Post op Post transition hormone levels

[Serenation]

Hi everyone, long story short after srs I had a single appointment with my endo and he said take this amount of pills every day for x amount of years then stop and you don't need to see me ever again. I got my gp to check my T a few months after op and it was ok, but I'm regurely getting migraines and flushes and it's been almost a year and a half now, shivers. Making me wonder if my E isn't right.

Now I have many post op friends that are on many many many times more E than I am but they are all still early in transition technically around 2 years on hrt, were as I have been on hormones 14 years or something.

Off to a new gp in 2 hours as I have moved, I know it's difficult to talk about hormones on susans (can't mention doses) but if someone has a source or opinion on what my blood test results should be (as far as I'm aware that is allowed) I'd appreciate it. I'm out of the system and gender clinics nowdays so I imagine it would take 6 months or more to get into an Actual trans specialist endo in Australia (not that the last one was that much help)

I was born with messed up hormones but I don't think that's of any relevance at this point.

[Dena]

First you definitely need a new doctor. You may mention blood test results on the site and that will allow us to discuss your treatment. You should have total estrogen and estradiol measured in your test and it's possible your levels are low. If your growth isn't complete, you should remain on the transition dosage. After that you can talk about reducing the dosage but you should never stop. My doctor told me to stop and I did for 10 years. It caused me to lose much of the hormone shaping and might have caused calcium loss had I not been aware of the danger and reduced the risk on my own. A transition estradiol levels should be between 100 and 200 pg/ml in blood tests taken just before your next dosage. Levels for a woman are.
   Follicular Phase   30-120
   Ovulatory Peak   130-370
   Luteal Phase   70-250
   Post-Menopausal   15-60
I am considered post menopausal and my current estradiol levels are at 51. Let us know your blood test results and we will verify if your treatment is correct.

[Serenation]

Thanks Dena, since I moved I dont have my blood tests results on me, from last time, I'll try and get a print out today and get more tests done.

[AnonyMs]

I see the endo Dr Jonathan Hayes in Sydney and he has 3500 trans patients and 20 years experience in trans medicine. I asked him about post-op blood levels and he said it would be no change from pre-op. There's no way I'm ever stopping HRT.

He does blood tests every time I see him, which currently is probably twice a year since I'm on implants. He gives me new implants when my estrogen blood level falls below 800 pmol/L, which is high by most standards but I trust him on this and the effects are fantastic. For what its worth I don't generally trust doctors on anything.

I like this chart, it shows blood levels all over the place.

https://en.wikipedia.org/wiki/File:Estradiol_during_menstrual_cycle.png

It sounds like your "doctor" has no idea what he's doing. I hope he doesn't prescribe ethinyl estradiol as some Australian doctors do.

[Zumbagirl]

Hi everyone, long story short after srs I had a single appointment with my endo and he said take this amount of pills every day for x amount of years then stop and you don't need to see me ever again. I got my gp to check my T a few months after op and it was ok, but I'm regurely getting migraines and flushes and it's been almost a year and a half now, shivers. Making me wonder if my E isn't right.

I was born with messed up hormones but I don't think that's of any relevance at this point.

That doesn't seem right at all. I am post-op over 13 years now and I still take my estrogen dose once per week like I did in the beginning. In fact I still take the same dose I did as a pre-op. My ends told me that it's necessary to keep taking a sex hormone for bone health and other organs which are impacted by it. If I were you I would be seeing a new doctor. I've experienced hot flashes and irritability and it's not fun.

[Serenation]

ok have been back, I need to elaborate I think.

My trans specialist endo who they finally made me see way back when, I used to be on premarin and progesterone about 14 years ago until I was finally forced to see him, he put me on microgynon (everyone says bad about it) by the time I was on that though I'd been on premarin and my development would have already been finished. I was on that a few years. After I had op he switched me to progynova and said take it till I'm 65. He didn't even have a blood test done after opp or changing to progynova.

