Discovering Super Low T While Considering HRT

[AlisonWood]

I've been lurking on this board forever (sorry) and am so grateful for all the tremendously helpful information that is on here! But wondering if anybody has ever run into a situation like this...

In an effort to cope with increasing gender dysphoria, and after seeing a gender therapist for a while, I visited an informed consent clinic to explore the possibility of doing low dose hrt. Like others here have described, my goal is to transition partially or slowly, but not socially due to family considerations.

Just got my initial lab results back and have learned that my t serum levels are a whopping 164 ng/DL! e level is in the normal male range.

But with this result, I believe most any doctor is going to say that I need to be on some kind of hormone therapy...if I was cis-gendered it'd be t.....but given my dysphoria...I feel like that would be moving me in the exact wrong direction. So I may be faced with a choice - ramp up t or go the other way and ramp up e.

This is a lot of me guessing because I haven't actually talked to my doctor about it yet - but anybody ever run into a choice like this? Can one maintain low/moderate levels of both e and t and still be ok in terms of metabolic function/bone health?

Is this a blessing in disguise? It seems, dysphoria aside, I actually need some kind of hormone therapy for other medical reasons. Or I wonder if my t has always been that low...and that's just how I am....

Grateful for any advice and thank you in advance!

[Dena]

Welcome to Susan's Place. Others have discussed this and while you are below the male range, you are still above 76 ng/dl which is the upper feminine level. I suspect where you to take T you would find your dysphoria would increase. The other side is that the blockers may be more effective and it's possible estrogen will suppress your T level enough that blockers might not be required.

Lab results are typical values and people can vary from them and it's still not a problem. That's why you need a skilled doctor to read the results and make judgement calls as to if a level is a problem.

It is possible for many people to maintain healthy bones without a sex hormone. It requires taking sufficient calcium, vitamin D and load bearing exercise. The other side is teens have had bone issues because the consumed soft drinks while eliminating milk and sunlight (vitamin D source). Sex hormones alone are not the total solution but make it easer to maintain bone health.

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[Beth Andrea]

Before I discovered I was trans, I was being treated for depression. My dr checked my T levels, and like yours, they were quite low (135, iirc).

He gave me patches (preferred over shots or pills, because if my dysphoria anxiety increased, I could remove the offending medicine).

I lasted just a few hours before I had to rip it off. Extreme anxiety, panicking, etc.

Realizing (like you) that I would need some kind of hormones (and that it'd take 2-3 months or more to get on E), I decided to try some over-the-counter menopause supplements. They didn't cause any significant breast growth or hair loss etc, but it worked well enough to tide me over until I got the real thing.

Even with those "phytoestrogens" and their relatively low dose I knew it was the right choice for me.

YMMV, good luck!

[Randi]

Around ten years ago, I told my internist that I lacked energy, and often found myself drifting off to sleep in the late afternoon even though I'd had adequate sleep the night before.

He tested my T levels and they were 150 on a scale of 300-1100.  He prescribed testosterone injections, and I started immediately.  His nurse showed my wife, also a Registered Nurse, how to do the injections.

Fast forward six months, and I discovered that my nipples were erect nearly all the time and my breasts were swelling.  Evidently my body had a large amount of the enzyme aromatase, which converts testosterone to estradiol, the most powerful of the three estrogens.

Frankly I enjoyed the feeling of my growing breasts.  At the same time my thoughts and dreams brought back feelings and thoughts I had kept safely buried since my teenage years.

I was born in 1949 and my mother was given DES, diethystilbestrol, to prevent miscarriage.  Now we know that about 1/3 of DES "sons" turn out to be transgendered. (I figure many of the rest are just in denial).

The rest of the story is too long to tell.  My body now produces no measurable amount of testosterone.  I can't really be male anymore because if I take testosterone it just converts to estradiol and makes my body more feminine.  I have been told I need to have either testosterone or estradiol to be healthy.

Estradiol seems to agree with me more.  When my doctor started me on testosterone a decade ago, he said "we're talking about a sex change here", if I didn't take testosterone.  Little did I know how prophetic that was.

