Proper Hormone Levels For MTF

[Azurefrost]

So, I recently had my next set of blood work and my estrogen values were sitting at 86.9pg/ml. My doctor today said that she would be ok upping my dosage by half of what I'm currently taking after I questioned her about what I feel to be a bit low blood test results, but she strongly discouraged it saying there isn't any evidence that upping my hormone levels will help from what she's read. She seemed a bit cautious and she once again brought up the risks associated with these meds. I've been on hormones for about 7 months now. I've been reading that I should really be more in the 200pg/ml range. What do you guys think? Is there anything I might be able to bring up with her?

Thanks!

[Ms Grace]

I'm sure my doc uses a totally different scale when telling me my levels... it all goes straight over my head and I never write them down anyway.

While I'd be inclined to say trust your doc, the question I'd ask is, how much experience does she have with prescribing HRT for M2F? If the answer is "not much" then it's probably best not to pressure her into more since she could potentially give you an inappropriate dosage - I'd suggest finding another endo for a second opinion. If the answer is "a lot" then I'd suggest trusting her on this but if you're still not happy then maybe ask for a different delivery method or find another endo for a second opinion.

[Azurefrost]

She supposedly has worked with a lot of MTF, but it still seems -very- low. Generally I'm hearing that others have same measurements nearly double mine. If it helps, I'm 23 and generally in picture perfect health...

[Ms Grace]

My understanding is that everyone has different levels. Person A on X dosage may have higher levels than person B on the same dosage. However, giving person B a 2X dosage (or 1.5X, or whatever) might actually be dangerous to their health and still make no difference to their levels. It's best not to compare your levels to others but chat with your doc about other delivery methods, or different HRT meds some can be more effective for some people than others. Regardless they do all come with risks as I'm sure you'd understand.

[AnonyMs]

I like this chart (Wikipedia also has a chart from T)

https://en.wikipedia.org/wiki/File:Estradiol_during_menstrual_cycle.png

My endo replaces implants when the blood levels drop below 800pmol/L, which is around 210pg/mL. I'm usually higher than that of course, 1000+. Implants are very stable, so levels only change very slowly, and I assume you get a reasonably accurate measurement. I understand that other forms of HRT are all over the place depending on when you take them. I'm not sure if this makes any difference.

I've heard quite often that many other doctors prefer a much lower level. I was on around 50pg/mL (on purpose) for a long time and its dramatically better now.

I suspect most doctors don't have a clue what they are doing, but I don't know which ones are which.

[Ms Grace]

...800pmol/L, which is around 210pg/mL...

ah, picomols per litre... that's why I could never figure out his system!!

[MichaelaLJ1972]

My pre-hrt labs had my estrogen at 201.7 pg/mL. I guess I feel pretty lucky after hearing from so many others who are trying to reach that. I have my first labs while on HRT on March 1 so I am pretty interested in seeing how low dose is working. I really do hope everything goes well for you on your journey!

[Lyndsey]

Hi Grace
My Doctor dropped my dosage by 1/3 because my reading was 526 pg/ml way to high. But I'm Post-op

Hugs Lyndsey

[Mariah]

My doctor tries to keep mine around 200 pg/ml. Hugs
Mariah

[KayXo]

So, I recently had my next set of blood work and my estrogen values were sitting at 86.9pg/ml. My doctor today said that she would be ok upping my dosage by half of what I'm currently taking after I questioned her about what I feel to be a bit low blood test results, but she strongly discouraged it saying there isn't any evidence that upping my hormone levels will help from what she's read. She seemed a bit cautious and she once again brought up the risks associated with these meds. I've been on hormones for about 7 months now. I've been reading that I should really be more in the 200pg/ml range. What do you guys think? Is there anything I might be able to bring up with her?

Thanks!

What are the risks associated with higher estradiol levels? I have levels that range from 1,000-4,000 pg/ml, I'm post-op and so far, my blood test results have come back normal (liver panel, clotting factor, lipids, glucose/insulin, etc.). Pregnant women have levels that go as high as 75,000 and the risk of DVT remains very low. It's also been observed that the more pregnancies, the lower the risk of breast cancer. Finally, studies on men with prostate cancer found that levels between 400-700 had no adverse effects on health and actually protected against the onset of thrombosis. Your doctor may be confusing non bio-identical estrogen with bio-identical estrogen.

