Estradiol Dropped Low, Desperate!

[farbanian]

Hello everyone,

So, I started HRT February 2015, my E levels where in the 400s range and I was on injectables up until end of April.

My doctor then decided to switch me to pills due to his concern of my "sky high" levels of Oestrogen, plus he considered I could maintain a more steady level of E that could be easier for him to read and keep track of.

Since end of April, up until now, so basically like almost 2 months, I have been taking my Estradiol sublingually and my labs showed my E dropped down to 50. I knew i was doing something wrong when the pill would sit soggy under my tongue for an hour or so.

He now suggested to swallow them. I read somewhere that the pill's bioavailability when swallowing it was only 5%. Clearly sublingually did not work for me, and I really would want to go back to injections.

What do you guys think about all of this?

PS: I drink A LOT of water daily, like around 4 liters a day, and I am worried that it may flush away the Estradiol and the Spiro that I'm taking.

Any thoughts? Suggestions? Some empathy and a helping hand would be amazing....... I am desperate i am 4 months in and haven't experienced any changes whatsoever.

xoxo

[Rachel]

Welcome to Susan's

Please check out the following links for general site info...
   

Things that you should read

Site Terms of Service & Rules to Live By	Standard Terms & Definitions	Post Ranks (including when you can upload an avatar)
Reputation rules	News posting & quoting guidelines	Photo, avatars, & signature images policy

[Rachel]

I am not a doctor so take what I say as just a comment.

I was on pills for 15 months and now I am on IM for 10 months My PCP does my trans care and they see thousands of trans patients. They do not measure E.

When I was on pills there would melt under my toung in 5 minutes. There are E pills meant for sublingual. I use to split my dose am ands pm. To measure E on pills is tough because the e varies so quickly through the day. IM I am on a high dose 9 day cycle. Through the 9 days my e varies. So when you measure the E it is just that moment in time.

I am not a doctor but 400 ng/dl does not sound high but it depends when measures and when the e is taken and type of e.

Spiro and water. I drink 3 liters of water a day plus.

Spiro effect is measured with your T count. My T is below 20 ng/dl. Above 50 ng/dl is a concern.

I am not a doctor and you need to review this with your doctor.

[farbanian]

Hi, thanks for answering!

But in your personal experience, would you suggest pills over injections? Or viceversa? I have a feeling injections are more effective, what do you think?

[Rachel]

We can not advocate one or the other.

For me and the personal experiences I have had I feel much better on IM and I have had better results. Keep in mind it takes time and patience is understated.

T is really important to suppress then E  needs to be adequate. If you have excess E it does nothing for you but increase chances of complications.

Talk to you doctor. I e-mail my PA-C and he is great.

[KimSails]

Hi farbanian,

I can share my experience with oral estradiol -- but with the understanding that people react to hormones very differently.

My endo has worked with transgender folks for decades.  He seems to be very highly regarded within the local transgender community.  I started HRT last August, about 10 months ago, on a very low dose -- Spiro and Estradiol, orally.  After three months I had my blood drawn and a checkup.  Blood draw showed testosterone levels very low and estrogen at 95.  At the time I had my blood drawn it had been a little over 24 hours since my last estradiol tablet.

My endo said the he likes to see estrogen in the 100-200 range for full-on transition. He said that my 95 on a low dose was nearly there.  Still, it was such a low dose that he doubled it.  My estrogen level at the next blood draw about 3 months later was about 240-something.  He has maintained that dosage since.

At work I drink about 80-100 oz/day (roughly 2-3 liters).  Not quite the same as your 4l, but still a lot of water. 

I had asked about injectables and bio-identical progesterone at my first appointment.  He wanted my to try the estradiol first, and discuss alternatives after six months. At a nine month check-up I asked again about progesterone. He said let's do that at the two-year mark. Clearly, he has his own opinions on what to do.  I can't really argue that his approach isn't working , because it is working for me.   I would like results to come faster, but that's not the way HRT works.

So, keep talking with your doctor. If you don't think your doctor has enough experience with HRT and transgender folks, then look for a different doctor.  If you think he has good experience, and seems to really want to help, then try what he says for a while.