All I have left to say is that if you want to become a woman, being a hypogonadic male gives you an excellent head start.  If you do decide to start testosterone, learn all you can about the enzyme aromatase.

Best Wishes,

Randi

[AlisonWood]

Dena: Thanks for your kind welcome and info!

Beth Andrea...that is a GREAT idea about supplements for menopause...even if it's just a placebo, it could help...just went out and got some for myself - great idea, and hopefully they'll help with energy and focus

Randi, I have thought the EXACT same thing - can't imagine taking supplemental T and think if I did, dysphoria would skyrocket and it'd probably all get converted to E2 anyway. Might as well do E2 to begin with and get desired effects.

You know, it's kind of funny (if that's the right word) a lot of the potential side effects of TRT and estrogen therapy can be the same:

Breast Growth
Shrunken Penis and Testes
Infertility

...never thought of that before...probably oversimplifying of course

Thank you so much ladies! Alison

[AnonyMs]

Did you get liver function tests done? Low T is a symptom of liver problems.

[KayXo]

Low T can be a symptom of many things of which the doctor, hopefully, is aware of and does the necessary tests to find that out.

Enough T or E is necessary not only for bones but for general health, psychological well-being and ageing. It gives one energy, libido, nice skin/hair, a younger profile, a reduced risk of some diseases, etc.

[Emileeeee]

Enough T or E is necessary not only for bones but for general health, psychological well-being and ageing. It gives one energy, libido, nice skin/hair, a younger profile, a reduced risk of some diseases, etc.

Not necessarily. I'm about as healthy as you can be and my pre-HRT T level was 22 NG/DL. I've never had a problem with energy or libido (until I started HRT), my hair is every woman's dream, and most people think I'm in my 20s when I'm actually in my 40s. I get blood screens every 3 months including for the liver and have zero issues.

[KayXo]

What about your E levels pre-HRT? For how long was your T level so low?

[Emileeeee]

I don't know about the E levels. They were never measured until after I started HRT. My T levels were low my whole life. But as I aged, my body started feminizing without HRT, just not as quickly as I would have liked, so I assume it was high too. My first E reading was after I was on HRT for a few months and was taken the day before my next injection. It was 540 PG/ML, which is well above the normal range.

[KayXo]

You remained healthy because of high enough levels of E, even if T was low. You need one or the other for good health.

[AlisonWood]

AnonyMs: My liver function looks ok - can't interpret it like doctor will I suppose, only thing out of reference was my ALT (SGPT) which should be between 0-44 IU/L, but was 53 IU/L...this is the same number I had when I had bloodwork done unrelated to HRT about 6 months ago...

Wish it was naturally higher, but Estradiol was 27 pg/ml (male reference is 7.6-42.6 pg/ml)

And again, my testosterone serum was 164 ng/dL (male reference is 348-1197 ng/dL)

I have been feeling very tired lately, many symptoms of low T...but worry that if I try TRT, dysphoria will skyrocket...so wondering if I can just try E2 instead. Suspect I've low T all my life, am hoping to try E2 because I think I'll either feel great on it, or not - but thinking I need some kind of hormone replacement either way for sure...decisions, decisions, decisions....

[Randi]

Anne Vitale has discovered that for some (certainly not all) people, testosterone increases dysphoria:

http://www.avitale.com/TNote15Testosterone.htm

In my case, I had only a small, tolerable, amount of dysphoria until I started HRT with testosterone.  Now that I'm balanced out on mostly estradiol and just a small bit of testosterone I feel "normal".  I wonder what all this concern about gender is all about.

The fly in the ointment is that now that my dysphoria is under control, my body has feminized to a fantastic degree. Now that I don't "need" boobs, I have them in abundance.  I've also got a case of "Kardashian Butt".  That has changed the way I sit and the way I walk.

As Dr. Vitale has noted, several of her patients thought the dysphoria had vanished and attempted to revert to their birth sex.  That didn't work very well.

