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Confused about med influences

Started by Nami1354, March 04, 2018, 05:58:03 PM

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Nami1354

Hello, kinda sorry to just explode into here without proper introductions and stuff but I'm just... I'm freaking out. Obviously I'm taking my transition as a rather sensitive and serious subject.

I go over information rather fanatically, I just... have to know things, have to check everything is perfect, that everything's going according to plan, that's how anxious I am about this and just..

I've been on HRT for 3.5 months now, Spiro and Estrofem daily. The blood work before I started HRT said I have 10nmol\l Total Testosterone (notice the measurements) and 221pmol\l Estradiol E2. So like... low testosterone and high estrogen for a "boy" eh? Endo said "that'll make things easier", so... good!
I just got my results from the checkup blood work and... even though my checkup with the Endo is next week I just CAN'T.. I'm freaking out too hard.
Estradiol E2 came back 294pmol\l. like yay, increase, but it's still really low...up my dosage? ok maybe.
but Total Testosteron came out 16.7nmol\l. 60% INCREASE. Now, I read somewhere, I think it was here, that "Spironolactone blocks reception so it's normal for more testosterone to be in the bloodstream" but that's incorrect. Spirnolactone blocks the receptors from getting the signals to PRODUCE testosterone. so by blocking that I should definitely have less testosterone in my body, so how in the world is such an increase possible on blockers??

Like, I'm getting dizzy, halp




*No Dosages Please*
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Devlyn

Hi Nami, welcome to Susan's Place!

Everyone reacts differently to HRT, my T went up on Spiro and stayed there. That was unacceptable so off with my nuts! My levels are perfect female range now and I feel better. As they say "Not having T is better than having to block T"

See you around the site!

Hugs, Devlyn
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Nami1354

Not exactly the solution I had in mind!
I mean, I suppose a change in medication is possible, going to a different antiandrogen but... I'm still really curious how did that even happen in the first place?? And how others who had this problem dealt with this...besides "off with my nuts" XD
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V M

Hi Nami  :icon_wave:

Welcome to Susan's Place  :)  Glad to have you here, join on in the fun

Here are some links to the site rules and stuff that we offer to all new members to help them along


Things that you should read



Hugs

V M
The main things to remember in life are Love, Kindness, Understanding and Respect - Always make forward progress

Superficial fanny kissing friends are a dime a dozen, a TRUE FRIEND however is PRICELESS


- V M
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Cindy

Hi Naomi,

Why you don't mention is the level of SHBG.

Endocrinology is a dynamic sistem, very rarely is one hormone just turned off, that is not how the system works.

In the case of blocking T with anti-AA it is the binding of Testosterone to its receptor that is blocked. The testosterone still circulates and is bound to Sex Hormone Binding Globulin. SHBG. That increases (usually) when anti-AA are being effective in order to mop up the unbound T.

The common methods of measuring serum T don't tell you whether it is bound to SHBG or not. They just all you it is circulating.

In your case you are probably fine and there is nothing to worry about.
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KathyLauren

If this is your first blood test since starting HRT, don't freak out about it. 

I can't explain the increased T.  Hopefully, your endo can.  But they might not.  Getting the right dosages is a matter of trial and error, and everybody's body responds differently. 

It took my doc 3 adjustments over 6 months to get my levels right.
2015-07-04 Awakening; 2015-11-15 Out to self; 2016-06-22 Out to wife; 2016-10-27 First time presenting in public; 2017-01-20 Started HRT!!; 2017-04-20 Out publicly; 2017-07-10 Legal name change; 2019-02-15 Approval for GRS; 2019-08-02 Official gender change; 2020-03-11 GRS; 2020-09-17 New birth certificate
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Cindy

I'll just add for clarity.

