Two things happened today. One that I'm real happy about and the other is just a flat out downer.
First, an email from my Endocrinologist confirmed testosterone and estradiol levels that look pretty good. Estrogen is 308 and the testosterone is 4. I was real happy about this and actually would have been happier if the estrogen was even higher. But then the endo called and said estrogen was way too high for the American Endocrinology standard. He wants a maximum of 200, so he prescibed a patch that will result in a circulating estrogen level way below what I got from my current dose. Then he said I may see some changes in feminizing effect and possibly mood swings. The Spiro will also be lowered by one third, and that will cause my T level to go up. This is going to kill me.
So what is this all going to do to me? Has anyone else had this happen, and were you ever able to get the endo to raise the script to something equal to your previous estrogen use? I'm stopping my self meds from Inhouse, and I promised my wife I wouldn't touch them when the prescription was filleded. I intend to keep that promise, but this is a crushing hit that I didn't expect. Not crying yet, but the day is only half over, and it's all building up inside. Then this dreaded script is going to be ready around 2:30.
Kathy
I know the effects will likely be slowed, (sorry, no personal experience to speak from) but it is better to be safe. Give it time, even A womans body has less E and more T than that, and they dont turn all manly overnight, they stay femme. HRT isnt meant to be an overnight "cure", better to be a woman in 10 years than the alternative.
Besides, feminization doesnt rely on huge levels of e and tiny levels of t. Just give a balance toward the female side of hormones and the effects will happen all the same in time.
Also remember, this is what your doctor is comfortable with. If you are not, perhaps you should speak to your doctor and get the reasons. Dont fret over this and certainly do not cry. Levels will not be the same for everyone either, each is their own specific case.
300-400???
Mines are usually like 700-800, and my endo says "that's perfect!"
I'm confused. Does this doc know what he's doing?? lol
Quote from: TessaM on September 17, 2012, 04:45:44 PM
It should be noted that I took my blood test at around 9-10 am. I had to fast for well over 12 hours... i last ate , took my hormones, or drank anything at 5 pm the day before. My endo said that when I take my dosage, my numbers will probably be in the 1000s.
So, at my lowest, my e level is 330. Pretty good I think? He said the goal was to get it in a range between 300-400. I take a good dosage of E, which I obviously cant post here... I couldnt imagine "doubling" my dosage the mgs would be rediculous.
the last time I tested I was due for my E shot in the same day, I could actually have E levels in the 2000's after I inject!
So much moodiness has been explained!:P
See, not the same for everyone. This might turn into a bit of a dangerous topic if numbers are going to be compared... Like I said, 200 is still higher than women with exception to the peak of the menstrual cycle (or pregnancy) when levels reach 200-300. If thats the low end of your range, its way above the standard level for a genetic girl on an average basis.
Just a note of caution: if we're from different countries, our E measurements are in different units, which could cause confusion when comparing results.
In the UK, for example, E is usually quoted in pmol/L - to get the equivalent in the US unit (pg/ml), divide the UK measurement by 3.671.
See here (http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/e5196/index_en.html) for a useful conversion table (and of course, quote no dosages, please :police: :))
Quote from: ashrock on September 17, 2012, 04:50:42 PM
See, not the same for everyone. This might turn into a bit of a dangerous topic if numbers are going to be compared... Like I said, 200 is still higher than women with exception to the peak of the menstrual cycle (or pregnancy) when levels reach 200-300. If thats the low end of your range, its way above the standard level for a genetic girl on an average basis.
yup, I agree. All my other test results seem good though, so maybe the good doctor knows what he's talking about?
Whowouldathunk. :)
Quote from: kathy b on September 17, 2012, 04:09:50 PM
Estrogen is 308 and the testosterone is 4. I was real happy about this and actually would have been happier if the estrogen was even higher. But then the endo called and said estrogen was way too high for the American Endocrinology standard. He wants a maximum of 200,
There seems to be no firm fixed rule for E levels. I remember back in the day, endos were prescribing much higher dosages for E than they do today. I think a lot is lawyers and CYA. From what I read (and recently posted) the recomendation for maximum feminizing is around 600. Seems like most endos in the USA prefer 200 pg/mL territory.
My E hovers around 600 and at times was much higher. T is in the very low 20s which is waaaay lower then nomal male. A woman in my groups T is 12 last check. She didn't mention her E level. I doubt you have to worry about T going a bit higher. I do only a portion of an Androcur to maintain mine. I can also tell when I miss a day or two in a row. (I hate pills. Big PITA)
Here in California I assumed they would be flexible according to patient needs. Especially since this state has such a large and vocal LGBT population. Never thought the American Endo Std's. were so low, and that they would deliberately cut the estrogen so deeply. Tried to calculate what % of my self med I'll be getting with this newly prescribed patch, and as near as I can tell it's about 25% with one patch per week. Antiandrogen (Spiro) will be cut by one third, and I have no idea what that's going to do to my T levels either.
Won't get another blood test until December, and the endo said he doesn't like to do any increase in E or AA until a 6 month run at the first dose.
I hope they ralize that purposely limiting the medication is counterproductive. This type of medical response to patient needs just drives those patients to self medication. And to keep this prescription, I'm going through with at least 6 months of gender therapy with a psychiatrist.
Yeah, this is starting to sound like a rant, and I really don't want to do that. But this sucks. It really sucks and sucks and sucks.
Kathy
JoanneB, have you tried a pill straw? They are for people who struggle swallowing pills. Makes it very easy. Hugs, Devlyn
Again, it is safer this way. It does sound like the endo will likely increase the levels after 6 months. Dont rush this, those six months will not hurt you, especially since you have a t blocker. Your t will not go to male levels.
