Susan's Place Transgender Resources

Hello all,

I had an appointment with my endocrinologist today and went over my latest lab work.  Everything seems to be going well and she told me that I'm in good shape (other than being vitamin d deficient).  However, she noted that my estrogen level had significantly dropped.  Now I don't understand much about these levels, so forgive me if I'm not explaining things right and this makes no sense.  She told me that the current level is 70 and I was about 110 3 months ago.  Obviously, this worries me because it sounds like I'm regressing.  I didn't take my hormones in the morning the day that did my recent bloodwork as I was running around, so maybe it appeared lower than it was?  I'm pretty sure I took my hormones before the previous labwork which is making me think that's the reason for the discrepancy. That's what my endo thinks and she doesn't seem worried, but it concerns me.  What do you all think?  Oddly enough though, my T level was also lower (she said it was 16) than last time, so it's a bit confusing.  Thanks for any input you may have. 

  Hi there ,

  I also had some low Estrogen levels when I did my lab tests , they were 59,5 pg/ml . I took the morning dose in the day I was tested , yet without food . I don't know if that would affect the results or that is the level I have every day  .  I hope that some more talking with the Endocrinologist and another blood test will clarify things . 
  I know it didn't help , I just related with this topic  , so please forgive me and I hope you will solve this issue soon  :)  .   

By the way, I should note that I am 25 if that helps.

I'm looking it up online and it seems very low.  This is a huge concern.  Even the good level of 110-120 doesn't seem all that great despite my endo's assurances that it's a good spot for me to be. I'm hoping my ignorance on this subject is just making me worry over nothing.  It just seems weird given my dosage that it would be so low compared to the numbers I'm seeing in my quick online research.  Panic attacks are fun, aren't they?  Anyway, I will welcome any informed opinions that can put me at ease with my current level.   

Quote from: Claudia_FF on May 22, 2014, 11:44:04 AM
  Hi there ,

  I also had some low Estrogen levels when I did my lab tests , they were 59,5 pg/ml . I took the morning dose in the day I was tested , yet without food . I don't know if that would affect the results or that is the level I have every day  .  I hope that some more talking with the Endocrinologist and another blood test will clarify things . 
  I know it didn't help , I just related with this topic  , so please forgive me and I hope you will solve this issue soon  :)  .   

I fast every time I get labwork, but usually sublingually take my hrt pills.  I have 3 doses throughout the day, so sometimes I take the early ones close together.  This time I took nothing, so I'm hoping that's why.  I'm just sort of freaked out right now. 

Hey , please try to relax . It is not something acute , something that affect you in a day , you will get a solution soon , don't worry .  I have no knowledge about the Estrogen levels , so I just compared them with standards that were shown next to them :)  , I was yet surprised to see my levels were low because the dose I take is a common one  . 
Again , don't over stress from this , I know how I do myself when I get obsessed with something and it is not fun  .  Beside if you are healthy , emotionally ok and your body show a response from the HRT maybe you really are in ' a good spot ' as your Endocrinologist say  . 
I don't use to make assumptions about things I don't know , but now I just want you to relax and deal with it In a calm way  :)

Quote from: Claudia_FF on May 22, 2014, 12:37:59 PM
Hey , please try to relax . It is not something acute , something that affect you in a day , you will get a solution soon , don't worry .  I have no knowledge about the Estrogen levels , so I just compared them with standards that were shown next to them :)  , I was yet surprised to see my levels were low because the dose I take is a common one  . 
Again , don't over stress from this , I know how I do myself when I get obsessed with something and it is not fun  .  Beside if you are healthy , emotionally ok and your body show a response from the HRT maybe you really are in ' a good spot ' as your Endocrinologist say  . 
I don't use to make assumptions about things I don't know , but now I just want you to relax and deal with it In a calm way  :)

Don't worry, I'm okay.  Just very concerned at the moment.  I've been on hormones for a while and want to get the best results that are possible for me.  The problem is that I know nothing about hormonal levels and where I should be, so I trust my endocrinologist.  She is okay with my current level and thinks it's only showing low because I didn't take my medication the morning of the test.  And she said the 110 or 120 (I forgot which one she said) was good.  However, after looking this stuff up, I feel like I may be low and am freaking out a bit.  That's why I want to see what other people think.  Still, I'm okay and healthy.  It seems like most of my labs came back good and have lost a good amount of weight since my last appointment.  I'm just checking to see if this is normal, but don't worry, I'm not freaking out in a big way. 

