High DHEA sulfate and poor feminization

[Lucie]

Ok. I wish you it will fulfill your expectations eventually.

[galaxy]

I'm 1 year postop and since surgery too much androgenes lead jnto a virilization. In summary i lost the little things i got through the 4 years HRT. Bicalutamide now is the third try after CPA and dutasteride. Which options wil left? Spiro is not strong enough or chlormadinone. If nothing will work i go back to CPA and have to live with high prolactin levels. Or i will lose all my hair and turn back to a man... Ive no idea how this could be possible after SRS.

[Lucie]

How is your E blood level ?

[galaxy]

I'm on gel. E2 is around 400 pg/ml after 6 hours after application. Application is every 8-10 hours.

[Lucie]

400 pg/ml is rather high. Your situation makes me think of some sort of estrogen insensitivity (?).

[Dena]

400 pg/ml is rather high. Your situation makes me think of some sort of estrogen insensitivity (?).

I believe she is totally estrogen insensitive because she has been on HRT for years without breast development. If your review the older post she documented her measurements. What I am still trying to figure out is what her body is doing with testosterone because while the levels are low, she seems to still be having destructive effects from it. So far, I suspect that the lack of places for estrogen to bind in her body mean that even post surgical testosterone and DHEA are still pretty effective.

[Lucie]

I believe she is totally estrogen insensitive because she has been on HRT for years without breast development. If your review the older post she documented her measurements. What I am still trying to figure out is what her body is doing with testosterone because while the levels are low, she seems to still be having destructive effects from it. So far, I suspect that the lack of places for estrogen to bind in her body mean that even post surgical testosterone and DHEA are still pretty effective.

And perhaps DHT also ? (a rather high level of DHT in some organs is not incompatible with a low testosterone level, especially when 5-alpha-reductase is very active).
In any case she needs to talk to a competent endo but it seems she has not found one so far.

[galaxy]

There are only 2 cases of estrogen insensitivity, means estrogene has no effect after binding on the preceptor. I dont know whats happening here and what causes my problems. The next problem is that dutasteride had no effect on my DHT levels. Same level as before around 140 pg/ml. How could this be? Questions after questions. Problems after problems. Since beginning the transition.

[Dena]

Unfortunately the correct wording would be two known cases. It could be more common in men but just unknown because most of the time they have no reason to be exposed to estrogen. One thing is very clear and that is we need to think out of the box for answers because anything could be possible here.

[galaxy]

An estrogen insensivity would mean my death setence. 

[Lucie]

dutasteride had no effect on my DHT levels. Same level as before around 140 pg/ml. How could this be?

You are in the low adult male range. I assume that your testosterone level also is rather high.
Have your doctors checked the functioning of your adrenals (ACTH, cortisol, etc.) ?

[galaxy]

You are in the low adult male range. I assume that your testosterone level also is rather high.
Have your doctors checked the functioning of your adrenals (ACTH, cortisol, etc.) ?

Yes, we checked the adrenal function. ACTH is low, cortisol is normal, DHEAS is a bit too high. I will never understand why i take dutasteride and it doesnt lowers my DHT.

[Lucie]

I will never understand why i take dutasteride and it doesnt lowers my DHT.

For how long time have you been taking dutasteride ?
It may take weeks before its effects can be felt (as well as for bicalutamide).

[galaxy]

Over 2 month.

[Lucie]

So now it should have its full effect.
But from what you say it has no effect at all. Weird. It sounds as if your 5-alpha-reductase is resistant to inhibition by dutasteride.
You should talk to a competent endocrinologist (unfortunately there are not that many).

[galaxy]

I talked to two endocrinologist. They told me my DHT was already in the female range and cannot be further decreased by and dutasterid. As it seems i only have resistances everywhere. 

[Lucie]

I talked to two endocrinologist. They told me my DHT was already in the female range and cannot be further decreased by and dutasterid. As it seems i only have resistances everywhere. 

I probably misunderstood your previous posts: I believed that your DHT was still in male range. If it is in female range and is still too much active yet, it seems to me that the best way for blocking its effects is bicalutamide.

[galaxy]

I take Bicalutamide since 6 weeks. Hairloss stopped a bit but its not the blocking effect i hoped for. Maybe i will take a additional little dose of cyproteron.

[Lucie]

In your case it may be that 6 weeks is not enough for seeing full effects of bicalutamide. However it's not a bad idea to add a low dose of CPA (together with dutasteride). Hopefully your endo will accept to prescribe it.

[galaxy]

I will stop dutasteride. It has absolutely no effect in my case. I started a very low dose of CPA today. Next bloodwork in 2 weeks will show if it works or not.