

2) Are you getting the results you want physically and mentally from the current regimen? Do you feel good, are you feminizing well? Any sign that your health is currently in a bad state due to this regimen? This should be discussed with your doctor.

3) Levels recommended by the Endocrine Society are based on what scientific data, justified by which studies exactly?  Why are higher levels considered dangerous? Based on what study (ies) that included 17-beta estradiol? Where does it show that higher levels aren't more effective in someone who obtains poor results on lower levels? I think it is important to look at the evidence behind statements so that at least one is more aware. 

[Wynternight]

1) Pregnancy levels range from a little less than 1,000 pg/ml to up to 75,000 pg/ml, therefore not supraphysiological levels as they occur naturally in the body of women, during the course of pregnancy. Risk of DVT during pregnancy is 0.05-0.2%. I have scientific sources for both these figures.

2) Are you getting the results you want physically and mentally from the current regimen? Do you feel good, are you feminizing well? Any sign that your health is currently in a bad state due to this regimen? This should be discussed with your doctor.

3) Levels recommended by the Endocrine Society are based on what scientific data, justified by which studies exactly?  Why are higher levels considered dangerous? Based on what study (ies) that included 17-beta estradiol? Where does it show that higher levels aren't more effective in someone who obtains poor results on lower levels? I think it is important to look at the evidence behind statements so that at least one is more aware.

The entire pregnancy and serum level is negated by the fact that we aren't natal females.

Yes, I am getting good results but at a serum level almost three times that as recommended by Endocrinologists who, I am sure, have done exhaustive studies on hormones and hormone levels. It's disingenous to ask for studies whose existance I'm sure anyone can infer are out there for teaching and residency, research, and clinical practice.

[KayXo]

The entire pregnancy and serum level is negated by the fact that we aren't natal females.

So what if we aren't natal females? How does that change anything in respect to health risks?  If their risks remain very low despite very high levels, why should it be different for us?

Studies have also been undertaken in male prostate cancer patients given high dose injectable/transdermal estradiol and risks were found to be negligible. One study even stated that thrombophilic activation was reduced and that this treatment protected against the risk of thrombosis

Yes, I am getting good results but at a serum level almost three times that as recommended by Endocrinologists who, I am sure, have done exhaustive studies on hormones and hormone levels. It's disingenous to ask for studies whose existance I'm sure anyone can infer are out there for teaching and residency, research, and clinical practice.

Have you actually taken a look at these studies and read them? How can you be so sure then?

Ideally, we need a study of several hundreds of transsexual women treated with ONLY injectable EV, some with lower, some with higher levels, adjusted according to their well-being and feminization. Then, do a long-term evaluation of health risks. This has not been done and so, I don't know how they can infer that high levels can be dangerous. The only available evidence we have, at the moment, is pregnancy in ciswomen, where levels are very high AND those studies in prostate cancer patients.

It is also important to note that other studies which consist of oral non bio-identical estradiol (ethinyl estradiol, Premarin) and often times, cyproterone acetate do not apply because they confer health risks due to their molecular structure, not native to the human body. Apples and oranges. Also, I came across one study where the patient in question was taking an unheard dose of another injectable estrogen combined with ethinyl estradiol and cyproterone so it would be of no surprise to observe what they observed.

Please do note that I'm not attacking anyone. I just think it's important and not disingenuous to question, look at facts to get as much an accurate picture as we can. 🙂

[Wynternight]

So what if we aren't natal females? How does that change anything in respect to health risks?  If their risks remain very low despite very high levels, why should it be different for us?

Studies have also been undertaken in male prostate cancer patients given high dose injectables/transdermal estradiol and risks were found to be negligible. One study even stated that thrombophilic activation was reduced and that this treatment protected against the risk of thrombosis

Have you actually taken a look at these studies and read them? How can you be so sure then?

I am not turning this into the kind of back and forth debate with you that so often happens in discussions about HRT. Yes, I have read the studies but they are too complex to get into here at this time. I'm going to see an endo and discuss it when them and see what they say. End of story.

[KayXo]

I am not turning this into the kind of back and forth debate with you that so often happens in discussions about HRT. Yes, I have read the studies but they are too complex to get into here at this time. I'm going to see an endo and discuss it when them and see what they say. End of story.

OK. We can continue this, privately, if you wish. 🙂

[Ms Grace]

Folks - posts are not to be argumentative. When and OP states they will consult the issue or suggestion with their Doctor then further dialogue to persuade the OP, or pitting one study against another, is argumentative and will not be tolerated.