Hrt dosage question

[Kadence1]

Ok, so I know talking dosages here isn't allowed, so I'm going to word this very carefully. Haha.

So currently, I'm on a certain mg of E and a certain mg of Spiro. I'm almost 9 months in to HRT....

The first 4 months, I was taking my E under the tongue.. blood tests always came back with super high E levels and super low T levels. My dr informed me that taking E under the tongue doesn't really matter, and I could swallow them if I wanted. Well, I didn't really want too, because I was worried my E levels would get lower... but I decided what the heck and I'll start swallowing them and see what shows on my next blood result (3 months later.)
So flash forward 3 months, to about a week ago. I got my test results back, and GUESS WHAT!!! E levels took a huge crash from my previous result. Which I knew cause I felt like crap and was tired 24/7. My T level was even lower though, so that's good. thank god... lol.
Anyways I told her I took her advice and swallowed them for the previous 3 months, as she told me "it doesn't matter." Well, she told me it MIGHT matter and to start taking them under the tongue again and we'll see what happens. She told me my body might metabolize them differently compared to other people. Ok, cool. Understand that.

Well, I mentioned upping my dose to higher mg of E, and she acted like I was crazy. Told me that's "super bad and worrisome" and started blabbing about blood clots, heart attacks, strokes, her license getting taken away, etc. She even told me she only has 1 other trans patient on "that high of a dose." I totally understand her concerns because I know E *can* cause those things. But small increase?! I know SO many other trans girls on that dose. Is my doctor crazy?? I don't really like the information she gave me. First she told me it doesn't matter how I took my E, then she realized my E was ALOT lower then before, then went back on her word and told me to start under the tongue again. Then told me that small increased mg is WAY to high and WAY too dangerous.... thoughts?

I'm sorry if I broke the rules by posting this, but obviously I am in no way condoning self medicating or going against the words of their doctors.... I didn't state the dose I'm currently on, just sharing some experience and seeing what you all think.


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[Bari Jo]

I won't comment on dosage, but will comment on time of the test relative to your last dose.  On pills you have a peak, then it tapers off till the next dose.  Most trans ladies I know did their test at the valley time.  I personally prefer pellets as it doesn't exactly work this way.  It's more constant, and the test can be done any time.

Bari Jo

[Deborah]

Your Dr is more conservative in dosage than mine.

I won't specify dosage but I tried for over 18 months to talk my Dr into increasing mine.  (I wanted to increase to what is generally listed as max dose from various internet sources.) She always said no because of blood clots and that my test results were high enough and in the proper range.  I agree that the test results were always good. 

Finally on this last visit she did agree to raise my dosage.  I can't be certain why but my guess is that despite my advanced age (LOL) my health is excellent and for the past year I have been taking steps in diet and exercise to further improve it.  Those steps showed up this last time in my blood test results with everything extremely good and my body maintained at a lower BMI, <25, for the last two visits.  I had also stopped smoking after my first visit in 2015 without restarting and have not had any alcohol since last year.  So maybe she thought that in my particular case the increased risk was minimal because of lifestyle.

Also, I had for several months increased my dosage to that level anyway because I ended up with some extra pills due to the way the pharmacy fills the order.  I was honest and told her that during my visit.


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[Denise]

Can you switch to injections?  My understanding is it's easier on your inards.

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[Kendra]

I am on patches - second endo visit doubled my dosage to an amount unavailable with this particular brand so I'm now slapping two patches on twice per week.  If I didn't remove old patches I'd have almost as many as Microsoft Windows. 

Patches also avoid stressing the liver, but I am starting to get the point about injections.

[Paige]

Ok, so I know talking dosages here isn't allowed, so I'm going to word this very carefully. Haha.

So currently, I'm on a certain mg of E and a certain mg of Spiro. I'm almost 9 months in to HRT....

The first 4 months, I was taking my E under the tongue.. blood tests always came back with super high E levels and super low T levels. My dr informed me that taking E under the tongue doesn't really matter, and I could swallow them if I wanted. Well, I didn't really want too, because I was worried my E levels would get lower... but I decided what the heck and I'll start swallowing them and see what shows on my next blood result (3 months later.)
So flash forward 3 months, to about a week ago. I got my test results back, and GUESS WHAT!!! E levels took a huge crash from my previous result. Which I knew cause I felt like crap and was tired 24/7. My T level was even lower though, so that's good. thank god... lol.
Anyways I told her I took her advice and swallowed them for the previous 3 months, as she told me "it doesn't matter." Well, she told me it MIGHT matter and to start taking them under the tongue again and we'll see what happens. She told me my body might metabolize them differently compared to other people. Ok, cool. Understand that.