Sounds like your endo is doing the right thing. I keep my E & T levels within those same ranges as well. E2 < 200 pg/ml & T < 40 ng/dl.
Here's some excellent info on MTF HRT levels: http://www.endo-society.org/guidelines/final/upload/endocrine-treatment-of-transsexual-persons.pdf (http://www.endo-society.org/guidelines/final/upload/endocrine-treatment-of-transsexual-persons.pdf)
Don't worry.
If I convert, 300 pg/mL is 1101.3 pmol/mL in the international system, which, while not dangerous, are in the highest normal ranges for women. So a reduction wouldn't be a catastrophe.
Your endo is a bit conservative with his maximum of 200 pg/mL = 734.2 pmol/mL, but it's still well in the values that should allow feminisation, albeit maybe a little slower. But you know, sometimes, gradual is better and safer. If he went down to 100, that would be worrying, but 200 is fine. If I were him, I'd aim for 200, maybe a little higher, instead of setting it as a maximum, but: 1. I'm no endo and 2. I don't know your exact age, but you don't handle a 40-year-old like you do a 20-year-old, so perhaps it's all perfect.
As for your testosterone, don't even start to worry. Your levels right now, at 4 ng/dL = 0.14 pmol/L, are abyssally low. Lower than the lowest value of recommended range for women, 0.3 pmol/L. A reduction in your antiandrogen probably won't bring that anywhere higher than the recommended value for women, and will just reduce the amount of medication going through your system, which is good.
Unless your endo is way too aggressive with the estradiol reduction and brings your levels way below what he said, don't worry, much less cry. If effects are stalled, and they shouldn't, it's probably not impossible to increase the dose a little again.
PS: And gosh, US, change your units to the ones the rest of the world uses already! T_T
Quote from: Devlyn Marie on September 17, 2012, 06:22:42 PM
JoanneB, have you tried a pill straw? They are for people who struggle swallowing pills. Makes it very easy. Hugs, Devlyn
I have no problem geting the down. It's the remembering them part.
JoanneB, how about daily alarms on your phone? You could also get something like this:
(https://www.susans.org/proxy.php?request=http%3A%2F%2F1.bp.blogspot.com%2F_h0HcvfA6e60%2FS_AZ-eT9CxI%2FAAAAAAAAADE%2FmfBHQ2pwS2M%2Fs1600%2Fdosette.JPG&hash=3621205a5a5e34100476e3654bbf0dd4fa600d82)
It's pretty straightforward. If you're not sure if you took your pill tonight, you look, and if they're there, you didn't. You can fill it yourself, or some pharmacies offer the service of filling them weekly for patients.
Quote from: TessaM on September 17, 2012, 07:18:33 PM
This is exactly what I use, but pink :p Sucha life saver
And now im a little bit confused. Is a T level of 1.3 too high? And an E level of 330 too low? All units in Canadia spec
you and A both live in quebec, so I think you use the same measurements.
Quote from: TessaM on September 17, 2012, 07:18:33 PM
This is exactly what I use, but pink :p Sucha life saver
And now im a little bit confused. Is a T level of 1.3 too high? And an E level of 330 too low? All units in Canadia spec
T: No. The female range is 0.3 - 4.2
E: Kind of. Not a super mega catastrophe like my 184 (which is, almost no changes), but it's pretty low, if you ask me, yeah. But I haven't had such levels, so I can't say for sure. Maybe it's ideal for older people (edit: lol, and then I remembered who I was addressing - someone younger than me). It's probably a pretty good starting dose. Again, I'm no endo, but I doubt optimal results are achieved with just that.
And yes, we have the same system. I don't know of any other country than the US that uses conventional units (like pg/mL) instead of international units (like pmol/mL).
Hey girls. I had a chance to think and calm down while doing some work on the house. I can accept the changes for now and as long as the patches will stick to me for a whole week things will be fine.
The script didn't get filled today because the pharmacy at the clinic here ran low and had to order it from their hospital in Vallejo. They said to pick it up after 12:00 Noon tomorrow. It's a 3 month prescription so I can set up my next set of blood tests a couple weeks before it runs out.
Oh yes, that's good info about the differences between other systems and the US standards. Seems like we are constantly rebelling over here. Still use miles, feet and inches, plus, pints, quarts, and gallons. That metric stuff and other widely used measurements will just confuse us.
Anyway. Thanks again to all of you.
Kathy
I try to follow the advice given to a menopausal female, take the smallest dose possible to get the results you are looking for. It sounds like to me you have a smart doctor who doesn't want to break your body in an attempt to get it feminized as fast as possible.
Folks, I deleted a link because it contained extensive dosage information. I hated to do it, but we're not supposed to discuss dosages. So if you're wondering what happened, now you know.
ETA: The link has been restored, as per Susan's instructions.
Stephe, you're looking very cute these days.
Quote from: Arch on September 18, 2012, 12:49:19 AM
Stephe, you're looking very cute these days.
Thanks *blush*
Picked up the script today for the Spiro and the estadiol patches. First test will be seeing how they stick to my skin. Waiting until tonight after house work and a shower.
Spiro smells a little better than what I was using, but it's still twice the size of an asparin.
K
I get the "small size" and just take how ever many I need to get to my dose. At least where I buy them, it's the same price as getting a horse pill + can adjust dosages easily without new pills.
Quote from: kathy b on September 18, 2012, 05:38:40 PM
Picked up the script today for the Spiro and the estadiol patches. First test will be seeing how they stick to my skin. Waiting until tonight after house work and a shower.
