Quote from: SamKelley on May 16, 2016, 07:31:05 PM
Injection (IM) will likely give you the best result as it pulses estrogen levels (similar to cycling) - especially with valerate, it will spike quite high for the first few days, but it also won't go lower than a certain amount, which is good. I was on a relatively low dose IM yet my blood estrogen went about twice as high as desired the day after injection (3300 pmol/L), so I halved my dose. This seems to vary person to person so it can be useful to know how it affects you.
If injection is not frequent enough, say every 2 weeks or more, levels will drop too much causing menopausal symptoms. A study showed after 7-8 days, levels reduced significantly.
My levels have gone as high as 14,000 pmol/L on third day after injection. My three doctors saw no reason to reduce dose. Pregnant women have levels as high as 275,000 pmol/L and yet their clotting risks are under 0.2%. Men with prostate cancer, between the ages of 49-91, with levels as high as 2,500 pmol/L did not show an increased risk of clotting or cardiovascular risk.
Cycles see estrogen levels reduce to very low levels, it is not quite the same thing as injections where levels remain quite high unless you wait too long for your next injection.
QuoteIf you're under 25, yes, you'll have better results, because puberty doesn't finish completely until around this age.
I know many girls under that age have poorer results than women much older than them, in their fifties and older.
QuoteSpironolactone can have side effects such as depression or mood swings, and/or fat accumulation in the mid section (NOT what we want).
In all my years (12+ yrs) of reading studies and reports on Spiro, I've never read of such effects. More likely with cyproterone acetate.
J Clin Endocrinol Metab. 2012 Dec;97(12):4422-8."Of the antiandrogens studied, only cyproterone acetate was significantly associated with depression[/u](8.3%, P 0.05) (see Table 4)."
"Cyproterone acetate use is statistically more likely to cause depression than the other antiandrogen types used in this study. These results are consistent with previous studies using cyproterone acetate to treat hirsutism (11–13)."
European Journal of Endocrinology (2011) 164 635–642"Depressive mood changes have been reported in cyproterone acetate use"
Basson RJ. Towards optimal hormonal treatment of male to female gender identity disorder. J Sex Reprod Med 2001;1:45–51."a high incidence of depression with its associated increased risk of suicide, for which persons with GID are already at increased risk, is reported by Asscheman et al (7) who routinely use CPA."
Metabolism. 1989 Sep;38(9):869-73.« Combined treatment with estrogen and cyproterone acetate in 303 male-to-female transsexuals was associated with (...)depressive mood changes (15-fold)"
Acta Endocrinol (Copenh). 1979 Jul;91(3):545-52.« One daily dose (...) cyproterone acetate (CA) was administered to 2 groups of 4 fertile men for 6 months."
"Three subjects who began the study were withdrawn because of depressive mood changes (2) and weakness combined with dizziness (1)."
QuoteLFT - Liver Function Test (less important on injection and spiro, but much more important on cyproterone acetate and/or oral estrogen)
Hepatotoxicity has been observed at high doses of cyproterone acetate, also with NON BIO-IDENTICAL estrogens. It's important to differentiate between the different types of estrogen.
QuoteThrombophilia screen / coagulation profile - blood clotting test
Despite my high levels of estradiol, my clotting times are normal. I get injections.
QuoteLipid Profile - (cholesterol, looking for hyperlipidema / high cholesterol)
High cholesterol, in recent studies, has been found to be a much weaker predictive factor in cardiovascular risk than say, cholesterol:HDL ratio or triglycerides or even Apo A or Apo B. My cholesterol level is high but my ratio is excellent as are my HDL and triglycerides. Focusing just on cholesterol could be misleading. There is no causal relationship established between cholesterol and cardiovascular risk.
Int J Clin Pract Suppl. 2009 Oct;(163):1-8, 28-36. "Several recent studies have shed additional light on the specific interplay between dietary cholesterol and cardiovascular health risk. It is evident that the dynamics of cholesterol homeostasis, and of development of CHD, are extremely complex and multifactorial. In summary, the earlier purported adverse relationship between dietary cholesterol and heart disease risk was likely largely over-exaggerated."
QuoteProlactin - checking for prolactinoma
More likely with non bio-identical estrogen and cyproterone acetate as suggested by reports in transsexual women.
QuoteLH
FSH
SHBG
Free Testosterone
Total Testosterone
Estradiol ("E2" - if you're on oral, you need E1 and E2, but oral is sub-optimal)
Progesterone (optional, probably not useful unless you're on cyproterone acetate as CPA is a progestin and can suppress progesterone to too-low a level)
I see no use in testing any of these post-HRT and to some, these may be costly. Your well-being and degree of feminization alone should help you determine whether current HRT regimen is effective. There is no ideal estradiol level or range, arbitrarily established by doctors. Testosterone is also sometimes blocked or will obviously be low. Hormone levels also fluctuate so not accurate.