Are you an endo? Or a gyno? Or even an MD? Ph, that's right, you're not.. 

Trust your endo, they know what they are doing. And it's kinda logical that if you don't take a dose that your levels will be down.

Quote from: kelly_aus on May 22, 2014, 02:14:02 PM
Are you an endo? Or a gyno? Or even an MD? Ph, that's right, you're not.. 

Trust your endo, they know what they are doing. And it's kinda logical that if you don't take a dose that your levels will be down.

I do trust my endocrinologist.  If I didn't, I would have moved on to another practice.

It's just that even my good level appears low when comparing it to others.  So, I wanted to see where others think about the level I am at.  Just to kind of get some consensus on where our levels should be.  The best patient is an informed patient that understands their own health and needs.  Right now, I know very little about hormonal levels, so I wanted to get some perspective on where I really stand.   Of course all of these things can vary and my endocrinologist knows my medical history better than anyone and is in a better position to make a judgement. 

Quote from: learningtolive on May 22, 2014, 11:31:35 AM
I had an appointment with my endocrinologist today and went over my latest lab work.  Everything seems to be going well and she told me that I'm in good shape (other than being vitamin d deficient).

Same here! I take supplements now.

Quote from: learningtoliveShe told me that the current level is 70 and I was about 110 3 months ago.  Obviously, this worries me because it sounds like I'm regressing.  I didn't take my hormones in the morning the day that did my recent bloodwork as I was running around, so maybe it appeared lower than it was?  I'm pretty sure I took my hormones before the previous labwork which is making me think that's the reason for the discrepancy. That's what my endo thinks and she doesn't seem worried, but it concerns me.  What do you all think?

Levels may vary somewhat across time, more so with certain administration routes such as sublingual and injectables. The important thing is that 1) you feel good 2) you have good feminization (breast growth, skin, body hair, face, curves, etc). Levels cannot tell you that, only you know that.

Quote from: learningtoliveOddly enough though, my T level was also lower (she said it was 16) than last time, so it's a bit confusing.  Thanks for any input you may have.

Just as E may vary, so can T. Like I said, I think physical and psychological results matter more. 

Quote from: KayXo on May 22, 2014, 03:03:26 PM
Same here! I take supplements now.

Levels may vary somewhat across time, more so with certain administration routes such as sublingual and injectables. The important thing is that 1) you feel good 2) you have good feminization (breast growth, skin, body hair, face, curves, etc). Levels cannot tell you that, only you know that.


Just as E may vary, so can T. Like I said, I think physical and psychological results matter more.

I guess your right.  I take pills but use them sublingually, so it's likely that my levels will change depending on the time.  I've certainly seen results and know I'm on a high dose; therefore, I'm probably worrying about nothing.  Just wanted to check, but I feel better now.

Yay! :)

If you normally take your tablets before a blood test but didn't this time that might account for it. I'm expected to fast before my tests, so do them first thing in the morning before breakfast and pills.

Quote from: KayXo on May 22, 2014, 03:03:26 PM
Same here! I take supplements now.

Levels may vary somewhat across time, more so with certain administration routes such as sublingual and injectables. The important thing is that 1) you feel good 2) you have good feminization (breast growth, skin, body hair, face, curves, etc). Levels cannot tell you that, only you know that.


Just as E may vary, so can T. Like I said, I think physical and psychological results matter more.

