So I've been on HRT for 1.25 years now, pills exclusively (E+Spiro), and thus far I feel like I've had a really great reaction to them, I pass pretty well... how well exactly I can't tell because I obsess over my flaws, but my girl friend says I pass, and when I'm out and about I'm rarely if ever clocked (mainly it's my name, or my driver's license, or my voice, or stubble (still doing the laser thing right now)). Anyways, the one and truly main problem I have left... is that my breasts are really, really small... like, I still don't fit my A-cup bra, and I haven't had any decent breast growth in six months according to my endocrinologist (although they still hurt like a bitch every time I bump them). Genetically I'm kinda doomed to be small as well (my mother is a B-cup apparently...), and a slight eating disorder has pretty much prevented me from gaining anything over 130 lbs.
*sigh*
Anyways, where I am going with all this, is I had an endocrine appointment on Tuesday, and I expressed my displeasure with my itty bitty titty bumps, and my endocrinologist gave me a prescription for Progesterone. She said it was a bit early for it yet, but since I was in good health and I'm young I should be able to go on it without any major health repercussions at this stage, and she believes it might help my breasts.
The problem is that like an idiot, I promptly went online when I got home and looked up information about it. Needless to say, what I read scared the crap out of me. Specifically a few posts that said that progesterone could actually halt breast growth entirely, or do nothing for it... not to mention it could make me feel like crap in the process. I also read a few articles that seemed to think it was good and vital for full and final development of breast tissue. Unfortunately, either way the jury seemed out on actual hard scientiffic data... and a lot of it seemed to result in little more than finger pointing and name calling.
So, I'm falling back on what I know... which is I'd rather here anecdotal evidence from fellow trans girls who have actually been on progesterone. How did it make you feel, did your breasts get bigger as a result, what other effects did it have (specifically did it do anything to your lower bits), and at what point in your transition did you start progesterone. Also while I have a specific prescription, is there a certain type of progesterone that I should look into that might give me a decent effect (naturally going back to my endocrinologist first, not getting from some other method)? and finally how long were you on it, and would recommend I should do the same.
Thank you so much!
I'm not on HRT so I have no anecdotes, but here's what we have on progesterone:
https://www.susans.org/wiki/Progesterone
The experienced ones will undoubtedly be by with their input too.
Hugs, Devlyn
Progesterone makes me feel good (calmer), appears to help with breast growth, making them fuller and protrude more, makes my skin/hair soft, strengthens my nails and I think, is helping with increasing fat deposition. I take bio-identical progesterone (Prometrium) which I personally consider to be safer and more beneficial than most other progestins, especially Provera and some contained in birth control pills.
Okay, so I got my patient portal set up and I have an exact name of the progesterone that I was prescribed... so hopefully that helps some. It's medroxyprogesterone acetate (tablets).
Medroxyprogesterone acetate is Provera. Some report depression/anxiety from it. It can have mildly androgenic effects in some. Has been associated with increased breast cancer risk and thrombosis in ciswomen whereas this has never been observed in studies with bio-identical progesterone (Prometrium, oral). Bio-identical progesterone has also been deemed non-androgenic according to several studies and is exactly the same molecule produced by our bodies.
Progesterone gave me rapid weight gain, even though it did not affect my appetite. The breast swelling lasted only a few days before the general weight gain covered up any growth and made them look just as small. Furthermore, the weight I gained came primarily on to the abdominal area and shoulders, making my body shape more masculine and covering up what little curvature I had. My face also became more vertical, and my chin pointier. In terms of mood, it made me tired and depressed, offsetting any beneficial effect of estrogen. My hair even thinned slightly, and it had no effect on my skin. I also had all of those same negative effects from MPA, although less severe. Unlike progesterone, though, the MPA gave me nightmares and made me slightly aggressive, too. By discontinuing those medications and staying on estradiol, it has been possible for me to reverse most of the damage, but not without considerable difficulty.
Progesterone, unlike estradiol, is not beneficial to everyone who uses it. It is also usually secondary to estrogen in cis women, for what that is worth. Please be careful with it.