The decrease in production of T occurs later when the feed back mechanisms come into play that the production levels of T are no longer needed. At that time the production of T drops and the production of SHBG also drops as it is no longer required to mop up the circulating unbound T.
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Nami1354

Isn't it kind of silly then that they don't check SHBG? I guess it's obvious that that's the case however, any other scenario is just illogical! It HAS to be that bounding thing, anything else won't make sense.
I just wonder how all this effects my progression, what's needed for this all to be fixed, I don't want it to impact my results! I'll just have to wait for next week I guess.
Thanks for the help!
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Nami1354

I'd like to update that I asked this question on my Dr's page as well, she has a page for all her patients and her to ask questions and talk (how awesome is that?).
She said we need to check LH and FSH, which are hormones in charge of testicle activity and testosterone production, to make sure those are ok, since that's a possible explanation, but if those are normal then it is a problem with the dosage. I told her I have checked those and they are normal to the scales, that I'll come and show her. I'll edit this post next week with what happened, if anyone's curious.
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KayXo

Spironolactone does many things and in some, even at high doses, does not reduce testosterone synthesis/production, but blocks all androgens including the stronger DHT to a certain extent and this would account for why men taking this drug and not seeing any reduction in T still experience gynecomastia, semen abnormalities, etc. The reason you are seeing an increase could be because spironolactone blocks androgen receptors and by doing so, your pituitary gland and hypothalamus aren't getting any negative feedback from the androgens circulating in your blood so that it thinks your body is not producing enough hormones SO it increases its signals, LH and FSH and up goes your T!

BUT, from my own readings, it seems that on spironolactone, T levels fluctuate quite a bit from day to day, up one day, down another so that they don't appear to be very reliable. The important thing though, IMO, is actual physical results and how you feel. If those are good, then you know that what you are taking is working!  :D Regardless of those numbers. A test can't measure how much is blocked, remember that and even recently, in a paper published in 2018, they admitted that measuring T levels on Spiro while treating transwomen is somewhat unreliable.

SHBG is increased by estrogen and will continue to be higher relative to pre-HRT because of the increased estrogen. This will bind more T, leaving less T available to bind receptors.

Finally, do realize that those numbers can be vastly different from one moment to another so another reason they can't be really fully trusted. Had you drawn your blood earlier or later, your T might have been low, E higher, etc.

Best of luck and keep us posted. :)
I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
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Nami1354

That's what's interesting, the FSH and LH are on the lows (within average) and so are TSH and other Pituitay and Thyroid activation hormones, so that's not it, which is why it's so confusing to me.
I was worried, not experiencing a lot of what Trans women say they go through, at least not at the same intensity, some things not at all! and that stands true with those test results, however I have been developing and changing, there's no question about it, maybe that can be attributed to my Prolactin levels though, that are through the roof.
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KayXo

Just out of curiosity (I can't assess as I am not a doctor), what are your FSH and LH levels and what about your prolactin?
I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
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Nami1354

FSH is 2.90lU\L (normal 1.4-18.1)
LH is 3.80 lU\L (normal 1.5-9.3)
and Prolactin is a whopping 564.7 mlU\L (normal 45-375)
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KayXo

Quote from: Nami1354 on March 05, 2018, 11:40:41 AM
FSH is 2.90lU\L (normal 1.4-18.1)
LH is 3.80 lU\L (normal 1.5-9.3)

Strange that at these numbers, your total T is so high. Are you sure it's total T and not free T = 16.7 pmol/L/ which would be within female range.

QuoteProlactin is a whopping 564.7 mlU\L (normal 45-375)

That certainly doesn't appear to be that high. The range you give is most assuredly that of males who have lower levels due to lower estrogen.

Normal range in non-pregnant females is: 106 to 850 mIU/L from trustworthy source, so you appear to be within range. In pregnant women, levels are much, much higher. On EV (estradiol valerate) injections, my levels were between 1,700 - 2,800, due to high estradiol and progesterone. During pregnancy, levels can get as high as 13,000!

As always, you need to discuss these numbers with your doctor and let them decide what to do next. Keep us posted. :)

I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
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Nami1354

Sadly I'm certain! It confused me so I just checked over and over to make sure.
I mean yeah, the Prolactin is super high for males but reading a little about it, that makes a lot of sense. I wasn't really alarmed about it, just thought that made sense with my chest developing. Even though my Estradiol is pretty low and Testosterone is pretty high, something's still cooking in there. But either way that's probably going to be in the past as of the next week or two, most likely just going to get an increase in the meds and sort this out.
Thanks for the info and reassurance btw!
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