Latest Hormone Levels - 21 Months

[allisonsteph]

My doctor checked my levels this weeks and my results are better than any other time in the past, but I still am not sure if they are ideal.

Estradiol: 163.6 pg/ml

Testosterone: 82 ng/dl

I have read so many different things about proper levels that I am beyond confused now.

[Girl Beyond Doubt]

Immediately before starting my HRT, my T was at 270 ng/dl and my E at 41 pg/ml.
Now, two years later, my T is below the detection threshold of 20 ng/dl and my E is at 95 pg/ml, but it seems to be fluctuating between 90 pg/ml and 250 pg/ml at my three-monthly checkups.
My trans-experienced endo says my hormone tuning is excellent and that we should not change anything.

This is from the Wikipedia article about estradiol (note the 30 pg/ml to 240 pg/ml range considered normal during the menstrual cycle):

[AnonyMs]

My levels levels in my last test were

E about 1000 pmol/L
T less than  0.4 nmol/L

This is with an estrogen implant and spiro. My endo replaces the implant when estrogen drops below 800 pmol/L.

You can see where these are on these two charts, for estrogen and testosterone respectively.

https://en.wikipedia.org/wiki/File:Estradiol_during_menstrual_cycle.png
https://upload.wikimedia.org/wikipedia/commons/c/cb/Blood_values_sorted_by_mass_and_molar_concentration.png

Your T is on the low end of female (I guess that's good) and mines way below (he said the test is not accurate in that range).

My E is significantly higher and I would be replacing the implant around 210 pg/ml by the look of it. So according to my endo standards your E is low. I've been on even lower, when I was doing low dose, and the difference to now is huge.

One difference might be that my estrogen levels are very constant since I have an implant. If you're not using one then presumably you're wold change depending on when you measured it. I've no idea how you account for that.

For what its worth my endocrinologist specializes in transgender medicine and sees a large portion of the transwomen in Sydney; I think he's very good.

I hope that helps.

[Maybebaby56]

According to the first chart you linked, 164 pg/mL is hardly low.  It is above average for all but peak values during ovulation. In contrast, I just started HRT in August, and my initial estradiol level was 27 pg/mL.  As of last month, it was 35 pg/mL.  My end doubled my E dose this month, so I will be interested to see what my estradiol levels are next month.

Terri

[AnonyMs]

According to the first chart you linked, 164 pg/mL is hardly low.  It is above average for all but peak values during ovulation. In contrast, I just started HRT in August, and my initial estradiol level was 27 pg/mL.  As of last month, it was 35 pg/mL.  My end doubled my E dose this month, so I will be interested to see what my estradiol levels are next month.

I was down around 50 pg/mL for some years, and there's a big difference to where I am now. I thought my breasts had stopped growing, but they restarted again! There's was a big emotional improvement too.

[Joi]

My endo is being  IMO a bit too conservative. In Mar. he started me  (with the patch) and  after 90 days my E level was only 32. In Aug. tested again. E @ 40. At that point he dbled. the dose saying he wanted to see it at under 200 which I thought would be a good target.  Tested again in Nov. E @ 70.  He thought that that was fine, but I disagreed as I have seen little to no effects.  My the test. levels are very low and this has resulted in changes, but no feminization apart from a slight sensitivity in the breasts from time to time from the e..  I convinced him to increase the E dosage again. Thus from the start I have tripled the dosage.  Will test again in Dec. to see if this works.  If it dbls. to 150, think that would be appropriate.  Running out of room on my backside for patches. He suggested injections, but I declined that, too many swings in the levels.. He wont prescribe pills due to my age and the possibility of thrombosis. We'll see what Dec. brings. 