Well, I mentioned upping my dose to higher mg of E, and she acted like I was crazy. Told me that's "super bad and worrisome" and started blabbing about blood clots, heart attacks, strokes, her license getting taken away, etc. She even told me she only has 1 other trans patient on "that high of a dose." I totally understand her concerns because I know E *can* cause those things. But small increase?! I know SO many other trans girls on that dose. Is my doctor crazy?? I don't really like the information she gave me. First she told me it doesn't matter how I took my E, then she realized my E was ALOT lower then before, then went back on her word and told me to start under the tongue again. Then told me that small increased mg is WAY to high and WAY too dangerous.... thoughts?

I'm sorry if I broke the rules by posting this, but obviously I am in no way condoning self medicating or going against the words of their doctors.... I didn't state the dose I'm currently on, just sharing some experience and seeing what you all think.


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Hi Kadence,

Really need KayXO to chip in here because she really understands the research but I'm pretty sure blood clots were associated with Premarin. It wasn't with bio-identical Estradiol.   

As for under the tongue vs. swallowing, I really don't know what your doctor is talking about.  Yes there's definitely a difference.  Google "Sublingual versus Oral Estrogen".  It's pretty obvious that you get more E in the blood stream by taking it sublingually because it's not going through the digestive system.

Take care,
Paige

[Pisces228]

I am on a pretty high dose of tablets ( taken sublingually) and my Dr isn't concerned about blood clots unless I start smoking again.  My understanding is that premarin causes blood clots at a much higher rate than estradiol.

[Dani]

My dr informed me that taking E under the tongue doesn't really matter, and I could swallow them if I wanted...

Anyways I told her I took her advice and swallowed them for the previous 3 months, as she told me "it doesn't matter." Well, she told me it MIGHT matter and to start taking them under the tongue again and we'll see what happens. She told me my body might metabolize them differently compared to other people. Ok, cool. Understand that.

In the long run, it really does not matter which way you take your Estradiol. Your blood levels just need to be in the normal female range for the magic to happen. It is true that we all have some variation in the way we metabolize the chemicals in our blood system. But the differences are not too terribly great so that we have huge differences in blood levels. Blood levels are mainly determined by the way any drug is absorbed into the blood system. For a given dose, faster absorption will result in higher blood levels.

Well, I mentioned upping my dose to higher mg of E, and she acted like I was crazy. Then told me that small increased mg is WAY to high and WAY too dangerous.... thoughts?

How much of an increase? 10% is not much. Doubling the dose is quite a bit, but still not over dosing depending on the first dose. Bio-identical Estradiol is not as dangerous as the older estrogens but there are risks with all medications and we accept the risks for the benefits Estradiol gives us in treating our condition.

Many people may have disagreements with their doctors on any issue. If the differences are way too much, we just find a different doctor.

I am in no way condoning self medicating or going against the words of their doctors....

Self medication is very dangerous. I am a Pharmacist and about 10% of all Pharmacists become chemically impaired   sometime in their lifetime to the point of not being able to do their job safely. We have access to the drugs and it is an occupational hazard. When I see a co-worker self medicating, I always step in to get proper medical care for that person.

[Kadence1]

Yeah I'm not sure what to do. I think I'm going to find a different doctor. I'm not taking premarin either.... I'm on estradiol. So I think she must be getting something mixed up xD like I said, my levels were high in the female ranges, but are now in the very low female ranges (pre- menopausal.) and the fact she won't bump me up 2 more Mg is a little confusing lol


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[amydane]

It's been pretty frustrating for me to find, and keep the perfect range. I think that until my testicles are gone it could be this way. I wish I could afford GRS.

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[TonyaW]

Could be that you're only 9 months in.

There is concern that too much too soon can cause tuberous (also heard it as tubular) breast growth.  Not something we want. 

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[Maddie86]

hmm, yeah maybe try a different doctor. I go to a doctor about an hour away from me in Oneonta NY and he and his wife specialize in transgender patients. I started HRT in July and he gave me a pretty low dose of estradiol and spiro. the estradiol was actually half the dosage of a trans woman I found on youtube that just started. I do take the estrogen under my tongue, that's how he said to do it so I didn't really question it. I went back in September and my blood tests were fine so he doubled both of my doses, and I go back in December and he said I might get another increase. On my last visit my testosterone was getting low but needed to be lower, so it'd be nice if it worked and I don't have to increase my spiro, spiro makes me a little nervous lol. My estrogen levels were still far from where they need to be, so I feel like that will be increased next time, but I don't know if they will double it. maybe your doctor saw something in your bloodwork that made her not want to increase?

[KathyLauren]

It totally makes sense that swallowing the pills would give you a lower dose than sub-lingually.  When you swallow, the stomach starts digesting the estrogen, and only the undigested portion can be absorbed.

I can see why your doctor would not want to up your dose right away.  Assuming that the drop in levels was caused by swallowing, going back to sub-lingual should bring your level back up.  It would be a mistake to change doses while making that other change, because then you couldn't tell how much of the level change was due to which change in administration.  So she would get you to switch back to sub-lingual, then see how your levels respond, and only then consider upping the dose.