Susan's Place Transgender Resources

Long time no post! Anyway, about a year ago I was going to do the informed consent thing. I was only out to an extremely small group of people, and was in no way psychologically prepared for it. In any case I had a minor meltdown, didn't go to the appt, and then immediately put myself back in therapy with a qualified gender therapist.

ANYWAY, almost a year later, I am completely out, in a much healthier emotional state, and have started HRT with a qualified endocrinologist. Now I'm gonna try and do this without breaking any of the board rules, since I know discussing HRT can get dicey with that. My apologies if I'm walking a fine line.

My endocrinologist, without yet seeing bloodwork, prescribed a very low dose of E to be taken 2x a day and absolutely no T-blockers. He said the E acts as a T suppressant on its own and many people don't actually need T-blockers. Not only do I feel dubious of the fact that I'm not on any T-Blockers, but I feel like the E dosage he prescribed is SUPER low.

Does this sound right to anyone?


Edit doseage

He is telling you the truth. The numbers below really do show how little to no spiro is needed to get the job done. Another MtF in the family never needed Spiro. She couldn't use it anyway due to how it affected her Potassium levels. If it makes you feel any better mine thinks the low dose I'm on is to high now. So you will be surprised how much a very low dose can do even with out a T-Blocker.
Here were my numbers before ordered by my primary care doctor.
06/11/2014   10:00 AM   ESTRADIOL   49.3   pg/mL
06/11/2014   10:00 AM   ESTRIOL,UNCONJUGAT   0.1   ng/mL   
06/11/2014   10:00 AM   ESTRONE   126   pg/mL   
06/11/2014   10:00 AM   FREE TESTOSTERONE   14.6   pg/mL
06/11/2014   10:00 AM   PROGESTERONE   1.76   ng/mL   
06/11/2014   10:00 AM   TESTOSTERONE   885   ng/dL
HRT started 9/20/2014
first numbers ordered by the endo who only checks the testosterone and Estradiol numbers with only low dose Estradiol patches.
10/27/2014   8:07 AM   ESTRADIOL   60.9   PG/ML
10/27/2014     8:07 AM    TESTOSTERONE 551   ng/dL
Shortly after that I was switched to self injections again low dose with a little bit of Spiro
12/02/2014   8:54 AM   TESTOSTERONE LCMSM   28   ng/dL
12/02/2014   8:54 AM   ESTRADIOL   244.8   PG/ML

He thought the Estradiol level was high, but since we had changed when the injection was at the beginning of that cycle I talked him into one more number he tries to lower what is already low.
12/17/2014   8:35 AM   ESTRADIOL   254.6   PG/ML

Thanks Mariah! That makes me feel better. He did say that if my T levels are not suppressing enough with my next round of bloodwork (2 and a half months from now) then he would put me on T-blockers then. I think I was more concerned about the low dosage of E he was prescribing on top of that. I know I can't say specific dosages, but it's very low from everything I know of starting dosages.

Your welcome. I know that is frustrating when they start us on such low doses, but sometimes we don't need high doses to get the job done. I dislike the idea of being lowered from the low dose I'm already on which I will take up with him once he goes to lower it.
Mariah

Quote from: BecomingDev88 on December 18, 2014, 11:45:02 AM
Thanks Mariah! That makes me feel better. He did say that if my T levels are not suppressing enough with my next round of bloodwork (2 and a half months from now) then he would put me on T-blockers then. I think I was more concerned about the low dosage of E he was prescribing on top of that. I know I can't say specific dosages, but it's very low from everything I know of starting dosages.

Many start out in low dosages to see how the body reacts to the changes.

Remember you will be on estrogen for life so they want the best effect vs possible reactions.

Hugs

Quote from: Mariah2014 on December 18, 2014, 11:09:24 AM
He is telling you the truth. The numbers below really do show how little to no spiro is needed to get the job done. Another MtF in the family never needed Spiro. She couldn't use it anyway due to how it affected her Potassium levels. If it makes you feel any better mine thinks the low dose I'm on is to high now. So you will be surprised how much a very low dose can do even with out a T-Blocker.
Here were my numbers before ordered by my primary care doctor.
06/11/2014   10:00 AM   ESTRADIOL   49.3   pg/mL
06/11/2014   10:00 AM   ESTRIOL,UNCONJUGAT   0.1   ng/mL   
06/11/2014   10:00 AM   ESTRONE   126   pg/mL   
06/11/2014   10:00 AM   FREE TESTOSTERONE   14.6   pg/mL
06/11/2014   10:00 AM   PROGESTERONE   1.76   ng/mL   
06/11/2014   10:00 AM   TESTOSTERONE   885   ng/dL
HRT started 9/20/2014
first numbers ordered by the endo who only checks the testosterone and Estradiol numbers with only low dose Estradiol patches.
10/27/2014   8:07 AM   ESTRADIOL   60.9   PG/ML
10/27/2014     8:07 AM    TESTOSTERONE 551   ng/dL
Shortly after that I was switched to self injections again low dose with a little bit of Spiro
12/02/2014   8:54 AM   TESTOSTERONE LCMSM   28   ng/dL
12/02/2014   8:54 AM   ESTRADIOL   244.8   PG/ML

