Doctor asking me what dose I want

[Asche]

I've been on estradiol and spiro for a month now, and I saw my doctor for the second time today.  I assumed I'd get blood tests and she'd decide, based on what she saw and what I described of my experience so far (not much), what dose I should get for my next prescription.

Instead, she asked me whether I thought I should increase either one of them, and how much.

To be honest, I was gobsmacked.  I mean, everybody says, ask your doctor, they're the ones who can tell what's safe and effective.  If the doctor has to ask _me_, why not just buy the stuff off the internet?  (Rhetorical question.)

I asked her, well, how would I know that I would want to increase the dose of either?  She just said some people really want to increase their dose of one or the other, and they go along with it.  Mind you, this is a well-known place that specializes in health care for the LGBT community.

Anyway: what are the things that would make it a good idea for me to ask to increase the dose of estradiol or of spiro (or both)?  And what things would make it a good idea to ask to keep them the same (or reduce them)?

Obviously, side-effects would be a reason, but I assume if I'd reported side effects, she would have said something, so I assume it's other stuff.

Any ideas?

P.S.: I am not asking about specific doses, which is rightly against the TOS, just what people would consider good reasons to ask the doctor to change the dose one way or another.

P.P.S: I am not dissing the doctor, either.  She seems competent enough and the center's combined experience with trans health is huge.  It's just not anything I expected or anything I quite know how to respond to.

[Tysilio]

It sounds like she has a lot of patients who are frustrated with their progress, and they assume that more is always better.

The best response would be to ask her what positive effects you could expect from increasing dosages, and what the negative consequences might be, if any. And I guess the question to ask yourself would be whether you're happy with how fast things are changing.

It's also possible that she started you on lower dosages, and she's just open to raising them. She sounds like the opposite of a gatekeeper (whatever that would be), anyway, and that's all to the good!

[AnonyMs]

I'd ask for blood tests and an implant.

[suzifrommd]

Anyway: what are the things that would make it a good idea for me to ask to increase the dose of estradiol or of spiro (or both)?  And what things would make it a good idea to ask to keep them the same (or reduce them)?

My doctor always makes his decisions based on my blood levels. If I'm normal for a cis woman, he keeps them the same. If I'm high E, he lowers the dose of estradiol, if I'm low E he raises it. Opposite for the T when I was taking spiro.

[KayXo]

My doctor always makes his decisions based on my blood levels. If I'm normal for a cis woman, he keeps them the same.

Normal for a woman can be anywhere from 20 pg/ml (follicular phase) to up to 640 pg/ml (mid-cycle) and even 75,000 pg/ml (pregnancy, third trimester) as women go through menstrual cycles, womens' levels vary alot (as do labs' ranges) and women get pregnant which is also a natural and frequent occurrence in ciswomen so whatever level you end up with, you will be in the range. Blood levels of E don't really seem to reveal much. Who's to say it's high or low? Doctors disagree and arbitrarily choose a range, based on no scientific studies whatsoever.

I think if you feel alright, if test shows no abnormalities, if feminization is going well, then why change things, whatever the levels are? That's just me...

[Ashey]

Helps to do your own research on what you put into your body. My endo doesn't know too much in relation to my situation so it's all a big experiment. I often ask to be put on something or for certain doses, but my endo has reviewed my blood-work and given the occasional recommendation, like my E levels were on the high side so I didn't need my dose upped. Which, I probably could have figured out if I had looked at the results and checked against normal ranges. A bit frustrating, but I think either way it'd probably be trial and error.

[Dena]

I was never given this option but you need to decide if you want low dose or transition dose as well as have a blood test run so you know where you currently are as far as blood levels. If you are comfortable with low dose, have the doctor target that. If you want a little more speed, target mid range, if you are in a hurry, go with a transition dose. The test will also tell you if the spiro is doing it's job. If the side effects from sprio are a problem, possibly you can back off on it.

