bloodwork question

[Laura91]

I am going in for my first estrogen bloodwork panel very soon and I have a question. Are you supposed to skip that mornings dose before the bloodtest or not?

[siouxsie]

Your doctor would know best.  But, in my case, no, I don't skip it.

[lisagurl]

If you are having the cholesterol checked fast for 12 hours.

[Audrey]

estrogen not cholesterol silly.  I scheduled my blood draw right around the time when I would take my meds in the morn.  That way I didn't screw up my hormone balance too much and they can get more of a "baseline" reading.  I would think if you took your pills before the test your levels would be shown to be higher.  I would ask your physician.  Also when I took my labs, they were more concerned about keeping the testosterone in the female range (ie really low).

Audrey

[lisagurl]

Blood work depending on the Doctor can entail 15 or more separate tests.

[Laura91]

Blood work depending on the Doctor can entail 15 or more separate tests.

Well, in my case this is just an estrogen check. The panel that I did before I started HRT was much more extensive and EXPENSIVE. OUCH!!

[Ember Lewis]

I don't' know if others have it different, but I don't need to skip any HRT doses before blood work. But I was told to fast for 10 hours before a test, so I just don't eat in the morning. I don't know why it's like that but I do know its important to not not eat cuz I was told all the time to fast before I do blood work. It helps with the test results or something

[KarenLyn]

I am going in for my first estrogen bloodwork panel very soon and I have a question. Are you supposed to skip that mornings dose before the bloodtest or not?

This is really a question for your doctor. S/he is the only one who can safely answer that. Now if it was cyclosporin, sirolimus or tacrolimus, I could probably give you the right answer.

Karen Lyn

[Kateri]

Hopefully without breaking any rules I can tell you what I have done for both of my bloodtests so far.  I went for my first one while only on AA not Estrogen and I had about 17 tests done, they must of had about a quart of my blood when they were finished(it was my new primary care doctor and he asked me if I wanted to add any tests and my thinking was 1 needle is better than multiple needles later on).  I had to Fast for the blood test so I just went in first thing in the morning to the lab and waited a half hour watching the news, I took my pills because he didn't say not to and he was well aware of when I take them hehe.  Anyway when the results came back it was actually really cool cause he was able to find something wrong with me that was unknown to me and had nothing to do with HRT but would have prevented me from being started on E when I went to the endo.  I had a second group of tests done at the endo office but that was all in the middle of the day hours after I had taken my medication.  The right answer to you would be ask your doctor, but it makes sense to take the meds since the test is to see how they are workin and if your having the blood drawn right during a break in your med cycle that'd show inacurate results.  The only time I have not taken my meds was when I had a very bad stomache virus but I only missed 1 dose during the 4 day event.  I am thinking of asking for an emergency patch or something for those situations but I wont see the endo for another 2 months almost. 

[siouxsie]

I am going in for my first estrogen bloodwork panel very soon and I have a question. Are you supposed to skip that mornings dose before the bloodtest or not?

Actually, I never get my estrogen levels checked.  I think the reason is how do you determine a baseline?  A genetic woman's estrogen level cycles wildly throughout the month, so what is "normal" range for TS on HRT?  I would question your physician's reason for wanting to measure this.

Testosterone level on the other hand, I have to get checked.  There is a normal range for females.

[lisagurl]

A genetic woman's estrogen level cycles wildly throughout the month, so what is "normal" range for TS on HRT?

You want a high enough level to assure body changes.

[siouxsie]

A genetic woman's estrogen level cycles wildly throughout the month, so what is "normal" range for TS on HRT?

You want a high enough level to assure body changes.

True, but the estrogen test is unnecessary.

[lisagurl]

True, but the estrogen test is unnecessary.

It is very necessary. Too low of numbers will yield poor results and you might be years before you know. Too high of the numbers can be dangerous to your health then it is too late.

[siouxsie]

True, but the estrogen test is unnecessary.

It is very necessary. Too low of numbers will yield poor results and you might be years before you know. Too high of the numbers can be dangerous to your health then it is too late.

I would like to reword my statement.  An estrogen test could very likely be inaccurate.  I found the following from a yahoo group I used to post on and if you can disprove this, I would welcome the discourse.  But, more importantly I fully trust my personal physician, and if he thinks I don't need one, then I don't.  But here is something to back up what I was saying:


1) Estradiol levels taken at a certain point in time do not reflect
your average level, due to fluctuation, especially (but not solely)
in the case of injectables, oral and sublingual. Another reason why
estradiol levels are an incorrect measure of what is really going in
your body. The test may give you the false impression that your
levels are in a certain range when, in reality, they fall under and
rise above that range periodically.

2) There is the issue of estradiol (estrogen) sensitivity (i.e.
genetics) which is also important and is not measured by labs. Some
may be more sensitive than others and thus an acceptable (i.e.
effective) level for one may be too much or too little for the other.
Add to that, the fact that different tissues/areas of the body
metabolize estrogen differently (i.e. configuration of enzymes such
as 17-HSD, aromatase, sulfatase) and respond weaker or stronger to
estrogen, as a result. So that a suitable level for one area of the
body (i.e. to trigger enough changes wanted) is not suitable for
another, being too much or too little. Relying on a predetermined
level does not take into account this reality and finding the correct
balance for oneself can be better achieved by titrating doses as a
function of outcomes.

