Susan's Place Transgender Resources

Hey,

Finally received my last blood work results.

Estradiol 338 PG/ML

Testerone 17 NG/DL

He said everything else looks fine, but that my Estradiol level is too high and needs to be brought down to 200-250-ish range. My last DR didn't really do blood tests, so I'm not sure on interpreting blood work results.

Is 338 too high or? Thanks

Just had my levels checked two days ago.   My E is like a pregnant woman:
Estradiol, Serum 627.70 pg/mL
Reference Intervals
Normal female follicular  12.50 - 166.00 pg/mL
Normal pre-ovulatory peak  85.80 - 498.00 pg/mL
Normal female luteal  43.80 - 211.00 pg/mL
Postmenopausal Female  <5.00 - 54.70 pg/mL
First Trimester Pregnancy 215.00 - >4300.00 pg/mL

Testosterone Total [0.03-0.48 ng/mL] <0.40 ng/mL  *Low*

Based on those E reference ranges from my testing facility, your E looks to be barely high for a normal female luteal.  I guess it depends on your Dr.'s intended E levels for you, though. ;) ....we are all different!  It may also have to do with how and when your take you E in relation to when the test was done, too.  Variables...

To be honest, the numbers bamboozle me - if my endo is happy with them then I'm happy. I know other people who see him and he treats them each in different ways which I can only presume comes down to other factors that he is monitoring - blood pressure, kidney and liver function, cholesterol, glucose, weight, age, etc, etc. Everyone is different and so their treatment and levels and medication must be too.

My e2 is almost 400 and they seem to think it's fine. I'm feminizing nicely and I don't have any negative effects on liver or any other part of my metabolism.

My E2 levels have been registered as being close to 4,000 pg/ml on the 3rd day after my injection. My doctors are fine. Everything else came back normal. Remember that peak levels during menstrual cycles reach as much as 650 pg/ml and levels can go as high as 75,000 pg/ml during pregnancy. So, personally, I don't understand why he considers such levels high when ciswomen experience MUCH higher levels. My doctors stress more how I feel and the body changes.

The ideal level varies according to the individual, our sensitivity to hormone varies and across time as well. So, to impose the same level on everyone seems strange as well. Finally, test results will also fluctuate so that at one point in time, levels may be higher and then significantly lower at another point in time, suggesting test results aren't really that reliable.

My 2 cents...

Every Endo/Dr different.

My Dr. wants my e around 400 and I am post. 

We also are trying to keep the menopause hot flashes at bay so that has been a workable number.

We need to trust our Doctors. 

Your levels are fine. If a level in the 300s really caused thrombosis, then the pre-menstrual peak would be a major cause of hospitalization in cis women. LOL

Many doctors frown upon levels exceeding 200 or so, which is unfortunate. Our goal is to feminize, and prior exposure to testosterone often means that higher levels are necessary to induce proper feminization. My current doctor believes levels of 200-400 usually produce a better result and says there is no evidence such a level is harmful.

Another question would be how that level relates to your dosing schedule. Is it the peak (shortly after a dose) or the trough (shortly before a dose)? A level that peaks in the 300s but quickly drops off to near zero may not be very helpful. My doctor does not even want to measure a peak level.

I would not see a male doctor for HRT. I made that mistake at first and the results were not pretty. :-\

Quote from: Steph34 on March 29, 2015, 09:00:17 AM
Another question would be how that level relates to your dosing schedule. Is it the peak (shortly after a dose) or the trough (shortly before a dose)?

I would not see a male doctor for HRT. I made that mistake at first and the results were not pretty. :-\

That level was around 12 hours after my last round of pills. When I was on pills i would take then when I went to work, and 9 hours later when I was getting off work. On the day in question I skipped my after work dose since I was asked not to take any with in a few hours of the appt.

I have to see a male doctor :( The hospital that accepts my crap insurance only has two endos and the female one outright refuses to take Transgender patients or even see transgender patients. I know cause I first made a Appt with her, and she cancelled it after I was already at the DR office and I had to wait a few extra hours to see the one I with now. He is a very caring doctor honestly from the interaction I have had with him, and he does have other Transgender patients on both sides(FTM & MTF)

Quote from: Ms Grace on March 29, 2015, 06:05:49 AM
To be honest, the numbers bamboozle me - if my endo is happy with them then I'm happy. I know other people who see him and he treats them each in different ways which I can only presume comes down to other factors that he is monitoring - blood pressure, kidney and liver function, cholesterol, glucose, weight, age, etc, etc. Everyone is different and so their treatment and levels and medication must be too.