Get the information you need from your blood work and see how it fits in your transition time table.

[Debra]

Yeah I'd have the doc check your levels AND check your platelets.

Make sure both E and T are where they should be (and note the time of your last dose when getting the blood test because it does matter).

Check platelets as well to make sure as you go along that your clotting levels are safe.

[Asche]

I think if you feel alright, if test shows no abnormalities, if feminization is going well, then why change things, whatever the levels are? That's just me...

I haven't noticed any feminization yet.  I just figured it's because it's only been a month (and I've always been slow, anyway )

[KayXo]

Make sure both E and T are where they should be

Where E and T should be depends on the person and is subject to debate. But, as always, follow doctor's recommendations.

Check platelets as well to make sure as you go along that your clotting levels are safe.

If bio-identical E is taken, especially non-orally, clotting is not significantly affected and can even be less of a risk as well as atherosclerosis. This issue mostly comes up when estrogen (or some progestins) that are not bio-identical are taken.

I haven't noticed any feminization yet.  I just figured it's because it's only been a month (and I've always been slow, anyway )

A month is too early. Wait a few months.

[stephaniec]

I'm guessing she's just getting a sense about how you feel. I was on patches for two years and thought I was doing pretty good. I started on injections a few weeks ago and my breasts feel more sensitive than they have for a long time

[whereto]

be sure to ask her about your blood test level and go from there. i think she just wants to see if you want to up your dose or not. it seems like a lot of LGBTQ know thoroughly about these kinds of thing, they tend to ask for more doses with their doctors. she may just wrap her head around that way. but at least you have choices ^^

[Debra]

If bio-identical E is taken, especially non-orally, clotting is not significantly affected and can even be less of a risk as well as atherosclerosis. This issue mostly comes up when estrogen (or some progestins) that are not bio-identical are taken.

There are other factors however....like genes that make you more likely to clot. My adopted mom who was trans was on a high dose of bio-identical estrogen and the doctor did a piss-poor job at monitoring anything apparently.

She ended up with clots in her legs and never got to go on estrogen again.

Through my own doc, I've had my dosage up'd fairly high (esp for post-op) and seen my platelets raise a bunch as well such that I decided I should jump back down on my dosage.

But after what happened with my mom, I am of course biased and afraid of something similar happening.

[KayXo]

Of course, if you are genetically predisposed, that is another matter. BUT Was she and are you only taking bio-identical estradiol? Nothing else? Would the clot have occurred regardless of whether or not she took estradiol? The same can be asked of you with platelets, did these only occur when you increased dose or was it the passage of time or perhaps some other factor that eventually caused this (age, diet, circumstances, change in other medication).. things to consider before jumping to conclusions. Non-oral bio-identical estradiol would definitely be the way to go if you want to be 100% sure as studies have shown this to be quite safe, even in higher doses. I know transwomen genetically predisposed with Factor V Leiden who did not have any problems on high dose EV injectables and I mean, really HIGH!

[allisonsteph]

The sad truth is that many of us have done far more research than our doctors have. My doctor told me that I am the first trans patient that she has ever treated. If I come to her asking for a change of dosage or request adding something to the mix she will say she needs to do some research and gets back to me in a few days. The other thing is that as others have pointed out how you feel is more important than numbers are. I agree with that wholeheartedly.

[Debra]

Of course, if you are genetically predisposed, that is another matter. BUT Was she and are you only taking bio-identical estradiol? Nothing else? Would the clot have occurred regardless of whether or not she took estradiol? The same can be asked of you with platelets, did these only occur when you increased dose or was it the passage of time or perhaps some other factor that eventually caused this (age, diet, circumstances, change in other medication).. things to consider before jumping to conclusions.

Yes she only took estradiol. I have taken progesterone as well.

You're right it could be many things....but when you see your platelets go up significantly and the only thing you've changed over the past year is your dosage.....it tends to make sense.