The Menopause Question and When to Reduce Estrogen?

[Tills]

Hi ladies,

I've had a lot of issues these past few months with extreme fogginess and light-headed moments. Allied with occasional hot flash symptoms I'm wondering if my body is trying to set the hormones into a level that is more natural for my age, which is 61.

The thing is, for 11 years now I have been merrily taking Estrogen doses to set a level commensurate with pre-menopausal females so, roughly, in the 400-600 pnmol/L range.

@Lori Dee posted on a different thread about PMS symptoms and I'm wondering if I really ought now to be allowing my body to go on a more natural curve. Speaking of curves, my breasts have levelled out at 42 DD which is clearly pretty full on. But I no longer have tingling in my nipples and my libido is absolutely zero. If I were 61 cis female I would certainly have expected to go peri- to post- menopausal by now.

Is it time to go to a more natural level?

Then there's the method of delivery. At present I'm taking gels twice a day and I think as part of the discussion some less complex method might be handy: patches or injections.

Empirically ,I am awaiting blood test results and I see my female GP on Friday. To be honest she's very likely to be more use than my Gender clinic who are almost impossible to get hold of and fairly useless when it comes to tweaking levels. She won't change my regime without a protracted exchange with the clinic but it might be helpful if I go informed.

This forum is also most likely better informed than any of them.

xx

p.s. please no-one introduce the phrase YMMV. I know. I know. 😉   😀

[Sarah B]

Hi Tills

The following is a post that I made about My HRT Story: What I Had, What I Want and Why in my blog "Sarah B's Story".

I did research into menopause and the various levels and silly me I deleted it I think.  However, I just might reincarnate it somehow.  The figure of "400 pmol/L was arrived at or was checked against that research.

I hope this helps.  So what I'm basically say here is that I'm not going on menopause levels, but will maintain the levels that I'm currently on.

Stay happy.

Best Wishes Always
Sarah B
Global Moderator
@Tills

[Allie Jayne]

Tills, I have always believed in taking the minimum drugs you need to keep you healthy, so it makes sense that when we are finished trying to medically transition, we should review our doses. Many doctors focus on blood levels in relation to cis women menopausal stage, but it really is about how you feel. If your current level is leaving you with hot flashes, or other symptoms, it would be prudent to adjust medication until you feel good. This may involve adjusting up or down, but how you feel is the point.

The most even delivery of hormones is via inserted pellets. It is possible to get 2 years medication from one insertion, and not having to worry about administering  hormones for years is amazing. They do take a little to get right at the beginning, and the initial insertions may last only 6 months, but generally this period lengthens with each new insertion. I know they are available in the UK (I was on a Pellet FB page in the UK), though may need to be compounded.

Hugs,

Allie

[NancyDrew1930]

I never plan to go to menopause levels, since I like the youthful look that estrogen and progesterone are giving me.  Plus, many cis women go on estrogen when they reach menopause in order to maintain their pre-menopause levels and it helps them, so it should continue to help us.

[Lori Dee]

I never plan to go to menopause levels, since I like the youthful look that estrogen and progesterone are giving me.  Plus, many cis women go on estrogen when they reach menopause in order to maintain their pre-menopause levels and it helps them, so it should continue to help us.

I agree with Nancy. There is good reason, post-op, to reduce dosage to a maintenance level. As Allie Jayne mentioned, it is less about actual levels and more about relieving symptoms. "If it ain't broke, don't fix it."

Many cis women enter menopause and have minor symptoms, or are not bothered by them, so there is no need to change anything. As for overall health, estrogen, vitamin D, and calcium work together in the body. Lower estrogen in menopause is believed to cause osteoporosis, and that is another reason to keep levels up as a preventive measure.

I am coming up on six years on hormones, so from my perspective, I am still going through puberty and will then be in the "peak reproductive" phase. I tell my doctors to ignore my chronological age. My hormonal age would be around 17 years old if the onset of puberty were at age 11.

Being post-op would not remove one's need for hormones, but lower doses can be used to achieve the same effect because the body would not have testosterone competing with estrogen. But even in this case, symptoms tell the story and indicate something isn't where your body feels it needs to be.

I also have a theory (just my own theory) that maintaining "youthful" levels contributes to delaying the aging process. The endocrine system, with all of its glands, controls and regulates almost all bodily functions. As we age, gland output diminishes, which in turn affects other bodily functions. Maybe, by maintaining those levels, the body can continue to function as if age is not a factor. Of course, this ignores other health issues that are important considerations.

Definitely discuss your options with your doctor. Medical school teaches to "relieve the symptoms" first, then look for a cause.

Let us know what you learn on this.

@Tills

[Tills]

Thanks ladies. That's all very helpful.

In terms of pre-op or post-op, I had an orchidectomy in 2016 so if I go without exogenous hormones my tank empties very fast, and very nastily. I tried once and it wasn't funny. Then they put me on T and it converted into estrogen

I do have a friend who transitioned many years ago and she is in her 70's now. She is taking no hormones at all, just some vitamins and calcium.

