Susan's Place Transgender Resources

What range do you keep your estradiol levels at? (For those on m2f HRT)

I don't see an option to make a poll so feel free to simply post below.

0-50 pg/mL

50-100 pg/mL

100-150 pg/mL

150-200 pg/mL

200-250 pg/mL

250-300 pg/mL

300-400 pg/mL

400+ pg/mL

Somewhere above hot flashes by day 14. Injections aren't that steady. It's like somewhere between 3000 and 200. LOL!!

I feel best around 250, but my endo likes me 150-200


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I have added the poll for you. Mine is generally kept just below 200 or at least that is what the Endo strives for. Hugs
Mariah

Quote from: Pipes on December 13, 2016, 06:46:31 PM
What range do you keep your estradiol levels at? (For those on m2f HRT)

I don't see an option to make a poll so feel free to simply post below.

0-50 pg/mL

50-100 pg/mL

100-150 pg/mL

150-200 pg/mL

200-250 pg/mL

250-300 pg/mL

300-400 pg/mL

400+ pg/mL

My doctor has me targeted at 400. I try to stay on the plus side of that. I will discuss going to 600 on my next check up.

Between 1,000-4,000 pg/ml. Health and blood test results all good. :)

Interestingly, I came across this

European Journal of Endocrinology (2008) 159 197–202

"There are no evidence-based recommendations for optimal hormonal treatment regimens for transsexuals, but there are a number of expert opinions in the literature (1–4)."

wszytsko it depends on when you're doing research, if for a few hours before the test you took tablet this result may be high, just as if you took a few days before injection. I usually explore a few days before the next injection as 3, and tablet I took no earlier than 10h. Last result I was at the level of 428

doing research because drugs, pointless, so if for example. measure your heart rate after strenuous exercise and wonder that is high

179

So far, for the first 6 months, <=50 pg/mL [emoji19]

That's the lower limit for this lab test. My endocrinologist wants to bring it up slowly. I'd say we have been successful at that. [emoji849]

We just made adjustments last week, that I expect to put me at 80-100 pg/mL based on pharmacokinetic data. Doctors don't seem to care for that math stuff [emoji35].

I did get the next check and adjustment moved to just 7 weeks out, at which point we will see what might work.



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I think you should change the endocrinologist after 6 months 50? is a joke. You take t blockers and estrogen?

My doctor likes me to be in the 200 to 250 range. Currently I am on about 240, which is about right for me that I find. I soon know and feel it if I drop below 200.
Judith

My endo is of the opinion that that anything higher than 200 is not advisable.

I was not expecting so many to be above 400 O.o

Not sure what to make of these results...

Am I harming/decreasing/stunting my feminization by following his 'playing it safe' regimen???

At my three month check up I was told my blood work showed I was well into the female range.  My Dr doesn't rely on numbers as much as if you are feminizing well. 

Quote from: Anastasija on December 14, 2016, 05:05:08 PM
I think you should change the endocrinologist after 6 months 50? is a joke. You take t blockers and estrogen?

I'm old, and my endocrinologist is being conservative.  We don't all hit HRT running!

In spite of the level not quite showing up on the (rather insensitive) test, between the blockers, estradiol patches, and a previous 6 years on the mild antiandrogen finasteride, I am seeing results.  34B on the chest, waist at 29", hips at 37".  Weight holding between 135-140 so far, with careful diet and basic exercise.

Would I like my serum estradiol higher?  Sure, and I think I'll finally have a decent level, not great, probably not in the usual transition range, when I do my next round of blood work in 7 weeks.


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I am surprised at the high numbers too. I go to a very well known LGBTQ... clinic in Chicago and have full faith in them'. I really have no idea what to say.

I'm convinced that there is no agreement on what level is best for trans women either before or after GRS.  My doctor likes to see 200 - 300 pg/ml, but always asks me how I feel.  I'm on oral estradiol, and my levels are quite stable in the low 200s.  T around 8 ng/dL.

Yes my T Level is now just under 2.0. I think 1.85 ng/dl at the last set of blood tests. When I re-started HRT it was 5.6 ng/dl.
Judith

400+ and I feel great, anything lower than 300 and I feel crappy.

Every body is different.  For some, it may not be safe to have levels above 400.  One of the primary concerns for people who are on E is the increased risk of developing deep vein thrombosis (DVT), a potentially deadly complication.  This is much more likely to happen if you are overweight, less active, older, and/or are a smoker.  If you have any of those risk factors, your doctor may be keeping your levels lower out of concern for your safety.