Spiro smells a little better than what I was using, but it's still twice the size of an asparin.
K
I'm on matrix-style patches (smaller and more comfortable than the reservoir patches). They don't stick so well, especially if you're active. I use strong medical tape to keep them on.
Quote from: Stephe on September 18, 2012, 07:18:52 PM
I get the "small size" and just take how ever many I need to get to my dose. At least where I buy them, it's the same price as getting a horse pill + can adjust dosages easily without new pills.
The smaller pills were prescribed but they ran out, so the pharmacy substituted the lage pill since it still met the needs of the prescription. And there's fewer bottles to rattle around.
Quote from: rachl on September 18, 2012, 08:06:29 PM
I'm on matrix-style patches (smaller and more comfortable than the reservoir patches). They don't stick so well, especially if you're active. I use strong medical tape to keep them on.
Actually can't wait to slap one on over my appendix to see how it sticks just below my waist. Next week I'll try it on my back. I'd just about bet the heavy home repairs will make them loose.
Well my lab results just came back I've been on the DIY method the last three months while waiting to get into my Endo.
Picking up my prescription tonight. Nurse says my E is wayyyyy to high it's 1100 and my test is at 47
Does this sound right? She says my E is three times as high as a pregnant woman and I should cut out the microgest
Quote from: Serena Lynn on September 24, 2012, 03:26:19 PM
Well my lab results just came back I've been on the DIY method the last three months while waiting to get into my Endo.
Picking up my prescription tonight. Nurse says my E is wayyyyy to high it's 1100 and my test is at 47
Does this sound right? She says my E is three times as high as a pregnant woman and I should cut out the microgest
I've learned that if you're getting morning sickness, it's time to go down on E. If you're getting headaches and hot flashes... it's time to go up.
Uhm, if that's in pmol/mL, I don't think it's so terrible. A bit high but still pretty all right.
If it's in American measures, then yeah, that's pretty tremendously high.
Quote from: Alainaluvsu on September 24, 2012, 03:49:34 PM
I've learned that if you're getting morning sickness, it's time to go down on E. If you're getting headaches and hot flashes... it's time to go up.
What's crazy is I feel the same. There is moments I have felt dizzy but I though that was do to not eating enough. I imagine the reason why I'm lactating is that it's so high.
Quote from: A on September 24, 2012, 03:53:00 PM
Uhm, if that's in pmol/mL, I don't think it's so terrible. A bit high but still pretty all right.
If it's in American measures, then yeah, that's pretty tremendously high.
It is American levels. I took my dose in the AM before getting my bloodwork I asked her if that was maybe the reason it was so high and she said nope. Took my blood test at 7:30am while fasting
Quote from: Serena Lynn on September 24, 2012, 04:33:22 PM
What's crazy is I feel the same. There is moments I have felt dizzy but I though that was do to not eating enough. I imagine the reason why I'm lactating is that it's so high.
When I was tested at 722 I was getting mild dizziness too. I've been pretty much dosing as I want even if my doctor has me prescribed on another dosage. Since you are self medicating just pay attention to how you feel. You can also pay attention to how animals are acting around you. My cat hates men... so I know my T levels are high when she is avoiding me. However... when my E levels are high she kneads on me when I'm laying in bed (I think she senses a mother).
Alaina: That reassures me as to why animals aren't so fond of me. xD Please, decent dose, quick!
Serena Lynn: Well, yeah, that's pretty crazy high, indeed. 1100 pg/mL = 4038 pmol/mL. Even "you'll just get sick from this" high.
Lookie, the normal values on my blood test sheet.
Quote17β-estradiol [Men: 36 - 220] [Women (follicular): 110 - 1470] [Women (luteal): 180 - 550] [Women (menopause): 18 - 110]
The endos of people I've spoken with seem to be aiming around 600 ~ 1300, depending, I guess, on the time on HRT, age and endos' preferences. It's probably unwise to go above 1470, not to mention it probably doesn't give you any additional effect. So at triple that... Yeah, it's more than unwise.
No medical logic behind this, but if I'm a body and 3 times the maximum hormones I'm ever supposed to see come my way, I won't say "TURBO DEVELOPMENT!" (there's a limited number of E2 receptors anyway), but rather go "poisoning!" and try to evacuate as much of the product in excess as I can.
That's why we tend to discourage self-medicating... But then, if you do self-medicate, make sure you know what you're doing and look levels and doses up well before doing anything. If people normally need doctors to do that properly, don't think you can without at least researching...
Quote from: A on September 24, 2012, 08:18:00 PM
Alaina: That reassures me as to why animals aren't so fond of me. xD Please, decent dose, quick!
Serena Lynn: Well, yeah, that's pretty crazy high, indeed. 1100 pg/mL = 4038 pmol/mL. Even "you'll just get sick from this" high.
Lookie, the normal values on my blood test sheet.The endos of people I've spoken with seem to be aiming around 600 ~ 1300, depending, I guess, on the time on HRT, age and endos' preferences. It's probably unwise to go above 1470, not to mention it probably doesn't give you any additional effect. So at triple that... Yeah, it's more than unwise.
No medical logic behind this, but if I'm a body and 3 times the maximum hormones I'm ever supposed to see come my way, I won't say "TURBO DEVELOPMENT!" (there's a limited number of E2 receptors anyway), but rather go "poisoning!" and try to evacuate as much of the product in excess as I can.
That's why we tend to discourage self-medicating... But then, if you do self-medicate, make sure you know what you're doing and look levels and doses up well before doing anything. If people normally need doctors to do that properly, don't think you can without at least researching...