Perfect- we can get hung up on serum levels real quick.  Mine have been low for most of the year of hrt.  I have boobs, curves, gentle changes, feel good.... and recently changed from sublingual to oral.

I am turning it all over to the endo to figure out.  When my dysphoria hooks into levels I drive myself nuts.

At least on oral I don't crash so much.

Good luck, I have bloods next week, they may or may not put me onto injections.

Have fun... its all good.

And I screwed my numbers up a couple times, they want it at the low level, test first then take, for this next round.  I was measuring spikes, bad science that way, misunderstood the endo's directions.

Quote from: Satinjoy on May 22, 2014, 03:26:21 PM
Perfect- we can get hung up on serum levels real quick.  Mine have been low for most of the year of hrt.  I have boobs, curves, gentle changes, feel good.... and recently changed from sublingual to oral.

I am turning it all over to the endo to figure out.  When my dysphoria hooks into levels I drive myself nuts.

At least on oral I don't crash so much.

Good luck, I have bloods next week, they may or may not put me onto injections.

Have fun... its all good.

And I screwed my numbers up a couple times, they want it at the low level, test first then take, for this next round.  I was measuring spikes, bad science that way, misunderstood the endo's directions.

I really wish I could do injections as I hear a lot of good things about the results.  Unfortunately, needles scare the hell out of me and there is no way I would inject myself with anything.  However, if you can handle doing that, it might work well for you.  From what I've heard, most people seem to prefer it over pills.

Quote from: Ms Grace on May 22, 2014, 03:24:09 PM
If you normally take your tablets before a blood test but didn't this time that might account for it. I'm expected to fast before my tests, so do them first thing in the morning before breakfast and pills.

Yeah, I'm hoping that's all it was.  I should probably be more consistent with the times I take them and be more careful to keep my doses away from each other. 

Quote from: learningtolive on May 22, 2014, 03:43:14 PM
Yeah, I'm hoping that's all it was.  I should probably be more consistent with the times I take them and be more careful to keep my doses away from each other.

Absolutely. Not always possible I understand but consistency is important. Bodies like regular cycles.

Personally, I don't care about estrogen levels at all and it doesn't seem to have been a problem, if that helps. :) My endo thinks E levels are so variable that it's not worth testing for, particularly when the real issue is whether testosterone is under control; she goes by T level and whether I'm happy with my rate of change. So far, so good! If your dose is otherwise working and you haven't *noticed* any regression, then it's probably just a quirk of the test (time of day, etc. can affect it).

I never take my hormones until after the test, since I am worried about taking them on an empty stomach. Am I doing something wrong?

Quote from: Julia (Apple-Whatever) on May 22, 2014, 04:17:04 PM
I never take my hormones until after the test, since I am worried about taking them on an empty stomach. Am I doing something wrong?

I'm not sure if it matters.  In my case, it was the discrepency of the numbers that caused alarm.  From what I got from my endo, she seemed to want me to take one of my doses first thing in the morning.  Usually, I avoid drinking coffee or eating before blood work as that can interfere with measuring things like glucose levels. 

Quote from: Jenna Marie on May 22, 2014, 04:14:20 PM
Personally, I don't care about estrogen levels at all and it doesn't seem to have been a problem, if that helps. :) My endo thinks E levels are so variable that it's not worth testing for, particularly when the real issue is whether testosterone is under control; she goes by T level and whether I'm happy with my rate of change. So far, so good! If your dose is otherwise working and you haven't *noticed* any regression, then it's probably just a quirk of the test (time of day, etc. can affect it).

Well, then that's a good thing.  My T level went from 25 to 16.  I have no idea what the values are as she only told me the number, but she seemed very happy with that.

Quote from: Ms Grace on May 22, 2014, 03:50:57 PM
Absolutely. Not always possible I understand but consistency is important. Bodies like regular cycles.