I do feel there's something quite important about respecting the natural processes of life, which means I'm prepared to accept going into post-menopausal phase. Apart from the final op below there is no transitioning left. I have finished transitioning and am a woman now. So I feel it's more about maintenance and less about transitioning , if that makes sense?

xx

[EllenW]

At 71 years young, my endocrinologist has reduced my estrogen prescription so that I will level out closer to the level that an average 71 CIS female. The main reason for this is that I have a family risk of strokes. Both my mother and grandmother died from a stroke.

We have slowly reduced my prescription so that it does not affect my emotional wellbeing. I am happy to reduce my risk of stroke while maintaining enough estrogen to keep well-balanced emotional state.

I think it is important to discuss with your provider at of the risk verses rewards of maintaining a higher level. Remember each one of us is unique and have different medical needs.

Ellen

[Tills]

I love this forum!

The insights and experience is so useful.

I accept that we all vary, and that's important. I shall go to see my GP on Friday with a better understanding of what it is I am after always accepting that my flippin' blood results come through by then: 11 days and counting!

xx

[Tills]

I was a bit whacked yesterday and I'm not sure I expressed things very well.

I love the thoughts and advice on here so much. I find navigating the hormones quite nuanced and, mostly, the knowledge base on here at least matches that of the professionals.

And although I personally don't much care for the mileage metaphor, it is true that we vary. In the main that's because far from being machines, we are complex organisms.

I suppose that's where I am coming from at the age of 61. I've been medically transitioned since I was in my 40's and my body is now where it should be (bar one final op). It cannot return 'male' as there's no masculising hormone. My breasts are huge, my laser hair removal is complete, and I'm a woman.

So I'm happy to allow my body gradually to go into a maintenance mode more commensurate with the organic process of a post-menopausal lady in her 60's.

xx

[NancyDrew1930]

I was a bit whacked yesterday and I'm not sure I expressed things very well.

I love the thoughts and advice on here so much. I find navigating the hormones quite nuanced and, mostly, the knowledge base on here at least matches that of the professionals.

And although I personally don't much care for the mileage metaphor, it is true that we vary. In the main that's because far from being machines, we are complex organisms.

I suppose that's where I am coming from at the age of 61. I've been medically transitioned since I was in my 40's and my body is now where it should be (bar one final op). It cannot return 'male' as there's no masculising hormone. My breasts are huge, my laser hair removal is complete, and I'm a woman.

So I'm happy to allow my body gradually to go into a maintenance mode more commensurate with the organic process of a post-menopausal lady in her 60's.

xx

That's one thing that I'm hoping with my bariatric weight loss surgery will help me with is getting bigger breasts.  Right now I'm at a 54B---is that large?  From what I can tell it's just outside that "normal" range that most bra manufacturers have based on cis women's breasts. To some it might be, but in my case what I'm also finding is that with all my weight I don't know how much of my breast tissue is actually hidden by the fat on my body (and I know that my skeletal structure is a little wider than cis women, however, on top of that how much wider is the fat making me).  Like the width of my stomach is larger than my breasts, so from the side you can see my breasts but then all of a sudden there is this round shape protruding that kind of hides my breasts, making me look pregnant.  Whereas I would like my breasts to be the part that was protruding more than my stomach.  I know that I will loose some volume from my breasts because of my weight loss, however, I have to wonder how much of the actual breast tissue is hiding behind the fat.  However, I know that for me, even taking my other condition into consideration, there is no going back because I feel that in terms of my body I was at the point where trying to contain it was just causing my body to burst and I was possible on a course for early death because my body was bursting at the seams and could no longer hold it in.

[Tills]

Blood results finally received.

Estradiol E2 is in at 500 pmol/L which is exactly where my clinic would want me (Range 400-600 pmol/L)
Testosterone <0.5 nmol/L: (Range 0.40 to 1.20 nmol/L - I take a microdose of T)

Serum Albumin 43 g/L: (midrange of 35.00 - 50.00 g/L)
Total Bilirubin 8 umol/L: (midrange of 00.00 - 20.00 umol/L)
Serum Alkaline phosphatase 68 u/L (midrange of 30.00 - 130.00 u/L)
Serum ALT level 28 u/L (midrange of 00.00 - 55.00 u/L)
Serum FSH 1.1 iu/L: (low? range Follicular 3.0 - 8.1; Mid-cycle 2.6 - 16.7; Luteal 1.4 - 5.5; Post-menopausal 26.7 - 133.4)
Serum LH 1.2 iul/L: (also low? Follucular 1.8 - 11.8; Mid-cycle 7.6 - 89.1; Luteal 0.6- 14.00; Post-menopausal 5.2 - 62.0)
Serum Sex Hormone Binding Glob: 48 nmol/L (range 11.70 - 137.00)
Free androgen: undetectable