[luna nyan]

ah, picomols per litre... that's why I could never figure out his system!!

Lol

I'm usually somewhere between 300-600 these days - obviously higher immediately after implant refresh.  Next to no T to speak of and that's with no progesterone in the mix.

[Lyndsey]

Lol

I'm usually somewhere between 300-600 these days - obviously higher immediately after implant refresh.  Next to no T to speak of and that's with no progesterone in the mix.

I know the feeling Mine is around 537 now and I'm post-op from October 2015

Hug's

[Maybebaby56]

What are the risks associated with higher estradiol levels? I have levels that range from 1,000-4,000 pg/ml, I'm post-op and so far, my blood test results have come back normal (liver panel, clotting factor, lipids, glucose/insulin, etc.). Pregnant women have levels that go as high as 75,000 and the risk of DVT remains very low. It's also been observed that the more pregnancies, the lower the risk of breast cancer. Finally, studies on men with prostate cancer found that levels between 400-700 had no adverse effects on health and actually protected against the onset of thrombosis. Your doctor may be confusing non bio-identical estrogen with bio-identical estrogen.

Kay,

Those numbers can't be right, if they are pg/mL.   Peak estradiol levels for women who are ovulating are usually less than 400 pg/mL (see chart cited by AnonyMs).  Here are typical numbers:

Male   < 60 pg /mL       

Females ovulating   Early follicular   Late follicular    Luteal phase
pg /mL                   30 - 100           100 - 400           60 - 150

Pregnant   First Trimester   Second Trimester   Third Trimester
pg /mL     190 - 2460        1280 - 7190            6150 - 3460

Postmenopausal   < 18 pg /mL

I doubt Azure's doctor is confused about estradiol. You would have to be completely clueless as an MD. Serum E2 levels are determined by enzyme immunoassay. The assay does not measure equine estrogens or semi-synthetics like ethinyl estradiol. 

~Terri

[KayXo]

My levels range from 1,000-4,000 pg/ml. These numbers ARE CORRECT. These levels have been verified several times by two different labs.

I have several sources showing that levels during pregnancy can range from 1,000-40,000, up to 75,000 before giving birth. Levels are in pg/ml. I can send them to you privately if you want.

[Maybebaby56]

Hi Kay,

I am hesitant to get into any debate about hormone levels, since that it is a clinical decision made by your endocrinologist, and I am chemist, not a medical doctor.  I read the scientific literature, and I have a casual interest in what other transgender women have observed. Your results are not typical if we are talking about free estradiol levels, and not including SHBG- and albumin-bound E2.  About 98% of E2 in the blood is protein-bound, so if your numbers include total estradiol, that could account for the large difference in your blood levels and everybody else's.

My free serum estradiol levels are now about 36 pg/mL.  They started at 27 pg/mL before going on the patch four months ago. I have experienced breast  growth, skin changes, including decreased body hair growth, less sebaceous gland activity, and changes in body odor.  And of course, mental changes.

My liver enzymes are normal, but I am experiencing an increase in my triglyceride levels and blood glucose levels (but not A1C), as well as some elevated creatinine levels, and it is something I am concerned about.

I guess all I wanted to add for anyone reading this thread is that the best levels are those that will achieve the desired degree of feminization with the least health risk, and that is an individual matter.

With kindness,

Terri

[KayXo]

Your results are not typical if we are talking about free estradiol levels, and not including SHBG- and albumin-bound E2.

Estradiol that is almost always measured in people in general is TOTAL estradiol, VERY rarely free estradiol. So, yes I meant total estradiol, not free.

About 98% of E2 in the blood is protein-bound, so if your numbers include total estradiol, that could account for the large difference in your blood levels and everybody else's. My free serum estradiol levels are now about 36 pg/mL.  They started at 27 pg/mL before going on the patch four months ago.