Kim

[KayXo]

I have trouble understanding why he changed you from injections to pills. Ciswomens' levels range from less than 100 to up 640 pg/ml (mid-cycle peak) during their menstrual cycle, while levels skyrocket during pregnancy, going up to 75,000. So your 400 is far from high. On top of that, levels significantly fluctuate on injections so one measure is a not an accurate indicator of what is really going on. Finally, there have been studies on men with prostate cancer whose levels ranged from 400-700 pg/ml, men whose age ranged from 49-91 yrs old, who were given estradiol either transdermally or by injections and yet, no complications arose, none at all. There was no incidence of thrombosis or cardiovascular complications. In fact, one paper concluded that estradiol protected against the risk of thrombosis. Perhaps, you should share these papers with your doctor and see what they say.

I am doing significantly better on injections than on oral. Night and day! My levels have ranged from 2,500-4,000, blood tests are fine. I'm under the supervision of my family doctor and an endocrinologist, Cambridge graduate and treating TS women/men for several decades.  He actually said he wasn't surprised I did better on injections as, in his experience, these are by far, more effective.

To each their own...my own experience, and the info I've come across.

[Jenna Marie]

I think people's individual responsiveness varies, so that a given method is best for *a specific person,* but someone else might do better on something different. I'm mostly commenting to mention that my endo didn't bother checking E levels at all, since she believed that if T was properly suppressed and feminization was going well then everything was fine. It worked well for me, anyway. So according to that philosophy... on the one hand, the lower levels now need not be a concern for you if things are working; on the other hand, if it's NOT going as well since the switch, your doctor could as easily disregard the higher levels and put you back on injections.

I'm not going to make any suggestions except "ask your doctor," but my endo also used to say she didn't believe in "chasing lab values at the expense of the patient," which might be a phrase to remember.   If your doctor values hitting a specific target over what his actual patient is telling him, that's a worrisome sign.

(I was on patches, btw, very very low dose, and still got excellent results. Experiences vary.)

[Rachel]

Please keep in mind 1 ng/dl equals 10 pg/ml. So when Kayxo says 4000 pg/ml it equals 400 ng/dl.

My doctor asks how I am feeling and am I seeing results too.; they never measure E in the bloodstream.

[Laura_7]

Please keep in mind 1 ng/dl equals 10 pg/ml. So when Kayxo says 4000 pg/ml it equals 400 ng/dl.

My doctor asks how I am feeling and am I seeing results too.; they never measure E in the bloodstream.

On biweekly injections levels people report levels up to 9000 (but there often is a low phase during the last few days so weekly should be better imo).

Quite a few endos only give estro and bioidentical progesterone as hrt. The estro is enough to drive the t down. (works usually on implants and injections. Oral is not considered safe for really high doses).
The bioidentical progesterone is supposed to help with breast ducts, has some antiandrogen effects and evens out some side effects of estro.


Concerning effectivity of sublingual you could have a look here:
https://www.susans.org/forums/index.php/topic,190982.msg1703299.html#msg1703299


hugs

[KayXo]

If your doctor values hitting a specific target over what his actual patient is telling him, that's a worrisome sign.

Agreed.

[KayXo]

Oral is not considered safe for really high doses

As far as I know, there have been no studies so far on the effects of really high doses of bio-identical estradiol in people except perhaps that one study that examined VERY high and low-moderate doses in women with advanced breast cancer. These women were 50+ yrs old. There was only one incidence of DVT in the VERY high group, after 6 months, which is quite surprising.

The bioidentical progesterone is supposed to help with breast ducts, has some antiandrogen effects and evens out some side effects of estro.

I several times read (I have all the papers) that estrogen promotes duct development while progesterone promotes lobulo-alveolar development. Also, progesterone's anti-androgenic effect is quite weak, it doesn't significantly block androgens, nor does it significantly reduce testicular production unless taken by injection (inconvenient) or pellets. DHT inhibition was only found to be significant at levels that cannot be reproduced in humans.

[Laura_7]

As far as I know, there have been no studies so far on the effects of really high doses of bio-identical estradiol in people except perhaps that one study that examined VERY high and low-moderate doses in women with advanced breast cancer. These women were 50+ yrs old. There was only one incidence of DVT in the VERY high group, after 6 months, which is quite surprising.


I several times read (I have all the papers) that estrogen promotes duct development while progesterone promotes lobulo-alveolar development. Also, progesterone's anti-androgenic effect is quite weak, it doesn't significantly block androgens, nor does it significantly reduce testicular production unless taken by injection (inconvenient) or pellets. DHT inhibition was only found to be significant at levels that cannot be reproduced in humans.

Yes, I'd also go for bioidentical.

Well, people report better development of breasts overall with bioidentical progesterone... with form, some say with nipples, rounding out... even after being a while on estro already.
Some people also report a help with mood... helping evening out some...


hugs