Quote from: jentay1367 on November 18, 2016, 02:39:43 PMMy Endo dropped my dosage by 33 percent after my test came back 305 pg/ml. She told me those levels were too high and she wanted them down.
If you are taking bio-identical estradiol, especially non-orally,
consider the following:
Am J Obstet Gynecol. 1993 Dec;169(6):1549-53."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)."
"Supraphysiological oestradiol levels are an uncommon consequence of oestradiol implants (...) These high serum oestradiol levels were not associated with any deleterious effects and may be necessary for the control of symptoms in specific women"
"The mean serum oestradiol level of the 1388 women attending the clinic in 1988 was 767 pmol/l (range 78-2925 pmol/l), 66% had serum oestradiol levels <1000 pmol/l and 3% (38 women) had levels >1750 pmol/l (Fig 1)."
2925 pmol/L = 797 pg/ml
"The 15 women with PMS had a mean serum oestradiol of 2209 pmol/l (range 1760-2820 pmol/l).
Their mean age at the start of treatment was 40 years (range 34-54) and the mean duration of therapy was 5.5 years (range 1-12)."
"The 23 menopausal women had a mean serum oestradiol of 2015 pmol/l (range 1785-2925 pmol/l).
Their mean age was 46 years (range 29-58) and the mean duration of therapy was 4.5 years (range 1-10)."
Cancer. 2005 Feb 15;103(4):717-23."Patients with prostate
carcinoma progressing after primary hormonal therapy received TDE"
TDE = transdermal estrogen (high dose)
"The mean (+/-95% CI) serum estradiol level
increased from 17.2
pg.mL (range, 14.8-19.6 pg/mL) to
460.7 pg/mL
(range, 334.6-586.7 pg/mL)."
"No change in factor VIII activity, F 1.2, or
resistance to activated protein C was observed, whereas a modest
decrease in the protein S level was observed. CONCLUSIONS: In
patients with APIC, TDE was well tolerated and produced a modest
response rate, but
was not associated with thromboembolic
complications or clinically important changes in several coagulation
factors."
Median age of patients was 75 (49-91).J Urol. 2005 Aug;174(2):527-33; discussion 532-3."Levels of VIIa and XIIa were unaffected by transdermal estradiol therapy. Although levels of TAT III were increased in some patients at 12 months, the increase was markedly less than that observed historically with equivalent doses of oral estrogens. Levels of the inhibitory and fibrinolytic factors including protein C, protein S, APC-R, TPA and PAI-1 remained stable. Reductions in F1+F2, fibrinogen and D-Dimer levels represented a normalization from increased levels to the physiological range."
"These results suggest that
transdermal estradiol reduces thrombophilic activation in men with advanced prostate cancer, and protects against the risk of thrombosis."
J Lipid Res. 2006 Feb;47(2):349-55."This prospective pilot study of 18 men with androgen-independent prostate cancer receiving ADT measured effects of TDE on lipid and inflammatory CVD risk factors before and after 8 weeks of TDE (...).
During treatment, estradiol levels rose 17-fold; total cholesterol, LDL cholesterol, and apolipoprotein B levels decreased. HDL2 cholesterol increased, with no changes in triglyceride or VLDL cholesterol levels. Dense LDL cholesterol decreased and LDL buoyancy increased in association with a decrease in HL activity. Highly sensitive C-reactive protein levels and other inflammatory markers did not worsen.
Compared with ADT, short-term TDE therapy of prostate cancer improves lipid levels without deterioration of CVD-associated inflammatory markers and may, on longer-term follow-up, improve CVD and mortality rates."
TDE = transdermal estradiol
ADT = androgen deprivation therapy
Horm Metab Res. 1994 Sep;26(9):428-31."Thirteen osteopenic women received (...) estradiol valerate and (...) hydroxyprogesterone caproate by intramuscular injections once a week for 6 months (so called "pseudopregnancy")."
"Six patients were peri- or postmenopausal (
49.5 + 4.8 years of age, group A)"
"The duration of the therapy was 6, and in 4 patients 9 months"
"Estradiol increased from 34.8 +/- 7.5 pg/ml to
3226 +/- 393 pg/ml after 3 months and to 2552 +/- 254 pg/ml after 6 months, respectively, in group A."
