Test Results want more?

[Bari Jo]

This marks 3.5 months in on hrt.  My first test results were based as me doing DIY using pills and as a baseline for pellets.  My second is pellets alone.  The first test round the lab forgot to do the t test.

First test
Estradiol 185 pg/ml
Estrone 1315 pg/ml

Second test
Estradiol 128 pg/ml
Estrone 44 pg/ml
Testosterone 5 ng/dl

I'm wondering if I'm out of line asking for more pellets.  I felt great when the pellets were first implanted, but I think that was doubling up on meds giving me that feeling.  It didn't last more than a seek though.   I've posted often here after that the GD was returning and wasn't happy anymore.  The first test also was at a time of day where my estradiol would have been the lowest.  I was due another dose before going in for the blood drawn.  The second test it's fairly constant because of pellets.

I've asked for an increase during my next appt which is tomorrow.  Fingers crossed.  I want to feel normal again.

Bari Jo

[Bari Jo]

This took great effort on my part to not take offense at that reply.  I do know if the peaks and valleys, he sent why I was mentioning it was tested during a time when I was due another dose.

The part that I'm questioning is what the levels of using pellets should be?  Is 128 a good level for pellets?  That's the question.  If that answer is yes, then I probably shouldn't ask for an increase.  If it's low, then I should.

Why so much more is getting read by my post I don't know.  Maybe I'm sensitive or hormonal?  See what I did there?

Bari Jo

[Dena]

Doctors are all over the place as far as what's the correct level. Typically it's 200 pg/ml however I have seen numbers between 100 and 400 pg/ml for estradiol. In my case when it's time to take a pill, I am at 45 pg/ml. I haven't been able to talk her into giving me any more.   

The following table will show you why it's so difficult determining what our levels should be.


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

[Bari Jo]

Thank you Dena.  My appointment is tomorrow.  This gives me an idea what to talk about.  My levels when on e pills were probably too high.  I'm glad I have a doctor to watch my levels and plan the right course of treatment.

Bari Jo

[KayXo]

The right level for one might not be the right level for another. Doctors really can't know in advance what that level will be for that particular individual at this particular time in their lives. Sensitivity varies from one person to another and changes throughout one's lifetime according to a host of factors. Is 128 or 185 a good level for YOU? You only know, not the doctor, not anyone else, based on how your mind and body are responding. Your doctor should be asking you questions like 1) how are you feeling 2) are breasts growing 3) is skin soft and drier 4) is ejaculate/erections less 5) is body hair growth less. Based on your feedback, they can assess whether your current regimen is effective or not, regardless of levels.

Many doctors will just aim for the average level in premenopausal women, so around 100-200 pg/ml (levels are much higher during pregnancy and lower during the first years of puberty, BY THE WAY) not taking into account the above where this range may be fine for some transwomen in terms of how they feel and overall feminization but not fine (too low) for others who need more to get optimal results.

Also, levels fluctuate, even on pellets. Hence, tests are unreliable in terms of determining the levels at which you are functioning 24/7.

Study after study has shown that bio-identical estradiol, when taken non-orally (even orally), is quite safe, even at higher levels and in populations at greater risk. Hence, aiming for a particular range because of the belief that higher levels may be harmful is just not substantiated.

Food for thought, remain critical.

[Bari Jo]

I just got back and the doctor basically asked similar questions, not about softer skin or growing breasts, but about my peace of mind and mental state.  She then proposed increasing the number of pellets, now I have triple what I did before.  The doctor was happy with all other results too but wants me to cut back on Spiro slightly though.  Target for t for me is about 15.  I'm following her advice and will retest in 6 weeks.

I'm so glad to have a local doctor I can get all this done through.

Bari Jo

[KayXo]

The doctor was happy with all other results too but wants me to cut back on Spiro slightly though.  Target for t for me is about 15.

Problem with Spironolactone is that, in addition to *sometimes* reducing testosterone and DHT levels, it BLOCKS androgens so that say you have a level of total testosterone of 15 ng/dl, part of this is blocked by Spiro but the test cannot tell you how much. To further illustrate, imagine you have a high level of 100 ng/dl but about 50% of that is blocked, if the doctor ignores that spiro blocks, she/he may end up increasing spiro while really it was unnecessary because the T that actually triggered receptors was much lower (around 50 ng/dl), within female range and perhaps, just fine for you.

Three other things to consider:
1) the same level in two different people might have different effects such that a level of 15 in one person might be too low and lead to very dry skin, low libido, fatigue, mild depression, etc and in another might be needed because they are very sensitive to T
2) T levels FLUCTUATE in time so the level could be 40 ng/dl at 9 am but much lower (too low?) at 9 pm, around 10-20.
3) Total testosterone includes SHBG bound testosterone that cannot bind to receptors so that if two women have the same level of total T of 15 ng/dl, but one has a greater amount of SHBG, the one with the higher SHBG will actually get less of the testosterone effects. Free or bio-available T would be a more accurate measure.

[Bari Jo]

Thanks KayXo, that's good info!