So when I got back to my home I got my local gp who had always been fantastic to check my levels, I can't recall the exact numbers but they were decent, they were not in menopausal range at least and my T was perfect. I had to move due to bad situation so I've had to get a new doctor, I live in a capitol city now and was happy that my new doc who is a womens sexual health specialist was happy to write me scripts for hormones etc.

So I seen her today and she said she isn't versed enough in hormones to adjust them but would with guidance from an endo, but we got bloods taken today and im booked in to see an Endo she knows in 8 weeks (not trans specialist endo) , I'll post the results when I get them.

AnonyMs does Hayes never lower the dose after develeopment has finished? I know a lot of post ops, I just don't know any post ops that have been on hrt a long time. That's the bit I'm unsure about.

On the plus side I did get a script for some estrogen cream for downstairs, not sure if thats enough to change levels or just helps with the skin down there.

Thanks zumbagirl, hmm

[AnonyMs]

AnonyMs does Hayes never lower the dose after develeopment has finished? I know a lot of post ops, I just don't know any post ops that have been on hrt a long time. That's the bit I'm unsure about.

I'm not sure the answer to that. I believe he never lowers the levels, but I'm not 100% sure.

If you can manage it perhaps you could come to Sydney to see him and get a treatment plan for your doctor to follow.
I know he does have interstate patients. Even better if you could visit him a couple of times a year because then you could get implants from him.

From what I've read I believe its possible a GP could do implants, if you could convince them to. Apparently some do. That's my plan if I ever move out of Sydney (or just fly back to see Dr Hayes).

[Serenation]

Having to fly interstate for implants sounds far to stressful for me, I think gp's can do the implants, at least I've had one offer to do them before. Just a matter of knowing my target range

[Mohini]

... transition estradiol levels should be between 100 and 200 pg/ml in blood tests taken just before your next dosage. Levels for a woman are.
   Follicular Phase   30-120
   Ovulatory Peak   130-370
   Luteal Phase   70-250
   Post-Menopausal   15-60

Dena, thank you for showing these numbers, as I am post-orchie for 10 years myself.  As I posted elsewhere, I have not been happy in the last two years of my regimen, a reduced dosage.  I switched to menstrual cycling a few weeks ago, so I have to see how that works out.  I don't know why, but the labwork I have done stopped showing estradiol levels and only show that my testosterone has measured less than 3 ng/dL and free testosterone direct being 0.3 pg/mL.  However, I do need to know what my estradiol level is.  It's fortunate that when I see the doctor next month, it will happen to be the day before my primary peak of the cycle as shown in the chart shown by AnonyMs.  Do you consider it important in my case to ask for DHT and DHEA levels?

[Dena]

If you suspect you are having issues you should check DHT and DHEA but I am not sure it's normally needed as you no longer have the raw material to make them with.

[Mohini]

Another symptom I have been feeling from low estrogen is formication, the skin sensation that there's ants or bugs crawling on your skin in various places.  I get that from time to time, and I need to watch that more closely.  I remembered that my previous doctor told me about that sensation, that usually, it means that there's not enough estrogen in your body.  Who else has experienced this?

[Serenation]

Another symptom I have been feeling from low estrogen is formication, the skin sensation that there's ants or bugs crawling on your skin in various places.  I get that from time to time, and I need to watch that more closely.  I remembered that my previous doctor told me about that sensation, that usually, it means that there's not enough estrogen in your body.  Who else has experienced this?

I used to get that a lot, then I convinced myself there was no bugs was just mind tricks, then I had to go to hospital because of bad spider bites (australia) lost feeling in leg.

[Serenation]

bump, got my bloods back today, they were serum hormones E2 290 pmol/L

It says menopause is 0-120 on the sheet.

I've been on hrt about 14 years so transition itself is long over.

[Dena]

Not a transition dosage and not menopause levels but it could be within the levels that a CIS woman might normally see though on the low end. That should be 79 pg/ml and I currently am developing with sore breast at 51 pg/ml. I don't see a problem with the levels unless you have another goal in mind.

[Serenation]

thanks Dena, i'll leave as it is for now and talk to a new endo in oct