Trying to interpret my blood test results.

[Jayne01]

Hi everyone. I don't know if this is the best place to post this topic.

I started HRT six weeks ago. I began with a low dose of E only. No anti androgen or other medication. The goal was to try and ease my dysphoria without transitioning. There has been no effect whatsoever. It doesn't feel like anything has changed at all. The only thing I noticed was a slight rash around my neck for about a week, which was listed as one of the possible side effects.

Yesterday I got the results for the second lot of blood tests after being on E for 6 weeks, the first blood tests were done the week before I started taking the hormones. I have no idea what the results mean. There are three pages listing all kinds of levels. What should I be looking at? My E has increased and my T has decreased a little, but I have no idea how to interpret the results.

I see my endocrinologist next week, but I was wondering if in the meantime, anybody could shed some light on the subject for me. Does the E or the T have a significant effect on how much dysphoria one feels? Is it a combination of the 2 levels or am I missing something here?

[Jayne01]

Oh, also, I was going to post the E and T levels from my blood tests but wasn't sure if that violates the forum rules.

[Devlyn]

Levels are fine as long as dosages aren't included. 

Hugs, Devlyn

[Thessa]

Oh, also, I was going to post the E and T levels from my blood tests but wasn't sure if that violates the forum rules.

You can post the values.
Only Dosage is not allowed.

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[Jayne01]

Ok, thanks for that.

Before I started,
E - 74pmol/l
T - 29.7nmol/l

After 6 weeks,
E - 378pmol/l
T - 20nmol/l

The results sheets suggest a nominal range of <160 for E and 9.5-28 for T for a "male". So it seems that things are moving in the right direction except for the fact that I am not noticing any changes in my dysphoria.

I think the units of measure we use here in Australia may also be different to what is used in North America.

[Dena]

Post my handy dandy little table. Testosterone is the biggie that will cause dysphoria so 29.7/3.47=8.56 which would be upper end male levels. 20/3.47=5.75 which would be mid range male levels so you have dropped but are still well into the male range. Now for estradiol. 74/3.67=20.1 which would be in the normal male range. 378/3.67=103 which is definitely in the female/transition range and possibly explains the testosterone drop that you have seen.


ESTRADIOL LEVELS
SEX                     pg/ml
Women (> 18 years old)   
      Follicular Phase  30-120
      Ovulatory Peak   130-370
      Luteal Phase      70-250
      Post-Menopausal   15-60
Male                    15-60

TOTAL TESTOSTERONE LEVELS
SEX      ng/dl        ng/ml
Females  6 - 86     0.1 - 1.2
Males  270 - 1100   2.4 - 12
Conversion factor: 1 ng/ml = 3.47 nmol/l


Analyte        Gravietric  Conversion International
               Unit        Factor     Unit
Estrone        pg/mL       3.699      pmol/L
Estradiol      pg/ml       3.67       pmol/L
Estriol        pg/ml       3.47       nmol/L

[Jayne01]

Thank you Dena for that great reply. It all makes a little more sense to me now.

When I see the doctor on Monday I suspect he will adjust my medication and likely add an anti androgen/blocker (are they the same thing?). He did warn me when I first saw him that HRT is a bit of trial and error. It affects everybody differently.

[Dena]

I suspect that  anti androgen/blocker aren't the same but I may be just as guilty of crossing the two as anybody else. The problem with an international site is that different drugs are used in different countries and if a person hasn't posted their location, you have no idea what is available to them. Even if they post a location, you may still not be sure what drug they will get.

It appears your doctors was attempting to block testosterone with estradiol because you are ether on a strong dosage or your body is very responsive to estradiol. My body loves to convert it to estrone and even though I am on a half transition dosage, my levels are half what yours are. Still my body is responding so while things may be happening slowly, I will get there eventually.

[Jayne01]

I told him when I first saw him that if possible, I would like to take just enough HRT to stop the dysphoria with no or minimal physical changes. He suggested to start on the Estrogen. It is actually Estradiol Valerate (which I'm guessing is the same thing).