Thanks A for the info I wouldn't of self medicated but had to I couldn't wait any longer and I had to wait 3 1/2 months to get into my Endo. I'm good now and under docs care so she wants me to cut the dose I'm gonna cut the dose back some as prescribed. My prescription will be ready tomorrow. :))))
Hi All,
I've been wanting to ask this question, but didn't want to start a whole new thread. I don't want to hijack somebody else thread, but this seems to be very related.
When I started HRT, I asked my therapist(He would get the results from the Endo and advise) why he was only concerned with my T levels and not my E levels as well. Obviously, he monitored other stuff, but as far as feminization(E & T levels) he was only concerned about my total testosterone level. His answer was that at my dose of E, my body is flooded with estradiol, and that my body is converting much of that estradiol to entrace which doesn't have any feminizing properties. With out going into dosages, can anyone tell me if this makes any sense?
Thanx
Dani
Estrace is a brand of estradiol as a medication... So if that's the very term your therapist used, no.
However, it does make sense to mainly worry about T at first. Testosterone is a "dominant" hormone, which means that when you have both testosterone and estradiol, estradiol has little effect, even if you take more. Then once T is tamed, the way is free, so to say, for estradiol to do its work.
^I'm not 100 % sure of what I'm saying; it's blurry, but I -think- that's how it was.
Quote from: A on September 25, 2012, 06:09:58 AM
Estrace is a brand of estradiol as a medication... So if that's the very term your therapist used, no.
However, it does make sense to mainly worry about T at first. Testosterone is a "dominant" hormone, which means that when you have both testosterone and estradiol, estradiol has little effect, even if you take more. Then once T is tamed, the way is free, so to say, for estradiol to do its work.
^I'm not 100 % sure of what I'm saying; it's blurry, but I -think- that's how it was.
[/quote/]
No... He stated that Entrace was a bi product of too much Estradiol and that Entrace has little or no feminizing ability. Basically, too much Estradiol leads to Entrace, which has no feminizing traits.
I wondered after reading about how many of you were monitoring your estrogen levels. From low levels to what were considered high levels, no body was talking about this point where estrogen converts to entrace.
I have lots of questions about my former therapist. Until I can get a new therapist and Endo.. I'm in the dark! ???
Quote from: DaniStarr on September 25, 2012, 04:23:16 AM
Hi All,
I've been wanting to ask this question, but didn't want to start a whole new thread. I don't want to hijack somebody else thread, but this seems to be very related.
When I started HRT, I asked my therapist(He would get the results from the Endo and advise) why he was only concerned with my T levels and not my E levels as well.
Thanx
Dani
My doc said the e level vary so much over the course of a day, when meds are taken etc that the E numbers aren't a good judge. That she could tell how effective the meds were by watching my T levels. That said my T levels never changed a lot but I now have B cup breasts and she stopped testing for T on me. I probably am NOT normal in my reaction or blood level response to the meds but I guess I am an example of what can happen.
If -you- are paying out of pocket, I would ask to only test things that have to be tested to make sure you are healthy. Take a reasonable dose and watch for results/how you feel. It's never a good idea to blast large doses of anything into your body wanting rapid change. The best results will happen over a few years, not trying to force the changes to happen in 6 months with extra high dosages. I see people say all the time "You want -blank- level of this and -blank- level of that." The human body isn't that simple and there is no cookie cutter path.
Your body will naturallyt convert estradiol to several estrogen products. I seem to remember there are three main estrogens Estradiol, Estrone, and Estriol. Can't remember exactly what my Endo said about them. But he did say that when a person takes very high doses of estrogen the body converts it and filters out some of the breakdown byproducts. These excess filtered strogen products are sometimes stored in body fat, or eliminated in urine.
Okay, I'm not an expert, but I could find this. (By the way, sorry, I had misread Entrace for Estrace.)
-The product you mentioned, entrace. It does not exist, from the looks of it. See for yourself: Wikipedia and Google are silent on the very existence of such a thing.
-You might mean estrone, which is an oestrogen with much weaker properties than estradiol, and the primary oestrogen in post-menopausal. I don't have the details, but I think when there's an excess of estradiol, it can be converted to estrone, and vice versa (though the former happens much more often). Once it's estrone, it can in turn be converted into estrone sulfate, which stays in the body for a long time. Then it can act as a sort of storage: estrone sulfate is converted to estradiol if it's lacking.
And of course, like with pretty much every product in excess in the blood, excess estradiol can most probably be excreted through urine.
So uhm... I'm not sure why he literally doesn't care about estradiol levels. It is true that testosterone can block the effects of estradiol (hence why most FTMs just take testosterone, period), but still... Your T levels are mainly dependent upon your T blocker, whilst your E levels rely on the actual E you take. It doesn't make much sense to me to just ignore it.
Going by that logic, you'd give someone just T blockers and expect breasts to grow. :x
I'm not sure I understand them, really. Of course, if T is still not under control, the E level is not all that important, but once T is low, I'm pretty sure the E level is a very important information...
You should really ask your endo directly. Therapists, no matter how experienced, aren't hormone experts, after all.
Quote from: A on September 25, 2012, 07:46:35 PM
Okay, I'm not an expert, but I could find this. (By the way, sorry, I had misread Entrace for Estrace.)
-The product you mentioned, entrace. It does not exist, from the looks of it. See for yourself: Wikipedia and Google are silent on the very existence of such a thing.
