My clinic blood results: heeeeeelp?!

[Richenda]

Hi everyone,

Please help?!

Will keep this concise. I took myself to a proper Gender clinic here in Thailand today for private tests. I've self-medicated for 18 months, had ups & downs, got into the UK GIC system and will be seen for apt no. 2 in c. two months. But I felt for various reasons I needed to be checked.

General health: good. Bp good, Cholesterol ok, no infectious diseases. Electrolytes all good though chloride is low. I'm also slightly low on hemacrit and haemoglobin but no signs of infection etc and they're in range.

The feminising indicator results are quite confusing and disappointing. Let me give background. 12 months ago I span out really horribly. I isolated Spironolactone as the cause and cut it, since when I haven't taken a proper AA. Instead I've controlled DHT through Finasteride and then, once Dutasteride (horrible drug). So today's tests did NOT cover DHT which is disappointing as I'd hoped they would.

Tests taken on a 12-hour water only fast including medications.

Testosterone 458 ng/dL (4.58 ng/mL) [High but see above re. DHT]
Prolactin 14.7 ng/mL
Folicle Stimulating Hormone FSH 0.57 mIU/ml [this is really really low?!]. Does this relate to body hair? If so mine has virtually stopped altogether.
Progesterone 0.18 ng/ml [this is very low too. Why?!]
Lutenizing Hormone 4.60 mIU/ml
Estradiol  E2 74.2 pg/ml [This is disappointingly low?]
Thyroid Stimulating Hormone 2.420 uIU/mL
Free T3 3.31 pg/mL
Free T4 1.31 ng/dL

Is there anyone on here who can contribute to the interpretation of all this?

My consultant at the clinic thinks I may have dud E tablets i.e. lower dose than they say on the packet. He wants to put me on Estradiol Gel + Spironolactone, carefully monitored.

Note: if I get medication through the GIC instead they will most likely NOT use Spironolactone. I don't know what they would use instead?

I'm sooooooo confused

Breasts are good though

[AnonyMs]

Progesterone is low, but if you don't say your taking progesterone? I'm on Microgest and find it works well.

[Richenda]

Hi, no am taking nothing along the progesterone line :/
x

[AnonyMs]

That would explain the low progesterone. I'd say more, but I'm sure KayXo will be along so I don't think there's much point. I will say my estrogen is far far higher.

[Deborah]

Your T is in the middle of male range and your E is pretty low.  Why are you concerned about spiro?  How do you know it caused you problems?


Sapere Aude

[Richenda]

Because I woke up one morning, just, with the world a tumble dryer, incapable of sitting up let alone standing, my blood pressure under the floorboards and my heart hardly beating. I nearly died. I'm not exaggerating. It wasn't finasteride or progynova.

That's what Spiro can do, or one of the things it can do, which is why I believe the NHS in Britain will not use it for MtF.

[Rachel]

I am not a doctor and you should seek advise from a doctor. With that said, your T is high and E is low. You need to be under a doctors care and have bloodwork done more frequently. There are alternatives to spiro. I take E injections (high dose) and spiro. My T is les than 3 ng/dl.

I had a bad time on spiro. I did not eat enough salt or drink enough water and I drank a lot of coffee. One time I fainted and hit my head and was out for a few minutes. I went down 2 other times bad. I stopped drinking caffeine and eat a lot more salt. I also do 24 to 30 flights of steps 5 days a week.   

[AnonyMs]

Its a bit off topic, but whats a proper gender clinic in Thailand actually like?

What kind of services do they offer, and what kinds of HRT? Any implants? What blood levels do they recommend?

I think I recall discussing this before, but you're in Thailand - good place for some surgical work... Skip all the GIC hassle.

[Laura_7]

Many endos strive for levels of estrogen of 180-200 pg/ml and testo of below 60 ng/dl.

All anti androgens have side effects. Some people report depressions from fina and duta.

There is one form of hrt which works without anti androgens by raising levels well into the female range which by itself can drive down t into the female range as well. This is considered safe only with internal appication like implants and injections.
With injections a weekly cycle might be preferred because this way levels are more stable.
People with implants and injections usually report good results unless there are adverse conditions.

With pills bioidentical estrogen sublingually does not raise clotting as much as swallowing.
Some non bioidentical forms may have serious side effects.
With sublingual intake levels rise fast and drop hours later so spreading the daily dose in a few small doses throughout the day may help keep levels more steady. It might affect mood.

You might discuss with them their target levels and how fast they intend to reach them.

And you might think about adding bioidentical progesterone.
There are studies showing for a fully developed tissue it may be necessary.
It may also help with mood.
If its too pricey it may be cycled, with 10 or 20 day cycles for example. Just watch out for mood then.

Talk all of it through with your doc/endo.

hugs

[Richenda]

Argh just lost a long reply on my mobile so will keep this brief and reply properly to the last one soon.

My estrogen was over 300 in December. I'm currently lactating. Weird 'eh?

