Estradiol drop after GRS

[Dorit]

I have been on HRT for 18 months, started with pills, then estradiol patches for over one year.   Before GRS last December my blood test showed a Estradiol(E-2) level of 151.6 pg/ml.    My first blood test post GRS in February showed a big drop of estradiol to 43.5 pg/ml.  I thought that this might be an anomaly, so did my endo doctor.   I just did another blood test, this is 5 months post op and my estradiol is 42.3 pg/ml.   Of course I am off T-blockers, my testosterone is .11 ng/ml, my patches remain the same dose as before.

Has anyone else experienced such a big change in estrogen levels after GRS?   This seems way too low.   I have developed an allergic reaction to the adhesive in the patches, my skin is red and broken up where they are placed.   Could this prevent the absorption of the estradiol from the patch?   I realize I need a new way of receiving estrogen.   I have an appointment next week with my endo doctor to discuss this and the addition of progesterone too.

[Quinn]

cannot help with what may be the issue with low E but you may be able to switch the brand of patch, I believe I have read on here before that some react to the adhesive on one brand but can use another without reaction. Different adhesives between brands. Im still using pill form but that reaction you had was one reason I have steered away from patches up to this point

[LizK]

Hi Dorit

Mine have been all over the place and I think finally with my latest adjustment I might be on track. I feel really quite human again for the first time in a long time. It was just feeling slightly off and since I have been recovering from GCS since December I just put it down to that. I then began to notice changes consistent with low Estradiol and had it checked...sure enough levels at about 40pg/ml they were only slightly higher switching from gel to patches...I have now doubled the patches and due for another review in a week or so with my Dr who is looking to get me into 120-130pg/ml.

I used to have real issues when using patches for medication and I would develop big red welts under where the patches sit...luckily for me I haven't had that issue with the Estradiol. When I was having this rash issue I treated the area with moisturizer prior to each patch being carful to avoid getting any on the adhesive which helped a little. In the end they became quite useless as my skin began to break down after about 3 and 1/2 years. I was then switched to the mechanical medication pump.

Hope this helps with any luck you will get it sorted out soon.

Liz 

[Dorit]

cannot help with what may be the issue with low E but you may be able to switch the brand of patch, I believe I have read on here before that some react to the adhesive on one brand but can use another without reaction. Different adhesives between brands. Im still using pill form but that reaction you had was one reason I have steered away from patches up to this point

This is a good suggestion, but there is one big problem.   We have social medicine, Israel is a small country, and there is the import of only one brand.   As a matter of fact, the patch dose I am prescribed for is also not imported, so I have to use two patches of the smaller dose which adds to the skin area being irritated.   On the plus side of social medicine is that even two patches cost me a total of only $10 per month.

[CynthiaAnn]

Hi Dorit,

  I'll add my experience with E levels as post op (3 years now), and I am 60. I first used patches 14 months (started at age 52), then IM (estradiol valerate) 6 years, and now this year I am back on patches, my levels were checked and I was at 72 pg / ml just last month. My Dr told me this is exactly where I should be given my age and HRT history. My levels are now in the expected "normal" range for post menopausal women. My 2nd puberty is over, I don't need anti androgen anymore (thank goodness), I am now in "maintenance mode" as an older post op. I don't need as much E in my blood as when I was first transitioning (subjective), and by the way I feel great !

Good luck to you

Cynthia -

[Dani]

Post op trans women should be in the 100-to 120 pg/ml range for Estradiol. Whatever dose you need to get there is what your should be using. Wearing more than one or two patches can be a bit disconcerting and if the patches are not getting you there, then there are other options.

Although many older women use patches for some very good medical reasons, I am using sublingual Estradiol tablets, which I feel are just as safe as patches. The down side is that I need to take these twice a day, every day. This is not a problem for me. One plus factor is that tablets are very economical and even if you must pay for them without health insurance, it should not cost too much.

Other girls prefer injectable Estradiol. Whatever works for you is what you need to do.

[Dorit]

I just came back from my endo appointment.   Her solution to my low estradiol and allergy to the glue in the transdermal patches is to try the gel.  So I will do the gel for two months and then go back to my endo with a full blood test.