-You might mean estrone, which is an oestrogen with much weaker properties than estradiol, and the primary oestrogen in post-menopausal. I don't have the details, but I think when there's an excess of estradiol, it can be converted to estrone, and vice versa (though the former happens much more often). Once it's estrone, it can in turn be converted into estrone sulfate, which stays in the body for a long time. Then it can act as a sort of storage: estrone sulfate is converted to estradiol if it's lacking.
And of course, like with pretty much every product in excess in the blood, excess estradiol can most probably be excreted through urine.
So uhm... I'm not sure why he literally doesn't care about estradiol levels. It is true that testosterone can block the effects of estradiol (hence why most FTMs just take testosterone, period), but still... Your T levels are mainly dependent upon your T blocker, whilst your E levels rely on the actual E you take. It doesn't make much sense to me to just ignore it.
Going by that logic, you'd give someone just T blockers and expect breasts to grow. :x
I'm not sure I understand them, really. Of course, if T is still not under control, the E level is not all that important, but once T is low, I'm pretty sure the E level is a very important information...
You should really ask your endo directly. Therapists, no matter how experienced, aren't hormone experts, after all.
Estrace is a brand name for oral estradiol...it exists.
Quote from: Stephe on September 25, 2012, 09:40:27 AM
My doc said the e level vary so much over the course of a day, when meds are taken etc that the E numbers aren't a good judge. That she could tell how effective the meds were by watching my T levels. That said my T levels never changed a lot but I now have B cup breasts and she stopped testing for T on me. I probably am NOT normal in my reaction or blood level response to the meds but I guess I am an example of what can happen.
If -you- are paying out of pocket, I would ask to only test things that have to be tested to make sure you are healthy. Take a reasonable dose and watch for results/how you feel. It's never a good idea to blast large doses of anything into your body wanting rapid change. The best results will happen over a few years, not trying to force the changes to happen in 6 months with extra high dosages. I see people say all the time "You want -blank- level of this and -blank- level of that." The human body isn't that simple and there is no cookie cutter path.
Well, as it turns out, I don't pay a dime for tests because they are covered under my insurance. As would be my therapy visits($30), Endo visits($30), and scripts for generics $15. But I couldn't find a therapist in my network or one who tok my insurance, and I have no Endo, just an "EX" online therapist. :P
But My PCP is aware of my "Transness" and has had some experience with it. She is monitoring all my primary functions and for the total T levels. My dosages, are about average from what I can tell. so I was wondering why my "care givers" where not worried about E levels like other here. ???
Confused as always..
Dani
Quote from: A on September 25, 2012, 07:46:35 PM
So uhm... I'm not sure why he literally doesn't care about estradiol levels. It is true that testosterone can block the effects of estradiol (hence why most FTMs just take testosterone, period), but still... Your T levels are mainly dependent upon your T blocker, whilst your E levels rely on the actual E you take. It doesn't make much sense to me to just ignore it.
E does affect your T levels being produced in many MTF and how much T is suppressed by the E is a better indicator than attempting to get any sort of accurate blood test on the E. Some people take just E, no t blocker and their T levels plummet. Some people like me take a T blocker and E and their "T levels" don't change (according to a blood test, even tho male sex drive goes away..), much but still have major body changes. Clearly there are things going on these tests aren't measuring, at least with me.
Quote from: A on September 25, 2012, 07:46:35 PM
Going by that logic, you'd give someone just T blockers and expect breasts to grow. :x
I'm not sure I understand them, really. Of course, if T is still not under control, the E level is not all that important, but once T is low, I'm pretty sure the E level is a very important information...
It would be nice if the human body was this simple. My T levels barely changed from pre HRT to now according to blood tests but I have B cup boobs now and 1/4 or less the male sex drive I used to have. And yes being on spiro for a year I started to grow boobs with no E. The below talks about how inaccurate these blood tests are.
http://www.womeninbalance.org/pdf/Kenna.pdf (http://www.womeninbalance.org/pdf/Kenna.pdf)
http://www.custommedicine.com.au/hormone-analysis/ (http://www.custommedicine.com.au/hormone-analysis/)
According to research I have done, if you are on any sort of transdermal E, a blood test is a total waste of time.
I think many people get way too obsessed with these level numbers and trying to force them into a certain range of "normal for a female" like somehow that will make them bio-identical to a natal female? At least for me, my goal was to feminize my body without causing damage to my body or to shorten my lifespan. A natal female takes years to develop breasts etc yet we seem to want this to happen in 6 months or less. I see posts about "I have been on HRT for 4 weeks and don't see boobs yet". Seriously??
Take a reasonable dose of meds and be patient. If you see no changes in 6 months, then it's time to consider a dose increase/change. Have someone monitor liver function levels, potassium/electrolytes and anything else a doctor wants to check to make sure these are not having an adverse effect on your health.
From everything I am reading a saliva test is much more accurate indication of hormone levels but given they will change based on when you took your meds and the time of the day your body secretes natural ones etc, this has the same limits on accuracy that a blood test does in many ways. The best indicator IMHO is how you feel, what your sex drive is like and are you feeling/seeing any results, i.e. are your boobs tender etc. I can tell when my T goes up or when there is no E in my system and when I have overdone either. You have to become aware of how you feel and what is going on with your body.
Quote from: kathy b on September 25, 2012, 09:57:38 AM
Your body will naturallyt convert estradiol to several estrogen products. I seem to remember there are three main estrogens Estradiol, Estrone, and Estriol. Can't remember exactly what my Endo said about them. But he did say that when a person takes very high doses of estrogen the body converts it and filters out some of the breakdown byproducts. These excess filtered strogen products are sometimes stored in body fat, or eliminated in urine.
Thanks Kathy... Yeah... I had read about those.... I just can't believe this person is so incompetent to be practicing! ???