There is also an increased risk of developing higher cholesterol with higher levels of estrogen.

Healthcare is a team effort.  The doctor can do his part, but you have to do yours by managing your weight, exercising regularly, and cutting out bad habits like smoking.  If you're very healthy, then your doctor is much more likely to approve higher levels of E in your HRT.

My levels have centered around 200 pg/mL.  I feel great and have no complaints about the physical transformations.  Even more importantly, dysphoria is long gone.  My testosterone levels run quite low, which I suppose may be a related factor in effectiveness of estrogen levels (I am no expert).

Also, make sure your Dr is checking your estradiol level, not just total estrogen.  Your estrone levels could be high, but estrone is a weak estrogen, and your estradiol levels could still be low.  My Dr specified estradiol on my tests.

Quote from: Pisces228 on December 15, 2016, 06:53:40 AM
Also, make sure your Dr is checking your estradiol level, not just total estrogen.  Your estrone levels could be high, but estrone is a weak estrogen, and your estradiol levels could still be low.  My Dr specified estradiol on my tests.

I can not be with you zgodić to the end, estradiol is the most powerful component, and in the estradiol estrogen falls, it makes no sense to study estrogen alone, because it did not show. Is getting the study of estradiol

Quote from: Michelle_P on December 14, 2016, 08:46:33 PM
I'm old, and my endocrinologist is being conservative.  We don't all hit HRT running!

In spite of the level not quite showing up on the (rather insensitive) test, between the blockers, estradiol patches, and a previous 6 years on the mild antiandrogen finasteride, I am seeing results.  34B on the chest, waist at 29", hips at 37".  Weight holding between 135-140 so far, with careful diet and basic exercise.

Would I like my serum estradiol higher?  Sure, and I think I'll finally have a decent level, not great, probably not in the usual transition range, when I do my next round of blood work in 7 weeks.


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Unfortunately, I also do not agree with that, I'm not endykrynologiem, but the level of estradiol, have on the level of post-menopausal women, women who reach menopause also take medications that increase the levels of estradiol, why? because of the low levels of hormones can lead to serious diseases and osteoporosis at the helm. Hormones manage the entire economy, all with low levels of T and E alone can convict the bad effects. I was in your place I'd go to another doctor. If one says something, does not mean that it has to be. It's your life.

225 made my endo happy. I need to get a blood test soon to see if adding prometrium has changed estrogen levels.

My doctor tests levels but doesn't really put a lot of weight into them, how I feel/results are what matters most to him. That being said I don't really know what levels my doctor does prefer and I can only assume that "in the female range" is what he prefers. My first labs were at just about 3 months testosterone was 34 ng/dL and estradiol was 34 93 pg/mL, the latter is what my peak levels would be based on when I was tested after taking my sublingual tablet. Fast-forward to 1.5 weeks ago taken at 6.5 months my Testosterone is unknown as he didn't bother getting it tested but my serum estradiol  jumped all the way to 151 pg/mL and that was 9 hours after my last sublingual tablet and 11 since my last spiro tablet so those are my rock bottom base levels, no clue what my peak levels would be. Guess my body made huge strides adapting/making better use of the estrogen in those 3.5 months.

Quote from: Pipes on December 14, 2016, 07:13:03 PM
My endo is of the opinion that that anything higher than 200 is not advisable.

I wonder what your endo's opinion of ciswomen is, since their levels are as high as 650 pg/ml during a menstrual cycle, or levels as high as 75,000 pg/ml during pregnancy? Have they consulted studies on women, men and even transsexual women where high levels were attained with minimal or no side-effects?

QuoteNot sure what to make of these results...

Use your common sense and intelligence. You will soon know what to make of these findings. Do some research, read actual studies, talk to other doctors.

QuoteAm I harming/decreasing/stunting my feminization by following his 'playing it safe' regimen???

Not necessarily. Some do very well on lower levels, some need more. Individuals vary. Your doctor and you, ideally together, should figure out what is best for you, for your feminization and health. If you're doubting your doctor's credibility and position, you can always go see other experts in the matter, get a second and third opinion.

