Should I insist on raising my estrogen dosage?

[Ruth Ruthless]

Hey people, tomorrow I'm having my check up with my endocrinologist and I've been 2 years on hormones.

They haven't done that much to change me. Mostly removed the bags beneath my eyes, made my skin softer and possibly maybe not sure made my cheeks a tiny bit fuller. The endo claims the hormones are working because my breasts are in her opinion fully developed, just small.

My endo seems to not want to raise my dosage even though my levels in the last test was: 43.8 pg/ml

And today I got 49.3 pg/ml

Usually my E2 levels were more around 68-90. In the first six months I had much higher levels, 160, 189... but then my levels dropped despite same or higher dose. I switched to gel eventually, and then we got a measurement of 199 with the highest dose we tried, but it quickly went down to 68-90 with the same high dose, and now 43.8 and 49.3 with a bit of a lower dose.

My T level is 2 nmol/l, last test was 1.6 nmol/l, and the rest of the results are below 1.5 nmo/l. The test range doesn't go below that. So T rose a bit, and I have been getting morning erections again sparingly (never had those with T <1.5 nmol/l), but no change to my actual sex drive (still pretty much zero).

I used to have bigger breasts when I started but I also weighed more because I ate more junk food (I'm vegan) and I had a really huge belly sticking out even though generally I am skinny. Now that I eat more whole plant foods I weigh less and I have less ass and less boobs but also much less belly, so overall my figure seems more feminine to me avoiding the junk food.

Still, I'm wondering if I get higher estrogen levels maybe my breast could grow a bit more and maybe my cheeks could fill up just a bit more and I'm hoping they could do that without inflating my belly the way oil and processed food does. I know I'm going to need surgery either way and hormones aren't doing enough for me, but my endo is pretty conservative about doses and I'm wondering if perhaps it's worth insisting she raises the dose back to the highest one in the hopes it might help get my breasts and cheeks a bit bigger? Or should I just let it go and hope the surgeries make enough of a difference?

[Dena]

Something you didn't mention is are you on a blocker. I was on a high dosage for almost 5 years before surgery and had a small amount of development. After surgery, the dosage was 1/4 the max dosage and I continued to develop. Blockers weren't available and I suspect my T levels were reducing my E levels. Unfortunately, blood hormone levels were never checked in those years so it is an unproven theory.

The problem with losing all that weight is you can't control where you lose it. In addition, you may not respond well to female hormone and could end up with a rather boyish figure like mine instead of a shapely feminine figure.

If you aren't on on blockers, I would think a higher dose would be needed before surgery to maintain the proper blood transition level however, the time of day you take the estrogen and when the blood draw is taken can greatly alter the blood test results.

[Ruth Ruthless]

I am on Androcur blocker and Estrogel. Used to take Estrofem instead of Estrogel, but when my E kept dropping we tried switching to gel and it started high and then dropped again.

Whenever I eat processed food, even for 1 or 2 days my belly becomes very very big, I can't tolerate it. It makes my already small breasts look even smaller, because when my belly is small enough the shirt clings to the breast which becomes visible, but if my belly is huge the shirt hangs on the belly and you can't see the bulge of the breast. It takes 1-3 weeks for my belly to get small again and undo the damage of just 1-2 days of eating processed food. I'm now 2 months without junk food at all and my LH and FSH were actually in normal range for the first time since I started HRT.

[Ruth Ruthless]

Also whenever I eat processed food it's like an emotional rollercoaser, maybe the fat in my blood activates a flood of estrogen, I don't know... but I feel really good while eating and the moment the last bite is done I feel an emotional crash. Could also be just my self judgement... but I never have emotional crashes eating whole plant food and I'm more stable emotionally.

It's possible the low fat content of my food helps keep me emotionally stable but perhaps also dampens estrogen levels. Just a theory... having high fat whole foods doesn't effect me emotionally like processed high fat foods do, so I have as much of those as I want - nuts and seeds, though I don't tend to want to eat a lot of those anyway. Fruits, whole grains and legumes are my main calory source and keep me energized and more emotionally stable.

