High estrogen or balanced hormones? Which is better for transitioning?

[ashw]

In terms of feminization and overall development, which is better? Having high estrogen in the thousands of ng/dl with no other sex hormones or an estrogen level in the 200's with proper testosterone and progesterone levels for a cis female?

Is a woman's figure (cis or trans) determined by just high estrogen and nothing else or a good balance of all hormones, no matter how high or low?

I only ask because I have high estrogen with very very low testosterone and progesterone (like undetectable levels) and I pass completely and have a feminine bone structure and face but my fat redistribution is very slow and uneven. The belly, thighs and bottom fill out but the breast doesn't and the stomach grows too much despite a healthy lifestyle. The hips don't grow out sideways while the thighs grow in diameter, if that makes sense. I only have hips because my bones grew wider, but the hips just aren't accumulating fat on the outer sides. I also have bad side effects that I didn't have before when I was on a lower estrogen dose and still had testosterone in me (about 15 ng/dl) when i was pre-op. I get bad mood swings, feel slow and foggy brained, and constantly feel bloated in the stomach and face.

[Dani]

If physical feminization is primary, then Estradiol is all you need. Sky high Estradiol levels are not needed and they will not get you there any faster. You just need to be in the normal female range of 150 to 200 pg/ml, (maybe a little higher is OK too), and keep it there for several years and let things develop.

Putting on the pounds where you least desire is the bane of all women. Welcome to the club.

What I am most concerned about is your reports of bad mood swings, feel slow and foggy brained, and constantly feel bloated. This is not normal or desirable. Your doctor or better yet, your Endocrinologist should be able to work these undesirable side effects out of your HRT.

[Dena]

We have members who are on low dose which might be a quarter of the normal transition dosage and some develop at an astonishing rate. My low level is around  50 pg/ml and while I had HRT in the past, I am seeing additional development at those levels. It seems that estrogen doesn't need to be very high to achieve results and the lower levels may have fewer side effects.

[PurplePelican]

Having high estrogen in the thousands of ng/dl is essentially pointless and may, in fact, hinder things. There's a growing number of people who are finding that a level of around 300 ng/dl provides great feminisation and has the added bonus of suppressing T in most - so no AA needed. Adrenal T is still produced, giving adequate levels for a woman.

[KayXo]

In terms of feminization and overall development, which is better? Having high estrogen in the thousands of ng/dl with no other sex hormones or an estrogen level in the 200's with proper testosterone and progesterone levels for a cis female?

High estrogen will automatically translate into lower testosterone because estrogen reduces it. Whether progesterone is helpful or not is debatable. Some doctors are willing to prescribe it but the jury is still out. I personally think I feel better without it.

Is a woman's figure (cis or trans) determined by just high estrogen and nothing else or a good balance of all hormones, no matter how high or low?

A woman goes through cycles with high and low estrogen and progesterone. During pregnancy, both hormones increase significantly. Her testosterone levels remain low relative to men. Genetics play a role as some women respond more while some respond less.

my fat redistribution is very slow and uneven.

It could have nothing to do with hormones. Some women report increased fat deposition with progesterone. You should discuss this with your doctor.

The belly, thighs and bottom fill out but the breast doesn't and the stomach grows too much despite a healthy lifestyle.

I don't know what you mean by "high" estrogen as you earlier stated. Levels fluctuate and high for someone can be low for another. Sensitivity across individuals varies. Studies tell us estrogen and testosterone prevent fat in the belly (low insulin and cortisol as well) and that estrogen promotes breast development. So....

I also have bad side effects that I didn't have before when I was on a lower estrogen dose and still had testosterone in me (about 15 ng/dl) when i was pre-op. I get bad mood swings, feel slow and foggy brained, and constantly feel bloated in the stomach and face.

I'm post-op. I take some testosterone and find it helps me. Since being on high levels of estrogen and some extra testosterone, I feel better (less bloat, brain works faster and more efficiently, memory improved, mood more stable, increase in energy), perhaps the best I have felt in years and my breasts are growing again. Some women can benefit from some T post-op. Again, you need to talk about this with your doctor and decide what is the best course for you.

You just need to be in the normal female range of 150 to 200 pg/ml, (maybe a little higher is OK too), and keep it there for several years and let things develop.