Two other things worth mentioning:

- the female range is WIDE and even overlaps that of men so chances are wherever you may be, low, medium, high or very high, you are in female range.
- levels vary from one moment to another so that levels may be quite different depending on when your blood is drawn. So while a target is desired, levels may exceed or be below it, at various points in time, and sometimes be within that target range. So, I ask you, are blood tests for this purpose really useful?

Quote from: Clara Kay on December 14, 2016, 08:56:54 PM
I'm convinced that there is no agreement on what level is best for trans women either before or after GRS.

Because individuals VARY in their requirements. Is the same concentration of alcohol in the blood going to have the same effect in every person? Or even in the same person at different times?

Quote from: EmilyMK03 on December 15, 2016, 04:55:15 AM
Every body is different.  For some, it may not be safe to have levels above 400.  One of the primary concerns for people who are on E is the increased risk of developing deep vein thrombosis (DVT), a potentially deadly complication.  This is much more likely to happen if you are overweight, less active, older, and/or are a smoker.  If you have any of those risk factors, your doctor may be keeping your levels lower out of concern for your safety.

I have to add that type of estrogen is very important as bio-identical estradiol is more quickly metabolized by the body and has a significantly lower impact on coagulation. The route of administration also matters as the hormone is delivered directly into the blood and much less makes it to the liver and in the portal vein.

High levels, taken non-orally (intramuscular injections, patches, pellets), even in older populations of men (up to 700 pg/ml) and women (up to 3,200 pg/ml) have shown to have minimal to no side-effects and even desirable as they could PROTECT against the risk of thrombosis and improve cardiovascular morbidity and mortality. I have several times posted these studies.

QuoteThere is also an increased risk of developing higher cholesterol with higher levels of estrogen.

It's a little more complicated than that. Depends on the type of estrogen and route of administration. In general, it appears bio-identical estradiol is favorable, even more so, non-orally, regardless of levels.

Am J Obstet Gynecol. 1983 Sep 1;147(1):77-81

"Oral administration of estradiol resulted in a significant increase in triglycerides (20% to 44%, p less than 0.05) and very low-density lipoprotein (VLDL) triglycerides (30% to 40%, p less than 0.05) and a decrease in low-density lipoprotein cholesterol (14% to 17%, p less than 0.05). In contrast, despite a substantial increase in serum estrogen levels, percutaneous estradiol induced a significant decrease in triglyceride (from 0.78 +/- 0.04 to 0.67 +/- 0.05 mmol/L, p less than 0.001) and VLDL triglyceride (from 0.44 +/- 0.16 to 0.35 +/- 0.12 mmol/L p less than 0.05) levels and no significant change in cholesterol levels. The increases of high-density lipoprotein cholesterol levels observed in the three groups were not significant. These data indicate that the route of administration modulates the metabolic and hormonal responses to estrogen therapy."

Lipids Health Dis. 2012 Oct 9;11:133.

"The effects of intranasal and percutaneous estradiol were similar, regardless of the addition of progesterone. Similarly, for the overall group of 86 women, micronized progesterone did not alter the response to E2. Blood pressure, glucose, insulin, HDL-c, triglycerides, and usCRP remained constant with or without micronized progesterone. Total cholesterol decreased after E2, and progesterone maintained this reduction. LDL-c levels were similar at baseline and with E2, and lower during E2+P in relation to baseline."

Hum Reprod. 2002 Mar;17(3):825-9.

"We examined metabolic parameters in cohorts of women with and without subcutaneous estrogen therapy with concomitant supra-normal concentrations of estradiol (SE)."

"Women with SE have similar triglyceride and HDL cholesterol levels but lower LDL cholesterol concentrations compared with post-menopausal women not taking ERT."

Acta Endocrinol (Copenh). 1986 Mar;111(3):419-23.

"Despite the high oestradiol levels produced by both types of implant, the only significant finding was a reduced LDL cholesterol"

"Oral oestrogens have been shown to elevate HDL cholesterol and reduce LDL cholesterol (Tikkanen et al. 1978). Reports on the effects of parenteral oestrogen on lipoproteins have been conflicting. Fähraeus et al. (1982), who studied oestradiol-17ß, administered as a cream, and Buckmand et al. ( 1980). who studied depo-oestradiol cypionate noted little change in lipoproteins. However, Brook et al. ( 1982) found that sc oestrogen caused a marked increase in HDL cholesterol and reduced VLDL cholesterol and LDL cholesterol, whereas Lobo et al. (1980) found that oestrogen implants increased HDL cholesterol, the other lipid fractions remaining unchanged. In a previous study (Farish et al. 1984), we followed lipoprotein levels for 6 months in bilaterally oophorectomised women who were treated with sc implants containing either oestradiol alone or oestradiol and testosterone. We found that both therapv regimens lowered LDL cholesterol and the oestrogen only implants also caused an increase in HDL cholesterol."