[Dena]

I have a totally unproven idea about the blockers, male and female hormones. My half baked idea is the body tries to control the level of the total of the blockers, T and E. What this means is if your T levels approach zero, your blocker and E levels may be to high and the excess is removed from the body in the proportions they exist in your body. That would mean in some people lowering the level of blockers, allowing T to come up a small amount may result in higher E levels.

I am not a doctor but if the idea is valid, it could explain why I see a number of post where people complain about low E levels.

[Ruth Ruthless]

My blocker dose is pretty low. One time we tried bumping it down a notch to try and get back my sex drive, and my e and t were male range again and my full sex drive returned like without HRT.

Since then I don't care about not wanting sex, I accepted it. Point being, lowering T again down a notch would probably make my levels in male range again.

[Ruth Ruthless]

Also I always do my tests 12-15 hours after the last time I took hormones.

[Laura_7]

As a rule of thumb many endos strive for levels of 200 pg/ml or above.
Higher levels might also be beneficial for well being.
If your levels do not rise with current intake, are there any changes that could help ? Using different places for creams ... changing daily ... or a different form of application. Many people are happy with injections or implants.
Another strategy could be patches or a cream for steady levels and additionally sublingual bioidentical estrogen tablets.

Another idea might be bioidentical progesterone, it might help with breats development, and even out some side effects of estrogen.
Many people said form changed from conical to more rounded.


hugs

[Ruth Ruthless]

My endo says not to look at the levels and look for clinical changes. Well, I've never noticed any clinical changes I can be sure to attribute to hormone levels. There was perhaps a very slow progress over the 2 years regardless of levels at any given point.

Changes that are immediately apparant seem to come only from changes in exercise and nutrition, i.e. I stop exercise I get a tiny bit less athletic figure, or if I eat processed food my belly inflates hugely and it takes weeks of healthy eating to reduce it. No other visible changes to appearance that I've noticed besides having lost the bags under my eyes which could be from hormones or from nutrition, but that hasn't changed. They're gone and haven't come back.

As for well being, every time I raise the E dose I get an emotional crash similar to the one I get from junk food but after a week or two on the new dose it goes away.

As for options of treatment, my only supervised options here as an mtf in Israel are Androcur or Spiro for blocker, Estrofem or Estrogel for estrogen. Nothing else. They don't support anything else and don't want to hear about anything else.

I'm already used to Androcur and I like that I'm not straining my liver with gel rather than pills, the question is, is there any point in raising the dose?

[Ruth Ruthless]

As for placement should I try to look for areas with visible veins?

[Laura_7]

You might :
-ask them for a combination of estrofem and estrogel.
Estrogel for a steady dose. So mood stays good.
Estrofem for higher levels. Taken sublingually there are spikes in levels. Thus additionally the gel, to keep levels and thus mood more steady.
I would agree that levels in itself are not that important.
But levels below 60pg/ml are in menopausal level and menopausal women usually do not feminize much .
You might tell them that, and that levels should be in the territory of a normal woman with about 200 pg/ml or above.

testo levels should be ok with below 3  .


hugs

[Laura_7]

As for placement should I try to look for areas with visible veins?

Look into the manual.
There are different possible positions.
If I recall it was inner arms and upper inner arms, covered by clothing some time after application.
Some people use the part of the inner arm below the hand to apply.
This way hands do not need to be washed which might take away part of the dose.

You might also see if it makes a difference if the area is washed before with warm water and dried then, to open pores.


hugs

[Dena]

Idea. I did an internet search and found Estradiol is almost insoluble in water, freely soluble in alcohol and partially soluble in vegetable oil. With your diet changes, there may not be enough oil in your diet to carry the estrogen into your system and as I suspect you are a non drinker there isn't alcohol to dissolve the estrogen. Possibly by altering your diet or the time you take your medication, you will be able to improve your test results. I agree with Laura_7 that the levels should be higher. At least above 100 and maybe close to 200.

This idea would be more like to apply if you are using pills instead of gel.

[Ruth Ruthless]

I don't drink alchohol, no. I hate how it tastes.

