On pills, estradiol still under 20 pg/ml, what's going on???

[SoraKat]

ok, so i dont know where else to go to ask this question. i've been on hrt for a year and a month now, and my levels have never tested even close to female range. each time i've gone to get labs done they've had to increase my dose and ask me to come back for labs in 3 months. ive had an orchie, and my most recent levels came back with my estradiol at 14.6 pg/ml and my testosterone at less than 3 ng/dl.  what on earth is going on here?

[Dani]

Susan's Place has a section devoted to Hormone Replacement Therapy.

To answer your question, 14.6 pg/ml does seem low. What form of Estradiol are you taking, injection, patches, oral or sublingual? Injection and patches give relatively steady blood levels. Oral and sublingual vary quite a bit. If oral or sublingual, is your lab taking your blood sample right before or right after you take your Estradiol or just anytime that is convenient for the lab?

[sarah1972]

The time between taking the pills and the lab test does make a difference. Also any other meds you take could counteract with Estradiol, so do certain life style choices (smoking being one).

I do take meds to control my triglyceride levels and that counteracts Estradiol, so I am on the maximum WPATH recommended dosage to get into a decent range (sorry, actual values are prohibited on this page).

Also standard off the shelf Estradiol comes in two levels, depending which size you take, it may actually still be a pretty low value...

[KayXo]

Injection and patches give relatively steady blood levels.

Actually, levels can fluctuate quite a lot on injections of estradiol valerate and this is why some doctors don't always like to prescribe it. My levels dropped from 2,500 to 1,300 pg/ml in only 2 days. Estradiol cypionate yields far more stable levels as does probably estradiol enanthate (available in Latin America and Asia), the most stable being polyestradiol phosphate (Estradurin) available in Europe only.

Oral and sublingual vary quite a bit.

Studies have shown levels to be quite stable on oral whereas the sublingual method is the complete opposite, with levels quickly peaking and dropping within hours.

SoraKat,

You may not be absorbing the estradiol effectively enough and this often occurs on oral intake. Regardless, I tend to focus more on how I feel and how my body is responding physically. If these are good, then who cares what the levels are?

[jentay1367]

Hi Sora....those T levels look like what you'd typically see., but your E levels are pretty low. What kind of Estrogen do they have you on? I'm going to guess estrace with those kind of numbers. The other question is, are you seeing changes? If the answer is yes, that's what you want....if not, you may want to ask about injected E. It tends to give better (higher) overall numbers to to the fact that you won't lose the Estrogen in your gut or liver. If you want more information that may help you, I urge you to PM KayXo as she's or resident alchemist....seriously.

[JinnieY]

May I ask how you take your medications and what other medications are you taking? Drug interactions can play a huge role in lowering the estrogen level. Some over the counter products may interact with estrogen, too (Also grapefruit juice)