My estrogen levels are dropping

[mikidiki]

Hi there,

I get my estrogen levels checked 6 monthly now as opposed to yearly and my estrogen keeps dropping despite me having made no change to my medication. My results in 2015 was 423 pmol/L (e2), 2016 was 337 pmol/L (e2), May 2017 it was 267 pmol/L (e2) and in November (now) it's 232 pmol/L (e2).

Any ideas as to why it's dropping? The doctor was unable to give me any advice.

Much appreciated,

Miki

[Dena]

There isn't enough information to know for sure but the normal problem is the time between the last dose and you blood test. Estrogen levels start very high after a dose and decline as time goes on. The half life of pills is only about 3 hours where as an injection is days. Patches are somewhere in-between and implants last months. To measure levels exactly you need to time your blood test to the same point in your cycle.

[Devlyn]

Metabolism, age maybe? 232 is a good number, is there a reason you want it higher? Are you seeing results?

Hugs, Devlyn

[Deborah]

232 pmol/l is 63 pg/ml.  That's pretty low and not far above the top of male range.


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[Devlyn]

Dena and Deborah have pointed out to me that I'm misreading your numbers. Sorry, all.

Hugs, Devlyn

[mikidiki]

Metabolism, age maybe? 232 is a good number, is there a reason you want it higher? Are you seeing results?

Hugs, Devlyn

Fast metabolism, I am 39. Yes, huge results, been on estrogen for 5 years now. I took a pill about 3-4 hours prior to my blood test. Pills are taken sublingual 3 times a day - morning, late afternoon, evening.

[Dani]

With blood levels that low, something is definitely wrong. Since you are getting your blood levels drawn 3 to 4 hours after taking your estrogen sublingual, there will be a dramatic lowering of your blood levels at that time. If you want a good reading, have two blood levels taken. The first should be right before you take your estrogen and the second about 30 minutes after you take your estrogen. This will give you a good reading on the peak and valley of your estrogen levels.

There is also another possibility for low drug levels. I am a Pharmacist, and all medications needs to be stored properly and within date from a manufacturer with a good reputation. There are also counterfeit drugs out there. Sometimes one batch of medication will be made slightly different so that it may cause decreases in the absorption of that drug. Lastly, sometimes there are errors in filling the prescription. This is rare, but it does happen.

[mikidiki]

With blood levels that low, something is definitely wrong. Since you are getting your blood levels drawn 3 to 4 hours after taking your estrogen sublingual, there will be a dramatic lowering of your blood levels at that time. If you want a good reading, have two blood levels taken. The first should be right before you take your estrogen and the second about 30 minutes after you take your estrogen. This will give you a good reading on the peak and valley of your estrogen levels.

There is also another possibility for low drug levels. I am a Pharmacist, and all medications needs to be stored properly and within date from a manufacturer with a good reputation. There are also counterfeit drugs out there. Sometimes one batch of medication will be made slightly different so that it may cause decreases in the absorption of that drug. Lastly, sometimes there are errors in filling the prescription. This is rare, but it does happen.

Everything is "kosher" when it comes to me taking my estrogen and storing it correctly. It's purchased from a pharmacy from a script by my local G.P (it's not purchased from the internet), it's not out of date, it's not taken out of it's foil blisters prior to being used, it's not stored in sunlight and it's not stored in the fridge. I have made an appointment at another doctors who will be able to help me out more as to why my E levels are dropping. My appearance hasn't changed and I don't feel different, I'm just concerned knowing that it's dropping so much. Thanks all for your replies.

[KayXo]

My appearance hasn't changed and I don't feel different

To me, personally, that's what truly matters so if things are going well, you feel good, changes are still taking place, forget those numbers. Estradiol will greatly fluctuate when you take pills sublingually, from up to 500 pg/ml (1,836 pmol/L) at 1 hour to less than 100 pg/ml (367 pmol/L) after 4 hours and really, ask yourself...what's the point of even measuring levels?? There is no ideal level for everyone, each person reacts differently.

[mikidiki]

To me, personally, that's what truly matters so if things are going well, you feel good, changes are still taking place, forget those numbers. Estradiol will greatly fluctuate when you take pills sublingually, from up to 500 pg/ml (1,836 pmol/L) at 1 hour to less than 100 pg/ml (367 pmol/L) after 4 hours and really, ask yourself...what's the point of even measuring levels?? There is no ideal level for everyone, each person reacts differently.

I agree but at the same time it bothers me that my readings are on the very low side. I just want to talk about possibly increasing my dosage (that will take me to an extremely high dosage which is undesirable) or including another form of estrogen to my dosage. He'll know what the best course of action (if any) for me is the best. p.s - Mine is a lot less than 367 pmo/L LOL!

[Deborah]

Just for comparison, on my last blood test my estradiol level was 503 pmol/l or 137 pg/ml when tested 15 hours after my last dose.  My dosage is on the high side but not out of the ordinary.  So while levels do drop off in the hours after taking a dose they don't necessarily drop real low even after a fairly long time. 

The logical conclusion then is that either your dosage is too low or that something else, either defective meds or some physical issue, is at work.