As for oil, oil is exactly what causes my huge belly problem and makes me look less feminine by way of my belly outshadowing whatever growth my breast and hips get. It does make my breast and hips grow a bit, but not nearly as much as my belly... also, it's amazing how fast it can catch on my body.

I don't know if it's water weight or fat weight, but my body stores whatever it stores really fast if I eat oil or processed food, I can pack on an extra kilogram a day, when comparing the morning before to the morning after... and half of that weight isn't lost immediately the next day if I go back to eating healthy, half of what I gain takes weeks of healthy eating to lose.

[Dena]

If you are on pills, possibly a small hand full of nuts with your pills. It wouldn't take much as normal hormone dosage is dealing with extremely small amounts of hormones. The oil in the nuts would carry the estrogen into your system. If nuts  or oily plants are a regular part of your diet, taking your hormones when you consume them would provide a carrier. I am providing a link that might help you determine which oils are in you diet so you only need to alter the time you take your medication instead of altering your diet.
https://en.wikipedia.org/wiki/List_of_vegetable_oils

[Ruth Ruthless]

I am not eating any vegetable oils, because they cause that problem with my belly.

I am eating nuts and seeds, usually freshly ground flax seeds because they have omega 3s and there is never a shortage of omega 6. Still, I also eat sometimes walnuts, almonds, brazil nuts and cashews.

Because I eat them whole, not as oil, I suspect they release the oil content much slower and more evenly into the blood, perhaps because of the fiber and other nutrients in them that help regulate fat intake from them.

Nuts and seeds don't have the same effect on me as eating vegetable oils, they don't make me gain weight and don't trigger an emotional crash. However, that very same quality means I probably wouldn't be able to time their fat release with intake of estrogen.

I guess I'm damned if I do and I'm damned if I don't.

Back when I ate junk food I had higher estrogen levels and a slightly bigger breast and butt but I also had an enormous belly that overshadowed my breast and butt...

Now on whole plant foods I have a much lower estrogen level, a slightly smaller breast and butt but I also have a much smaller belly that allows my small breast to actually show a bit and I feel less of an emotional roller coaster.

I'm also afraid of the possability that the phyto estrogens in the flax seeds for example might bind the estrogen receptors instead of the estrogen I'm taking.

I can try putting on the gel right after eating nuts or seeds, or switch to pills and try to take them sublingualy. I don't know if that will work.

[Laura_7]

Here were some hints concerning nutrition:
https://www.susans.org/forums/index.php/topic,203388.msg1808921.html#msg1808921

Oils are not the same .
Olive and avodado oil, especially avocado oil are said to have a mix of ingredients that might help with a more rounded figure and not go straight to the belly.

Flaxseed contains phytoestrogens which might compete with estrogen for estrogen receptors and make for a weaker effect there.
I would cut flaxseed and soy products, especially in high doses. Normal doses from time to time should be ok.
There are other sources for omega3, like linseed oil , which also contains phytoestrogen, but flaxseed contains even more.


hugs

[KayXo]

Lack of estradiol and lack of body fat (due to diet) may probably account for the ineffective feminization. Levels range from less than 20 to about 650 pg/ml during the menstrual cycle, up to 75,000 pg/ml during pregnancy. I need at least 400-500 pg/ml to start seeing some breast growth. Currently my levels are anywhere from 1,000-4,000. All blood tests, including clotting, liver, glucose, insulin, etc came back normal. I weigh 160-165 lbs, at 5'6-5'7. I eat plenty of fat (including animal) and moderate carb intake.

Your T levels may also be a little high, in the upper female range, inhibiting breast growth, for instance and other feminization factors. My level is 0.3 nmol/L. BUT, Androcur also blocks T so part of what is measured is INACTIVE. Goes to show you that blood tests aren't always 100% reliable and don't necessarily give you the whole picture.

Your doctors refuse to listen to you or read studies showing that higher E2 levels aren't harmful so I'm afraid there is nothing you can do. There are no other doctors around so you are stuck with them. Doctors' ignorance, narrow mindedness, lack of real care for you are harming you. It's unfortunate.