My clinic blood results: heeeeeelp?!

[Laura_7]

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?

With sublingual intake levels rise fast, and drop after a few hours...
here is a graph showing that this has an influence on levels and that they are far away from an average after 12 hrs:
https://www.susans.org/forums/index.php/topic,186946.msg1665088.html#msg1665088

Estradiol valerate should be good if you want to stay on sublingual.

You might consider switching to injections because they can make for higher levels and it may be possible to go without anti androgen.

Often endos test levels two to three days after injections. Its possible testo levels may be lower 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.

Injections of estradiol valerate. It may stay longer in the system than other forms.
One example might be progynon depot.
Another might be multidose vials.

Just talk about it with your endo.


hugs

[Richenda]

With sublingual intake levels rise fast, and drop after a few hours...
here is a graph showing that this has an influence on levels and that they are far away from an average after 12 hrs:
https://www.susans.org/forums/index.php/topic,186946.msg1665088.html#msg1665088

Blimey!! That's amazing. Wow. A question though: for tests should we be reliant on intake levels i.e. those that are spiked by intake or by residuals in the system?

It does kind of explain the difference though. In December my tests were a couple of hours after my progynova intake.

[Laura_7]

Blimey!! That's amazing. Wow. A question though: for tests should we be reliant on intake levels i.e. those that are spiked by intake or by residuals in the system?

It does kind of explain the difference though. In December my tests were a couple of hours after my progynova intake.

With sublingual intake your levels are alwas spiked.

So imo most sense would make a test after a few hours to have some kind of average between spikes as a result.

Yes of course a few hours after intake levels are still higher.
That would explain the difference.

If you changed anti androgens that would explain some male features coming back.

[Richenda]

Just talk about it with your endo.

Not being polemical, but I wonder for how many of us 'having an endo' is an aspiration we never attain? In Thailand endocrinology has historically been little studied and wasn't an available discipline to study within medicine. In the UK, if you are in the GiC / NHS system the people to whom you are referred from your GP are primarily psychiatrists (which I think is dreadful). These Psychs may have branched into endocrinology but that's not their first subject, nor do the guidelines come from that angle. It's more about RLE and the psychological profile of the patient. Indeed you are expected to live in your 'chosen' gender before being prescribed meds, something in my view akin to sending a soldier to the front line in order to train.

I suspect the majority of us on here have to settle for less-than-perfect most of the time. It's part of that living on the edge of a knife.

So, concretely, what do I do? Do I shell out $260 a month for treatment I'm not 100% sure is right for me?Do I wait, wait, wait for the GiC hopefully to prescribe me? Or do I wander down to Boots the Chemist and change my meds as someone bearing my description might have allegedly been seen doing last night?

That's why this forum is so helpful, providing everyone pitches in as much as possible. The fact is that, clinical testing aside, we probably collectively know as much as the professionals.

[Richenda]

Just analysing and cross-referencing the results again it's not all bleak.

The FSH of 0.57 mIU/ml is extremely low against a normal male range of 1.5 to 12.4. This is the test that indicates sperm production, so I pretty much don't have any sperm. So something is clearly working. I suspect the T to DHT would look really good, but that still doesn't explain the relatively low E2 level. I say 'relatively' because the E2 reading of 74.2 pg/ml is still above male range of 25.8 to 60.7 albeit not where I'd hoped it would be. 12-hour fast?

[Laura_7]

So, concretely, what do I do? Do I shell out $260 a month for treatment I'm not 100% sure is right for me?Do I wait, wait, wait for the GiC hopefully to prescribe me? Or do I wander down to Boots the Chemist and change my meds as someone bearing my description might have allegedly been seen doing last night?

That's why this forum is so helpful, providing everyone pitches in as much as possible. The fact is that, clinical testing aside, we probably collectively know as much as the professionals.

Imo its necessary to get informed yourself so you can dicuss with them. Or consider options.

You have a few options:
- you could look for someone doing implants in Australia or the us
- you could look for someone doing bridging treatment in the UK
- you could stay with the thai cinic and ask them for specific target levels and times when to achieve them.
An altenative to tablets would be injections of estradiol valerate with the possibility to go without anti androgens.
The possibility to go without anti androgens may also be there with implants.


hugs

[Stevie]

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.

This was most likely due to low blood pressure when taking Spiro you need to drink a lot of water and eat extra salt. I had this happen I passed out my BP was 60/40 was taken to hospital and put on saline IV. Was scary as hell, but Dr. told me it was not life threatening. This happened early in my transition I was afraid to use any restrooms when I went out shopping with my spouse and I avoided drinking so as not to have go, apparently this is not a good idea when taking a diuretic.
stephanie

[KayXo]

A few things to add:

- estradiol levels fluctuate over time and aren't useful in this context as science has not established an ideal level or range for us, purely speculative (nothing more). Levels in women can be anywhere from 20 - 75,000.
- FSH will reduce as E increases and with some anti-androgens so the more of either of these, the lower FSH will be and this will have an effect on spermatogenesis.
- half life of progynova (estradiol valerate) is actually around 13-17 hours as confirmed by this study.

Arzneimittelforschung. 1998 Sep;48(9):941-7.

"A randomized, single-dose cross-over study in 32 postmenopausal women was performed to demonstrate bioequivalence of two estradiol valerate containing formulations"

"The terminal elimination half-life of estradiol was calculated at 16.9 +/- 6.0 h (Test) and 15.0 +/- 4.8 h (Reference)"

- it's normal your T levels are relatively high since you are not taking enough E and no anti-androgen that reduces T. There are alternatives to Spiro like bicalutamide, that block androgen or higher E through injections.