Perhaps, the difference in how it both affected us is how much estradiol we had in our bodies (I have very high levels) so that progesterone's somewhat anti-estrogenic effects were more pronounced in her whereas in me, it *seems* to instead be complementing it well but I'd be open to perhaps taking half of what I take for awhile and see if I notice a difference, negative or positive. Will discuss this with my doctor shortly. :) I also probably take a higher dose of progesterone than what she took so that the sedative effects and its benefits to me outweigh the negative. Speculations...but goes to show you, how we all differ in our responses. ;)
Quote from: Steph34 on April 30, 2015, 12:01:43 PM
It is also usually secondary to estrogen in cis women, for what that is worth. Please be careful with it.
In pregnant ciswomen, it is essential, otherwise if levels are too low, the fetus cannot survive and there is miscarriage. Both estradiol and progesterone are very high during pregnancy AND progesterone is also on the rise during the second phase of a woman's cycle, leading up to pregnancy if ovum "meets" sperm. Ciswoman and even fetus are exposed to very high levels of progesterone and estradiol during course of pregnancy.
Quote from: KayXo on April 30, 2015, 12:12:13 PM
Perhaps, the difference in how it both affected us is how much estradiol we had in our bodies (I have very high levels) so that progesterone's somewhat anti-estrogenic effects were more pronounced in her whereas in me, it *seems* to instead be complementing it well
That seems plausible, since my estradiol level was low (in the 70s) at the time. Still, we both experienced weight gain from it, right? Not everyone is looking to *gain* weight while transitioning. I am certainly not.
QuoteIn pregnant ciswomen, it is essential, otherwise if levels are too low, the fetus cannot survive and there is miscarriage. Both estradiol and progesterone are very high during pregnancy AND progesterone is also on the rise during the second phase of a woman's cycle, leading up to pregnancy if ovum "meets" sperm. Ciswoman and even fetus are exposed to very high levels of progesterone and estradiol during course of pregnancy.
I really do not see how pregnancy is relevant in the context of trans women, who cannot become pregnant. Most cis women become pregnant only after they have feminized nicely; pregnant women's levels are therefore supra-physiological from the context of feminization. And of course, pregnant women also have incredibly high estradiol levels to offset any anti-estrogenic effect of the progesterone. Progesterone is secondary to estrogen during most of the cycle, which makes sense because E is the more widely accepted feminizing agent.
My own estradiol level is pretty high, I can't give an exact number, given I'm waiting for them to put my labs up on the patient portal... but 6 months ago I was almost into the normal female range, and my testosterone if I remember what my doctor said, is only around 70~
>_> I'm always a bit weary when it comes to these drugs inflicting weight changes... when I first went on HRT, I lost 20 lbs. in the first week of being on it... it leveled off immediately, and it put me at a completely average weight for my height... but it was kinda freaky at the time xD
Quote from: Steph34 on April 30, 2015, 12:41:18 PM
That seems plausible, since my estradiol level was low (in the 70s) at the time. Still, we both experienced weight gain from it, right? Not everyone is looking to *gain* weight while transitioning. I am certainly not.
Not everyone also gains weight from progesterone and some actually do need the added fat. Depends.
QuoteI really do not see how pregnancy is relevant in the context of trans women
You stated that progesterone is secondary to estrogen in CISWOMEN so then I just stated the obvious, that it isn't so if levels are so high during pregnancy, similar to estrogen and if during
half the cycle, progesterone levels start to become significant, while actually estrogen levels are low in the first week of the cycle, then drop temporarily after ovulation. I consider both hormones as important and both contribute as much to ciswomen in the context of feminization and other things as well, including how one feels, psyche, etc.
Quotepregnant women's levels are therefore supra-physiological from the context of feminization.
Supraphysiological means that it doesn't occur naturally, in excess of what is normally seen, when indeed such high levels do occur naturally in pregnant women and some women experience several pregnancies during their lifetime.
QuoteAnd of course, pregnant women also have incredibly high estradiol levels to offset any anti-estrogenic effect of the progesterone.
I see both as complementing each other despite the somewhat anti-estrogenic effect.
QuoteProgesterone is secondary to estrogen during most of the cycle, which makes sense because E is the more widely accepted feminizing agent.