I can't explain it, all I can do is tell of my experience.  As a "late onset" transsexual, I can't explain how I was "OK" with being male for all those years, except to note the whole journey started with that shot of testosterone in the Doctor's office.

Randi
 

[AlisonWood]

Thanks so much for sharing this Randi - it's hugely helpful.

Not sure if your story represents cause for caution or the possibility of a dream come true.

For me, I'm thinking it's probably the later. Hope that has been the case for you too.

Thank you so much again!

[AlisonWood]

So, I have an update...

Wound up talking to my doctor, who basically gave me a choice about how to deal with my low T combined with dysphoria. He was like, "well, you can go one way, or the other" offering to start me on testosterone to get my T levels up (and thereby hopefully just have more energy) OR start me on spiro to get my T levels all the way down (and thereby hopefully address my dysphoria).

On the way to the doctor's office I felt like an hold man, my joints hurt and it was just altogether depressing. I'm in my early 40s and knew I shouldn't feel that way. The thought of making that worse by dropping the bottom out of my T was hard to fathom. So I opted to go on beginning dose TRT injections (self injected, weekly).

I have to say, the testosterone actually made me feel better, sharper - not so especially anxious. HOWEVER - I very much experienced the crash over the course of the week. Weirdly, my dysphoria actually vanished on the days I took the injection, and as it wore off during the week the dysphoria rose. At the same time, I started to feel physically like crap.

After three weeks I went in for a blood test and my T serum level came back as...wait for it, a whopping 139 ng/dl (down from 164) and my estradiol serum level was 11 pg/ml (down from 27). At the same time, though I was feeling physically better at the start of the week, I just worried I was headed in the wrong direction. At one point, the thought of more T in my system started to make my skin crawl a little bit.

Several months ago I had made an appointment with an endo, which I had kept, so I might get a second opinion of sorts about my low T issue by itself. Intended to mention that I was grappling with gender dysphoria in passing, but main reason for the visit was to learn more about why I might have such low T naturally.

So, I start talking with my endo and he asked me to talk more about the dysphoria. He reviews my history, examines me, looks at my lab results. Then, to my great surprise, he says: "look, you are clearly transgender - the low T is probably just because you're heavy right now - but do you want to start HRT?" The word "yes" came out of my mouth so fast I couldn't believe it.

So I'm starting out on a crazy low dose of estradiol + sprio because, like many others on this Forum, I don't want/expect/intend to socially transition. My life is incredibly blessed with family and career stuff and I don't want to mess it up. Part of my thinking (perhaps a rationalization I suppose) is that I'm trying to deal with my dysphoria proactively so I don't erupt and need to go full transition later down the road (at least anytime soon).

It's been almost a week now and, though it's probably all placebo, I feel very different but increasingly, also very good. I can tell my already low T is now even lower, but surprisingly, the aches and pains I felt have completely vanished. I can only guess that it's the estrogen, even though its a small dose, coming to rescue and doing its part.

Compared to being on supplemental T, it feels like I'm running in a slightly lower gear, but it's such a smoother ride.

My family doesn't know exactly what is going on but knows that I'm trying to get my hormone levels right...that I tried injectible T, and am now trying something that will keep my T levels low, but steadier. In the last couple of days my wife even said, "I'm so proud of you for taking medicine/getting help you need - you're like a new person" She said that she loved me all the time but this new version is so much better and I'm so much better with our kids/less grumpy all the time." This was incredibly reassuring.

So - while I have my doubts and fears, I also have lots of hope and excitement. Sometimes when I take my pills I ask "is this really what I want to do?" But have taken a lot of inspiration from the ladies on this forum and take comfort in knowing, while MMV, that I'm starting on such a low dose that I ought to be able to slow things down if I want to.

Sorry this is so long; but I had a lot to share! TY for being here, Alison

[HughE]

A lot of us (particularly from the DES era) do seem to have hormone levels even pre-transition that are intermediate between male and female. It's yet more evidence that being trans is actually a form of intersex!