He thought the Estradiol level was high, but since we had changed when the injection was at the beginning of that cycle I talked him into one more number he tries to lower what is already low.
12/17/2014   8:35 AM   ESTRADIOL   254.6   PG/ML

Your testosterone levels really fell when you switched to injections. Most often (NOT ALWAYS), other methods (excluding pellets) are INEFFECTIVE at suppressing T sufficiently enough.

Also, if he thought your E was high, what would have been his reaction to my almost 4,000 pg/ml?! LOL. Did you tell him that ciswomen can have levels as high as 650 pg/ml during a menstrual cycle and up to 75,000 during pregnancy? And what about those men who had prostate cancer and took E by injections? Their levels ranged from 400-700 without any apparent complications; in fact, researchers noted a protective effect against thrombosis. I have trouble understanding why he would think these would be too high.  ??? Can you ask him next time, to show papers that levels beyond a certain level are dangerous with NON-ORAL BIO-IDENTICAL estradiol?

Also, when were your levels tested? After how many days? Are you on estradiol cypionate or estradiol valerate?

Quote from: KayXo on December 18, 2014, 02:29:24 PM
Your testosterone levels really fell when you switched to injections. Most often (NOT ALWAYS), other methods (excluding pellets) are INEFFECTIVE at suppressing T sufficiently enough.

Also, if he thought your E was high, what would have been his reaction to my almost 4,000 pg/ml?! LOL. Did you tell him that ciswomen can have levels as high as 650 pg/ml during a menstrual cycle and up to 75,000 during pregnancy? And what about those men who had prostate cancer and took E by injections? Their levels ranged from 400-700 without any apparent complications; in fact, researchers noted a protective effect against thrombosis. I have trouble understanding why he would think these would be too high.  ??? Can you ask him next time, to show papers that levels beyond a certain level are dangerous with NON-ORAL BIO-IDENTICAL estradiol?

He has not yet responded to the result that came in yesterday yet. I expect to hear from him this week and will find out why he thinks it is to high and why he is so keen on lowering it. I may need to mention some of things you mentioned. My medical history may be playing a role in this. I'm not sure.

Also, when were your levels tested?The date and times are listed in my first post in PST as far as when in the cycle the last number was taken on the same day a week later than the shot the week before. The previous ones were taken a day earlier in the cycle considering the possibility of waiting might be a problem due to a break that would have occurred due to an outpatient procedure. I didn't want to take a chance in the break in Spiro messing the number up. The first numbers ordered by the Endo were taken with the patches so everyday was supposedly the same dose. No HRT in play on the numbers in June. After how many days? The last number was on the exact same day of the week one week after the shot. Are you on estradiol cypionate or estradiol valerate? Estradiol Valerate

I hope my responses helped answer your questions
Mariah

I started on super low dose E (within the range that's prescribed to menopausal cis women) and no anti-androgens at all; within 3 months I was a C cup and my T was in the middle of the female range. In fact, it turned out that even that dose was causing liver damage and I ended up on half *that,* which explains why some endos start at a very low level - you never know how a specific person's body will react, and better safe than sorry.

If your 3-month checkup shows you need it, I'm sure he'll raise the dose.

Thanks for all the replies guys! Helped calm my nerves :-P. My only other question, which Mariah answered via PM is does it matter HOW you get hormone levels in a female range when it comes to end results or just that you get there? Just cause there's the choir always preaching different methods for their supposedly superior results. But basically the truth seems to just be that any variation of getting you there works just the same, it's just a, for anyone starting HRT your mileage may vary based off of factors like genetics, age, etc that have nothing to do with your dosages or method. Is that correct?

Sex hormones are regulated via a feedback mechanism. If there are enough in the system your body will stop producing a large quantity of them.