Another thing that's odd is that, despite lots of transgender people in Thailand, endocrinology is historically weak here. Many Kathoey self-medicate, often at dangerous levels.
Hence I had to travel 160kms to find a proper gender clinic and even then it's a place founded by an American. They have a good business plan by also pitching to the male body builders.

I'll reply some more soon

X

[Laura_7]

Argh just lost a long reply on my mobile so will keep this brief and reply properly to the last one soon.

My estrogen was over 300 in December. I'm currently lactating. Weird 'eh?

pg/ml ?  Otherwise its about a third.

Here is some info about lactation :

https://www.susans.org/forums/index.php/topic,206787.msg1839298.html#msg1839298


Important for good feminization is the combination of estro and testo in the female range.


hugs

[Richenda]

Thanks Laura, right I'm back on the laptop.

Yes same measurement: down by a third. I would say that, anecdotally, my libido has rocketed this past fortnight and I'm producing sperm again (tmi sorry) so perhaps he's right about the dodgy Estrogen tablets. He says 30% of all products in Thailand are fake. Most likely, he says, is that a typical pill may have 1/3rd to 1/4 the actual dosage.

It's certainly very odd to go from 320 to 74 in 5 months. I don't really know what to make of it.

Laura, re the levels he said he'd basically like to see the T and E swap positions! Which is the one type to which you are referring by the way?

It's depressing. I'm tempted to get my testicles removed tbh.

Hugs back x

[Richenda]

Just to add to all this, I'm one of those people caught betwixt and between. I'm in the GIC system but not yet officially prescribed the meds nor officially monitored by the NHS. Can I wait? No. Without being melodramatic I'd rather not be on the planet than stop my meds altogether. That's the terrible tension in which so many of us find ourselves. The most important thing is that I'm currently safe. But the second thing is to get these darned levels right.

Today's appointment cost me £120 c. $150. Cheap I guess but also not cheap. To come under their care, including tests, will cost me £180 or $260 a month.

[Laura_7]

Units are very important in this.
If your previous measurements were in pmol/l and now are in pg/ml they are on about the same level.

I personally would aks for weekly estradiol valerate injections. It may be possible to adjust levels so no anti androgens are needed.

Another option may be an endo doing implants in Australia:
https://www.susans.org/forums/index.php/topic,209284.msg1855337.html#msg1855337


Its only one or two visits possibly. It may be possible to do blood tests locally and send them in.



Or you might think about bridging treatment.

https://www.susans.org/forums/index.php/topic,208198.msg1845578.html#msg1845578

https://gendergp.co.uk/

They also have materials to help with the NHS.


hugs

[AnonyMs]

Today's appointment cost me £120 c. $150. Cheap I guess but also not cheap. To come under their care, including tests, will cost me £180 or $260 a month.

That seems amazingly expensive for Thailand. Its way more than anything in Sydney is costing me. Any idea why?

[Richenda]

Well I don't want to bad mouth them as they have been really friendly to me but it's clearly pitched to westerners. Their take would be that 1. you're screened as often as needed. If you need 30 tests a month they will do that and 2. they source their meds properly.

But I agree it's very expensive. A few months of that and I could have my goolies whipped out

[Richenda]

Yes same measurement: down by a third.

Laura as I said, down by a third. It was in a good female range in December as confirmed by the test and endo report.

Very disappointing

[Laura_7]

Laura as I said, down by a third. It was in a good female range in December as confirmed by the test and endo report.

Very disappointing

Tests taken on a 12-hour water only fast including medications.

Hm 12 hours is a long time. Levels are very likely to be low.
Was it 12 hrs for both measurements ?

What is your kind of intake ? Swallowing or sublingual ?

I have heard from people on fina and duta having depressions.
Would you consider switching to injections ?
Usually people have good effects, and it may be possible to go without anti androgen.

With pills you might prefer bioidentical micronized estrogen.
An example is estrace or a generic.
Estradiol valerate would also be a possibility though it may take longer to dissolve.
Its usually written in the description what the pills contain.

Your endo should be able to provide both kinds.


hugs

[Richenda]

Hi Laura,

I must admit I did wonder if the 12 hour fast had an impact as he told me not to take the meds either: so a total water only fast. The half-life of progynova is, as you probs know, max of 6 hours so the test would have been for latent oestrogen in the system I guess?

Progynova = estradiol validate which I take sublingually. Are you suggesting I consider switching from the e.v. then?

Yes, I'd definitely consider switching to injections. Injections of what, may I ask? I've not noticed any issues with Finasteride and depression, although I know some people do. I appear to tolerate it well. Dutasteride is very powerful: my ejaculate vanished entirely for instance, but I found it made me dizzy, which I now discover to be a well-known side effect that they don't like to publicise.

[Richenda]

Sorry, don't think I actually explained in my first post. I take:

Progynova and Finasteride. Can't put dosages but nothing outlandish by trans standards.