Not necessarily. In a recent study, it was admitted that in transwomen, the ideal level for optimal feminization is not known. This number is based on an average in ciswomen without taking into account certain critical parameters and forgetting transwomen differ markedly from ciswomen in many ways.

ALSO,

Levels may be within "range" when tested but below or higher at another time so one must ask oneeself if measuring levels is really reliable. Furthermore, can one really expect each and everyone to respond similarly to such a narrowly defined range (which no studies have been done to determine if, in fact, it produces the best results) given the wide individual variation in sensitivity across the population. A nice analogy is alcohol. Does everyone react similarly to a given concentration of alcohol in the body? Does response vary in the same individual across their lifetime and not depend on a host of factors that continually changes? I personally believe these are important questions to ask and discuss with our doctors.

An interesting study reported average levels across 3 menstrual cycles in women aged 20-30 yrs of age to be 340 pg/ml (range 230-556 pg/ml) with average ovulatory peak levels of 565 pg/ml (324-1,000 pg/ml). BUT, ciswomen, we are NOT.

Putting on the pounds where you least desire is the bane of all women.

Women have fluctuating levels of hormones and produce progesterone. Our situation is different. Men also have issues with weight. It is not necessarily the bane of just women.

We have members who are on low dose which might be a quarter of the normal transition dosage and some develop at an astonishing rate. My low level is around  50 pg/ml

It's important to mention that you take your estrogen bucally/sublingually because taken this way, levels peak and are quite high for at least an hour to a few hours so that if you had drawn your blood at a different time, say 1-4 hours after dose, levels would probably be much higher, perhaps as high as 400-500 pg/ml. Taking levels at one point in time only gives incomplete information. If, for instance, we had measured your levels every hour for 24 hours, then we would have a better idea of the overall concentration in 24 hours. This would be more reliable.

It seems that estrogen doesn't need to be very high to achieve results

True in some women. Others find fewer side-effects and benefits from going higher. YMMV, as always. This needs to be looked over with a competent doctor to minimize side-effects and maximize benefits.

Having high estrogen in the thousands of ng/dl is essentially pointless and may, in fact, hinder things.

Estrogen is in the thousands of pg/ml (not ng/dl) as 1,000 pg/ml = 100 ng/dl. Some studies I've come across indicate that high levels may be necessary for certain populations and produce desirable effects such as improved mood, impressive breast development, bone density increase, etc. while having little to no side-effects. But, of course, every individual is different. The doctor determines what is right for their patient.

There's a growing number of people who are finding that a level of around 300 ng/dl provides great feminisation and has the added bonus of suppressing T in most - so no AA needed.

300 pg/ml (0.3 ng/dl).

Adrenal T is still produced, giving adequate levels for a woman.

Not necessarily so as a ciswoman also gets T from her ovaries and may have higher adrenal androgens due to her younger age, resulting in higher T and DHT concentrations in her cells. I find I need testosterone post-op for skin health, libido, energy, etc. Some women appear to do fine without it. We cannot make generalizations.

[Mountain Warfare Girl]

From my research you what your E to be in the 200-300 range and if you want to maintain labeto you need to keep your T between 26 and 50 both are normal Female ranges

[KayXo]

From my research you what your E to be in the 200-300 range and if you want to maintain labeto you need to keep your T between 26 and 50 both are normal Female ranges

In ciswomen, E levels range anywhere from 20 pg/ml to up to 1,000 pg/ml during the menstrual cycle, based on different studies and lab sources while during pregnancy, levels can go as high as 75,000 pg/ml. T levels range anywhere from 6-120 ng/dl.

While total T may be high or low, free and bio-available may be even lower due to high SHBG levels. Also most anti-androgens block T, tests do not provide any information as to how much is blocked.

[Mendi]

Rather than to look at lab values, I would observe what feels good for me. I´ve been following this guideline now, as I don´t have the money to pay for labs.

Observation #1: At start I was sweating during nights so much, that my mattress soaked from sweat. Definitely too low dosage of E and too much T supressed. Immediate increase of E, which reduces the symptoms.

Observation #2: Too high dose, and the same thing starts to happen as in Observation number 1.

And I don´t really need lab values to tell, that there isn´t much of T left in this body, I can see and feel that just fine