[Maybebaby56]

My endo is being  IMO a bit too conservative. In Mar. he started me  (with the patch) and  after 90 days my E level was only 32. In Aug. tested again. E @ 40. At that point he dbled. the dose saying he wanted to see it at under 200 which I thought would be a good target.  Tested again in Nov. E @ 70.  He thought that that was fine, but I disagreed as I have seen little to no effects.  My the test. levels are very low and this has resulted in changes, but no feminization apart from a slight sensitivity in the breasts from time to time from the e..  I convinced him to increase the E dosage again. Thus from the start I have tripled the dosage.  Will test again in Dec. to see if this works.  If it dbls. to 150, think that would be appropriate.  Running out of room on my backside for patches. He suggested injections, but I declined that, too many swings in the levels.. He wont prescribe pills due to my age and the possibility of thrombosis. We'll see what Dec. brings.

We must have the same endo, lol!  He is very conservative, but he knows I am frustrated and tells me to be patient.  I have seen some changes as far as skin oil, and breast development.  One of my girlfriends says my skin is smoother and the pores are smaller (I can't really tell to be honest).

Unfortunately, there are some other changes which are not so good. My fasting blood sugar went from 96-99 mg/dL to 115 and my creatinine levels are above normal.  The latter could be, ironically, from the low-carb, high-protein diet I drifted towards to keep my blood sugar lower, and also not drinking enough water.  I am trying to train myself to drink more water during the day.

I am in the same boat as you, Joi. I am 58 and can't take oral estrogens.  I am on patches, and already have one on each cheek.  My insurance prefers mail-order delivery, and they switched my prescription to a generic Climara, which is a once-a-week patch, as opposed to the twice-a-week Vivelle dot, and it is taking a toll on my skin.  I have a series of red marks on my rear end, from previous applications.

The only option I can see is injections, and I am not wild about that, because of the swings in blood levels, and the simple fact I have a $20 co-pay every time I walk in to a doctor's office.  I'm not sure I could do self-injections.   

[Maybebaby56]

I was down around 50 pg/mL for some years, and there's a big difference to where I am now. I thought my breasts had stopped growing, but they restarted again! There's was a big emotional improvement too.

That's good to know.  Thanks!

Terri

[jenifer356]

Vivelle now comes in a generic package - ironically made by same company (Sandoz - a division of Novartis) in same factory as the name brand - I was originally put on the Mylan once a week generic but had problems with irritation, rashes and constant falling off

be well
jenifer

[Joi]

Maybebaby 56: Yes, conservative treatment is the rule.  I like the word cautious better. When we get the green light to become truly us, the impatience levels go off the charts.  I think the older we are the worse it gets because we have missed so much of our chances for self expression and our timeline is shorter.

I'm using the "Alora" patch.  I've heard a lot of the girls complain about adhesion isssues, I've had very few with this patch & I'm using 3 - 2x per week now.

Hugz,
Joi

[Mariah]

Allison, my doctor likes keep mine slightly below 200 for my Estrogen levels. So your level isn't to bad in the 160's. He likes to stay conservative and isn't the only doctor of mine keeping an eye on the levels besides the GP on me. Hugs
Mariah

[KayXo]

He suggested injections, but I declined that, too many swings in the levels..

If injections (of estradiol valerate) are administered frequently enough (usually every 7 days, 5-10 days), there won't be significant swings and you should feel fine. I inject every 5 days and I'm fine.

Unfortunately, there are some other changes which are not so good. My fasting blood sugar went from 96-99 mg/dL to 115 and my creatinine levels are above normal.  The latter could be, ironically, from the low-carb, high-protein diet I drifted towards to keep my blood sugar lower

Low carb high protein can be harmful for one's health. You need a source of energy, either fats or carbs. If one decreases carbs, one must increase fats (including saturated, read the latest Atkins book from Volek, Westman and Phinney) to compensate. Protein is not an effective source of energy and too much can also lead to increase in blood sugar but like I said, protein is not a main source of energy. Low carb, HIGH protein can lead to rabbit starvation, sometimes fatal. Please read about it.

Too little estrogen can impair insulin sensitivity, increasing blood sugar in the process. Some anti-androgens/progestogens (Androcur) can also affect blood sugar, I think. Creatinine can be increased due to spironolactone or perhaps too much protein.

also not drinking enough water.  I am trying to train myself to drink more water during the day.