As stated before, I consider progesterone's contribution equally important to that of estrogen, even during a cycle. Typically, assuming a 28 day cycle, the first week, both hormones are low, then the second week, estrogen rises and levels become significant while progesterone remains low, third week, estrogen drops somewhat while progesterone increases significantly and last week, if not pregnant, both hormones begin to drop. If pregnant, both hormones increase and will do so, gradually, over the course of 9 months. I also don't personally believe that it is natural for ciswomen to have so many cycles during a lifetime and that traditionally, women would become pregnant much more often, spending more of their lives, either pregnant or nursing instead of cycling every month or so. There is a reason hormones start to build up in the second phase in the menstrual cycle, to prepare for pregnancy as this is, in my opinion, the natural cycle but because of modern habits, birth control pills, etc, this whole natural cycle has been disturbed.
Just my 2 cents. A layperson sharing her thoughts on the matter...and don't worry, me and Steph enjoy conversing...no fighting here, just nice civilized discussion. Right, Steph? :)
So I heard back from my doctor... and the reason I got MPA rather than a bio-identical, was because MPA is like $10, while the bio-identical is $100... also the bio-identical isn't covered by my insurance (at all... big surprise.) So yeah... I guess I'm not doing progesterone? Idk the more I hear about it the more problematic it sounds. If the only way to go is a bio-identical version, then I can't afford that on my income... not if I want to be able to afford surgery at some point...
I have been taking promethium for over a year. There was a slight increase in breast growth. I was thinking of asking my doctor if he thought it would be detrimental to cycle off and see if there is a difference. If I saw or felt a difference then ask him if I could cycle back on.
According to my doc E makes permanent breast increases and P makes slight swelling of the breasts for as long as you are on it.
Quote from: Kaylin Kumiho on May 01, 2015, 08:07:09 PM
So I heard back from my doctor... and the reason I got MPA rather than a bio-identical, was because MPA is like $10, while the bio-identical is $100... also the bio-identical isn't covered by my insurance (at all... big surprise.) So yeah... I guess I'm not doing progesterone? Idk the more I hear about it the more problematic it sounds. If the only way to go is a bio-identical version, then I can't afford that on my income... not if I want to be able to afford surgery at some point...
There are still options. You can ask for progesterone capsules (suspended in oil) or rectal suppositories to be prepared by a compounding pharmacy (there are plenty!) at an affordable price...or hydroxyprogesterone caproate injectable (Proluton Depot) prepared by manufacturer or compounding.
Quote from: KayXo on April 30, 2015, 02:49:38 PM
Not everyone also gains weight from progesterone and some actually do need the added fat. Depends.
It depends on body type and genetics, I guess. Some trans women feminize better with more fat, but I personally see better feminization when I have less fat. It makes sense that progesterone, the pregnancy hormone, would increase body fat since body fat increases fertility. Since breast tissue is mostly fat, anything that increases body fat would likely cause breast swelling. Cookies would work too, and they taste much better than progesterone! ;D
QuoteYou stated that progesterone is secondary to estrogen in CISWOMEN so then I just stated the obvious, that it isn't so if levels are so high during pregnancy, similar to estrogen and if during half the cycle, progesterone levels start to become significant, while actually estrogen levels are low in the first week of the cycle, then drop temporarily after ovulation.
I just meant that progesterone levels are low for a larger portion of the cycle; that is all.
QuoteI consider both hormones as important and both contribute as much to ciswomen in the context of feminization and other things as well, including how one feels, psyche, etc.
Is the same necessarily true for trans women, who have already developed badly and are receiving estradiol for the first time, often in low doses? I question that, especially given the ambivalent results often reported from adding progesterone. Many report significant improvements in mood and rapid feminization from low doses of estradiol, and as you suggested, those of us with low estradiol may be more susceptible to the anti-estrogenic effects of progesterone. My first doctor did not even want to prescribe it because he has seen it cause depression in other trans-female patients; I was not the first one.
QuoteSupraphysiological means that it doesn't occur naturally, in excess of what is normally seen, when indeed such high levels do occur naturally in pregnant women and some women experience several pregnancies during their lifetime.
Many doctors and the WPATH consider pregnant women's levels supraphysiological because they are not seen during a normal cycle, the levels in which are often used as a reference. Although exceeding menstrual cycle levels is sometimes necessary for proper feminization depending on individual sensitivity to hormones, I find it rather odd to use pregnancy as a justification, since pregnancy is not considered necessary for feminization (or for good mood) in cis women.
QuoteI also don't personally believe that it is natural for ciswomen to have so many cycles during a lifetime and that traditionally, women would become pregnant much more often, spending more of their lives, either pregnant or nursing instead of cycling every month or so. There is a reason hormones start to build up in the second phase in the menstrual cycle, to prepare for pregnancy as this is, in my opinion, the natural cycle but because of modern habits, birth control pills, etc, this whole natural cycle has been disturbed.