With your T that low to start with, a separate antiandrogen probably isn't even necessary as long as you take sufficient estradiol (which is quite effective as an antiandrogen in its own right). Spiro has a lot of harmful side effects, so if it can be avoided then that's a good thing.

If you've had chronically low T levels all your adult life, then you could be suffering from the effects of sex hormone starvation. This can result in all sorts of health problems as you get older, including osteoporosis, adverse metabolic changes that lead to type 2 diabetes and heart disease, depression, cognitive decline and so forth. Under those circumstances a low dose of estradiol might not be a good idea (since it would perpetuate the state of you having insufficient sex hormones). You may be better off supplementing with a dose of estradiol high enough to take your hormones fully into the female range, so your body is no longer being starved of sex hormones.

[Randi]

Alison:
It looks like you are on the right path now.  As you proceed along this path, you may find that your natural testosterone production shuts down completely.  That's what happened to me.

Although I survive mostly on estrogen, I find that occasionally I need the boost that comes with a small shot of testosterone.  Natal women don't have zero testosterone, and neither should we.

I mentioned Anne Vitale's article earlier in this thread.  At this point, my dysphoria has vanished nearly completely.

The paradox is that now that I don't feel a great desire to have a feminine body, I've pretty much got one.

As Hugh mentioned, you will eventually need "normal" levels of sex hormones to maintain your health.  Low dose can work for a while, but I expect your dosage will eventually need to creep up.

I've found an estrogen level that virtually eliminates my dysphoria.  After 10 years of estrogen my body is essentially female.  In my dysphoric days I would have been ecstatic to have the body I have now.  Now, with my dysphoria mostly gone, I'm nearly indifferent to the changes.

As my wife says, once you get a visit from the titty fairy, she won't take them back.  Barring surgery, they are with me for life.

Was all this worth the trouble?  Yes!  Dysphoria is horrible and no way to live.  Just don't count on low dose HRT to last forever.

Best wishes,
Randi

[Joelene9]

  Mine was high for a male. It is turning out that I may have more estrogen receptors than androgen receptors. The high levels may have been my endocrine system was compensating for the low amount of androgen receptors. Beth, your story of low T before treatment of any kind is anecdotally not unusual on this forum group.

Joelene

[melissa_h]

I made the decision to start HRT before I discovered my T levels were low.  I was at about 165 T the day I started on E and Spiro. My APN was happy bc it meant less spiro to manage my levels.

For me though.... It felt validating. If I'd known a year before, I'd likely have first started addressing with more T... Back when HRT felt unattainable.

But yeah, feeling a bit off, perhaps more tired at first is normal, maybe more so if you'd been taking T. Emotionally though, it's been a wonderful experience and really diminished the dysphoria.


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[josie68winter]

I've been lurking on this board forever (sorry) and am so grateful for all the tremendously helpful information that is on here! But wondering if anybody has ever run into a situation like this...

In an effort to cope with increasing gender dysphoria, and after seeing a gender therapist for a while, I visited an informed consent clinic to explore the possibility of doing low dose hrt. Like others here have described, my goal is to transition partially or slowly, but not socially due to family considerations.

Just got my initial lab results back and have learned that my t serum levels are a whopping 164 ng/DL! e level is in the normal male range.

But with this result, I believe most any doctor is going to say that I need to be on some kind of hormone therapy...if I was cis-gendered it'd be t.....but given my dysphoria...I feel like that would be moving me in the exact wrong direction. So I may be faced with a choice - ramp up t or go the other way and ramp up e.

This is a lot of me guessing because I haven't actually talked to my doctor about it yet - but anybody ever run into a choice like this? Can one maintain low/moderate levels of both e and t and still be ok in terms of metabolic function/bone health?

Is this a blessing in disguise? It seems, dysphoria aside, I actually need some kind of hormone therapy for other medical reasons. Or I wonder if my t has always been that low...and that's just how I am....

Grateful for any advice and thank you in advance!

I was on T injections every 2weeks due to very low t levels of 84 at the time. Those shots made me feels so wrong inside, I had to quit them. Now I feel I am in the right direction of starting hrt this week.

Jo