Yeah, I got to get better on this.  Usually I take two doses in the morning very close to one another.  For now on, I'm going to take one each for morning, afternoon and evening.  Hopefully that will make things more stable. 

Both 25 and 16 are within the cis female range for T (assuming it's the standard values that go along with those sorts of numbers, the range is about 15-80), and I'd say *dropping* T numbers is a solid indicator that the dose is working and even increasing in effectiveness.

Quote from: learningtolive on May 22, 2014, 03:43:14 PM
I really wish I could do injections as I hear a lot of good things about the results.  Unfortunately, needles scare the hell out of me and there is no way I would inject myself with anything.  However, if you can handle doing that, it might work well for you.  From what I've heard, most people seem to prefer it over pills.

I also have a phobia of needles, not as much anymore and I have them done by a nurse at the health centre. So you don't have to do it yourself and your fear can be overcome...trust me! I was really scared before and slowly, but surely, that fear is subsiding. Switching to injections was totally worth it and I also refrained from them due to fear for several years...big mistake. Not only do they work better for ME, but I feel better for overcoming my fear. :)

Quote from: learningtoliveI should probably be more consistent with the times I take them and be more careful to keep my doses away from each other.

Personally, I don't see the point in testing E levels when on sublingual since they fluctuate SO much. In the order of several hundreds of pg/ml in a matter of a couple of hours. Drawing levels gives absolutely no indication of what your average levels are, the curve, the highs and lows, etc. You would have to draw levels at several points in time. Just my 2 cents. ;)

Quote from: Jenna Marie on May 22, 2014, 04:14:20 PM
Personally, I don't care about estrogen levels at all and it doesn't seem to have been a problem, if that helps. :) My endo thinks E levels are so variable that it's not worth testing for, particularly when the real issue is whether testosterone is under control; she goes by T level and whether I'm happy with my rate of change. So far, so good! If your dose is otherwise working and you haven't *noticed* any regression, then it's probably just a quirk of the test (time of day, etc. can affect it).

Totally agree.

Quote from: Julia (Apple-Whatever) on May 22, 2014, 04:17:04 PM
I never take my hormones until after the test, since I am worried about taking them on an empty stomach. Am I doing something wrong?

With estrogen, I don't think it's a problem. I've never had any problems, either way. With other medications, could be. Like Spiro is sometimes better taken with food to decrease stomach upset, if any. Food also slightly improves Spiro bioavailability which is high already. Progesterone (oral, Prometrium) is usually not recommended to be taken with food as sedative effects are increased (drowsiness, sleepiness) but so is the bioavailability of progesterone. Always check with your pharmacist and doctor. ;)

This is a repost from a while ago

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2FAxPE5WL.jpg&hash=0da494d763cf6a174525ed02857b8752e1bc45aa)

I was taking estrogen sublingually and got blood work done three times within three months at different times and had three drastically different levels reported (as pictured). Nothing in my lifestyle changed throughout these tests - medications, diet, activity, etc.

I've now switched to both lowering my dose and swalloing the pill. I haven't got bloodwork done yet, but already I've noticed my mood steady out and even noticed slight changes (positive) in my face and elsewhere.

My thoughts are that taking it sublingually, although bypassing the liver, emits all the estrogen into the blood at once but fades quickly, hugely inconsistent levels. I'm not an endocrinologist, but having c. 400 levels in the morning and c. 100 levels at night (all occurring within only 12 hours) cannot be healthy for the body.

Quote from: learningtolive on May 22, 2014, 07:07:10 PM
My T level went from 25 to 16.

Mine is around 15-16 (total testosterone). I'm post-op though.

Quote from: learningtoliveFor now on, I'm going to take one each for morning, afternoon and evening.  Hopefully that will make things more stable.

Not really as long as you take your tablets sublingually.

