To keep it short, I have my 3 months blood work done and I am going to see my endo in a week or two. I am going to talk about possible dosage increase and since she is very good endo but she still learns the TG treatment specifics, I usually prefer to present her with several options and then wait for her medical opinion on them.
So, those, who have seen Your E dosage upped, how were You taking Your pills afterwards - twice per day (like with AA) or once per day, but the dosage is increased x-times?
Don't push to increase your dosage if your estrogen levels are within normal range. Too much will only lead to problems.
I'm not sure about the exact number, but the half-life of estradiol is, I think, 12 hours. It means that once it's done absorbing, the estradiol level will have peaked and gone down to half the peak's level within 12 hours. With that in mind, I think the level would be pretty low after 24 hours. If a steady hormone level is desirable (and while I'm not sure, I think it is), then doses should probably be spread out more.
Now whether you take it two, three, four or whatever times a day is up to questioning, but one is questionable in my opinion. When my dose was increased from a number divisible by two to a number divisible by three, my endo said it didn't matter if I took them in one, two or three shots, if you're curious. But I wouldn't listen to him. Because nothing usually matters to him, not even common sense.
Anyway, even though your endo hasn't dealt with many trans people, she's dealt with hormones. If she's a good endo, with the product's half-life, desired levels and knowing whether it's desirable to have more stable levels rather than rare, steep spikes (which she should probably know, but you can research to make sure), she'll be able to prepare a treatment schedule properly. I think you can trust her with that.
Oh yeah, just one thing. Being in the female normal levels isn't enough. And having just enough estradiol to see some change isn't either. In terms of numbers, what should be aimed for is the higher normal female values, in the upper third of the normal range maybe. Upper half minimum. Because the lower half is close to and somewhat overlaps with the male normal/not worrisome levels.
In terms of effectiveness, I personally think the most sensible approach is, once testosterone is appropriately assassinated, to gradually increase the dosage, until no additional desirable effects are noticed. Within reasonable bounds, and being careful of the placebo effect, of course.
I think too many doctors are overly prudent by going with "the lowest dose to achieve results", while the principle should actually be to go with "the lowest dose to achieve the DESIRED results", and the desired results just so happen to be the maximum results. Many will feed you with "you have a limited number of estrogen receptors, and at some point they'll all be busy and adding more estrogen won't do a thing", but they assume a bit fast that the patient is already at the limit where all receptors are busy, having never tried a higher dose.
Orihime: Actually it depends on the endo. Apparently, some, even with antiandrogens, believe it's more appropriate to use amounts between once and twice the normal female range. Maybe it's because they want to mimic puberty and that in puberty hormone levels are higher? Maybe? I don't even know if puberty levels are higher than adult levels. Seriously, I wish HRT were less of an endo opinion thing, so we could understand things properly and wouldn't need to speculate like I did above.
Well, my E has upped but it is still within range, which is acceptable for men, thought it has almost reached the upper point (my estradiol is 54, and everything less than 56 is ok-ish for men). Funny thing is that as far I understand those numbers tend to overlap with female estradiol levels depending on the day of their female cycle. Meaning that 54 can be acceptable for lower female ranges as well... But last time we met, she said that we are going to look at female levels, so I trust her decision on that.
Quote from: A on September 10, 2013, 03:05:25 AM
But I wouldn't listen to him. Because nothing usually matters to him, not even common sense.
LOL! Sounds like he is quite a fun person to deal with.
So, I was not wrong when assumed that at certain range level both fem and male ranges do overlap.
It not only depend upon the desired effects but also in what your blood and particularly liver biochemistry is looking like. If there is any evidenc of even a slight increase in liver toxicity most endos wont move an inch. Mine looks very closely at my GGT, if it is rising and I don't have a great excuse, like I went out for dinner and had a few glasses of wine, I'm under suspicion. This is one chick who def doesn't drink before her blood tests!