Without mentioning specific dosages, he told me to start on one dosage (let's call it x). Over the 6 week period he told me I can experiment with the dosage up to 3x per day. So I started with 1x the first week, 2x the second and 3x the third and have remained on the 3x.

As I mentioned before, there has been zero effect on the dysphoria and I assume it is too soon to notice any physical changes. If anything, the dysphoria may be getting worse with an even stronger desire to be female. I don't know if that is from the hormones or because I recently had a makeover at a male to female transformation studio. That was the first time I ever fully dressed and saw myself as a woman. It created many mixed emotions, but overall, it felt right.

I don't want to transition, but I cannot continue living the way I am with the dysphoria as bad as it is. I have to find the right balance. I have not completely ruled out transitioning, but I want to give the doctor a chance to find a combination of HRT that may ease the dysphoria to a tolerable level without having to transition.

[Dena]

Estradiol Valerate is a little different than estradiol because they tack on a few extra atoms to the chain. In the body estradiol valerate is converted to estradiol so you can consider both to be the same when talking dosage or effects on the body.

I suspect your additional desire to be feminine is because you have reached the breaking point and are unable to contain the feelings as you could before. At one point you wouldn't have considered HRT or a dressing session but now you are willing to attempt both. Until I am told otherwise, my discussions with you will target living without a transition. You are far from the only one on the site with that goal and the transition is something you don't want to undertake until you are ready for it.

I am waiting to see what the doctor does at your next appointment and then see what the follow up is over the next few weeks. If he prescribes a blocker, I suspect the results will happen pretty quick.

[Jayne01]

There are many reasons I don't want to transition. It would certainly be less complicated to remain male. I wouldn't have to relearn how to live in the world, or take voice lessons. The list can go on and on. But the main reason is that I don't want my wife to have to make that kind sacrifice. Even though our love for each other is very strong and she has stuck with me through some very dark times, she still married a man. If I can do it, I want to be able to be that man for her.

Something has changed inside me. I am not quite sure exactly what it is. It might be that I am really starting to accept who I am. The female part of me feels more real now, like it is an integral part of who I am. Before it felt kind of surreal, like a fantasy almost. It is t a fantasy anymore, it is who I am.

I will update you with what my doctor comes up with next week.

[Ayla]

Jayne
I am another non binary and non transitioning Aussie who has worked with their Endo to find the 'sweet spot' where dysphoria is under control and physical change minimised.  Like you I have a wife and know that a binary transition would be just as problematic. 
Be prepared to work with yourself and with your endo.  I started on E and on Spiro and moved to transition level dosages and hormone levels.  This was really discomfiting for me and for my wife.  So I tried working with varying doses of E with no Spiro, then a fixed level of E with varying levels of Spiro.  I then moved on to just taking Spiro with no E.  It really is quite a journey and provided you have a good Endo all should be fine.
After several years I am now back to transition levels of E and Spiro and have added Progesterone to the mix.  Physical change has been manageable and comfortable while I have gradually retreated from the binary male persona that I had hidden behind for much of my life.  In doing this I have become far more andro and far more gender fluid both in emotional breadth and in presentation (longer hair, no facial hair etc.).  As these changes have been at a pace which has minimised discomfort for my wife and I, I have also been able to change employer and career to allow me to enter far more trans friendly environments.
You may find, as many of our fellow travellers have, that your objectives, your desires and your direction may change.  This is not a bad thing as it will likely reflect a growing understanding, acceptance and expression of your identity.
Not sure if you are in Sydney but if you are looking for a a really good endo, then I recommend Jon Hayes as he really partners with his clients as they craft their direction and shape their future.
Safe travels
Aisla   

[Jayne01]

Hi Aisla

I don't think I am non binary. To be honest, I have a hard time understanding what non binary means, that is why I don't think that is me. If I can get the dysphoria to a manageable level, then hopefully that will be enough.

I am in Sydney and Jon Hayes is my endo. I have seen him twice so far and I go back to see him again tomorrow. He does seem very good.

[kat69]

I hear you, finding a balance between the dysphoria and living your current life will be a goal you will constantly have to work on. 

