My doctor already took a--what she thought--was an appropriate reaction, but which I don't think is the right one. I'm 6 months into HRT. Anyway, my blood work showed a Estrogen level of 303 pg/ml. What would have been the appropriate action with a level like that? My total T levels were 62 NG/ml.
I think I want to find a new doctor, but I'm scared I will offend her. But she kinda offended me when i asked for a breast exam and she rolled her eyes at me. 

Estradiol level is pretty ok (slightly high but nothing out of the norm) while T level is on the high end and could go down if need be. I would suggest finding another doctor if she won't help in breast health (exams) for cancer prevention. No real need to give her a reason because she won't do the job as assisting on total health (and not just prescribing things).

As Flan said.

E is fine, T is a bit high are you on AAs or is the E driving the T down?  If you are not on an AA as yet it may be worthwhile.

Ask her to demonstrate how to do a self breast exam. She may have been thinking that you may not have a lot of boobage and did you want reassurance rather than education.

Boobs take a while to develop and are very variable between folks.

I also thought my E was fine and that the T could go down, but really was in check compared to the 300 it was a month ago. But to my suprise, my doctor halved my E dose. She said it was way too high. When I asked her if it would cause my T to go up, since she is of the school that high E lowers T, she blew me off...warned me about self medicating/over dosing and left. I don't know what to do. I've listened to her though...but I know this is a step back that I don't and shouldn't take. All my BMP levels were fine by the way. My liver was nowhere close to shutting down. Blood pressure was fine. I'm fine. I don't know why she did it, and she is too hard to talk to.

An E2 serum level of 303 pg/ml is high... but not super high by any means. Many docs like to keep their MTF patients E2 level between 100-150 pg/ml. I've talked to more than 1 or 2 docs that ascribe to this protocol. I don't agree with it personally. You will not get the most benefit from HRT this way, it's slower, perhaps safer, but the docs of this mind set are usually more concerned about you developing any side effects. Basically, they are more concerned about getting sued than helping you.

From your response I take it you are not on any AA (like Spiro, Androcur, et al). I also do not agree with this protocol either, although many endocrinologists who treat MTF patients do. I have a deep background in medicine and science and as with all things in life, if you ask 4 different people the same question, you most likely will get 4 different answers. Just because you asked 4 different doctors the same question, don't expect the results to be any different.

I generally like to keep my E2 level between 150-200 pg/ml (if it shot up to 300 pg/ml for a month or so I wouldn't worry, but I'd get it tested again in 2 weeks, and lower my dosage if it remained there). I like to keep my total T at 40 ng/dl or lower. If it was lower than 15 ng/dl, I'd cut back on my AA to keep it around 20-40 ng/dl. Also not sure if your doc mentioned the importance of monitoring your potassium levels (especially if on Spironolactone) and liver function (monitoring liver hormone levels)... but checking these 2 things is also very important.

I am on spiro but its not working for me. Spiro alone, at a high dose only dropped my T levels by about 100. It was the high level of estrogen that got it down to 60. I already know that cutting my dose of E had raised my T because I got an erection this morning putting makeup on. I don't know what to do here.

My doctor doesn't order blood test often enough or include the right test either. She upped my estradiol dose before she even ordered a blood test. She had no clue what the starter dose she gave me had done. She doesn't check anything but T levels and rarely E levels. This is the first time she actually ran a BMP.

Quote from: Hippolover25 on February 27, 2013, 11:25:57 AM
I am on spiro but its not working for me. Spiro alone, at a high dose only dropped my T levels by about 100. It was the high level of estrogen that got it down to 60. I already know that cutting my dose of E had raised my T because I got an erection this morning putting makeup on. I don't know what to do here.

My doctor doesn't order blood test often enough or include the right test either. She upped my estradiol dose before she even ordered a blood test. She had no clue what the starter dose she gave me had done. She doesn't check anything but T levels and rarely E levels. This is the first time she actually ran a BMP.

Then I'd find another doc. What you are describing above is borderline negligence. You should have your blood tested every 3 months during the first year of HRT, and at least 2-3 times per year thereafter... and a baseline of all levels should have been done before administering any medications. A total T level of 60 is in the somewhat normal range for a preop MTF... but lowering it to 40ng/dl will help more. A higher level of Spiro sounds like what is needed. It should work for you, albeit in a higher dosage, unless you have some sort of other medical condition.

Oh and as for what tests to run:
1. Serum estradiol (E2)
2. Total + Free testosterone
3. Hepatic panel (aka liver function)
4. Serum potassium (usually included in a single test called CMP: complete metabolic panel which includes K, Na, etc)

302 is kinda high. Being at half that isn't going to kill you. My first doctor wanted me between 150-200, my current doctor wanted me between 200-300. I've only measured over 200 twice and I've gotten amazing results on HRT.

I think it's more important to get the T down. 60+ isn't terrible, but I probably wouldn't want to be there. I have yet to measure above 25. A random erection would make me want to lower the T for sure, though. Haven't had one of those in forever...

The doctor sounds a bit wonky tbh. Measuring E is important and IDK why she wouldn't do that EVERY time. I'd ask her. Both of my doctors worked WITH me and weren't stubborn. I'd suggest looking around a bit if you could... but that can get expensive VERY quickly.

If you'd like, you can PM me to talk about this in more detail.