We Should NOT Be Treated Hormonally Like Natal Females

[Richenda]

I had a meeting with a new doctor yesterday. 

I realize the medical community had to start somewhere and they started with what they knew about natal females and applied it to transwomen.  But today there should be sufficient data available that the medical community can comfortably abandon the idea they can look at natal female data and use that to apply to transwomen. 

It's apples to oranges and it needs to end.

I'm really sorry for your experience Julie Marie, but I'm also glad you posted this because it tallies with something I've been mulling for a while.

The default position on here and often elsewhere, which is partly for legal protection, is 'go and see your doctor / endo / clinician.' This is of course sound for safety. Self-medicating is potentially very dangerous and various levels need testing on a regular basis. All of that is right and proper. But it doesn't alter the fact that on trans issues a lot of trained medics are simply rubbish. They weren't trained in it, haven't studied it and don't know what they're doing.

[AnonyMs]

The default position on here and often elsewhere, which is partly for legal protection, is 'go and see your doctor / endo / clinician.' This is of course sound for safety. Self-medicating is potentially very dangerous and various levels need testing on a regular basis. All of that is right and proper. But it doesn't alter the fact that on trans issues a lot of trained medics are simply rubbish. They weren't trained in it, haven't studied it and don't know what they're doing.

If I assume my endo is correct, and I do, then its quite close to 100% of doctors and endo's don't know what they are doing.

[Richenda]

  

[Debra]

Yeah the whole post-op dosage thing being lower was always kinda screwy. I'm at the same or even more of a dosage than I was pre-op and have been for years. My doc monitors my clotting factors (platelets) every 6mo-1yr though.

[ainawa88]

... many endos strive for levels of 180-200 pg/ml.  That, to me, my previous doctor and all of his patients, is way too low.  He goal was for levels of 350-450 pg/ml.

Bleh ... My levels as of May 20, 2016 were 182 pg/ml and I was told that they would be concerned if it were any higher. That's already slightly higher than they'd like, but before they increased my estradiol dosage it was only 119 pg/ml.

Don't get me wrong, I'm very happy with my results, but it's a little frustrating to know that things could possibly be going better.

[Julie Marie]

I'm really sorry for your experience Julie Marie, but I'm also glad you posted this because it tallies with something I've been mulling for a while.

The default position on here and often elsewhere, which is partly for legal protection, is 'go and see your doctor / endo / clinician.' This is of course sound for safety. Self-medicating is potentially very dangerous and various levels need testing on a regular basis. All of that is right and proper. But it doesn't alter the fact that on trans issues a lot of trained medics are simply rubbish. They weren't trained in it, haven't studied it and don't know what they're doing.

There is only one doctor I know who ignored data done on natal females and he would tell you right now that data needs to be ignored because it isn't relevant.  Natal is not the same as trans.  Period.

My new endo got the blood test results and they called today.  The nurse said, "Your levels are normal."  First thing I thought was she is used to patients who only need to hear, "You levels are normal."  The nurse was about to hang up when I said, "What were the numbers?"  I think she was surprised.  My previous doc would have a lengthy discussion about the levels and what they meant.  He would also tell you where he thinks levels need to be.  I wanted numbers, not "you're normal, goodbye."

So she started rattling off the numbers.  E was 160.  I said, "That's pretty low." 

There was a pause on the other end.  "Oh, no, that's normal."

"Not for a transwoman, it isn't." 

No reply...

So she gave me the rest of the numbers and transferred me to the front desk so I can make an appointment to see the doctor.

I think some people will be going to school very soon.  And it won't be me. 

[SadieBlake]

My doc shied away from estrogen levels that came back at 700. My blood work was OK but protein levels a bit out if whack and so we reduced (injection) dose 1/2. I'm fine with that as long as T is still suppressed. While the serum albumin was at the low end of normal I don't care to ever flirt with VTE, having poor circulation in my feet already worries me.

[KayXo]

There is only one doctor I know who ignored data done on natal females and he would tell you right now that data needs to be ignored because it isn't relevant.  Natal is not the same as trans.  Period.

Some of the data on natal women is indeed relevant to transwomen while other isn't. One shouldn't be so absolute. We still belong to the same species.

So she started rattling off the numbers.  E was 160.  I said, "That's pretty low." 

There was a pause on the other end.  "Oh, no, that's normal."

"Not for a transwoman, it isn't."

There is no such thing as normal levels for either trans or ciswomen. Levels in ciswomen can be anywhere between 20-75,000 pg/ml depending on the woman and her reproductive status. Individuals vary. 160 might well be sufficient for some transwomen for optimal feminization and well-being while for others, higher is needed. It depends. There is too much focus on numbers while the rest, what matters most, like well-being and degree of feminization is ignored. Should be case by case, I think.

My doc shied away from estrogen levels that came back at 700. My blood work was OK but protein levels a bit out if whack and so we reduced (injection) dose 1/2. I'm fine with that as long as T is still suppressed. While the serum albumin was at the low end of normal I don't care to ever flirt with VTE, having poor circulation in my feet already worries me.

I think it's important to mention units when stating levels. Also, estrogen levels is not the same as estradiol levels. Estrogen is the sum of estrone (a less potent estrogen) and estradiol.

Levels as high as 2,500 pmol/L (close to 700 pg/ml) in men with prostate cancer , aged 49-91, weren't associated with an increased incidence of thrombosis. Pregnant women with levels as high 75,000 pg/ml suffer blood clots at a rate of less than 0.2%.

And this...

Am J Obstet Gynecol. 1993 Dec;169(6):1549-53.
Fibrinolytic parameters in women undergoing ovulation induction.

"As serum estradiol levels increased throughout each phase (maximum mean estradiol 739.8 pg/ml)"

"Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event."

Br J Obstet Gynaecol. 1990 Oct;97(10):917-21.

"There is some anxiety about the possible harmful sequelae of supraphysiological estradiol levels but no data are currently available to show any deleterious effects of these levels on coagulation factors, blood pressure, glucose tolerance or the occurrences of endometrial or breast cancer (Hammond et al. 1974; Thom et id. 1978; Studd B Thom 1981; Armstrong 1988)."

My own levels are between 1,000-4,000 pg/ml. Clotting factors remain normal.