I won't say it's the same for everyone, but living an authentic life can be one of the best ways to remove the dysphoria.  What I mean to say is that even though my wife and family mean the world to me, I would never have been able to continue with my male persona...because it wasn't me.  My wife said many times she married a man, not a woman...even if I'm the same person...we aren't husband/wife anymore, we aren't a couple.  It does hurt me to see what I have taken from my wife....but not being my authentic true female self, well....more would have been taken away. 

Please be sure you are still being true and honest to yourself if you choose not to transition.   Be so honest with yourself that you promise yourself to reconsider your plan if continuing with your male persona if not possible any more. 

[Jayne01]

Hi kat69,

I agree with what you are saying. I only plan to do what is necessary. My wife is the love of my life. She is the reason I am still here today. As difficult as it is for her, we are on this ride together. I am trying to go as slow as I can for her sake and I will only take as many steps towards transition as is absolutely necessary. My wife is so far willing to stick by me and support me on this journey. I can't ask for any more than that. I don't want to lose her and she doesn't want to lose me. Hopefully I can get by with as little transition as possible. Time will tell.

[debrferguson]

I had similar goals over three years ago when I started counseling. Two and a half years ago I started with spiro and a low level of estradiol.
My wife of 26 years and love each other deeply. The medicine got rid of the distress fairly quickly and as soon as I was free of that, I knew I could never go back. A little less than a year after starting hormones, I began to struggle more and more with identity. It wasn't distress like before where I just had to do something feminine. But it was a growing internal conflict over who I was vs. what I presented to the world. It was super frustrating because I couldn't logically explain it. I tried to hide it from my wife but she would hear me crying in the shower in the morning. Eventually she pushed for me to fully transition while at the same time saying she couldn't be married to a woman. We divorced but remain close. I live a mile away. Her mom lives with me. I miss her deeply but I could never go back to how things were before.
My reason to share isn't to say your path will be the same. It is just to say that there are layers here and the power of living authentically was something I couldn't understand the power of until I did so. Be prepared for a journey not at a one step solution.


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[Jayne01]

I saw my endocrinologist today. I told him that my current medication is doing nothing for my dysphoria. He said that there is scope to increase my estrogen dosage so he added an estrogen gel to my tablet intake. So now I will be on roughly 5 times the dosage that I originally started on.

I asked him if I need any anti androgens. He told me that anti androgens will turn off the T which will cause more physical changes to take place, but it is the E that is supposed to ease the dysphoria. That is opposite to what I am being told on this forum. He told me if I want minimal physical changes that I should just stick with E only.

He also said that most people like me who are not looking to transition usually only take a very low dose of E and that fixes their dysphoria and they get on with their lives. I seem to be some one of exception. I have been on 3 times that low dose and now the dosage is increasing again.

Hopefully this will work. Once we figure out what dosage I need to be on, then we can look at slow release pellets every six months or so instead of daily pills.

[Dena]

Some people have reported that higher dosages of estradiol affect them emotionally. This is something I can't personally verify because my levels are less than a quarter of their levels so I have never experienced it. On the other hand, I have experienced the loss of testosterone. The higher estradiol levels will reduce you testosterone so I guess it might be possible that the combination of the two may work. It will be interesting to see what happens and I might learn something from this.

It appears this doctor is willing to work with you and is doing his best to deliver what you ask.

[Ayla]

Jayne

I can recommend the implants.  Less hassle than taking a daily pill and less stress on your liver.  As I said earlier, folk vary in their response to hrt - low dosage can be sufficient to shut down the dysphoria, often S or E is enough by themself.  But I have found that the emotional benefits are such that you are always drawn to trying a higher dose.  There is nothing wrong with this but changes do accelerate.  Enjoy the journey and try to avoid making any promises to your spouse that you may live to regret.

Safe travels

Aisla

[Jayne01]

This doctor seems to be very good. Many people have recommended him to me.

Aisla, I do intend to move to implants once we figure out the right dosage for me. It's kind of difficult to make adjustments once the implants are in.

I am hoping with this new dosage there will be some kind emotional reaction, preferably a positive one. My wife and I are just taking it day by day. No promises neither of us can keep.

Thank you for your input.

Jayne