"Investigations of lipids, liver enzymes and haemostasiology to be published later will show the absence of unwanted metabolic effects of this regimen."
"In conclusion, our data show, that the treatment (...) by means of high parenteral estrogen-progestogen depot injections is effective. Virtually no side effects occurred. The therapy is well accepted by the patients."
Aust NZ J ObTtet Gvnaecol 1998. 38: 3: 455"The long-term effects of a steadily increasing oestradiol baseline on body weight have been investigated by Barlow et a1 (6) who failed to demonstrate significant changes in mean weight, blood pressure or liver function in their patients during 3 years of implant treatment."
CLIMACTERIC 2005;8(Suppl 1):3–63"In women with supraphysiological estradiol levels during treatment with implants, no adverse effects on lipid metabolism, but a reduction in LDL cholesterol and fasting insulin were observed."
Obstet Gynecol. 2015 Mar;125(3):605-10."In transgender women, estrogen therapy, with or without antiandrogen therapy,
was associated with lower BP."
"Transgender women (persons assigned male at birth, but who identify as females and who use estrogens with or without an anti-androgen to develop female secondary sex characteristics) had normal median baseline and 6 month body mass index (24.8 kg/m2 (IQR=4.3) and 23 kg/m2 (IQR=4.5) respectively). Both systolic and diastolic median blood pressures in this group dropped significantly from baseline to 6 months (130.5 mmHg (IQR 11.5) to 120.5 mmHg (IQR 15.5) p=.006; 78 mmHg (IQR 21) to 67 mmHg (IQR 12), p=.001 respectively)."
"All transgender women had estradiol levels at least in the physiologic female – range at 6 months,
with 3/16 (19%) having supraphysiologic levels > 1000pg/dl (including the one transgender woman using intramuscular estradiol valerate). At 6 months, free testosterone was in the female physiologic range in 14/15 (93%), however only 10/15 (66%) had total testosterone levels in the female physiologic range (Table 4)."
Typo: instead of pg/dl, should be pg/ml.
Regarding breast cancer or cancer in general,
Journal of Clinical & Translational Endocrinology 2 (2015) 55-60"There is no increase in cancer prevalence or mortality due to transgender HT."
"While some guidelines for transgender medical care express concerns for elevated cancer risk with certain hormone regimes, current data suggest that the risk of cancer may not rise."
"Although studies are small, overall cancer incidence in transgender men and transgender women to-date has not been found to be different than their respective male and female controls [5]. There are no reports of change in breast cancer specific risk among transgender individuals on estrogen compared to secular trends of male breast cancer incidence. Rates are lower relative to secular trends of female breast cancer rates."
This, despite the use of very high doses of estrogen for the larger part of the 20th century (after 1950-1960).
Regarding prolactinoma,
Andrologia. 2015 Aug;47(6):680-4."Prolactinomas in oestrogen-treated MtoF persons are rare. In the Amsterdam Gender Clinic between 1975 and
2006, 2306 MtoF transsexual subjects were treated. The mean age at initiation of treatment was 29.3 12.7 years,
with
a range of 16–83 years. Mean follow-up in these subjects was 21.4 years, providing a total of 51 173 person-years of exposure and follow-up. Follow-up of 20 years or more was available of 303 individuals, including follow-up of 30 years or greater in 151.
In this population, only one case of a prolactinoma was encountered."
"In Trangender Clinic of Hospital das Clınicas, at the Medical School of University of Sao Paulo, 166 MtoF transsexuals have been followed since 1996. Unsupervised use of oestrogens was estimated in 88.2% of the total cases. The mean age at initiation of oestrogen use was 21.4 7.2 years, with a duration of oestrogen administration ranging from 9 to 48 years. In this population, abuse of injectable hormones was noted sometimes in combination with oral oestrogens. (...)
Even though the majority of subjects followed at our clinic have used extremely high doses of oestrogen during several years, the frequency of prolactinomas in our group was very low. This was also the case in the Amsterdam gender clinic in subjects who had used very high doses of oestrogens."
Share this with your doctor, see what she has to say.