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[mikidiki]

Just for comparison, on my last blood test my estradiol level was 503 pmol/l or 137 pg/ml when tested 15 hours after my last dose.  My dosage is on the high side but not out of the ordinary.  So while levels do drop off in the hours after taking a dose they don't necessarily drop real low even after a fairly long time. 

The logical conclusion then is that either your dosage is too low or that something else, either defective meds or some physical issue, is at work.


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I'll keep you all posted. Appreciate your help,

[mikidiki]

Just for comparison, on my last blood test my estradiol level was 503 pmol/l or 137 pg/ml when tested 15 hours after my last dose.  My dosage is on the high side but not out of the ordinary.  So while levels do drop off in the hours after taking a dose they don't necessarily drop real low even after a fairly long time. 

The logical conclusion then is that either your dosage is too low or that something else, either defective meds or some physical issue, is at work.


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p.s - Can you give me an example of what you mean by "physical issue"?

Thanks,

[Deborah]

p.s - Can you give me an example of what you mean by "physical issue"?

Thanks,

I don't know.  I'm just speculating on some metabolic or adrenal issue that might interfere with estradiol absorption and circulation.  I don't  think a fast metabolism by itself could be the reason because my metabolism is pretty ramped up too. 

It would be simpler if we could just compare our doses, but we can't.   If it helps though my dosage right now is the maximum you will find listed elsewhere for medically supervised regimens.


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[mikidiki]

I don't know.  I'm just speculating on some metabolic or adrenal issue that might interfere with estradiol absorption and circulation.  I don't  think a fast metabolism by itself could be the reason because my metabolism is pretty ramped up too. 

It would be simpler if we could just compare our doses, but we can't.   If it helps though my dosage right now is the maximum you will find listed elsewhere for medically supervised regimens.


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That does help a lot, mine is just under yours then so at least I know I have room to move as such although I don't know how much of a difference taking one extra pill is going to do.....

[mikidiki]

So I saw my doctor who told me that he will assess my estrogen levels in about 6 weeks (I increased my dose about 2 weeks ago). If my estrogen levels are at a level he is happy with he will keep things as they are however if they are still low he will add a patch to my regime and decrease the tablet dosage.

[Mandy M]

I take it that you haven't altered the method of administration?

I notice that Thomas Bevan's excellent 'The Pyschobiology of Transsexualism and ->-bleeped-<-' (2015) does not advocate sublingual administration of estradiol valerate, unlike other forms of estrogen.

Since I've been taking EV by sublingual method for 3 years, I would love some more on the science of this. Are the two methods (sublingual and oral) really likely to deliver a different uptake of estrogen?

[KayXo]

If my estrogen levels are at a level he is happy with he will keep things as they are

And what about your well-being or your physical development/changes? Do these not matter? If your levels at time X (they could be quite different at time Y and Z) are "good" but you don't feel well and your feminization is poor, what then?

Lancet Diabetes Endocrinol. 2017 Apr;5(4):291-300.

"The precise concentration of oestradiol that results in adequate feminisation with the lowest risk of complications is not known.28"

Since I've been taking EV by sublingual method for 3 years, I would love some more on the science of this. Are the two methods (sublingual and oral) really likely to deliver a different uptake of estrogen?

Personally, I didn't notice an iota of a difference taking estradiol (Estrace) sublingually vs. orally as far as as HOW I FELT or feminization (i.e. breast growth) so I just swallowed. Studies have, however, clearly demonstrated that when estradiol is taken sublingually, higher levels are attained but it's short-lasting.

[mikidiki]

And what about your well-being or your physical development/changes? Do these not matter? If your levels at time X (they could be quite different at time Y and Z) are "good" but you don't feel well and your feminization is poor, what then?

"The precise concentration of oestradiol that results in adequate feminisation with the lowest risk of complications is not known.28"

Personally, I didn't notice an iota of a difference taking estradiol (Estrace) sublingually vs. orally as far as as HOW I FELT or feminization (i.e. breast growth) so I just swallowed. Studies have, however, clearly demonstrated that when estradiol is taken sublingually, higher levels are attained but it's short-lasting.

My physical changes haven't altered in any way shape or form since my estrogen levels have been decreasing, it's just the fact that they have decreased to such a level that it is not far from top of the male range as already pointed out; hence why I wanted to see my doctor in case they drop even more. I only recently increased my dose so he would rather wait until early January to check my levels again and then reassess then.


[/quote]

I take it that you haven't altered the method of administration?

I notice that Thomas Bevan's excellent 'The Pyschobiology of Transsexualism and ->-bleeped-<-' (2015) does not advocate sublingual administration of estradiol valerate, unlike other forms of estrogen.

Since I've been taking EV by sublingual method for 3 years, I would love some more on the science of this. Are the two methods (sublingual and oral) really likely to deliver a different uptake of estrogen?

No, I haven't altered the method of administration - I have always taken them under the tongue as opposed to swallowing.

[mikidiki]

So after increasing my dosage my results are now above the recommended level of estrogen for trans women which I am happy about. The doctor will reassess again in a month and consider dropping my dosage or leaving me on the same dosage depending on how high my next results are (I just started swallowing as opposed to taking them sublingually so I'm interested to see if that also has some effect on the results).