Ok...I know the rules and I know I'm breaking one of them, but I'm desperate here. I can't afford to pay the initial 200 - 300 dollar counselling fee to get a 2nd opinion. I'm rather stuck with the doc I have and I just need to know if my doctor is worrying a bit too much about putting me on too high of a dose. I think she's trying to cover her ass and protect against malpractice suits in case something happened to me but really, is xxx oral estradiol realistic for someone who is just starting transition? (I'm big, 240 lbs) I'm begging you guys, don't nerf this post. I've got a doc but I need something to go on, somewhere to get some good information to convince her if she is under dosing me, because otherwise I'm just wasting my time and money. I'm not asking for dosing information in specific, even some good medical journals that give me what I need. A place where I can find optimum blood serum level would be best, because dosage is useless if the blood level isn't right. Then I can have her show me my levels and compare the two.
edited this - for some reason i put high instead of low in the title.

Maybe the doctor will raise the amount after a few months.  They could be starting you out slowly, planning on adjusting depending on how your blood tests go.

My endo started me on a low dose and has recently increased it. It seems to be common practice to start you off low. According to my endo, sometimes the levels aren't accurate to the person's well-being. He's met transmen starting out their transition whos blood levels indicated one thing, but the way they felt indicated another. For me, I'm sure theres something going on inside me for the last month, but i can't really tell, and after having told my endo that I dont feel any different, he upped my dosage. I'm pretty big too, I'm 6'1" and weighed (at the time) 215 lbs (currently down to 203). I think size has little to do with dosage since its relevant to genetics and not hormone levels. Example: My dad's side of the family has high T-levels, but my facial features are soft and not too male looking, they've always been this way. Even though my T-levels might very well be higher than the average MAAB person. Hence why sometimes levels are not cohesive with the way you feel or look.

It depends solely on the individual. What works for some won't work for someone else. I had stayed on a consistent dose for a long time. I made the mistake of having my dosage increased after I had my orchi because I thought that was what I needed to do and it totally screwed me up. Once the dose was taken down to what it was before, things got back to normal.

How did increasing dose screw you up? This could be useful information for all of us.

I agree that levels really don't mean much as sensitivity to levels varies according to individual. Besides, levels are not an indicator of risks. The form of estrogen is. Pregnant womens' levels go up to 75,000 pg/ml, non pregnant pre-menopausal womens' levels typically go up to 500 during their cycles. Studies have also shown that levels do not necessarily equate to increased risks, neither predisposing to a thromboembolic event or adversely affecting lipids.

Quote from: KayXo on March 17, 2014, 02:29:04 PM
How did increasing dose screw you up? This could be useful information for all of us.

I had hot flashes, night sweats and when that wasn't happening, I felt HOT all the time (and I don't mean "sex-ay" hot), I was friggin boiling hot. You could have fried a friggin egg on me. Part of the blame I put on myself, but I also place blame on the dumb quacks at the internal medicine clinic that I had been shuffled to once my original endo closed their practice and moved out of state. I have since found a MUCH better endo and now everything is peachy keen.

The symptoms you describe are observed when estrogen (or androgen) is too low. Not when estrogen is too high. Menopausal women and castrate men (eunuchs, prostate cancer patients) typically have those.

Quote from: KayXo on March 17, 2014, 08:20:47 PM
The symptoms you describe are observed when estrogen (or androgen) is too low. Not when estrogen is too high. Menopausal women and castrate men (eunuchs, prostate cancer patients) typically have those.

No, I was fine until this happened. I was post-orchi for a year and when I got my bloodwork back following a test, I saw that my E levels had dropped from what they were before the orchi. Keep in mind that I felt perfectly fine with these levels. But I had to be an idiot and act like I was the doc and I actually suggested that my E dosage be doubled and the fools at the clinic went ahead and did it with no questions asked. Once the dose was increased, all hell broke loose. Once the dose was lowered back to what it always was, things were fine. So, it certainly wasn't a case of the E being too low.

My dose of E, taken sublingually has been what most people I can tell it to think should have been totally ineffective but I have been on it nearly 5 years and things are great.  It is not the amount of the stuff in your blood stream that does the work on you, its the amount put into action by receptor cells at various parts of your body.  All my endo has ever checked for on levels was too high, and the rest of the tests are for liver function and certain antibodies for cancer issues.  My blood levels are fairly low, but the effects have given me breast development, minor reversal of MPB in a couple of areas, and the rest of the good stuff we look for. 

Taking estrogen orally, the first place the absorbed estrogen goes to is the liver, where most of it is metabolized. Taken sublingually, injected or topically, it goes to the body first and then to the liver. Taking estrogen topically or injected or sublingually is many times more effective in giving you a higher blood level of estrogen than taking it orally.

Without knowing your full medical history I would suggest that your Doc is giving you low dose oral because of your weight. You are in a high risk for DVT/stroke because of it. To be honest depending upon your age I would be reluctant to put you on orals before weight loss. You are probably on them so they can be withdrawn rapidly if you have side effects.

Your Doc is doing the correct treatment, allowing partial feminization and limiting the clinical risk.

My absolute best advice? Lose weight, never smoke, get as healthy as possible. You have a chance of a new life in a new body; why not look forward to it and get super fit and healthy!

Then you will blossom!

I just started estradiol too, about six weeks now...and my doctor started me out  estradiol, and  Spiro.  Only today did I have the second round of blood work, and he wanted to see how much effect  had for my particular body so he could calibrate a dosage.  Turns out my body is pretty sensitive to it, so I am going up only to .  So maybe it has something to do also with just getting baseline effects?