As a feminist, I would have to respectfully disagree. Having so many pregnancies is only 'natural' because women were subjugated throughout the evolutionary past. Another perspective is that the hormonal build-up is to enable pregnancy; without it, that would not be possible at all, and it gives cis women the choice.
Quoteand don't worry, me and Steph enjoy conversing...no fighting here, just nice civilized discussion. Right, Steph? :)
Yes, always. :)
Quote from: Kaylin Kumiho on May 01, 2015, 08:07:09 PM
So I heard back from my doctor... and the reason I got MPA rather than a bio-identical, was because MPA is like $10, while the bio-identical is $100... also the bio-identical isn't covered by my insurance (at all... big surprise.) So yeah... I guess I'm not doing progesterone? Idk the more I hear about it the more problematic it sounds. If the only way to go is a bio-identical version, then I can't afford that on my income... not if I want to be able to afford surgery at some point...
There is a generic version of prometrium made by Teva. It is considerably cheaper than the brand name version.
Quote from: Steph34 on May 02, 2015, 10:40:27 AM
Some trans women feminize better with more fat, but I personally see better feminization when I have less fat.
Women have more body fat than men. Increased fat deposition helps hide muscles, male bone structure so can be very helpful for some girls to appear more feminine.
QuoteIt makes sense that progesterone, the pregnancy hormone, would increase body fat since body fat increases fertility.
Progesterone significantly increases AFTER ovulation, after the fertile period (estrogen is the fertility hormone). It aids in body fat accumulation in certain areas to insulate fetus and prepare body fat stores for baby when mother will breastfeed it.
QuoteSince breast tissue is mostly fat, anything that increases body fat would likely cause breast swelling.
Breast tissue is mostly fat in menopausal women usually. Before that, breast tissue is composed in big part by glandular tissue due to the action of estrogen and progesterone, ducts, lobules and alveoli. There is also some fat of course and connective tissue.
QuoteCookies would work too, and they taste much better than progesterone! ;D
Dr. Curtis? Lowdown on progesterone? I consider cookies to be much more harmful to health than progesterone. Harmful advice, in my opinion.
QuoteI just meant that progesterone levels are low for a larger portion of the cycle; that is all.
Estrogen is low half of the cycle, high during 1/4 of the cycle, and moderate another 1/4 of the cycle. Both estrogen and progesterone are high during pregnancy. They are both equally important to women, in my opinion. For example, without progesterone, lobuloalveolar structures in the breast cannot develop. I have plenty of papers that document this and verify this. I can send them to you, if you wish. Estrogen increases water retention, progesterone is a diuretic. Estrogen decrease sebum, progesterone increases it. Etc.
QuoteMy first doctor did not even want to prescribe it because he has seen it cause depression in other trans-female patients; I was not the first one.
Very strange since progesterone through its metabolite, allopregnanolone, acts onto the GABA receptor, exerting anxiolytic and antidepressant effects. If I stop progesterone only for a short time or if levels drop, my mood worsens. I feel dead inside. Progesterone livens me up. :) Are you sure your doctor meant women on bioidentical progesterone and not MPA? it is also important to not confuse calmness with depression. Progesterone relaxes someone and I consider this effect beneficial not only to the psyche but to the to the body, as it counters stress and slows down ageing in the process. I've noticed it helps my memory a lot.
QuoteMany doctors and the WPATH consider pregnant women's levels supraphysiological because they are not seen during a normal cycle, the levels in which are often used as a reference.
The right term must be used then. I explained what supra physiological means and levels during pregnancy are certainly not supra physiological.
QuoteI find it rather odd to use pregnancy as a justification, since pregnancy is not considered necessary for feminization (or for good mood) in cis women.
I only mention pregnancy to illustrate that if very high levels pose very little risk to ciswomen, then one can safely assume, I think, that levels several times lower in us, but still relatively high compared to what is is usually recommended, are fine. Some may need higher levels, some may not, of course. It's up to the doctor and patient to find out together.
QuoteAs a feminist, I would have to respectfully disagree. Having so many pregnancies is only 'natural' because women were subjugated throughout the evolutionary past.