Quote from: A on September 25, 2012, 07:46:35 PM
Okay, I'm not an expert, but I could find this. (By the way, sorry, I had misread Entrace for Estrace.)
-The product you mentioned, entrace. It does not exist, from the looks of it. See for yourself: Wikipedia and Google are silent on the very existence of such a thing.
-You might mean estrone, which is an oestrogen with much weaker properties than estradiol, and the primary oestrogen in post-menopausal. I don't have the details, but I think when there's an excess of estradiol, it can be converted to estrone, and vice versa (though the former happens much more often). Once it's estrone, it can in turn be converted into estrone sulfate, which stays in the body for a long time. Then it can act as a sort of storage: estrone sulfate is converted to estradiol if it's lacking.
And of course, like with pretty much every product in excess in the blood, excess estradiol can most probably be excreted through urine.
So uhm... I'm not sure why he literally doesn't care about estradiol levels. It is true that testosterone can block the effects of estradiol (hence why most FTMs just take testosterone, period), but still... Your T levels are mainly dependent upon your T blocker, whilst your E levels rely on the actual E you take. It doesn't make much sense to me to just ignore it.
Going by that logic, you'd give someone just T blockers and expect breasts to grow. :x
I'm not sure I understand them, really. Of course, if T is still not under control, the E level is not all that important, but once T is low, I'm pretty sure the E level is a very important information...
You should really ask your endo directly. Therapists, no matter how experienced, aren't hormone experts, after all.
Thanks A...
No, it was Entrace he said. It was over the phone, but it wasn't Estrone or any other for of Estrogen or what Kathy said it breaks down to. I know that T blockers alone, in high doses can cause breast grown and sexual dysfunction. But I was more concerned with why E levels were not being checked, when all of your Endos are concerned to E levels down to the ENDO association approved levels. ::)
But, again.. Thanks A aka "SWEETS"! :P
Quote from: Stephe on September 26, 2012, 09:04:35 AM
E does affect your T levels being produced in many MTF and how much T is suppressed by the E is a better indicator than attempting to get any sort of accurate blood test on the E. Some people take just E, no t blocker and their T levels plummet. Some people like me take a T blocker and E and their "T levels" don't change (according to a blood test, even tho male sex drive goes away..), much but still have major body changes. Clearly there are things going on these tests aren't measuring, at least with me.
It would be nice if the human body was this simple. My T levels barely changed from pre HRT to now according to blood tests but I have B cup boobs now and 1/4 or less the male sex drive I used to have. And yes being on spiro for a year I started to grow boobs with no E. The below talks about how inaccurate these blood tests are.
http://www.womeninbalance.org/pdf/Kenna.pdf (http://www.womeninbalance.org/pdf/Kenna.pdf)
http://www.custommedicine.com.au/hormone-analysis/ (http://www.custommedicine.com.au/hormone-analysis/)
According to research I have done, if you are on any sort of transdermal E, a blood test is a total waste of time.
I think many people get way too obsessed with these level numbers and trying to force them into a certain range of "normal for a female" like somehow that will make them bio-identical to a natal female? At least for me, my goal was to feminize my body without causing damage to my body or to shorten my lifespan. A natal female takes years to develop breasts etc yet we seem to want this to happen in 6 months or less. I see posts about "I have been on HRT for 4 weeks and don't see boobs yet". Seriously??
Take a reasonable dose of meds and be patient. If you see no changes in 6 months, then it's time to consider a dose increase/change. Have someone monitor liver function levels, potassium/electrolytes and anything else a doctor wants to check to make sure these are not having an adverse effect on your health.
From everything I am reading a saliva test is much more accurate indication of hormone levels but given they will change based on when you took your meds and the time of the day your body secretes natural ones etc, this has the same limits on accuracy that a blood test does in many ways. The best indicator IMHO is how you feel, what your sex drive is like and are you feeling/seeing any results, i.e. are your boobs tender etc. I can tell when my T goes up or when there is no E in my system and when I have overdone either. You have to become aware of how you feel and what is going on with your body.
Hey Stephe...
Its not really a matter of me not getting the changes I would like to see, as much as understanding why some Endos are monitoring E levels and my "les than confidence inspiring" therapist is a "BOOB". ???
Dani
Quote from: rachl on September 26, 2012, 07:55:28 AM
Estrace is a brand name for oral estradiol...it exists.
Thanks Rachl,
Its that he said the Entrace was a biproduct, not a brand name... ???
Tnx
Dani
Estrone is the byproduct.
Quote from: DaniStarr on September 26, 2012, 09:24:31 AM
Hey Stephe...
Its not really a matter of me not getting the changes I would like to see, as much as understanding why some Endos are monitoring E levels and my "les than confidence inspiring" therapist is a "BOOB". ???
Dani
I tried to explain. Blood tests of E levels aren't very accurate and can make people think they need to change the dosage when in fact there is nothing wrong. Both of the people I have seen about HRT (one retired after 25 years of doing TS HRT) saw no reason to test E levels. Why "some" do it, I have no idea. Maybe they just do it out of habit. Doctors are human and not all are sharp/right about everything. Actually from my own experience there are a LOT of bad ones.
If you don't like this -not testing E levels- and feel your doctor is a "boob", then change docs to one who follows this other school of thought. From what I have read on the subject + what two different doctors have told me, blood testing E levels, esp in a MTF taking meds, seems to be a waste of everyone's time. Maybe people like to be told "You have E levels in the female range"? I'm just not sure.