I often think people worry too much about the numbers and try and interpret them without medical advice/context. As was explained to me they change from day to day.

Also it would help if there was a single worldwide standard!

As others have stated it's not to high, but each doctor's preferences and your medical history will dictate what levels they aim for. My endo prefers my numbers not be very much above 200.
Mariah

Quote from: Mariah2014 on March 29, 2015, 09:51:46 AM
As others have stated it's not to high, but each doctor's preferences and your medical history will dictate what levels they aim for. My endo prefers my numbers not be very much above 200.
Mariah

Yeah, I think its due to He is with the same hospital my GP is so he 100% knows my medical history which isn't the best IMO. Had a heart attack at age 18 :(

Quote from: akegia on March 29, 2015, 09:20:02 AM
That level was around 12 hours after my last round of pills. When I was on pills i would take then when I went to work, and 9 hours later when I was getting off work. On the day in question I skipped my after work dose since I was asked not to take any with in a few hours of the appt.

I have to see a male doctor :( The hospital that accepts my crap insurance only has two endos and the female one outright refuses to take Transgender patients or even see transgender patients. I know cause I first made a Appt with her, and she cancelled it after I was already at the DR office and I had to wait a few extra hours to see the one I with now. He is a very caring doctor honestly from the interaction I have had with him, and he does have other Transgender patients on both sides(FTM & MTF)

Wow, that's a pretty high level for pills after not taking any in the preceding hours. Am I the only one who is unable to attain a good level no matter what I do? :(

My male endocrinologist sounded very caring and knowledgeable and had many other transgender patients, but eventually I realized his program failed to deliver meaningful results and that many of his 'facts' were contrary to the scientific evidence. A good doctor will care more about a patient's progress than about levels, assuming the levels are reasonable.

Quote from: akegia on March 29, 2015, 09:54:58 AM
Yeah, I think its due to He is with the same hospital my GP is so he 100% knows my medical history which isn't the best IMO. Had a heart attack at age 18 :(

I was hospitalized for irregular heartbeat myself at age 18 and have had many milder episodes since then. Interestingly, the HRT has been very helpful in normalizing my heartbeat, even though my level has still been rather low. Much of the problem for me seems to have been that my body was never meant to run on testosterone. I am not aware of any evidence that estradiol poses any risks to the heart, so that should not be a contraindication to higher levels. :)

Quote from: Steph34 on March 29, 2015, 10:03:00 AM
Wow, that's a pretty high level for pills after not taking any in the preceding hours. Am I the only one who is unable to attain a good level no matter what I do? :(

My male endocrinologist sounded very caring and knowledgeable and had many other transgender patients, but eventually I realized his program failed to deliver meaningful results and that many of his 'facts' were contrary to the scientific evidence. A good doctor will care more about a patient's progress than about levels, assuming the levels are reasonable.

I was also taking a VERY high dosage on pills due to my last OB/GYN doctor that was prescribing them being meh.

Well I trust him so far, I don't want to feminize overnight. I came in knowing it would take a year to a few to get myself where I want to be. So I am fine with a slower rate of feminizination at the moment.

Exactly. I haven't had heart problems in the past but other health problems in the past and those are I have no doubt why my Endo likes keeping my numbers at a certain level and the fact I think he tries to keep all his MtF patients at this level on the most part.
Mariah

Quote from: akegia on March 29, 2015, 09:54:58 AM
Yeah, I think its due to He is with the same hospital my GP is so he 100% knows my medical history which isn't the best IMO. Had a heart attack at age 18 :(

This is funny, I just wrote this over in mtf a few minutes ago, so just pasted to here.

Nationally renowned clinics. for example University of California San Francisco Transhealth Clinic (The Center of Excellence for Transgender Health), do not even test estradiol serum blood levels, only rate of femininization and overall health.  Just spoke with one of their doctors by phone the other day.  Serum levels are far too unpredictable and not considered indicators of any one reproducible, verifiable biological outcome.   Dani

P.S.  UCSF is having a national transgender health summit next month, April 17, 18., and they have downloadable protocols for health care providers. 

Thought I would put up one more post that offered my personal placement.  My last estradiol level was 837pg/ml, this is actually at a reasonably upper end of low for dosage of Estradiol Valerate IM and Spiro.  I just reached that (for "me") sweet spot in regards to femininization, and emotional stability, T was 15.   Dani

Quote from: KayXo on March 29, 2015, 08:43:15 AMMy E2 levels have been registered as being close to 4,000 pg/ml on the 3rd day after my injection. My doctors are fine. Everything else came back normal. Remember that peak levels during menstrual cycles reach as much as 650 pg/ml and levels can go as high as 75,000 pg/ml during pregnancy. So, personally, I don't understand why he considers such levels high when ciswomen experience MUCH higher levels.