CLIMACTERIC 2005;8(Suppl 1):3–63

"Implants of estradiol showed only minor effects on lipid metabolism with a slight decrease in LDL cholesterol and a slight increase in HDL cholesterol"

"In women with supraphysiological estradiol levels during treatment with implants, no adverse effects on lipid metabolism, but a reduction in LDL cholesterol and fasting insulin were observed."

J Lipid Res. 2006 Feb;47(2):349-55.

"This prospective pilot study of 18 men with androgen-independent prostate cancer receiving ADT measured effects of TDE on lipid and inflammatory CVD risk factors before and after 8 weeks of TDE. During treatment, estradiol levels rose 17-fold; total cholesterol, LDL cholesterol, and apolipoprotein B levels decreased. HDL2 cholesterol increased, with no changes in triglyceride or VLDL cholesterol levels. Dense LDL cholesterol decreased and LDL buoyancy increased in association with a decrease in HL activity. Highly sensitive C-reactive protein levels and other inflammatory markers did not worsen. Compared with ADT, short-term TDE therapy of prostate cancer improves lipid levels without deterioration of CVD-associated inflammatory markers and may, on longer-term follow-up, improve CVD and mortality rates."

TDE = transdermal estradiol
ADT = androgen deprivation therapy

Aust N Z J Obstet Gynaecol. 1978 Aug;18(3):198-201.

"The effect of oestradiol valerate on levels of blood cholesterol, triglycerides, free oestradiol and coagulation factors, as well as on urinary oestrogens and free cortisol was measured in 10 oöphorectomised women. Despite the very high urinary oestrogen levles obtained, there was no significant change found in the other parameters during and after treatment."

Maturitas. 1980 Jul;2(2):95-100.

"During the course the serum estradiol level increased 5-6 fold from the postmenopausal levels."

"No significant changes occurred in the serum triglycerides and total cholesterol, whereas in the control group the triglycerides decreased. The proportional concentration of beta-lipoproteins decreased. There was also a slight decrease in the pre-beta-lipoproteins. The proportional concentration of beta-lipoproteins increased, as also serum high density lipoprotein (HDL) cholesterol."

Fertil Steril. 2001 May;75(5):898-915.

"Two-hundred forty-eight studies provided information on the effects of 42 different HRT regimens. All estrogen alone regimens raised HDL cholesterol and lowered LDL and total cholesterol. Oral estrogens raised triglycerides. Transdermal estradiol 17-beta lowered triglycerides."

Obstet Gynecol. 2015 Mar;125(3):605-10.

"All transgender women had estradiol levels at least in the physiologic female – range at 6 months, with 3/16 (19%) having supraphysiologic levels > 1000pg/dl (including the one transgender woman using intramuscular estradiol valerate)."

Typo: should read 1,000 pg/ml

"transgender people receiving cross-sex hormone therapy do not develop abnormal blood pressure or lipids in the short term."

Whether total cholesterol is a really important gauge of cardiovascular risk is seriously put into question by several findings from studies. Studies showing an association do not prove anything as there is no cause and effect established.

BMJ 2016;353:i1246

"Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files."

"Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings."

"The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline −13.8% v −1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol in covariate adjusted Cox regression models (hazard ratio 1.22, 95% confidence interval 1.14 to 1.32; P<0.001). There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts. Systematic review identified five randomized controlled trials for inclusion (n=10 808). In meta-analyses, these cholesterol lowering interventions showed no evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27)."

BMJ 2016;353:i1512

"As expected, the diet enriched with linoleic acid lowered serum cholesterol concentration. But it did not reduce mortality: in fact participants in the intervention group had a higher mortality than controls. The pooled results of the MCE and four similar trials failed to find any reduction in mortality from coronary heart disease.3 4 5 6"

N Engl J Med. 1977 Sep 22;297(12):644-50.