Please have a doctor address your concerns and be safe. 

[Richenda]

This was most likely due to low blood pressure when taking Spiro you need to drink a lot of water and eat extra salt. I had this happen I passed out my BP was 60/40 was taken to hospital and put on saline IV. Was scary as hell, but Dr. told me it was not life threatening. This happened early in my transition I was afraid to use any restrooms when I went out shopping with my spouse and I avoided drinking so as not to have go, apparently this is not a good idea when taking a diuretic.
stephanie

Wow Stevie that's scary. I've since heard of some people who never woke up again from that issue

The day before it happened was very hot and I was very dehydrated. Bingo.

[Richenda]

I think I may have fathomed some of the potential reason for the E to have dropped so sharply.

I'm taking dicloxacillin for a belly button piercing infection. It's actually the only med the doctor told me to continue, so I took it 2 hours prior to the blood test (and for 4/24 for 5 days prior). I've just discovered that there is a known interaction with all forms of oestrogen intake because it suppresses the bacteria in the stomach that are important for reabsorption of oestrogen in the blood stream. Hence why it becomes a risk of causing birth control pills to stop working.

This makes sense to me.

[Richenda]

And just as an aside, I've been studying all the blood results carefully: there are pages of them. I've been flagged for low:

Haemoglobin
Hemacrit
Sodium
Chloride
Protein
Iron

Interesting. I went two months without red meat or, indeed, any meat. Going to address this.

Meantime I'm going to look into bicalutamide (as per KayXo's message) and reintroducing low dosage of dutasteride (1 per week raising to max 2 per week).

I just cannot see myself taking spiro again after what happened. I'd sooner have an orchiectomy.

Oh, re injections: it's not difficult to get them done in Thailand if I really wanted. I'll await my next GiC clinic before any radical steps like that.

p.s. breasts & nipples are large, sensitive and I'm lactating. Body hair has virtually stopped entirely and sperm has vanished. So I know something's right.

[Richenda]

- half life of progynova (estradiol valerate) is actually around 13-17 hours as confirmed by this study.

Arzneimittelforschung. 1998 Sep;48(9):941-7.

"A randomized, single-dose cross-over study in 32 postmenopausal women was performed to demonstrate bioequivalence of two estradiol valerate containing formulations"

"The terminal elimination half-life of estradiol was calculated at 16.9 +/- 6.0 h (Test) and 15.0 +/- 4.8 h (Reference)"

Although administered sublingually the half-life of estradiol valerate is actually 3-4 hours and the 12 hour figure is 1/8th of peak concentration. Conclusion of the study:

'Conclusion:

Sublingual administration of micronized 17β-estradiol results in a rapid, burst-like absorption into the systemic circulation, yielding high E2 levels that fall rapidly over the first 6 hours.'

http://www.sciencedirect.com/science/article/pii/S0029784496005133

xx

[AnonyMs]

Can you get implants in Thailand?

[Richenda]

Yes I could but as with most things out here it would probably mean self-administering which is kind of scary

xx

[AnonyMs]

Yes I could but as with most things out here it would probably mean self-administering which is kind of scary

I don't think it would be feasible to self-administer implants. It's more like a minor surgery, and not many people would be up for that. I wouldn't anyway.

Its worth it if you can find it as they last a very long time, 6+ months, and well over a year in time if you're lucky.

[Richenda]

Ah thanks. They are definitely here because kathoeys are always telling me about it. Thy whack them into each other. That's Thailand for
you

[Laura_7]

Ah thanks. They are definitely here because kathoeys are always telling me about it. Thy whack them into each other. That's Thailand for
you

Well what about a cooperation with the thai clinic then ?
They could administer the implants and have levels tested.


hugs

[AnonyMs]

Ah thanks. They are definitely here because kathoeys are always telling me about it. Thy whack them into each other. That's Thailand for
you

I guess its not that difficult, but that's actually a bit scary.

Do they get blood tests?

[Richenda]

No generally they don't. Actually I haven't met a single one who does and I've chatted to loads of them: as an aside I thoroughly recommend doing this if you're in Thailand or Cambodia. Some of them have such fascinating stories and it's not all about the sex industry at all. I was listening to one the other day telling me how she knew aged three that she wanted to transition.

But Thailand's carefree attitude to many things (not all, there's no same sex marriage) coupled with Buddhist rebirth/karma does tend to lead to a slightly reckless approach. It helps explain why the roads are the second most dangerous in the world. In our topic it also contributes to self-medication of over the counter medicines without supervision.

Laura, I've never had any desire to visit Australia (well perhaps Perth on the west coast) and anyway I can't really see the point in shelling out $500 dollars for a 10-hour flight + all the costs whilst there. As you say, I might as well go to the clinic here for six months for the same money. But I've lost some confidence in that clinic tbh. My spironolactone reaction is uncommon but not unknown and I wouldn't be suggesting someone who had experienced ultra low blood pressure with the drug to be going back on it, monitored or not. There are other options.

I'm going to look into either flutamide or bacilutamide as mentioned earlier, alongside a better form of oestrogen administration. I think these might very well provide a viable option alongside taking myself for regular tests in Bangkok and in the UK system when I can get there. I think these might provide the best and still safest overall options.

So, Flutamide or Bacilutamide. Any thoughts anyone? xxx

[Richenda]

Well here's an oddity. 4 days on and after buying new oestrogen from Boots, my libido, which suddenly flushed back ten days ago, has vanished again and I have zero sperm production: it has just gone altogether now.

So maybe the clinic were right about dud tablets before. I was on that batch for about 10-14 days.