[ForeverLacey]

I've been on patches for 11+ years and my lab results were all over the place my first couple years before my endocrinologist and myself figured out why. When you schedule blood work, try to do so mid patch cycle. If you are on a 3 1/2 day patch do it on the second, and if you're on a 7 day aim for the 3rd or 4th day. If you are tested on day one of a patch cycle it's possible to have higher than average readings, and the opposite happens with lower than normal readings if tested on the last days of a patch cycle. That said, my patch dosage and lab results still remained the same Post Op as they were Pre.

[Linde]

I've been on patches for 11+ years and my lab results were all over the place my first couple years before my endocrinologist and myself figured out why. When you schedule blood work, try to do so mid patch cycle. If you are on a 3 1/2 day patch do it on the second, and if you're on a 7 day aim for the 3rd or 4th day. If you are tested on day one of a patch cycle it's possible to have higher than average readings, and the opposite happens with lower than normal readings if tested on the last days of a patch cycle. That said, my patch dosage and lab results still remained the same Post Op as they were Pre.

This should not be the case!  The idea behind the patches (our labs developed them) is an even as possible release of the medication to be transdermal delivered.  This is achieved by micro-encapsulating the substance, and over time a certain number of microspheres get broken and release the medication.  If you have very high initial values, it could be that you put to much pressure onto the patch when attaching it, and thus break more spheres, and that amount of medication is missing at the end of the cycle.

I don't have SRS, but with my orchi, my hormone levels should be the same as those of SRS persons, and my endo keeps me at about 140 pg/ml.  My testosterone is below the reliable detection level.

[pamelatransuk]

This should not be the case!  The idea behind the patches (our labs developed them) is an even as possible release of the medication to be transdermal delivered.  This is achieved by micro-encapsulating the substance, and over time a certain number of microspheres get broken and release the medication.  If you have very high initial values, it could be that you put to much pressure onto the patch when attaching it, and thus break more spheres, and that amount of medication is missing at the end of the cycle.

Thank you Linde for that point which had not occurred to me before. Perhaps in my early days I was applying too much pressure but now my readings are fine.

Hugs

Pamela

[Kendra]

I used Mylan brand patch at first.  Six months after starting estradiol (no anti-androgen) I had GCS/GRS.  E levels jumped as expected, but during the following half year E levels fell sharply and a rash developed under the patch wherever I wore it.  At 12 months I switched from patches to weekly intramuscular self-injection.  E levels have been steady ever since.

In the past I hated needles, but injecting E works great for me.

[Linde]

I used Mylan brand patch at first.  Six months after starting estradiol (no anti-androgen) I had GCS/GRS.  E levels jumped as expected, but during the following half year E levels fell sharply and a rash developed under the patch wherever I wore it.  At 12 months I switched from patches to weekly intramuscular self-injection.  E levels have been steady ever since.

In the past I hated needles, but injecting E works great for me.

It might very well be that the pH level of your skin changed, and the result was blistering under the patch.  I had this happen to me immediately with the first patch I ever tried.  Once you have skin blisters, the medication cannot get into direct contact with the skin anymore, and the result is a reduced transfer rate.

[Dorit]

Once you have skin blisters, the medication cannot get into direct contact with the skin anymore, and the result is a reduced transfer rate.

This is what my endocrinologist thought.  She changed me to gel.

[Linde]

This is what my endocrinologist thought.  She changed me to gel.

Are you OK with gel?  Because it might be a skin irritant, too!  I have this baby skin, and after my not so great adventure with patches, I went to pills, which I take sublingual.

My breasts seem to be my only indicators that estrogen is working.  About an hour after taking a pill, my breasts start to hurt.  This is a clear indicator that subinguinal works pretty well to get the stuff into the blood steam!

[Dorit]

My small town pharmacy had to order the gel.   I will have it next Tuesday and let you know how it goes.   In the meantime I continue with my patches.

[Linde]

My small town pharmacy had to order the gel.   I will have it next Tuesday and let you know how it goes.   In the meantime I continue with my patches.

Make sure to always attach patches to new skin sections, and please, for the sake of your skin, remove the patch as soon as you feel that it may start to hurt your skin!  it is better to be a little low in E than having permanent skin damage.