We're not pregnant though, and cis women don't experience these level 99% of the time. I'm confused as to what you get from levels in the thousands, when literally everyone besides you seems have levels in the low hundreds?

Quote from: Blush on March 29, 2015, 02:12:04 PM
We're not pregnant though, and cis women don't experience these level 99% of the time. I'm confused as to what you get from levels in the thousands, when literally everyone besides you seems have levels in the low hundreds?

The point was that if pregnant women don't die left and right (the risk of thrombosis has been evaluated at 0.05-0.2%) with levels reaching up to 75,000 pg/ml (and some women experience multiple pregnancies during their lifetime), levels far lower than these like in my case, around 4,000, shouldn't pose a risk. It's just common sense. What I get from higher levels which I didn't get at lower levels (i.e. 1,000 and less) is improved breast growth, feeling better, having more energy, skin is softer, increased fat redistribution and overall better feminization, looking *much* younger, strong nails, shinier hair, good libido, etc.

I've personally known women who suffered from blood clots on low levels of estradiol while on ethinyl estradiol because doctors didn't realize that estradiol was only part of the picture, that ethinyl estradiol also affected estrogen receptors and later switched to injectable estradiol with quite high levels similar to mine and had no recurrence of health complications. They also welcomed, much to their surprise, the increased breast growth and overall better feminization.

I'm not saying that everyone needs high levels like me, it depends on each person's sensitivity and circumstances but to impose one standard level on everyone is ignoring the simple and undeniable fact that individuals vary in their sensitivity and that higher levels, necessary for some, don't appear to pose significant risks, otherwise there would be much less women living on our planet and much less babies which is NOT the case.

Take male prostate cancer patients, for instance, genetic men, who were given injectable estradiol, with levels ranging 400-700 pg/ml. Hundreds were observed and tested. Researchers concluded this treatment did not increase cardiovascular risk nor thrombosis; in fact, their conclusion was that it might protect against the latter. Why? Because, similar to ciswomen, the form of estradiol was bio-identical and it was given non-orally.

When you understand how estradiol (bio-identical vs. not) is metabolized in the body, its half-life, the mechanism whereby it increases clotting (i.e. portal vein from intestines to liver and estrogen receptors) and when you take into account the facts that I pointed out above, the conclusion, at least to me and my doctors, is quite clear.

Our goal, contrary to ciswomen, when taking hormones, isn't relief of menopausal symptoms but development of secondary sexual female characteristics and suppression of male ones, at a time when contrary to ciswomen, our growth hormone levels aren't as high as theirs were during their puberty. So the levels that are imposed on them, although effective for relief of menopause *might* not be for attaining our goals.

I personally think and it is my opinion only, that it is unfortunate that a maximum level be imposed because some transwomen needing higher levels for better results suffer because of this rule, a rule that is not based on any sound scientific facts. Just ask your doctors the reasons why and use your common sense. Make your own conclusion. 100-200 might be fine for some but might not be for others.

I think it is important to work with a doctor at all times but also to work proactively with them, ask questions, etc. so that the best, most effective and sound treatment be given. Blindly trusting doctors can potentially harm patients because doctors are simply human and do make mistakes too occasionally, are sometimes not aware of all the facts so bringing to light their reasons for doing something, arguing with them, questioning them should be welcomed by a doctor who is humble enough to accept that they don't know everything and that they can perhaps learn something from their patients. In doing so, they only become better at what they do and in the end, the patients benefit. :)

My only intention here is to make everyone think more, become more involved in their treatment without EVER self-medicating so that they can gain from it, all the benefits all the while minimizing their risks. That is all I gain from my posts, nothing else. :) My heart is in the right place. I offer my opinions, I am not a doctor and do what you will with what you read. Bring it up with your doctor next time you talk, share their feedback with us, get details, etc. The more informed we are, the better it is for all of us. I remain open to constructive criticism, to disagreement as it is the only means of furthering knowledge and sharpening our minds.

P.S.: there is also no guarantee that higher levels may bring the results you want. Sometimes, there is only so much breast growth we can get, imposed by our genes, and perhaps other circumstances. ;)

I always enjoy and learn from your posts Kay..All of us need to understand and evaluate our own growths. To blindly follow set
standards relegates us back to the 1950's..I much rather have a discourse with my doctors and arrive at some newer goals than;
live within some pre-subscribed (sub) standards that I am unable to relate or grow with.