I think you may be mistaken. Your estradiol and that of others reported, including mine, are total estradiol. The numbers you provided earlier are also total estradiol.

Free estradiol levels are MUCH MUCH lower. Range in ciswomen (probably higher during pregnancy) is 0.6 - 7.1 pg/ml according to this source. For males, 0.2-1.5.

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/91215

Also they indicate that between about 1.5 and 3.5 % in women is free estradiol, meaning 98.5 to 96.5 % is bound to SHBG and albumin and that number (percent of free estradiol) is slightly higher for males, 94.6 is bound.

36 pg/ml is a low number BUT the important thing is feminization and health, also well-being.

My liver enzymes are normal, but I am experiencing an increase in my triglyceride levels and blood glucose levels (but not A1C), as well as some elevated creatinine levels, and it is something I am concerned about.

My triglyceride levels are normal, so is glucose, insulin, HbA1C (measured last year) and creatinine. I don't take anti-androgens though. My levels of estradiol are high while my progesterone levels range from 13-20 ng/dl. I am careful with my diet, so restrict carbs as these tend to significantly raise triglycerides. I was under the normal range once when I restricted all carbs! And my HDL was wayyyyyyy high! Glucose, HbA1C, and insulin are also adversely affected by too many carbs, more so in some than others.

I know that, in a few, creatinine is adversely affected by spironolactone.

I guess all I wanted to add for anyone reading this thread is that the best levels are those that will achieve the desired degree of feminization with the least health risk, and that is an individual matter.

I agree.

Happy new year to you and everyone. Health, peace of mind and lots of fun. Do as your heart desires.

[Laura_7]

Well a rule of thumb for decent feminization for many people is 200pg/ml estrogen and 50 testosterone.
Of course individual reactions vary and its also a matter of form of application.
With internal applications like implants and injections there are very few studies showing adverse effects with higher doses.
Some endos even use higher doses of estrogen which can drive down teststerone into the female range. So no anti androgens are needed. Anti androgens also have side effects.
As said its only considered safe with implants and injections.

And any endos ask how people feel . Its not only blood levels. (Treat the patient not the lab ).

Additionally bioidentical progesterone could be helpful.
Its also present in natal females and can help with breast development, possibly with mood and some side effects of estrogen.


hugs

[KayXo]

Well a rule of thumb for decent feminization for many people is 200pg/ml estrogen and 50 testosterone.

I disagree. Where are the studies proving this? Levels also don't stay put, they move up and down.

With internal applications like implants and injections there are very few studies showing adverse effects with higher doses.

There are NO studies as of yet showing adverse effects. If there are, please let me know.

As said its only considered safe with implants and injections.

I'm not convinced of this either as I think bio-identical estradiol in general, even when taken orally, is quite safe. This is just my opinion based on everything I read. I'm not a doctor.

[Laura_7]

I disagree. Where are the studies proving this? Levels also don't stay put, they move up and down.

As said its a rule of thumb.
Its from people asking other endos and watching peoples progress.
Of course people are individual.
And some endos do not give much to levels because it shows free substances and not absorbed ones.
They rather ask how people feel and watch overall health.

I'm not convinced of this either as I think bio-identical estradiol in general, even when taken orally, is quite safe. This is just my opinion based on everything I read. I'm not a doctor.

With oral, not sublingual intake, there is a certain strain on the liver because it immediately breaks down part of the estrogen. Also not really wanted estrogens like estrone are produced. And clotting factors may rise. The liver seems to suppose an internal leak.

So risk seems higher with oral intake, still present yet lower with sublingual intake for really higher doses.


*hugs*

[Joi]

I'm 9 mos. into cross sex hormone therapy.  I've been on the patch.  Initially one, then two, then three.  Total E levels only moved from 31 at 90 days (one patch)  42 at 120 days (2 patches) 76 at 180 days (3 patches). Little feminization.
Some breast tenderness, mental changes, body odor. T is very low.  My endo is taking me off the patches in favor of injections.  His target was around 200.  We'll see if this change is effective.  Have to stop all hormones next week in prep. for GCS.  Who knows what will work after my surgery.

Bring it on!  I'm down for this!