If you can, and I know this varies between countries, explore E implants. They give you 24/7 4-6 months steady level release, and you don't have to remember to take tabs.
My physiology seems a bit odd, which is why I may be looked after a little more closely, my E level is about 450 on implants, which is OK, it was over 10 x higher on pills at a starting dose divisible by 2 (yeah!!!!!). I was feeling fine! But I was potentially heading to the undertaker via a stroke.
In the end I trust me colleague who specializes in her area. And funny enough she never questions my expertise in mine!
No, we dont have any implants here and even if we had, it is way too easier to get prescribed pills than getting into situations which involve person-to-person contact. I remember, I was going for the genetic testing and the doctor wanted to discuss my issues beforehands (I went there not as a TG person, but someone who allegedly had fertility issues - openly going as TG would: a) put me out of state coverage, b) I might have to wait waaaay too longer till I get to submit my results). So, yeah, she wanted to examine me and asked to unbutton my shirt - luckily for me she just looked at my chest without going for the breasts and nipples (I just unbuttoned and parted my shirt a bit) - but I felt like I was a spy who is about to get caught...
My endo might have an issue with my cholesterol, but thats genetic and I used to have increased Ch for last five years.
Oh, something else that is interesting about my endo. He isn't checking for health issues apart from prolactin. Now I'm young and it would be the negative equivalent of a miracle for me to run into any liver problems, so I guess the worry isn't huge, but. Yeah, he's like that. Retirement in one year. One year to go before I can hopefully see his replacement.
And yeah, Emily, at this point if health issues aren't a worry, I think may not even need to go slowly, with such low numbers, ahaha.
Also, Cindy, that sounds nearly impossible. A bit like my levels of 400 and 1000 pmol/L (the latter of which was "TO BE REJECTED - The laboratory", and the endo still believed it and it put a one-year gap of crappy doses in my HRT) on a gel dose equivalent to what they give menopausal women to get the strict minimum to reduce heat flashes.
I shouldn't talk about this too much. The incompetence and inconscience of my endo makes me too angry.
My doctor tells me to take in the morning, no need for mult times/day.
Quote from: A on September 10, 2013, 03:54:24 AM
Oh, something else that is interesting about my endo. He isn't checking for health issues apart from prolactin. Now I'm young and it would be the negative equivalent of a miracle for me to run into any liver problems, so I guess the worry isn't huge, but. Yeah, he's like that. Retirement in one year. One year to go before I can hopefully see his replacement.
And yeah, Emily, at this point if health issues aren't a worry, I think may not even need to go slowly, with such low numbers, ahaha.
Also, Cindy, that sounds nearly impossible. A bit like my levels of 400 and 1000 pmol/L (the latter of which was "TO BE REJECTED - The laboratory", and the endo still believed it and it put a one-year gap of crappy doses in my HRT) on a gel dose equivalent to what they give menopausal women to get the strict minimum to reduce heat flashes.
I shouldn't talk about this too much. The incompetence and inconscience of my endo makes me too angry.
Ye don't get angry/upset , I think this is a good discussion. The first thing that happened when my E levels were 'OK ready for IVF now dear (exaggeration) was let's use another lab. I'm in the position to retrieve my sample I split is and sent it to two other labs, same result.
We then started to think of the particular test group, and in her experience my endo did say straight out, I think there is a cross reaction in that companies kit (used by the testing labs) but I only ever see it in trans*women. Mmm wonder what that means.
Of course in our national QAP program there is no requirement to test for trans*women's results.
Ye I'm ancient :laugh: so I make sure I'm checked for stuff because I know my cell biology should be starting to fail so I make sure it is checked. Very much different strokes for folks.
A little bit of Old Person advice.
Especially for Medics who look after long term conditions. The longer you are in the game the more you know. My Endo reckoned I was the second person she had seen in my response to the tablet. I'm certain (now) it was not a lab error. It was me.
She saw it and picked it.
Most people are fine.
I run labs, we make mistakes, but not like that.