Susan's Place Transgender Resources

Hi everyone.  I am new to this forum but not new to transitioning.  I have been on Dr supervised  HRT for about  6 years.  The problem is that nothing seems to be working.  I started on estradiol injections but then transitioned  to estradiol pills. I also am on spironolactone as well as medroxyprogesterone  and  finasteride.  Through the years my Dr has adjusted dosages on everything trying to find one that will work.  However,  not only is my hormone cocktail not producing results,  I am actually going the opposite direction.  Before starting hrt,  my testosterone levels were fairly low (250). Within the first year, those levels went down to the 17 range. However,  there were still no physical changes.  After  5 years,  my blood work is showing that my testosterone is going the wrong direction.  3 months ago,  my testosterone level had gone up to  382.  As of last week my blood work  showed my t levels at  784. I am getting VERY disturbed by this and don't know where to go from here. Is it possible to develop a resistance to spiro over the years?  Are there any other combos to suggest to my dr at my next appointment  (1 1/2 months)  thanks for any replies.

Hi KelKel, welcome to Susan's Place! You're new to the forums and did a good job not breaking our "No dosages, please" rule. There's lots of experienced people here, you should get some good advice. See you around the site, hugs, Devlyn

I've been around various trans forums in the past and know the dangers of fueling self medicators with dosages.  I haven't really been a part of the  "community" in years though so this is my reintroduction.

You're going to do just fine here! Hugs, Devlyn

Quote from: KelKel on March 19, 2013, 06:17:23 PM
Hi everyone.  I am new to this forum but not new to transitioning.  I have been on Dr supervised  HRT for about  6 years.  The problem is that nothing seems to be working.  I started on estradiol injections but then transitioned  to estradiol pills. I also am on spironolactone as well as medroxyprogesterone  and  finasteride.  Through the years my Dr has adjusted dosages on everything trying to find one that will work.  However,  not only is my hormone cocktail not producing results,  I am actually going the opposite direction.  Before starting hrt,  my testosterone levels were fairly low (250). Within the first year, those levels went down to the 17 range. However,  there were still no physical changes.  After  5 years,  my blood work is showing that my testosterone is going the wrong direction.  3 months ago,  my testosterone level had gone up to  382.  As of last week my blood work  showed my t levels at  784. I am getting VERY disturbed by this and don't know where to go from here. Is it possible to develop a resistance to spiro over the years?  Are there any other combos to suggest to my dr at my next appointment  (1 1/2 months)  thanks for any replies.

You are a good candidate for an orchiectomy.

Though I am not sure if you are quoting total testosterone, free testosterone, or some other value.
And what units.

Sorry but I gave the wrong number earlier.  I am at  734 ng/dL  of total testosterone and 108.7 pg/mL of free testosterone. (reference range for total is 2-45 and for free  is 0.1-6.4)

Similar thing happened to me.  What are the estrogen levels doing?  Need that information to go beyond guessing.  Also, please check units for testosterone again.   Possible to help define problem.  Not MD so cannot give solution but sometimes problem definition leads to good solution.  Dent from phone, sorry clipped.

The units are correct.  As far as the estrogen levels,  my latest lab on that same in January.  (the lab forgot to do the test on my latest blood work)  then it was VERY low.  45 pg/ml

Wow... that sounds like E is not even getting into your blood. What method are you using to get E into the blood?

Well like I was saying earlier,  I was on im injections for years but switched to oral estradiol.  Neither of which seem to have worked.

Wow, you need to talk with your doctor..... 

Suggest you two discuss Estradiol patch - estrogen pills are esterone and the injections are conjugated estradiol.  Neither of these is in the same form as the patch.  As far as the T, temporary chemical castration???  Depo or similar will do that.  Orchi is another possibility.  Your doctor needs to broaden the horizons...  It may be something like slow adsorption.  Are you taking the spiro with food? (food can slow adsorption down).  Think about how you took is a few years ago versus how you are taking it now. 

You really need to talk with the doctor as this could also be due to some other problem in the gastrointestinal system.  Weight change?  Diet change?  (Not for me, for the Doc.)

Oh, my Dr and I DEFINITELY discuss possibilities and treatment options.  He is the first person I go to with questions about this.  The difficulty comes in the fact that my Dr of 5 years retired on me last year .  The Dr who took over his practice is quite knowledgeable as well and I really like him but don't have the familiarity with him as with my old doctor.  My old doctor had treated  hundreds, if not thousands of Transgendered patients throughout his career and yet said that he had never been as stumped over a patient as he was with me.  He considered me his  "challenge"  (which he never actually fulfilled before retiring on me).  Now the new doctor has inherited  the "challenge" and I hope he does better in the end than his predecessor.
As for the estrogen pills,  we did indeed discuss  estrone but due to its weak action never even seriously considered it.  Instead I am on estradiol.  When on injections,  it was estradiol Valerate but to be honest I am not entirely sure of which form of estradiol  the pills are.  I thought i saw Valerate somewhere but upon looking,  the labels only say estradiol  (from walgreens)

If it only says Estradiol on it, it's probably 17b Estradiol, which is exactly E2 (estradiol).

Sounds like your body is somehow isolating excess estradiol from your bloodstream... perhaps it's found a way to metabolize any excess very effectively?

Have you had any other tests, such as a Sex hormone-binding globulin test? That may some answers...

Are you taking any vitamins?  Any adidtional vitamin C?  Sounds strange but E can lower essential vitamins (which can adversly affect metabolism and cause the body to treat E like a weak toxin) and C is helpful in adsorption of E when both are taken orally.  There are also a few drugs that negatively impact E second pass adsorption, like antibiotics plus a few other.  Another thing is induction of the 3A4 system in the liver which lowers E and there are a plethora of those drugs out there. 

I just like the patch for E.  Adsorption through the skin bypasses adsorption issues and immediate metabolism by the liver.

Now, I think I'm getting a little close to the rules of medication on this site.  So please, think about everything you are currently eating and taking as well as when you are taking the E.  Then, talk to your doc.

Thank you all for the wonderful advice.  There are many things to consider before my next appointment.  One of which is looking more into the sex hormone-binding globulin test. I will also discuss other possible modes of delivery in further detail.  We have discussed various other options such as the patch in the past but at the time decided against it due to the fact that even the injections were not producing results.  The focus was then shifted toward adjusting dosages of progesterone and finasteride.  It may be time to reevaluate alternative methods though.