Pregnant women experience these levels for a very short time compared to their average hormone levels over their whole lives, plus there is so much more going on during pregnancy that it's not fair to use this as a means to logically discuss high estradiol levels in transwomen.

I don't think the more the better is likely whatsoever. I'd assume SHBG would bind them all to a normal level anyway? From my understanding the body can only accept so much - people taking shot after shot of testosterone aren't doing anything productive as SHBG will bind it all away anyway.

Certainly you're not so rare as to need 20x the average dose in HRT?

Again, pregnant women experience these levels for a very short time compared to their average hormone levels over their whole lives, where as transwomen are on HRT for the rest of their lives with little dosage adjustment. So just because pregnant women don't die from these high levels within 9 months, doesn't mean it won't do harm to transwomen who are on this stuff for their entire lives.

I don't think men would accept estrogen as a means to treat prostate cancer, in fact I've never heard of it until now. They'd start transitioning, if anything DHT blockers are equivalent to estrogen blockers in instances of breast cancer.

What is clear about bio identical and not? You've mentioned having shots above, which from my understanding are synthetic, unlike bio identical topical creams and gels.

Estrogen levels are no higher during puberty than they are over the course of the rest of life before menopause, it's growth hormone levels that increases, stimulating SHBG levels to lower during puberty in males and females thus allowing more of the hormones that are already there to be used, then growth hormone levels drop, SHBG levels return and puberty ends.

In encouraging people to think more of their treatment there's the risk of trusting some anonymous person's advice over the internet rather than a licensed medical professional, who may not know all, but at least knows how to keep patients healthy.

I don't understand why levels aren't disallowed to be discussed alongside dosages, if someone says, my levels are X, and I've got huge breasts, but whoops I can't tell you how much I'm taking sorry!! Guess what many people will do? Start chomping down pills hoping to get bigger breasts.

And don't get me wrong I'm all for working with physicians to find what's best for our bodies, but levels in the thousands just really doesn't sit well with me.

Quote from: Blush on March 29, 2015, 06:19:21 PM
I don't think the more the better is likely whatsoever. I'd assume SHBG would bind them all to a normal level anyway? From my understanding the body can only accept so much - people taking shot after shot of testosterone aren't doing anything productive as SHBG will bind it all away anyway.

If the body can only accept so much, why is it that only at higher levels, did I see improvement in my well-being and overall feminization? The same can be said of several transwomen who noticed better results on higher levels. Why do womens' bodies produce such high levels during pregnancy if their bodies can only accept so much?

QuoteAgain, pregnant women experience these levels for a very short time compared to their average hormone levels over their whole lives, where as transwomen are on HRT for the rest of their lives with little dosage adjustment.

I explained this but I will explain it again.

Yes, most women will experience these levels for a short time while a few, for a longer time, depending on how many pregnancies they have had. But, if a ciswoman can survive amounts of 1,000 - 75,000 pg/ml for several months and some for several pregnancies (thus, several years) AND if you consider that levels will usually be no more than 5,000 pg/ml (mine were less than 4,000) for several years and perhaps decades for transwomen on injectables, 15 x less than the maximum reached during pregnancy, I consider their risk quite low as well.

And besides, what risks are you concerned about?

- breast cancer is extremely rare amongst transsexual women, noted to be similar to genetic men who haven't taken any HRT, by a leading specialist and expert working with tens of thousands of transsexual women for decades.
- it has been noted that the more children and thus the more pregnancies a ciswoman experiences, the lower her breast cancer risk.

I explained that thrombosis incidence was very low in pregnant women and in male prostate cancer patients despite high levels.

Cardiovascular risk is lower in premenopausal women (relative to men), who go through pregnancies and peaks during the menstrual cycle. It was also not increased in male prostate cancer patients during bio-E administration parenterally.

QuoteI don't think men would accept estrogen as a means to treat prostate cancer, in fact I've never heard of it until now.

Men with prostate cancer have been treated with estrogen ever since the 1960's and even perhaps, before that. With risky forms of estrogen in the past such as DES and more recently with estradiol, transdermally or by injection. This information can be found on pubmed.com and in a document published by Harry Benjamin. I can PM you links and more info, if you want.

QuoteWhat is clear about bio identical and not? You've mentioned having shots above, which from my understanding are synthetic, unlike bio identical topical creams and gels.

I receive estradiol valerate shots. Estradiol valerate, upon entering the blood, quickly transforms into bio-identical estradiol; estradiol valerate is not active. So I end up getting the exact same molecule (bio-identical) produced by the human body and found in high levels in ciswomen during pregnancy.