3)Serum (blood) estradiol levels are also often inaccurate and
misleading, as they often don't correlate with tissue levels, where
it counts the most. Tissues can convert estradiol to weaker
estrogens (estrone, estriol) or inactive compounds and amplify
estrogenic action through local synthesis or conversion of androgens
into estrogens.

[Kateri]

Now I am no expert but it only makes sense that if your paying for something and you have too much of it you'd want to cut down on how much your buyin....that said why wouldn't you want your estrogen checked and if its plenty high your endo MIGHT(I'm no expert) drop the amount of stuff you take in HRT therefore reducing your cost per month.  Any penny you can save now is that much more you can spend on surgeries!   Also insurancewise my Insurance pays any outpatient bloodwork 100% I don't even have to pay a copay to the specialist if thats all I am going there for.  My meds are all oral which means they're goin through the liver so I'd imagine its also nice to know if I can drop the amount of estrogen I have to take therefore lessening the load on my liver.  Either way I dream of the day I can drop my AA medication its absolutely dreadful on some days. 

[Keira]

For estradiol to be dangerous for your health it has to be VERY high,
in pregnancy, E levels are massive and even then it doesn't cause
too many problems except in a minotry. You can't get those levels
through a normal HRT.

What I see is doctors using the E test to keep TS at a too low
level (lower part of average range) for their age and
as a result, things grow too slowly.

Since our HGH is lower than earlier and everyone's reaction
to it is different, we should have higher
E levels than our levels would have been earlier to get the same
result.

Also, everybody's got a different E sensitivity (independent
of HGH, so that's another problem).

There's no studies relating E -> results of any kind at any age,
because the response is individual. Yet, we get a best cookie
cutter dosages, or the lowest that afford minimal progress.


Endo's a good at talking the big talk, but in the case of TS
they've got nothing. Even with plain HRT, after thousands
of studies, people still don't agree on its usefullness or
if its that bad. Hormones have so many feedback systems
in the body and they have such global effcts
with hormones that get conclusive out of them is
next to impossible.

Seeing how much it would cost to get inconclusive general
conclusions, a personalized non conservative program is best
for most, but that's not what they get.

The only thing I agree with is checking T to ensure that your either
E is high enough to suppress it, or anti-androgens have been able
to suppress it.

My opinion is that ideally, we should only used estrogen to control T levels
in the body (that's how the body works) and thus use higher E levels. The
higher E level is the level the body needs to suppress gonad production.

The reason for using anti-androgens initially was that ethinilestradiol and premarin
was dangerous in higher doses, so keeping estrogen levels low was better.

By the way, ethinilestradiol or Premarin levels could not be compared to GG levels. So, until very recently, there was no such thing as checking levels and doctors just played with the dosage of a much more dangerous product than estradiol completely blind. Don't tell me they need to check levels now

I think 90% of endo's who treat TS don't know crap, and the 8% other barely know as much as the TS before them. Maybe 2% are truly good and actually go beyond the strict minimum to treat TS patients.

[Audrey]

estrogen isn't that expensive, and I highly doubt that youd save enough money by cutting back on it to even be a drop in the bucket.

Audrey

[Purple Pimp]

More useful might be to check your Prolactin levels.  As long as they're not abnormally high, your estrogen level is fine and you'll be ok.

Lia

[gothique11]

I think 90% of endo's who treat TS don't know crap, and the 8% other barely know as much as the TS before them. Maybe 2% are truly good and actually go beyond the strict minimum to treat TS patients.

I agree, which is why I don't see the only Endro around here who sees TS people (and only after getting a recommendation from the GID doc, which is a years wait). My GP does a better job, and a lot of TS people have been seeing my GP because he's better in comparison... he also listens, and is willing to learn as much as he can to help TS people. Meanwhile Endro treats TS like post-med women, has conflicting things he tells people, and often does weird doses. IE, one person I know saw him for a year -- not one blood test -- and was just put on birth control. Sadly, she ended up getting extra meds off the internet since her Endro did zilch. Another friend of mine had such a low dose and a high T level, but she didn't know until she went to my GP and got her blood work done, and it was plain as day -- her medication was adjusted and she saw great improvements.

So, yeah, there can be crap doctors and good doctors. I like my GP because he's very willing to work with TS people, and learn and study what he can. He also attends different trans-related health conferences to keep up-to-date. Although is practice is extremely busy (as with all doctors in Alberta), he still takes on TS patients, even though is practice is technically not accepting new patients. He's kind, funny, and very friendly to talk to. He also is musician and has five CD's out, which is pretty cool.

So, yeah, my rocken GP is cool, and I feel pretty luck to have found him. His website, for those interested. It's not so much my style of music (mostly folk/jazz), but still, I think it's cool that he's a doctor and a musician. He's also into theatre productions, and played a small part in a movie once.

--natalie