On spiro, one needs to drink more water and eat more salt. Low carb also increases the need for salt or else, you might suffer from dizziness, fatigue, headaches, heart palpitations.

The only option I can see is injections, and I am not wild about that, because of the swings in blood levels, and the simple fact I have a $20 co-pay every time I walk in to a doctor's office.  I'm not sure I could do self-injections.   

Injections do not cause swings if administered FREQUENTLY enough AND I was scared of needles, like deathly afraid and do them on myself now.

Allison, my doctor likes keep mine slightly below 200 for my Estrogen levels. So your level isn't to bad in the 160's. He likes to stay conservative and isn't the only doctor of mine keeping an eye on the levels besides the GP on me. Hugs
Mariah

There is no ideal level for everyone, doctors disagree and there is no scientific ground on which to state that a certain range is ideal for optimal development in transsexual women. People differ, what works for one may not for the other. I needed levels well above 200-300 to trigger positive physical changes.

[Joi]

When my endo made the statement that a level of 70 was within the "guidelines"  I almost fell out of my chair. Just a few months earlier when my levels were at 41 he said that he felt that a level just under 200 would be his preferred target.

We know if the hormone therapy is working or not and at 70 I knew it was not.   After 8 mos., I knew that I needed more and expressed my position to him.  He agreed to increase the dosage again and test again in 30 days.

We need to be pro-active on this aspect of our transition sometimes. 

[Jessie Ann]

I am so glad I have an experienced Endo who put me on injections right from the start. It is really not hard to do. My insurance has mail order and I get 3 vials for $20. I don't have to take Spiro because I was on Avodart which is a good blocker. My last T test had me at a very low female level and my E level was very good high normal female level.  An Endo who has experience with trans patients is indispensable and a major asset in transition. I am so lucky to be in LA where I have a therapist, Endo and electrologist who are all very experienced in treating trasngender patients.

If you are having issues with getting proper treatment you may need to look at changing doctors. We really are the best judges of how we are feeling the effects of our medications. I'm on the older side at 54 but I have made a pretty drastic change over the last 8 months.   

[judithlynn]

At my last check up my E Levels were 197 pg/ml, with my doctor aiming for an average of 240 pg/ml with my T levels now at 4.5 (spiked from 2.5 a year ago), which he wants down to a maximum of 1.5 which then will be well within normal female hormonal range. What he indicated was that it was OK to fluctuate between 150-250 on a monthly cycle, but that I do not want to drop below an average of 200 pg/ml.
Judith

[KayXo]

We need to be pro-active on this aspect of our transition sometimes.

Agree.

I don't have to take Spiro because I was on Avodart which is a good blocker. My last T test had me at a very low female level

Just to clarify, spironolactone and dutasteride (Avodart) do not work the same way and Avodart is not a good replacement since it only reduces conversion of testosterone to DHT by inhibiting alpha reductase activity while spironolactone BLOCKS androgen AND reduces levels of testosterone. Avodart on its own does not reduce testosterone levels, just DHT levels.

The reason your T is so low is because of E.

At my last check up my E Levels were 197 pg/ml, with my doctor aiming for an average of 240 pg/ml

I personally don't see how we can aim in advance for a certain level of estradiol as everyone is different and reacts differently. There is no scientific basis on which to say that a certain level is optimal for everyone. Like I said, at levels between 200-300, I didn't have much change, if any. Some will, some won't. It would have been disastrous if my doctor thought a higher level was useless and that I was doomed to what I was getting. That's the problem with aiming for a certain level, it can harm people who would do well on higher levels like me.

with my T levels now at 4.5 (spiked from 2.5 a year ago), which he wants down to a maximum of 1.5 which then will be well within normal female hormonal range.

Can you please state the measure? I'm assuming it is neither ng/dl or nmol/L. Ng/ml? Optimal level of testosterone is also very much an individual thing, some feel better on a higher level, others lower.