All I know is I'm not interested in those hormone levels/numbers from a blood test any longer as they clearly in my case have no relevance to the changes I have seen in my own body. According to my blood work,
nothing should be happening. Maybe the doc you are seeing is an idiot but it wouldn't be just because he isn't testing E levels.
Stephe
Quote from: Stephe on September 26, 2012, 01:25:15 PM
I tried to explain. Blood tests of E levels aren't very accurate and can make people think they need to change the dosage when in fact there is nothing wrong.
I checked into this and the estradiol hemihydrate that is used in my patch is one estrogen compound that is difficult to test. I'm glad you brought this up as part of your post. Seems like anything that's prescribed in very low levels, like micrograms, is going to have results that are difficult to measure.
Quote from: kathy b on September 26, 2012, 09:14:17 PM
I checked into this and the estradiol hemihydrate that is used in my patch is one estrogen compound that is difficult to test. I'm glad you brought this up as part of your post. Seems like anything that's prescribed in very low levels, like micrograms, is going to have results that are difficult to measure.
I know I read people saying how dosages have to be individualized but I really believe there is a standard "normal" dosage for MTF HRT that is known to give results. The less you have to take, the less strain you put on your system. I would NOT take more than the upper limits of what is recommended for females to take yet I see people taking 4X that amount. As you just stated, some patches and cremes won't show up in a blood test so if someone insists of making your blood test hormone levels match some "ideal", you could end up taking WAY more meds than you needed to feminize your body.
I think common sense should prevail here. There are concerns of heart attack, stroke and DVT etc at the "max dose" females should take and people feel it's OK to take 4X that much?? I'm on a "max dose" suggested for females + the "standard" spiro dose and that's all I'm going to take. It's feminizing my body over time and that's all I want.
Quote from: Stephe on September 26, 2012, 10:06:10 PM
I know I read people saying how dosages have to be individualized but I really believe there is a standard "normal" dosage for MTF HRT that is known to give results. The less you have to take, the less strain you put on your system. I would NOT take more than the upper limits of what is recommended for females to take yet I see people taking 4X that amount. As you just stated, some patches and cremes won't show up in a blood test so if someone insists of making your blood test hormone levels match some "ideal", you could end up taking WAY more meds than you needed to feminize your body.
I think common sense should prevail here. There are concerns of heart attack, stroke and DVT etc at the "max dose" females should take and people feel it's OK to take 4X that much?? I'm on a "max dose" suggested for females + the "standard" spiro dose and that's all I'm going to take. It's feminizing my body over time and that's all I want.
While I overall certainly agree people shouldn't take any more than they need, I don't quite agree with your argument.
"There are concerns" doesn't say anything, there are concerns that cell phones and aspartame cause cancer despite a myriad of evidence failing to support any such hypothesis.
In terms of HRT, the research available is somewhat conflicted but generally in support of blood clotting risks last I checked, however this is hard to translate to us because it is all done in postmenopausal cisfemales, evidence suggests that HRT given at younger ages for non-menopausal reasons (i.e. the ages you would expect to have that level of hormone in your system as opposed to an age when you wouldn't) is of lower risk.
The 'max dose' is worked out for a certain set of circumstances that don't always apply to us.
Ultimately it depends from person to person.
Regarding your heart disease concerns...
http://www.sciencedirect.com/science/article/pii/S0002934310009265 (http://www.sciencedirect.com/science/article/pii/S0002934310009265)
http://jcem.endojournals.org/content/96/2/255.full (http://jcem.endojournals.org/content/96/2/255.full)
Hi Stephe:
Had an appointment with my GT today and told her I was upset and depressed about the low dose of the new patch. And that I had trouble finding any kind of equivlency for estradiol hemihydrate in order to relate it to other types and methods of medicating. She said low doses are necessary with this patch due to serious concerns about blood pressure, thrombosis, breast cancer, etc. Especially for tg women over 45 or 50 who start wih higher doses. So, I just need to be patient. The Endo said the same thing last monday, but I just didn't want to listen.
Anyway, finally accepted that I'll be on this patch the way it is for at least three months, and maybe six. I'm just happy to be on prescribed meds now.
Kathy
Stephe: Oh, right, I'm sorry. I was disregarding spironolactone, which, if I remember well, doesn't reduce T levels all that much in some cases but still blocks its action. I take cyproterone and it destroyed all T in me, and my girlfriend on spiro had that too... Apparently, spiro varies in what it does. Unless it's a story of bio-available/total testosterone.
But still, since spiro sometimes lowers T significantly, sometimes doesn't, something remains: it has the potential to have most of the impact on T levels, the way I understand it. So it makes HRT management purely based upon T levels pretty bad if you ask me.
And anyway, even if it's of limited use, which I seriously doubt, why skip a test entirely? It's not true that it's entirely useless; no one can say that. And I'm pretty sure the expensive, long-analysis test is the testosterone one anyway, estradiol being common and fast.
And uhm, my endo prescribed me a blood test while I was only on transdermal HRT, while he knew my testosterone was already too low for even the average female. Pretty sure he was testing estradiol, and that it has a use in determining what dose I'm going to need.
This is all going by feeling, but all this sounds logical to me.
DaniStarr: I think you have the proof that your therapist doesn't know what he's talking about. Or was very, very tired when he called, and said some nonsense word instead of estrone.
Quote from: Asfsd4214 on September 26, 2012, 11:05:34 PM
While I overall certainly agree people shouldn't take any more than they need, I don't quite agree with your argument.
"There are concerns" doesn't say anything, there are concerns that cell phones and aspartame cause cancer despite a myriad of evidence failing to support any such hypothesis.
*sigh* So you think the risks of DVT from being on HRT is up there with cellphone and diet Coke risks?
