Susan's Place Transgender Resources

Hello everyone. I'm rapidly approaching my 3 month mark on HRT. Pulled a set of labs recently to find out my Estrogen levels went down since March as follows:

Mar 07, 2019   
205.9 pg/ml

May 03, 2019   
109.4 pg/ml
   
101.4 pg/ml drop in less than 90 days. I'm waiting on Monday to see if my Endo DR thinks we need to make any adjustments with medications. Have any of you found a similar reduction after the 1st 90 days?

Other than my E levels reducing I'm doing great. I gave a TG speech couple days ago and that went VERY well. I've since been asked to speak at 3 other engagements! Thank you to everyone who helped me when I was gathering information!

Onward.

Sophia

I think it might be a bit early to establish a pattern.  Here are my results, taken a couple of hours before I started on HRT.  They use different units, so I don't know how they compare to yours.

Estradiol 85    <162 pmol/L

Testosterone 10.5    8.4 - 28.8 nmol/L

I see my Testosterone is towards the low end of normal.  I assume that's due to 2 years on Dutasteride.  I have no idea what effect it has on my Estradiol.  Perhaps someone with medical knowledge can comment.

Anne/Sophia

Just thought you may like to see this thread which explains method of conversion from/to Intl/US.

https://www.susans.org/forums/index.php/topic,234373.msg2093709.html#msg2093709


Hugs

Pamela

Sophia,

I would like to comment on your reduction in your blood levels, but I need more information first.

1. What is your route of administration? Injections, patches or tablets? If you are taking tablets, are you swallowing right away or keeping under the tongue until they melt?

2. Did you take a dose  right before or after your blood test?

We all get fluctuations in our blood levels depending on these two factors. The only way to get accurate results is to take the blood sample right before your next scheduled dose. Depending on your route of administration, this can be days or hours.

Dani, I take sublingual Estradiol letting it dissolve, always have taken it this way. I take my morning dose around 6am and take my evening dose at 6pm. Day of blood draw: I took am dose as normal, went to work, had my blood drawn around 12pm that day (I work in the hospital where they draw my labs)

So I guess I don't really know it its a fluctuation or my E levels have dropped to the lower reading. My Dr said she wants to keep me on my current dose of E until 5-23 when I'll be at my 3 month mark. Might be a fluctuation but I don't know if E levels fluctuate over 100 points or if that's excessive?

Thanks for your input,

Sophia

Quote from: Sophiaprincess2019 on May 07, 2019, 08:26:17 AM
Dani, I take sublingual Estradiol letting it dissolve...I take my morning dose around 6am .... Day of blood draw: I took am dose as normal, went to work, had my blood drawn around 12pm that day...Might be a fluctuation but I don't know if E levels fluctuate over 100 points or if that's excessive?

I see the problem right there.

Sublingual has a very fast rise and fall in your blood levels within hours of your last dose. This is ok, but you can never predict where your blood level is at the time of your blood sample collection. This is where you are getting the variation.

I take my Estradiol as sublingual twice a day, just like you do and on the day when I need to give a blood sample, I will delay taking my Estradiol until after the blood is drawn. I try to schedule my blood draw as early as possible in the day to avoid any inconvenience and just get on with my day.

This way my doctor will get the lowest point of the rise and fall of my Estradiol levels. This is the only proper way to interpret blood levels and dose your Estradiol safely.

QuoteI take my morning dose around 6am and take my evening dose at 6pm.

My prescription says to take two pills, once a day.  I've often wondered why it wasn't one twice a day, if the goal is to maintain a more or less constant level.

AnneK,

If you are swallowing your tablets, the half life is much longer than sublingual. For oral administration once a day is just fine.

If you are taking your Estradiol sublingual, then twice a day or even three times a day is preferred.

Quote from: Dani on May 08, 2019, 08:10:10 AM
AnneK,

If you are swallowing your tablets, the half life is much longer than sublingual. For oral administration once a day is just fine.

If you are taking your Estradiol sublingual, then twice a day or even three times a day is preferred.

I am taking them sublingual.  However, I would have thought twice a day would have been better no matter which method was used.  I am on two types of blood pressure meds and my doctor told me to take one in the morning and the other at night, to spread around the benefits.

I'll start twice a day tomorrow.  It's a bit late to start today.    ;)

BTW, it would be a bit difficult to split two pills into three times per days.

Quote from: Sophiaprincess2019 on May 04, 2019, 05:41:43 PM
Hello everyone. I'm rapidly approaching my 3 month mark on HRT. Pulled a set of labs recently to find out my Estrogen levels went down since March as follows:

Mar 07, 2019   
205.9 pg/ml

May 03, 2019   
109.4 pg/ml
   
101.4 pg/ml drop in less than 90 days. I'm waiting on Monday to see if my Endo DR thinks we need to make any adjustments with medications. Have any of you found a similar reduction after the 1st 90 days?

Other than my E levels reducing I'm doing great. I gave a TG speech couple days ago and that went VERY well. I've since been asked to speak at 3 other engagements! Thank you to everyone who helped me when I was gathering information!

Onward.

Sophia

Don't know if it's "normal" but my estrogen was also lower than the baseline at the 3-month mark despite the fact that my testosterone did go way down and I started at a decent dose of estradiol sublingual split between morning and evening. Ironically, I am very happy with modest but meaningful breast growth an 3 months and my breasts continue to be sore. My doctor bumped the estradiol dose and we'll see how things are at six months and re-evaluate. That's all you can do tbh. Be patient...there are a lot of options for getting estrogen up and testosterone down and eventually you will get to female levels.