Nature is not emotional. You are. It's just how it works. Whether you like it or not. There is a natural cycle. There is no choice in nature, we didn't choose that we were women, gays didn't choose to be gay, it just is that way.
It seems really hard to estimate the effect Progesterone will have on a person. I did some research too, asked my doctors, and on here asked a lot of questions and ran survey. In the end it was so inconclusive I just tried it for myself.
From what I found, micronized progesterone has three common effects; mood changes, a more active libido, and fuller breasts due to swelling (as long as you have it in your system). Side effects can include masculinization (mainly abdomen and face), mood swings, increased appetite and weight gain.
Quote from: mfox on May 04, 2015, 05:24:58 AM
From what I found, micronized progesterone has three common effects; mood changes, a more active libido, and fuller breasts due to swelling (as long as you have it in your system). Side effects can include masculinization (mainly abdomen and face), mood swings, increased appetite and weight gain.
Are you talking only of bio-identical progesterone or other progestogens which have very different effects due to their different molecular structure? Bio-identical progesterone is NOT androgenic in any way. It does not trigger androgen receptors nor does it increase androgen levels, this has been confirmed by studies. Bio-identical progesterone is also given to pregnant women so if it were androgenic, it would definitely be contraindicated in the case that the fetus might be female. Finally, it if were masculinizing, then one would expect pregnant women who produce great quantities of progesterone to come out masculinized which is clearly not the case; the fetus is also exposed to very high concentrations of progesterone during pregnancy. On the other hand, some progestogens such as Provera and others sometimes found in birth control pills can be mildly androgenic. These cannot be taken by pregnant women.
Personally, I find progesterone STABILIZES my mood and it seems to do so in many others. Also, it actually decreased my appetite from when I was just on estrogen and that effect was also reported by others. Finally, it can counter estrogen's water retention as it is a diuretic so can help one shed a few pounds BUT can also indeed increase fat deposition, helping with butt/hip enhancement and facial rounding. Progesterone actually stimulates glandular formation in the breast as well, this has been also verified by several studies.
It is absolutely important to make the distinction between different progestogens. Effects vary. ;)
Quote from: KayXo on May 03, 2015, 08:41:19 AM
Women have more body fat than men. Increased fat deposition helps hide muscles, male bone structure so can be very helpful for some girls to appear more feminine.
It is the distribution, not the presence, of body fat that is considered feminine/masculine. Fat distribution is affected greatly by genetics; there are plenty of women who store fat in the abdomen and shoulders and therefore do not look so feminine when they are too heavy. Also in those of us who are still transitioning or have done so recently, fat cells may still be distributed in a male pattern due to past exposure to testosterone. Some new body fat will go to those old fat cells; many trans women see fat deposition change over a period of years. It is not surprising, then, that most of my fat (when I gain/lose weight) goes on/off the abdominal area, making me look more feminine when I weigh less.
QuoteProgesterone significantly increases AFTER ovulation, after the fertile period (estrogen is the fertility hormone).
Since progesterone is high during pregnancy and affects the development of the cis female reproductive system, it obviously has a role in fertility.
QuoteIt aids in body fat accumulation in certain areas to insulate fetus and prepare body fat stores for baby when mother will breastfeed it.
One of those areas is the abdomen; several of us have seen that.
QuoteBreast tissue is mostly fat in menopausal women usually. Before that, breast tissue is composed in big part by glandular tissue due to the action of estrogen and progesterone, ducts, lobules and alveoli. There is also some fat of course and connective tissue.
Glandular tissue contains fat though, right?
QuoteI consider cookies to be much more harmful to health than progesterone. Harmful advice, in my opinion.
From a general health perspective, that may be true, but at least cookies are not anti-estrogenic!
QuoteFor example, without progesterone, lobuloalveolar structures in the breast cannot develop.
That is unimportant to most trans women who are more concerned about size, appearance and sometimes firmness. Progesterone typically does not cause breast growth, but merely temporary swelling that subsides when the P level drops. Estrogen, by contrast, causes permanent growth.
QuoteIf I stop progesterone only for a short time or if levels drop, my mood worsens. I feel dead inside. Progesterone livens me up. :)
I felt dead inside after a single dose of progesterone, but I get very perky after taking estrogen.
QuoteAre you sure your doctor meant women on bioidentical progesterone and not MPA?
I am sure, since we were talking specifically about bio-identical progesterone. He does not even prescribe MPA because of health risks.