Quote from: Jenna Marie on May 22, 2014, 09:48:33 PM
Both 25 and 16 are within the cis female range for T (assuming it's the standard values that go along with those sorts of numbers, the range is about 15-80), and I'd say *dropping* T numbers is a solid indicator that the dose is working and even increasing in effectiveness.

But T is also not the whole story. Finding the right dose of E can be tricky and varies according to the individual.

Quote from: teeg on May 22, 2014, 10:19:57 PM

I've now switched to both lowering my dose and swalloing the pill. I haven't got bloodwork done yet, but already I've noticed my mood steady out and even noticed slight changes (positive) in my face and elsewhere.

My thoughts are that taking it sublingually, although bypassing the liver, emits all the estrogen into the blood at once but fades quickly, hugely inconsistent levels. I'm not an endocrinologist, but having c. 400 levels in the morning and c. 100 levels at night (all occurring within only 12 hours) cannot be healthy for the body.

Good points. I tend to agree with this. Fluctuations can cause ups and downs in mood, negative neurological symptoms. I sort of noticed this on sublingual, very quick ups and downs. Orally, I also found levels to not be where the should be just based on how I felt, something was off. Duration of action of estradiol seemed too short. On injections, I feel better, levels are up for longer, though levels do fluctuate somewhat on them too but not as much, more steady IF taken frequently enough. I just went from every 7 days to 5 days. :)

Quote from: KayXo on May 22, 2014, 10:17:17 PM
With estrogen, I don't think it's a problem. I've never had any problems, either way. With other medications, could be. Like Spiro is sometimes better taken with food to decrease stomach upset, if any. Food also slightly improves Spiro bioavailability which is high already. Progesterone (oral, Prometrium) is usually not recommended to be taken with food as sedative effects are increased (drowsiness, sleepiness) but so is the bioavailability of progesterone. Always check with your pharmacist and doctor. ;)

I will ask my endo on my next control (June the 9th). The only one I take on an empty stomach is the dutasteride capsule. Progesterone is just a topical non-prescription cream for me, endo won't prescribe the real deal.

Quote from: teeg on May 22, 2014, 10:19:57 PM
This is a repost from a while ago

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2FAxPE5WL.jpg&hash=0da494d763cf6a174525ed02857b8752e1bc45aa)

I was taking estrogen sublingually and got blood work done three times within three months at different times and had three drastically different levels reported (as pictured). Nothing in my lifestyle changed throughout these tests - medications, diet, activity, etc.

I've now switched to both lowering my dose and swalloing the pill. I haven't got bloodwork done yet, but already I've noticed my mood steady out and even noticed slight changes (positive) in my face and elsewhere.

My thoughts are that taking it sublingually, although bypassing the liver, emits all the estrogen into the blood at once but fades quickly, hugely inconsistent levels. I'm not an endocrinologist, but having c. 400 levels in the morning and c. 100 levels at night (all occurring within only 12 hours) cannot be healthy for the body.

You raise an interesting point.  I always hear sublingual is the way to go with pill form hrt, but maybe that's part of the problem with the instability of my levels.  Maybe that will even effect my results too.  For now, I'm going to just make sure I take them at specific times that are at least 4 hours between each other.  But I'm going to look much further into this.

Quote from: KayXo on May 22, 2014, 10:20:39 PM
Mine is around 15-16 (total testosterone). I'm post-op though.

Not really as long as you take your tablets sublingually.

I'm pre-op, but I'm also on sprio.  That's probably why my T level is low in conjunction with my low levels prior to starting hrt. 

Is sublingual really that bad?  Am I hurting my results by taking it this way?  Pills are really the only way I can afford and mentally handle hrt at the moment, so I got to go down this route.  Even if injections work better, I literally can't emotionally handle getting injected on a frequent basis.  I do want to try the pellets at some point when I can afford it.  Still, I'm only able to take pills at the moment, so I want to maximize their effectiveness. 

I will know more in about a week and a half on the sub vs oral serum change.  I had actually tracked hour by hour for sub, drove myself crazy, was a daily roller coaster ride.  Doesn't work for me, will be very interesting to see the new baseline.

