Surprising lab results

[AshleyP]

About a week ago, I went for my first lab work since starting HRT a little over two months earlier. I was totally surprised by the results and decided to share them and see if anyone else has had a similar experience or any other feedback.

A little background: I'm an older transitioner that started with an initial dosage of what I'd describe as a moderate dose of estradiol and a moderately low dose of spiro. I'd already been on a low dosage of spiro for several years for a heart condition. HRT doubled that. On my initial labs, the testosterone clocked in at a little over 600 ng/dL. According to the directions, I take the full dose of E orally once per day (I take it in the evening) and the spiro is twice daily.

Like I said, I'd been on that regimen for a little over two months and really hadn't noticed any effects except maybe softer morning erections. Frankly, I was getting a little impatient and was starting to wonder if on my next visit, whether the doctor might increase the dosages.

So I go for the labs maybe 15 hours after taking the E, get the results and find that my total T had dropped to just less than 30 ng/dL and the serum estrogen had soared to a little over 920 pg/mL. I was expecting it to be at a much lower level, so I was shocked. I haven't gotten any feedback from the clinic and my follow up appointment is in a week.

Now I'm afraid they're gonna cut my dosage. lol And maybe they should, I don't know, but I'm still frustrated that not much is going on. Has anyone else had a similar experience or have any other feedback?

All the best,
--AshleyP

[Deborah]

That's pretty high.  Not that I really know anything about medicine but it sounds very unusual.  I would recommend asking for it to be tested again if the Dr. wants to lower the dosage unless you are taking some huge amount.

It took my T a year to drop that low and that was on a considerable spiro dose.  My E took a while too but it finally got to a good place above 150 pg/ml after a year also on normal transition dosage.


It is better to be hated for what you are than to be loved for what you are not.
André Gide, Autumn Leaves

[Dena]

Yes, I am going down this road. The first issue is when you had your blood draw. It should be just before your next dose. If you dose twice a day, 15 hours is good. If you dose once a day, it should be 24 hours from your last dosage.

The second issues is the term estrogen. There are two primary estrogens of interest, estrone and estradiol. Estrone is very weak, maybe 10% as potent as estradiol. Total estrogen measures both and totals them so to find your estradiol levels, you need to add an additional test just measuring estradiol. When you are on pills, estradiol is absorbed and sent directly to the liver on the first path where most of it is converted to estrone. This is why we dissolve them in our cheeks or under our tongue to avoid the first path and reduce the amount of estrone.

So if these numbers are total estrogen, that is to be expected with pills.

[JeanetteLW]

   My first lab test were about 6 weeks into HRT. I had been taking spiro and low dose of E. All of my T results were well below male levels and firmly within the female levels. (one was even a tad below both)  My E level was 93 pg/ml  which  is about double the male max and well within the female range.

   Here is the lab eval info for Estradiol.    MALE > 17YRS - 7.6 - 42.6 PG/ML FEMALE > 17YRS - SEE BELOW: FOLLICULAR PHASE - 12.5 - 166.0 PG/ML OVULATION PHASE - 85.8 - 498.0 PG/ML LUTEAL PHASE - 43.8 - 211.0 PG/ML POSTMENOPAUSAL - <6.0 - 54.7 PG/ML PREGNANCY, 1ST TRIMESTER - 215.0 - >4300.0

  Jeanette

PS This test was specifically for Estradiol.

[KayXo]

The second issues is the term estrogen. There are two primary estrogens of interest, estrone and estradiol. Estrone is very weak, maybe 10% as potent as estradiol. Total estrogen measures both and totals them so to find your estradiol levels, you need to add an additional test just measuring estradiol. When you are on pills, estradiol is absorbed and sent directly to the liver on the first path where most of it is converted to estrone. This is why we dissolve them in our cheeks or under our tongue to avoid the first path and reduce the amount of estrone.

So if these numbers are total estrogen, that is to be expected with pills.

Exactly that! Total estrogen of 920 pg/ml is the sum of Estrone and Estradiol. Since on oral, estrone is significantly more abundant than estradiol, in a ratio of around 5:1 (sometimes more), the major part of that number is probably estrone. Next time, ask for Estradiol levels too. It's more accurate.

[AshleyP]

You all are absolutely great! Thanks so much for the input. It really helped me a lot

I would recommend asking for it to be tested again if the Dr. wants to lower the dosage unless you are taking some huge amount.

Deborah, that's good advice. Sometimes I'm not so quick on the feet to think of something like that. If need be, I'll use that.

The second issues is the term estrogen. There are two primary estrogens of interest, estrone and estradiol. Estrone is very weak, maybe 10% as potent as estradiol. Total estrogen measures both and totals them so to find your estradiol levels, you need to add an additional test just measuring estradiol. When you are on pills, estradiol is absorbed and sent directly to the liver on the first path where most of it is converted to estrone. This is why we dissolve them in our cheeks or under our tongue to avoid the first path and reduce the amount of estrone.

So if these numbers are total estrogen, that is to be expected with pills.

Dena, I had read this information before but for some reason, it just hadn't coalesced in my mind. Thanks for bringing it together for me. The test was indeed a total serum estrogen test, not an estradiol test. I had taken some doses sublingually, even though the doctor specified orally. I thought for the purposes of the test, I should follow instructions for a week or so prior.

Exactly that! Total estrogen of 920 pg/ml is the sum of Estrone and Estradiol. Since on oral, estrone is significantly more abundant than estradiol, in a ratio of around 5:1 (sometimes more), the major part of that number is probably estrone. Next time, ask for Estradiol levels too. It's more accurate.

Extrapolating the numbers, the estradiol level is probably about where you'd expect for the dosage that I'm on. Funny thing is, I tried to get an estradiol test, too. I've had two labs done where I've requested the hormone level tests. Both times it's been a bit of a circus. Maybe it's because I'm a genetic male asking for what's usually tests for a female. I don't know. I'm getting the labs ordered and blood drawn at a small town clinic and send the lab results elsewhere for evaluation. Thinking back on the encounter, I'd be willing to bet that we had the estradiol test in the queue, but they removed it when I showed them the letter that specified the tests that the other clinic wanted. It only specified estrogen among all the other routine tests.

The lab work is actually performed by a national company, Quest Diagnostics. I googled it and found their website. Much to my delight, I found that you can enter a test name and get detailed information along with a test code and a CPT code that specifies that particular test. That was what all the confusion was about at my clinic. Literally, there were three people trying to figure out which tests to specify. Four, counting me. lol

Thanks to y'all. I'm going in next time with much better information.

All the best,
--AshleyP

[Dena]

I to had to use Quest because the other labs in the Phoenix area weren't able to run the estrogen tests. They could run the testosterone tests but I suspect estrogen isn't tested very often because it's all over the place in a CIS woman.