"Two well designed contemporaneous27 , 28 trials showed that both niacin and clofibrate reduced cholesteremia by 15 to 20 per cent below starting levels, and yet neither drug had a measurable effect on the behavior of coronary heart disease after five years of observation. This is important evidence (Fig. 3 and 4) because the effect of drugs on cholesteremia is about twice that achieved by the most rigorous, fat-modified diets.29"

Lancet. 1995 Dec 23-30;346(8991-8992):1647-53.

"After standardization for age, there was no association between blood cholesterol and stroke except, perhaps, in those under 45 years of age when screened. This lack of association was not influenced by adjustment for sex, diastolic blood pressure, history of coronary disease, or ethnicity (Asian or non-Asian)."

J Epidemiol Community Health. 2002 Feb; 56(Suppl 1): i19–i24.

"This analysis of the EUROSTROKE project could not disclose an association of total cholesterol with fatal, non-fatal, haemorrhagic or ischaemic stroke."

Am J Med. 1977 May;62(5):707-14.

"Lipid and lipoprotein values, including fasting triglycerides and high density lipoproteins (HDL), low density lipoproteins (LDL) and total cholesterol levels, were obtained on 2,815 men and women aged 49 to 82 years chiefly between 1969 and 1971 at Framingham. In the approximately four years following the characterization of lipids, coronary heart disease developed in 79 of the 1,025 men and 63 of the 1,445 women free of coronary heart diseases."

"At these ages total cholesterol was not associated with the risk of coronary heart disease."

Quote from: SadieBlake on December 15, 2016, 07:27:52 AM
225 made my endo happy. I need to get a blood test soon to see if adding prometrium has changed estrogen levels.

Volume 18a of Elsevier's New Comprehensive
Biochemistry, Titled 'Hormones and Their Actions, Part I', editors BA
Cooke, RJB King and HJ van der Molen.  Published 1988.  ISBN
0-444-80996-1.  Dewey 612.405.

"Binding of progesterone to its receptors then leads not only to progestational effects, but also antiestrogenic
effects by causing a reduction in estrogen secretion into the systemic circulation; by stimulating the enzyme 17B-hydroxysteroid dehydrogenase which converts estradiol to the less active estrogen estrone"

Post Reproductive Health 2014, Vol. 20(2) 69–72

"Micronised progesterone stimulates the 17 beta hydroxy steroid dehydrogenase transformation of
estradiol into less potent estrone E1. E1 competes poorly with estradiol E2 for binding to the estrogen
nuclear receptor and diffuses out of the target cells more easily than E2."

Quote from: DuchessBianca on December 15, 2016, 10:32:07 AM
My doctor tests levels but doesn't really put a lot of weight into them, how I feel/results are what matters most to him.

Personally, I think this makes the most sense. My 2 cents, I'm not a doctor.

QuoteThat being said I don't really know what levels my doctor does prefer and I can only assume that "in the female range" is what he prefers.

Female range is WIDE, from less 20 pg/ml (men have 10-30) to up to 650 pg/ml during cycle, to 75,000 during pregnancy.

QuoteMy first labs were at just about 3 months testosterone was 34 ng/dL and estradiol was 34 93 pg/mL, the latter is what my peak levels would be based on when I was tested after taking my sublingual tablet. Fast-forward to 1.5 weeks ago taken at 6.5 months my Testosterone is unknown as he didn't bother getting it tested but my serum estradiol  jumped all the way to 151 pg/mL and that was 9 hours after my last sublingual tablet and 11 since my last spiro tablet so those are my rock bottom base levels, no clue what my peak levels would be. Guess my body made huge strides adapting/making better use of the estrogen in those 3.5 months.

Estradiol levels fluctuate.

Maturitas, 12 (1990) 171-197

"When the serum concentrations of natural or synthetic sex steroids are measured
at short time-intervals after administration and repeatedly during long-term
treatment, it becomes obvious that there are large intra-individual and interindividual
variations. This holds true for both the contraceptive steroids and the natural
oestrogens and does not apply solely to the oral route. Long-term studies
indicate that an important influence is exerted by predisposing factors, particularly
the metabolic capacity of the liver, on the pharmacokinetics of sex steroids.
Large variations in oestradiol and oestrone levels can be observed in an individual
woman from day to day or from hour to hour, even during transdermal therapy
with oestradiol"

Just a reply to some of the comments on my levels and treatment...