Quoteit is also important to not confuse calmness with depression. Progesterone relaxes someone and I consider this effect beneficial not only to the psyche but to the to the body as it counters stress and slows down ageing in the process. I've noticed it helps my memory a lot.
For those of us who are prone to depression, myself included, calmness can feel like, or even lead to, depression.
A certain amount of stress is necessary to motivate people to get through the day; that is called eustress.
QuoteThe right term must be used then. I explained what supra physiological means and levels during pregnancy are certainly not supra physiological.
I think it would be fair to consider such a level supra-physiological for infertile women.
Quote from: KayXo on May 04, 2015, 09:50:31 AM
Bio-identical progesterone is NOT androgenic in any way. It does not trigger androgen receptors nor does it increase androgen levels.
Both my doctors said it binds to androgen receptors. My current doctor actually recommended it as an androgen receptor blocker, but given the efficacy of my other medications I did not experience any benefits pertaining to that.
QuoteBio-identical progesterone is also given to pregnant women so if it were androgenic, it would definitely be contraindicated in the case that the fetus might be female.
Estrogen and progesterone levels in pregnant women are very high regardless of the sex of the fetus; the two cancel each other out.
QuoteFinally, it if were masculinizing, then one would expect pregnant women who produce great quantities of progesterone to come out masculinized which is clearly not the case
If progesterone were not masculinizing, one would expect pregnant women to experience dramatic feminization due to their high estrogen levels, which is also not the case. Again, the two hormones act against each other.
QuotePersonally, I find progesterone STABILIZES my mood and it seems to do so in many others.
Stability is not necessarily good; I personally enjoy the emotional ride of estrogen alone.
QuoteAlso, it actually decreased my appetite from when I was just on estrogen and that effect was also reported by others. Finally, it can counter estrogen's water retention as it is a diuretic so can help one shed a few pounds
Water weight is trivial compared to its effects on metabolism. The calming/anti-aging effect that you speak of indicates a reduced metabolism. When metabolism is lower, weight gain will occur even without an increase in Calorie intake; one will need to eat less to maintain weight. For me personally, progesterone increased my Calorie intake by nullifying the euphoria caused by estradiol and by reducing my emotionality, which suppressed my eating by making me feel more guilt after overeating.
QuoteBUT can also indeed increase fat deposition, helping with butt/hip enhancement and facial rounding. Progesterone actually stimulates glandular formation in the breast as well, this has been also verified by several studies.
Again, the effect of fat deposition on body shape varies from one person to another and is not necessarily feminizing. The smaller average breast size of trans women is believed to be due to their larger skeletal structure, not low P, although I have a feeling that many are also not given enough estrogen to develop properly. The breast swelling caused by progesterone is often temporary; estrogen is more effective at promoting glandular formation.
No sense in arguing over and over about the same issues although I admit you raise some interesting points. Personally, I like the effects of progesterone. Enhances my mood, makes my skin/hair look better, helps me sleep better at night, gives some fullness to my breasts and I think, gives me a more prominent butt. Certainly doesn't increase my appetite. To each their own. ;) I hope you find the regimen that works for you.
There are studies showing it prevents Testosterone to DHT conversion (only bioidentical progesterone).
QuoteProgesterone typically does not cause breast growth, but merely temporary swelling that subsides when the P level drops.
Some people say it might help some with the structure of breast tissues.
( development of the lobules and alveoli in the breasts)
Some people reported this after being already some time on hrt.
The one study that showed significant inhibition of T to DHT by progesterone was in the presence of extremely high levels of progesterone that do not naturally occur in humans, even during pregnancy.
Quote from: KayXo on May 08, 2015, 03:48:37 PM
The one study that showed significant inhibition of T to DHT by progesterone was in the presence of extremely high levels of progesterone that do not naturally occur in humans, even during pregnancy.
This one ? :)
ncbi dot nlm dot nih dot gov/pubmed/1828548?dopt=Abstract
hugs
YES! this one. :) Progesterone levelsin this study were 10(-4) mol/l or after conversion to ng/ml, 31,450 ng/ml compared to peak levels reaching at most 400 ng/ml during pregnancy. On typical doses prescribed to us, we can hope, at most, to reach 50-100 ng/ml for a few hours and that is stretching it, in those whose metabolism is slow or impaired.