From your link:
"A recent large meta-analysis examined the risk of venous thromboembolism in women using hormone therapy (11). The odds ratio of first time venous thromboembolism in current users of oral estrogen therapy was significantly elevated, with a relative risk of 2.5 and CI of 1.9–3.4."
That sounds like a real risk, not a suspected one.
" Although current studies are under way to determine whether CHD risk will be impacted by the timing of initiation, the cancer risks are present at all ages, and some seem to persist after stopping hormone therapy."
Doesn't seem this risk only affects old people.
"Because of the potential harms of long-term use of MHT, including the long-term rising risk of breast and potentially lung and ovarian cancer, therapy should be discontinued after treatment of vasomotor symptoms or other menopause-related symptoms is no longer required."
Like everything else I have read, long term use of HRT, especially at high dosages, is risky to your health.
90% of what I see on these forums is people trying to get on higher dosages simply to speed up the process. Most have been on HRT for less than a year, many times they have been on the for less than 3 months and want to dosage cranked up because they haven't seen any results yet. The max safe dose isn't based on "I want big boobs in 9 months", it's based on balancing the -long term- health risks against short term gains.
Yes the short term risks are lower for a 20 year old person but also these younger people are going to be on HRT for a much longer period of time than someone starting HRT at 50. No one really knows what the risks of being on HRT for 30 years is, there are no studies on what HRT on a male body really is risking health wise. Maybe I'm being stupid but I'd rather not be the person who finds out it kills you, causes cancer or causes a stroke just because I wanted to speed up the process taking large doses of the stuff.
Quote from: Stephe on September 27, 2012, 12:19:28 AM
*sigh* So you think the risks of DVT from being on HRT is up there with cellphone and diet Coke risks?
From your link:
"A recent large meta-analysis examined the risk of venous thromboembolism in women using hormone therapy (11). The odds ratio of first time venous thromboembolism in current users of oral estrogen therapy was significantly elevated, with a relative risk of 2.5 and CI of 1.9–3.4."
That sounds like a real risk, not a suspected one.
" Although current studies are under way to determine whether CHD risk will be impacted by the timing of initiation, the cancer risks are present at all ages, and some seem to persist after stopping hormone therapy."
Doesn't seem this risk only affects old people.
"Because of the potential harms of long-term use of MHT, including the long-term rising risk of breast and potentially lung and ovarian cancer, therapy should be discontinued after treatment of vasomotor symptoms or other menopause-related symptoms is no longer required."
Like everything else I have read, long term use of HRT, especially at high dosages, is risky to your health.
90% of what I see on these forums is people trying to get on higher dosages simply to speed up the process. Most have been on HRT for less than a year, many times they have been on the for less than 3 months and want to dosage cranked up because they haven't seen any results yet. The max safe dose isn't based on "I want big boobs in 9 months", it's based on balancing the -long term- health risks against short term gains.
Yes the short term risks are lower for a 20 year old person but also these younger people are going to be on HRT for a much longer period of time than someone starting HRT at 50. No one really knows what the risks of being on HRT for 30 years is, there are no studies on what HRT on a male body really is risking health wise. Maybe I'm being stupid but I'd rather not be the person who finds out it kills you, causes cancer or causes a stroke just because I wanted to speed up the process taking large doses of the stuff.
It's a complex subject and there are risks AS WELL as benefits.
Obviously estrogenic cancers are at increased risk with HRT, but are those risks any higher in trans people on HRT with an estrogen level the same as any other women in her 20s, that's a difficult one to answer.
Quote from: Asfsd4214 on September 27, 2012, 12:27:17 AM
It's a complex subject and there are risks AS WELL as benefits.
Obviously estrogenic cancers are at increased risk with HRT, but are those risks any higher in trans people on HRT with an estrogen level the same as any other women in her 20s, that's a difficult one to answer.
Agreed, I personally am not interested in being a test dummy to find the answer.
Maybe I'm thinking overly simplistic but given there is a risk, everything I have read has said lower dosages lowers the risk and people should take the lowest dosage that produces results, be it relief from menopause symptoms or MTF feminization. It appears, in the case of menopausal women, that they are not raising the estrogen levels in their system higher than it was earlier in their lives, it's a -replacement- therapy and it still raises their risk for cancer. + clotting factors, blood pressure issues etc. We are assuming everyone taking this has an ideal BMI, eats healthy, never smoked, never drank excessively nor did drugs. I can't answer yes to all of those and know I'm not the only person who can't.
I personally feel given for most of us it's something we will be doing the remainder of our lives we should, like anything, be doing it in moderation. Clearly I feel the benifits are worth the risks but plan to mitigate the risk as much as possible and still get the benefits. It's why specific dosages and certain meds are banned from even being discussed here. HRT can be dangerous and that is something I rarely see discussed in trans forums.
HRT
is a quality of life issue. While having a fem body and a pretty face is great, if getting cancer, a heart attack or having a stroke is what ends up happening then no, that would not improve the quality of my life.
Quote from: Stephe on September 27, 2012, 10:14:17 AM
HRT is a quality of life issue. While having a fem body and a pretty face is great, if getting cancer, a heart attack or having a stroke is what ends up happening then no, that would not improve the quality of my life.
Well said. I was one of the high-dose and over anxious self meders. Wised up in the last six months, and made a greater commitment to living this life the best way I can.
But there's a certain fatalistic view when it comes to the horribly compelling need to take estrogen. I fully understand why some girls feel so dependent on those levels, and I was right there with them until I talked again to the endo and had honest discussions with my therapist.
Kathy