Prior to starting on HRT, I had blood tests done.  The results show my testosterone to be near the low end of normal.  I expect this is due to being on dutasteride for over two years.  Hopefully, that gives me an advantage over someone just starting on anti-androgens.

Thanks everyone for the wonderful insights. I'm currently in female levels for Estrogen and Testosterone. My T levels came back yesterday at:

Date   Result   Reference     Range                   Flag
May 03, 2019   8.7 ng/dL    240-950 ng/dL             L

Mar 07, 2019     32.0 ng/dL  240-950 ng/dL             L

As far as I can see I'm about bottomed out for Testosterone levels, they have gone way down since last labs. My Endo didn't want to move my Estrogen dose, which started out high to begin with, and she's confident we are on the correct path for someone 50 y.o MTF.

You might be able to detect some slight changes: Keep in mind I've only been on HRT the last 3 months:
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi66.tinypic.com%2Fkcnhb7.png&hash=ec7e1666651c3c9ecd2256707da2f4b18bcca9f4)

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi65.tinypic.com%2F2a0kmpt.jpg&hash=71c6a5105b25e60dc4f72457a6c752efbbd0b72c)

Hello everyone, just came back from my 3 Month Endo appointment and things have been progressing nicely. My Endo Physician would like some input to help her get a more accurate reading on my Estrogen levels. She did decide to bump my Estrogen Rx to the next higher dose this afternoon and changed my appointments to every 6 months.

My Dr. believes Estradiol has a 12 hour 1/2 life when taken sublingual. She told me I should have my next E2 test 3 to 4 hours after taking my morning dose.  She asked me to ask any of you to help fact check her on the hours and  1/2 life calculation to ensure she is correct. I really like this Doctor because she is not above asking other professionals to weigh in about testing and getting an accurate reading.

She mentioned from now (3 month mark) forward is where "the art" of a good transition comes...getting my E levels around 350 pg/mL is her target.

Does all this sound correct from what others have experienced? I'm on a very high estradiol dose from the beginning and now that she has increased that to my current dose, (which is only able to be adjusted once more before exceeding recommended FDA guidelines for Estradiol given in a 24 hour period), I'd like to proceed with caution since I'm a lucky girl with no side effects, no mood swings just great, awesome, wonderful results of becoming more feminine and starting to look like a woman. I'd much rather keep my current dose than go with an increase if I run the risk of horrible mood swings or other nasty side effects.

Thank you for your input!

Sophia

See this article for how the estradiol concentration goes down over time...

http://transascity.org/sublingual-versus-oral-estrogen/

Sarah, thank you for the estradiol article. Looks like we need some Neuroscience research to help get our Doctors more precise dosing information. Perhaps we might be fortunate enough to have either a large research institution or a pharmaceutical company independently undertake more estrogen research for transgender women.

I'm somewhat leery of taking too much estradiol all at once so I've decided to ease my dose up slowly over the course of the day. I'm doing every 8 hours instead of a large dose in the morning and a smaller dose later in the evening. I'd rather not shock my system or "play with fire" because I've felt what this drug can do when things don't go as planned and I DO NOT want a repeat of that. 

All comments and or guidance are welcome and helpful......Thank you!

Sophia

Quote from: Sophiaprincess2019 on May 24, 2019, 07:11:41 AM
Sarah, thank you for the estradiol article. Looks like we need some Neuroscience research to help get our Doctors more precise dosing information. Perhaps we might be fortunate enough to have either a large research institution or a pharmaceutical company independently undertake more estrogen research for transgender women.

I'm somewhat leery of taking too much estradiol all at once so I've decided to ease my dose up slowly over the course of the day. I'm doing every 8 hours instead of a large dose in the morning and a smaller dose later in the evening. I'd rather not shock my system or "play with fire" because I've felt what this drug can do when things don't go as planned and I DO NOT want a repeat of that. 

All comments and or guidance are welcome and helpful......Thank you!

Sophia

I think your strategy is correct, and I too am spreading the daily dose out 3x per day. On the margin, one probably gets more time with hormone levels in the ideal zone that way.

Sarah

Quote from: sarahc on May 24, 2019, 09:35:17 AM
I think your strategy is correct, and I too am spreading the daily dose out 3x per day. On the margin, one probably gets more time with hormone levels in the ideal zone that way.

I'm taking mine twice a day, sublingual.

Hi, I think you look years younger in the latest picture (side to side comparison), and your facial features are softening already, congrats !

Enjoy the continued changes, it's an amazing experience.

Cynthia -

Thank you Cynthia. Sarah, I think we are both on the same page, spread out our sublingual tablets and hopefully we can enjoy the nice E ride! I'd really like it if everything stayed the same with my higher dose, the past 3 months have been quiet and no mood swings have reared their ugly heads. Spiro has made me achy-breaky in the morning but that goes away in 10 minutes of moving around usually. I sometimes get fatigued and I lay down, if work allows, in the afternoon for an hour or so.

Can't complain, my transition has gone quite smoothly. I understand after the 6 month mark things start to happen then a year and so on. I'm excited. I started living full time right after I started HRT in February this year (2019) and everyone in my local community has been great.

Thank you to everyone who offers insight!!!  I appreciate every word!

Sophia