Yes, I know the levels are well below transition levels.  Yes, my current endocrinologist is conservative, and to be blunt, I strongly suspect I'm her first MtF.  She won't comment, and she's who I drew in this giant HMO.

The giant HMO does do transsexual care, and in fact operates a center that is considered a leading program in the nation, the Oakland Multi-Specialty Transition (MST) center.  My therapist was associated with that program, and was running a sort of unofficial satellite program from the HMO medical office branch near where I lived, and had said that she could connect me with needed services such as evaluation and treatment for facial hair, and eventual GCS and FFS.  She's retiring at the end of the year.

The endocrinologist I am assigned to is out of that same HMO medical office branch, and is not associated with the MST.   From discussions with her, I am not entirely sure she understands the pharmacokinetics for a MtF person on HRT.  Unlike an AFAB person, we don't naturally synthesize estradiol, of course.  In an AFAB body, estradiol synthesis isn't confined to the ovaries, but happens in a number of tissues.  Much of this is done by oxidation of testosterone by aromatase, yielding estradiol.  When I was on just finasteride I had estradiol levels bouncing around 30 pg/mL by the high sensitivity assay.  Now that I'm on blockers testosterone is almost nonexistent and there's nothing to oxidize into estradiol, so all my estradiol has to come from the patches.

The pharmacokinetics for the patches suggest that in a post-hysterectomy ciswoman the standard treatment I was receiving would produce a level averaging about 80 pg/mL, sufficient to prevent osteoporosis and keep her feeling healthy.  With my body, and the lack of other synthesis paths, that should produce a level of roughly 50 pg/mL, consistent with the low sensitivity test reporting a level of less than or equal to 50 pg/mL.

My current treatment, wearing two of the largest patches carried by the HMO pharmacy system, should produce a level of somewhere around 80-100 pg/mL.  Still not in the normal transition range, but getting there.  Measurements in 7 weeks will likely confirm this.  I will likely need to wear four biweekly patches at a time to get in the transition range, which is both ludicrous and expensive.  The damn things cost $10 each, and at 4 patches at a time, twice a week, we are looking at $80/week, or $960 for a three month supply.  I also don't have enough lower abdomen to rotate through multiple sites for that many patches.

So, yes, the current course of treatment won't work, and in fact is completely absurd.

It may surprise you to learn that I am aware of these facts.  *SIGH*

Now, I've tried telephoning Member Services, the folks who supposedly advocate for patients, to move me into the MST program.  I've tried their secure e-mail.  Nope.  Nada.  Zip. "Please use our web site to select a primary care physician". Yah.  Which ones are trans-friendly?  *SILENCE*   There is a primary care physician in the MST program, the Director of the program.  She's not accepting new patients, at least not via the HMO's automation.  Thus the contacts with Member Services.

I've asked my therapist to refer me to someone inside the program.  Her plan is to continue seeing me while in 'retirement' (really private practice, in a town over an hour away), and she reassures me that since she's been with the program since it started over three years ago that they'll take her calls and honor her requests.

So, I'm here with a broke-down Miata, a HMO medical center two blocks from me, the Oakland MST convenient at just 5 stops away on the rapid transit system. I'm expected to drive off an hour or so (if there's no traffic) into the Central Valley to get my care.

I am not a happy camper.  In fact, I am [emoji35].

So, yeah, I am aware that my estradiol levels are low.  I am aware that the care I am receiving is substandard.

Fortunately, I also have access to lawyers.  And that is all I have to say on the subject.


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Patches can be applied to the buttocks and in fact, some studies have shown slightly increased bioavailability this way but 4 patches at one time is expensive and inconvenient, I agree. Been there, done that!

This study Journal of Clinical Endocrinology and Metabolism 1996 by The Endocrine Society Vol. 81, No. 6 found that 2 patches gave E2 levels between 776-1066 pmol/L (211 - 290 pg/ml). Absorption will also vary from one person to another and even intra-individually.

Maturitas, 12 (1990) 171-197

"Large variations in oestradiol and oestrone levels can be observed in an individual
woman from day to day or from hour to hour, even during transdermal therapy
with oestradiol"

Regardless, I personally feel that what matters most is feminization and well-being. I really do hope you find a competent and experienced doctor. Best of luck with everything. :)

It's important to remember that there are lots of different brands/sizes/dosages of patches.

The huge spectrum of responses in this thread truly shows how we are all doing our best but have little in the way of hard science/guidelines to go on when making these choices =(