What I will say is I feel good on orals, no crashes.  And as far as I can tell, the body is doing what is always does on E.

My T is 35 last test.

The endo is the one who said sub wasn't working and he changed the dose method and timing, one last chance before needles.

To get what I need for estro, I would do needles in a heartbeat.  Its the dollars that worry me, and I don't want any more crashes, nor do I want liver issues.

So its all for the endo to figure out, he has treated many, many trans before.  Me being non binary is interesting for him, not too many of us out there I guess.  Very nice man.

Quote from: Julia (Apple-Whatever) on May 23, 2014, 02:42:21 AM
Progesterone is just a topical non-prescription cream for me, endo won't prescribe the real deal.

Why?

Quote from: Satinjoy on May 23, 2014, 11:14:14 AM
To get what I need for estro, I would do needles in a heartbeat.  Its the dollars that worry me, and I don't want any more crashes, nor do I want liver issues.

If taken frequently enough for you, you won't experience crashes. Best to usually take weekly, I take them every 5 days now. Since injectables bypass the liver and deliver estradiol in much the same way as genetic women get them, liver should not be compromised. There was no change in liver function or clotting from studies on men afflicted with advanced prostate cancer who were given injectable bio-identical estradiol. 

One thing I also disliked about sublingual was the inconvenience of it, having to put it under the tongue, wait until it dissolves and do this several times daily.

LTL,

You will find that the levels peak higher on sublingual and vary more.  If you're making good progress, I wouldn't be too concerned.  Everyone is anxious to have the boob fairy visit overnight. =)

If your mood is good, T levels are down, then that's a good baseline to go from.  On 3 doses a day, you should make progress regardless.  On the injection thing, it's a common phobia that many people have to get over (think about type 1 diabetics) - if the benefits to you are big enough, I'm sure you'll manage!

I agree with others about the inconvenience of sublingual - it just took too long to dissolve, and I kept on thinking I was having an angina attack sucking on them.  I do like my pellet (scarring be damned!)

Quote from: luna nyan on May 25, 2014, 05:45:48 AM
I do like my pellet (scarring be damned!)

That's why I would never go this route, the scarring. I don't heal well. I'd rather injections as they leave absolutely no scar. And I heard that perhaps, too constant levels of E on pellets could desensitize cells to E.

Quote from: luna nyan on May 25, 2014, 05:45:48 AM
LTL,

You will find that the levels peak higher on sublingual and vary more.  If you're making good progress, I wouldn't be too concerned.  Everyone is anxious to have the boob fairy visit overnight. =)

If your mood is good, T levels are down, then that's a good baseline to go from.  On 3 doses a day, you should make progress regardless.  On the injection thing, it's a common phobia that many people have to get over (think about type 1 diabetics) - if the benefits to you are big enough, I'm sure you'll manage!

I agree with others about the inconvenience of sublingual - it just took too long to dissolve, and I kept on thinking I was having an angina attack sucking on them.  I do like my pellet (scarring be damned!)

Yeah, I definitely having results but I 've been on estrogen since June so it's been about a year (well, not really cause my current dose started in October).  It's possible that it could have stopped being as effective, though I doubt that is the case as I've been seeing things improve as of late.  I just worry to much sometimes.

I never had a problem with taking pills sublingually.  The pills always dissolved under my tongue fairly quickly.  In any case, my phobia with needles is very unlikely to go away, lol.

Quote from: KayXo on May 25, 2014, 12:15:44 PM
That's why I would never go this route, the scarring. I don't heal well. I'd rather injections as they leave absolutely no scar. And I heard that perhaps, too constant levels of E on pellets could desensitize cells to E.

That's a good point I haven't thought of.  I keep hearing that pellets are amazing and have been considering switching to that in a few months (mainly because of cost issues) but I know nothing about it and the downsides to it.