Bio-identical forms are metabolized faster by the body, hence, have a lesser chance of staying long enough to stimulate clotting by recirculating through the portal vein again and again like non bio-identical forms. No matter the form, and except for Premarin, every other form of estrogen is a synthetic as it is made in the lab, not produced internally by the body.

I agree that transwomen injecting estradiol cypionate may perhaps incur higher risks as I strongly suspect (not proven in studies) that Estradiol Cypionate actively triggers estrogen receptors and since remaining longer in the body, stimulates, perhaps, significantly clotting.

But, if bio-identical estradiol is taken and the only active estrogen (other than estrone and estriol) in the body, I personally consider risks aren't significant, especially if taken non-orally, even in higher levels. Again, I repeat, I am NOT a doctor. This is MY opinion only.   

QuoteEstrogen levels are no higher during puberty than they are over the course of the rest of life before menopause, it's growth hormone levels that increases, stimulating SHBG levels to lower during puberty in males and females thus allowing more of the hormones that are already there to be used, then growth hormone levels drop, SHBG levels return and puberty ends.

GROWTH =  keyword. More growth hormone is one of probably many other factors (like younger age) during puberty that explains body's high sensitivity to hormones. It may be that to reach the same potential, we need higher levels, due to older age and less GH.

QuoteIn encouraging people to think more of their treatment there's the risk of trusting some anonymous person's advice over the internet rather than a licensed medical professional, who may not know all, but at least knows how to keep patients healthy.

I encourage people to always question everyone and anyone, including me, of course. I offer opinions and it is up to others to dig deeper, question, do their own research, talk with several doctors, etc. If they have something to bring to the table, then all the better. :)

A licensed professional may harm his/her patient if a less than effective (and safe) regimen is given because it may impact on their well-being and on their feminization. Higher levels *may", in some instances, produce improved well-being as well as give better feminization which helps patients feel better about themselves, feel more in tune with their bodies which, as you know, is very important for us. 

QuoteI don't understand why levels aren't disallowed to be discussed alongside dosages, if someone says, my levels are X, and I've got huge breasts, but whoops I can't tell you how much I'm taking sorry!! Guess what many people will do? Start chomping down pills hoping to get bigger breasts.

In no way am I promoting high levels or a certain level, EVER. I actually discourage this. I'm just saying that it depends, that individuals vary. That what works for some may not for others. Some do wonderfully well at lower levels, other need more. What I'm arguing over is the concern over higher levels and how it can potentially harm those that may benefit from higher levels.

And besides, as I have explained it several times, levels will fluctuate so how valid is a test really? And what does it really tell us that we don't already know?

Quote from: Blush on March 29, 2015, 06:20:40 PM
levels in the thousands just really doesn't sit well with me.

Why? What actual facts, scientific studies support your fear over higher levels (in the thousands)?

I'm with KayXo on this since I also experienced first hand better results when my levels were a lot higher into the 1,000s, overall I just felt better and didn't have any negative side effects either. My endo doesn't like high levels so I was put back to the original dose I started with for injections. However even at this conservative dose my levels are still too high for my endo. I love injections and I'm not going back to pills since I felt even worst on that. It's really getting on my nerves that my endo is so concerned about my estrogen levels when I'm not showing any serious negative symptoms. I'm tired of chasing "ideal levels" since I feel fine.

Quote from: Lady_Oracle on March 29, 2015, 07:50:18 PM
I'm with KayXo on this since I also experienced first hand better results when my levels were a lot higher into the 1,000s, overall I just felt better and didn't have any negative side effects either. My endo doesn't like high levels so I was put back to the original dose I started with for injections. However even at this conservative dose my levels are still too high for my endo. I love injections and I'm not going back to pills since I felt even worst on that. It's really getting on my nerves that my endo is so concerned about my estrogen levels when I'm not showing any serious negative symptoms. I'm tired of chasing "ideal levels" since I feel fine.

Lady Oracle,

Maybe this may help,  http://www.transhealth.ucsf.edu   These are very qualified doctors and researchers, they do not even test estradiol, as for a few reasons it is not important.  They have downloadable protocols for healthcare providers, and maybe your endo may just get persuaded by their top notch knowledge and experience.   Dani

My primary care does not measure E. They ask how you feel and are you seeing results. They see thousands of trans (10 doctors, PA-C's and NP's). I am on a high dose of E injectable and feel great through my cycle. The original period of 14 days was too long and 10 days is about right.