Susan's Place Transgender Resources

Hi Everyone,

I have been reading this site for a LONG time, and I love so many people here already for their sympathetic ear and sage advice.  However this is my first time posting.

I desperately need some advice....and some moral support from people with similar stories would be very, hugely, greatly, massively appreciated as well.

I am 165lb, 47 year-old trans-girl. I have been taking hormones of one variety or another, at one dosage or another, for 9 months. Despite this, my estrogen levels have never even approached being what they should be. 


I started estrogen and spiro on December6, 2013.  Initially I was just on starter doses spiro twice daily, and generic estradiol micro tablet taken orally twice daily. That yielded blood test results on 1-10-14 of testosterone levels at 356 ng/dl and estrogen levels of 32 pg/ml.

We then increased my estrogen to oral estradiol twice daily and spiro twice daily.  That yielded blood levels on March 7, 2014 of 308ng/dl testosterone, and 26pg/ml estradiol.

We adjusted the medicines to spiro twice daily, and went to taking the oral estrogen sublingually.  That yielded blood test results on June 5, 2014 of 97ng/dl testosterone and 286pg/ml estradiol. This estradiol level seemed artificially high, but my endo lowered my estrogen dosage to daily ( morning, and at night).  I was annoyed by this,as I told her upon getting the result I had just taken my morning dose of estradiol before coming in and being tested, so it is obviously registering the dosage at its peak, or it is simply a bad lab result.

My next blood test, as a result, I insisted on taking 30 days later.  This time I made it a point not to take my morning estrogen right before my blood was taken an hour later at 8:30 a.m.  This test yielded 145ng/dl and <20pg/ml estradiol levels (anything under 20 for estradiol levels is considered "undetectable" for testing purposes).

So, we switched to patches.  My endo prescribed me a patch, to be changed twice weekly. But, not being particularly happy with taking off each patch after only 3 and 1/2 days, effectively almost doubling the amount of estrogen delivered.  This yielded test results on August 4, 2014 of 33ng/dl testosterone and 41pg/ml estradiol levels.

My endo then wanted to double the patch dosage, and have me wear two patches at a time, changing each patch after 3 and 1/2 days.  Insurance refused to pay for that, so we are as of today switching to injections....he has prescribed estradiol IM per week.  And I know this is a conservative dosage.

So, being on hormones for nearly a year has got me some minor breast growth and softer skin.  That's it.  I look every bit the guy I have always looked like, otherwise.  It's incredibly frustrating, depressing, and it's all I can do not to cry if I think about it for more than 2 minutes at a time.

So, b/c my endocrinologist isn't pro-acive at all about adjusting my meds unless I am complaining and suggesting things, is there any advice out there that I might suggest to her?  (And believe me, I'm very close to switching doctors, I am just very limited for endocrinologists who do trans-care where i live).

AND, has anyone out there had this this ridiculous level of difficulty, yet ultimately got their hormone levels to get where they needed to be and kept them there so that they could achieve some decent level of feminization?  I am desperate for some reassurances that what is happening to me has happened before, and that it might still turn out well after all.


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I think you just need to titrate dose to a level where you feel good and are having decent results and do this under a doctor's supervision. If current dose is not effective, then ask for an increase and hopefully, they agree. If not, get a second opinion and even, third opinion until you find someone who is wiling to prescribe an adequate dose for you. Levels seem quite low, except for that one time on sublingual, 1 hour after intake so switching to injections is one step in the right direction (it did wonders for me!), slowly but surely, you will get there hopefully, your doctor seems at least open to switch up things if things aren't going well.

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I know you are new and it is your first post but you said you been around for some time.

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Safe passage on your path
Mrs. Izzy

Perhaps its not estrogen thats the culprit, but not enough Anti Androgens, or perhaps you could ask if adding finesteride in addition to spironolactone would help.

I have never had my estrogen levels tested at all; my endo believes it's irrelevant as long as T is in the female range and the results are good. However, and here's the kicker for you - she'd also agree that in your case (when the results are NOT good), it'd be necessary to up the dosage.

Frankly, it sounds like you may need a new doctor.

Quote from: Kara211 on August 06, 2014, 02:01:25 PM
I started estrogen and spiro on December6, 2013.  Initially I was just on starter doses spiro twice daily, and generic estradiol micro tablet taken orally twice daily. That yielded blood test results on 1-10-14 of testosterone levels at 356 ng/dl and estrogen levels of 32 pg/ml.

It took me until about February of this year to get the levels that I wanted. I PMed you

For me, on my first blood test, I'd been off Etradiol for about a week.
My results where:
T: 145
E: 20.
So I had a higher amount still but my body never masculineiced.  So now I have to wait till Tuesday to check the new results.

BTW, it was the still higher amount of T levels that makes me think I have PAIS.

I'd be curious to know if there's ever been a study to determine that induced hormone levels in trans people, and the subsequent development of secondary sexual features, is/isn't determined by the amount of HRT alone. It seems to be such a complex process that what works well for one does not work well for the other, what are the full range if factors involved? Some people respond well with a relatively low dose while others get underwhelming results even from higher dosages. It can't just be the HRT alone.

That would be interesting!