Mariah's HRT update

[Mariah]

So back on September 20, 2014 I Started HRT with just patches of estradiol. Then on October 31st I was switched to injections followed by the addition of Spiro on 11/1 of 2014. Over time the Endo tried to find the right dosage of estradiol but every time he thought he had the right dosage he found that the next time around the changes he made had little to no affect on my levels despite getting the right amount of Spiro figured out. As a result of the fact he couldn't get my estrogen level regularly down where he wanted it he lowered the dose I would be taking as soon as I resumed HRT after SRS.

Due to getting married and getting everything moved and adjusted in Phoenix I didn't get my levels tested tell recently. The Testosterone levels were exactly were we wanted them, but estrogen needed to be adjusted. We found levels were far lower than we had planned them to be after surgery. My PCP who is prescribing my hormones now has moved me to pills instead of injections to get a consistent level of estrogen in my blood and added progesterone for the first time.

Breast growth before was  just to slow and really behind where it should be and is why we are changing things up now along with the female hormone levels being to low now. This is why the adjustments with both progesterone and estradiol. Hugs
Mariah

[LizK]

So back on September 20, 2014 I Started HRT with just patches of estradiol. Then on October 31st I was switched to injections followed by the addition of Spiro on 11/1 of 2014. Over time the Endo tried to find the right dosage of estradiol but every time he thought he had the right dosage he found that the next time around the changes he made had little to no affect on my levels despite getting the right amount of Spiro figured out. As a result of the fact he couldn't get my estrogen level regularly down where he wanted it he lowered the dose I would be taking as soon as I resumed HRT after SRS.

Due to getting married and getting everything moved and adjusted in Phoenix I didn't get my levels tested tell recently. The Testosterone levels were exactly were we wanted them, but estrogen needed to be adjusted. We found levels were far lower than we had planned them to be after surgery. My PCP who is prescribing my hormones now has moved me to pills instead of injections to get a consistent level of estrogen in my blood and added progesterone for the first time.

Breast growth before was  just to slow and really behind where it should be and is why we are changing things up now along with the female hormone levels being to low now. This is why the adjustments with both progesterone and estradiol. Hugs
Mariah

I am just having a "reshuffle" of my regime and my new Dr has proposed putting me back on pills to get the levels stable rather than relying on the implant. Good luck and I hope these changes give you the desired effect. You have had a pretty full on 12 months lets hope the next 12 are just as positive.

[KayXo]

I personally don't see the point to measuring levels because everyone is unique and responds differently (think alcohol level in blood and how everyone reacts differently to the same level), and levels fluctuate quite a lot (even on patches, as stated in one study) so what you get is really a random number at a random time. Female levels of estradiol also vary so much as to be an unreliable standard to compare to and contrary to cisfemales, we have a different hormonal history such that our sensitivities and requirements may be quite different. There's also the issue of bio-available E or T vs total E or T because the former gives a better indication of what is actually available to tissues and in women taking pills, SHBG may be significantly higher thus giving perhaps the impression that our total levels are fine but that bio-available levels may not be fine after all. Bio-available E is NEVER or very rarely measured.

[Laurie]

 Hi Mariah,

  I am no doctor nor an endocrinologist so I'll leave you to their experienced advice. Far be it for me to presume I might have better advice than they would have. So I will only offer my hopes and wishes that you now have better results than you have had in the past.

Hugs,
   Laurie

[Soli]

I personally don't see the point to measuring levels because everyone is unique and responds differently (think alcohol level in blood and how everyone reacts differently to the same level), and levels fluctuate quite a lot (even on patches, as stated in one study) so what you get is really a random number at a random time. Female levels of estradiol also vary so much as to be an unreliable standard to compare to and contrary to cisfemales, we have a different hormonal history such that our sensitivities and requirements may be quite different. There's also the issue of bio-available E or T vs total E or T because the former gives a better indication of what is actually available to tissues and in women taking pills, SHBG may be significantly higher thus giving perhaps the impression that our total levels are fine but that bio-available levels may not be fine after all. Bio-available E is NEVER or very rarely measured.

thanks for more info on that subject, KayXo (after similar on my thread). I always like your posts. They're informative. So what then should we rely on? My response to everything I take is always quite fast, and I can actually see by looking at my face in the mirror if my E is low, or high as it has been (I'm sure) since I switched to gel estradiol last week. Should I simply rely on these signs and not pay much attention to the blood tests?

for your info Mariah, my E levels have been fluctuating from 350 to undetectable to 550, to 185 and stuff like that from blood test to blood test since I started HRT some 2 years ago. It is puzzling and I was happy to read KayXo's comment about that on my thread. I guess simply how I feel, how I look should be good enough.

and also, Kay, my T levels have been steadily very low after going down rapidly... my question is: is T more stable than E as for its detection? It's always total T also.

Also I feel my E varies throughout the day, but that shouldn't have been on patches (that I was on before), it should have been stable, no? How could it vary from morning to evening with a regular and stable intake of E? How does that work?

[KayXo]

So what then should we rely on?

In my opinion, one should rely on how one feels and the development of female secondary sexual characteristics and attenuation of male ones so breast growth, less body hair, increased fat in thighs, butt, face, reduced body odor, testicles shrinking, sperm being less, libido changing, erections less frequent, etc.

Should I simply rely on these signs and not pay much attention to the blood tests?

I personally think so but I'm not a doctor, I should mention this. Just being rational about it. How strangers react to you is also something you should pay attention to. That can reveal a lot despite you not noticing any change.

is T more stable than E as for its detection? It's always total T also.

T is usually more stable, yes but an inaccurate measurement as I explained before. Also, if you take an anti-androgen that blocks T, the test can't tell you how much is blocked. I mean it's pretty obvious you have less androgen when you don't smell anymore, hair is becoming sparser, muscle is diminishing, testicles are shrinking, sperm is no longer as viscous and plenty, etc.

Also I feel my E varies throughout the day, but that shouldn't have been on patches (that I was on before), it should have been stable, no? How could it vary from morning to evening with a regular and stable intake of E? How does that work?

Maturitas, 12 (1990) 171-197

"When the serum concentrations of natural or synthetic sex steroids are measured at short time-intervals after administration and repeatedly during long-term treatment, it becomes obvious that there are large intra-individual and interindividual variations. This holds true for both the contraceptive steroids and the natural oestrogens and does not apply solely to the oral route. Long-term studies indicate that an important influence is exerted by predisposing factors, particularly the metabolic capacity of the liver, on the pharmacokinetics of sex steroids. Large variations in oestradiol and oestrone levels can be observed in an individual woman from day to day or from hour to hour, even during transdermal therapy with oestradiol"

Skin can also be more or less permeable depending on the external environment, whether hot, dry, humid, sweating, patch getting older, etc.