Back on HRT after years off

[Karen_A]

I got back on HRT after being off about 6 years (I started HRT 1/97 and had SRS 8/98). She put me on patches... I just got my estradiol blood result back ... it was 63 ng/mL....

Which is obviously too low... I was put on the highest dose patch...

I am a rather large woman so maybe because of my size that is not enough. Years ago I did injectables and I had VERY high E2 levels but they never caused me an issue (but I did not have great HRT results even then)

Has anybody else had issues with patches not supplying enough estradiol?

- Karen

[Dena]

I have been back on Estradiol about 5 months after being off it for around 10 years. I was placed on half a transition dosage with pills resulting in a blood result of estradiol of 51 and total of 733. That place my estrone at 682 and with estrone being 1/10 as effective as estradiol my equivalent effect would be 68.2+51=119.2 estradiol.
Though I am at about half the transition level, I am seeing changes in my body happening at a far faster rate than they ever did on Premarin. I don't think I ever had all the change that should have taken place as my post surgical dosage was pretty low and I would like to be on a transition dosage for long enough to complete the process but I don't think it will be allowed. The though is that I have completed my transition a long time ago and as I am "older", menopause dosages are appropriate for me at this point in my life. The problem with that idea was the Premarin was half the dosage I am taking now and I was put on it shortly after surgery. So much for cook book medicine.

[Karen_A]

I have been back on Estradiol about 5 months after being off it for around 10 years. I was placed on half a transition dosage with pills resulting in a blood result of estradiol of 51 and total of 733. That place my estrone at 682 and with estrone being 1/10 as effective as estradiol my equivalent effect would be 68.2+51=119.2 estradiol.

These days because of the Framingham Study most doctors want to keep estrogen dose very low because elf the reported issues... The  problem with that is that  in the study  the estrogen used was Premarin dosed orally as well as synthetic progesterone analogues ...

As most here know,  Premarin is mixture of horse estrogens so the conclusion drawn from the study (based more on correlations rather than biochemical mechanistic studies AFAIK) don't necessarily apply to estradiol itself  dosed IM (intra muscularly) or transdermally or even sublingually. Also studies have show that much of the 'toxicity' of estrogens come from the first pass through the liver from taking pills orally... which is not an issue for IM, Transdermal or sublingual administration.

In short that study has made MD's reluctant to prescribe estrogens for at reasonable doses for TSes... And for TSes there is another factor...

The hypothesis is that the longer on estrogens the larger  the risk... But natal females typically have 40+ years between puberty and menopause... and during pregnancy the blood estrogen skyrocket....

Few if any of us, even these days. start estrogen between the ages of 10-14 (at the typical range for female puberty)...  So even by that hypothesis IMO there is no real scientific  justification for treating is as typical postmenopausal women until a significantly latter age...

Which is supported by the fact that only  1 or 2 cases of MTF breast cancer have been reported in the literature

Optimal dosage ranges for us have never been definitively established , and likely never will be (who would fund the very expensive studies necessary for that?)

But we do know that estrogen helps us both emotionally as well as to pass better - which has significant benefit...

There are endos who understand all of this and are willing to prescribe reasonable levels... but they are hard to find.. My old endo was one such, but he is a 2.5 hour drive away in another state, and my current insurance would not cover him in network.

I don't know where my current endo will stand on blood levels ... I will see how she reacts my estradiol level.

- Karen

[Karen_A]

In Email the new Endo I am seeing says her target Estradiol level is 50-150 pg/mL... so my 63 pg/mL  is in range... That to me is just nearly above the top of the menopausal range (< 55 pg/mL)... That does not seem reasonable to me... When I was on IM EV my levels were MUCH higher

I am 60 but because i was off HRT for 6-7 years I have only been on  estrogen for about 13 years (compared to about 40 years for gas). Although overweight my blood tests (COMPREHENSIVE METABOLIC PANEL, CBC, TSH) show  I am healthy - all tests results were in the normal range...

Even the Lipid pannel looked good and I had eaten lunch 2 hours before the blood draw:

Code Select Expand

Component Your Value Standard Range
Cholesterol, Total 132 mg/dL 130-200 mg/dL
Triglycerides 93 mg/dL 56-150 mg/dL
HDL Cholesterol 55 mg/dL 40-90 mg/dL
LDL Cholesterol 58 mg/dL <130 mg/dL
Non-HDL Cholesterol 77 mg/dL <190 mg/dL
Normal primary prevention <190 mg/dL
High risk primary prevention <160 mg/dL
Secondary prevention <130 mg/dL
High risk secondary prevention <100 mg/dL
VLDL 19 mg/dL
Chol/HDL Ratio 2.4  2.0-5.0


So it seems to me there is no reason to stay so low....

Just got an Email from her... She is willing go to 2 patches and test again in a month...  I will see how it goes and if I have to find another endo.

- Karen

[Dena]

Women can vary all over the place ranging from 30 to almost 400 depending on the time of the month. Often the upper treatment level is set at 200 which is kind of mid way between the two extremes. I would agree that something over 100 would be desirable and with two patches you should be able to accomplish it. A question you need to ask yourself is did your body  fully develop. If it did, there isn't much of a reason for a higher dosage. In my case, I knew I had fallen back while I was off HRT and am now discovering that my dosages were so low, I never fully developed in the first place. I suspect the odds of me getting a higher dosage are pretty small at the moment.

[Karen_A]

A question you need to ask yourself is did your body  fully develop. If it did, there isn't much of a reason for a higher dosage.

I have thought about that and agree being lower makes sense if i "fully developed"...

But I never had much HRT results besides better skin and reversal of some male pattern hair loss... and i I hope I did not "fully develop"...  But I know there is a good chance i did...

Then again maybe i was on TOO high a dose (at times with IM E2 was over 1000 pg/mL - BTW pregnancy levels are significantly higher then that IIRC)

That said I do believe HRT risks are overstated if being dosed with estradiol transdermally or intramuscularly compared to orally. Most studies evaluating risk were done with oral Premarin.

Thanks,
- karen

[Doreen]

I was off HRT off & on for several years post-op.  I'm back on now, using estradiol cypionate (injectable 1/wk) and a bioidentical progesterone daily.   I thought I was done with breast growth, BOY was I off... its growing in overtime now.  Also, found out I'm osteopenic now, so I highly recommend continuing HRT if at all possible to prevent bone loss like I had.

[Tanya62]

... found out I'm osteopenic now, so I highly recommend continuing HRT if at all possible to prevent bone loss like I had.

Yep, I am back on estradiol . I discovered I am also osteopenic, plus osteoarthritic. I wonder how closely the 2 are related? Any ways, absolutely continue HRT to avoid the osteopenic stuff. It's a drag.

[Tanya62]

Doreen, mind if I ask if your bio-identical progesterone is prescription or something you found online? (no product placement intended, just a honest question). I am considering that myself. Also, do you find it helps get a handle on the osteoporosis thing?

[Doreen]

Sorry for the late reply, its prescription strength micronized Progesterone. Currently on a standard dose (I see most osteopenic /perotic women are usually 50% higher, but doc only wanted my current dosage for now).