hi everyone,

I just got prescribed Estradiol last week, after being on Spiro for around 6 months. I'm 18, and live in Toronto, Canada.
I'm really worried and afraid because I've been prescribed probably the lowest dose possible, and my friends around the same age are on many times what I have, and the doctor doesn't want to raise my amount or do any blood/hormone level testing for another 6 months which is super scary...

should I be worried that mine is so much lower than my friends? I'm definitely worried that I'm not having frequent testing to even tailor my dosages amount to myself, after all the years of waiting... would it be a good idea to switch doctors? or am I overreacting to all this.

Quote from: parashep on April 29, 2014, 11:22:03 PM
hi everyone,

I just got prescribed Estradiol last week, after being on Spiro for around 6 months. I'm 18, and live in Toronto, Canada.
I'm really worried and afraid because I've been prescribed probably the lowest dose possible, and my friends around the same age are on many times what I have, and the doctor doesn't want to raise my amount or do any blood/hormone level testing for another 6 months which is super scary...

should I be worried that mine is so much lower than my friends? I'm definitely worried that I'm not having frequent testing to even tailor my dosages amount to myself, after all the years of waiting... would it be a good idea to switch doctors? or am I overreacting to all this.

I just got my first Rx today (low dose) but my doctor says that there was the option to go on half of a low dose aka extra low.

I guess there is a lot of anecdotal evidence that an extra low dose for the first 6-9 months of E will lead to better overall breast growth. Something to do with hitting the body too quickly with a higher (level typical low dose) of E will stunt the total growth.

Personally I didn't get the extra low because I don't really want anything larger than C. Hoping for medium A to small B.

that's good to hear, I mean, I'm not cutting any pills in half so I guess I'm not TECHNICALLY on the lowest then. I've been searching for things for a while, but haven't found anything related to starting on such a low dose, do you have any links?

Sorry no links. Its just something my doctor mentioned when she asked which dose I wanted to start on.

FWIW she isn't checking my hormone levels until at least 3 months either. I think after my 3 month checkup she will up my dose and have me get a blood test on my way out the door, then email me if there is a need to cut back. (The joys of digital medical records)

that reminds me that I haven't even seen the results of my blood tests from 6 months ago to the one last week (all paper documents at this place...), I hope I don't have to make an appointment and wait another 2 months if I want to find out.

I guess if it's a sure method then it could be ok? the major reason I'm worrying is because my friends seem to be on a different timeline, starting higher and being bumped up after only 2 months. and I don't think there will be any supplementary patches/gel or progesterone ever prescribed to me either.

I know it's tempting to compare ourselves to others - especially when the other is getting more, but every one has different biology, weight, height, metabolism etc. Your doc needs to take that into consideration and start you off on a low dose to evaluate your physical response before, most likely, increasing the dose. I was on a low dose for the first three months, went fast enough and have been readjusted upwards accordingly.

I'm not as much worried about the dosage amount anymore, but I still am about the doctor. I wouldn't be concerned if there was a 2 or 3 month gap, but 6 months is twice as much... I doubt I will be able to switch doctors since other places are either full or have long wait times so I will have to try to find out what this doctor is doing, even if I'm not really comfortable with him.

thanks a lot, though. sorry for taking up your time

Quote from: parashep on April 30, 2014, 12:31:28 AM
I'm not as much worried about the dosage amount anymore, but I still am about the doctor. I wouldn't be concerned if there was a 2 or 3 month gap, but 6 months is twice as much... I doubt I will be able to switch doctors since other places are either full or have long wait times so I will have to try to find out what this doctor is doing, even if I'm not really comfortable with him.

thanks a lot, though. sorry for taking up your time

Well on the extra low dose I don't think you would need levels monitored for 6 months... They would be much lower than the low dose. But you ate right. If you don't feel comfortable with how your doctor is treating you, either talk with your doctor about it, or try to fond a different one.

I think you can call the doctors office and ask to set up a phone call to ask questions like you have (rather than waiting 2 months for an appointment) usually reception will forward you to the Dr's personal voicemail. Maybe they can email or fax you your old blood tests you wanted to see.

And don't worry about using my time, I'm glad to help! The more I can help people on this forum, the better. (And I can't really post encouragements on the passing/ before and after threads very well because I can't distinguish facial features.)

My only concern would be that you are not taking enough estrogen to compensate for the loss of androgen from Spiro and the effects of that such as bad mood, poor memory, tiredness, unmotivated, not looking quite healthy and vibrant as usual, beginning of osteoporosis, hot flashes, problems with sleep, waking up in a sweat, etc. If you notice any of these, what they commonly refer to as PMS, menopause symptoms, then you should advise your doctor immediately. There is no reason you should suffer from this, I think it's important to give you just enough (and eventually more for feminization, if need be) so as to avoid this which I'm assuming your doctor did but just in case, if this happens, then let them know ASAP.

I'm from Canada too, province right next to yours, Quebec.

My Endo advised me that starting on a low dose for a few months means your transition mimics a natural puberty more closely thus giving better results in the long term. When a girl starts puberty her body doesn't instantly produce the higher levels of E that a fully developed woman has.

Here in the UK they do my blood tests every couple of months then they slightly alter my dosages depending on the results so I understand how 6 months may seem like a long time, this may be due to legislation of it may just be down to the GP/Endo you see. If you have any concerns then see if your GP would at least give you a phone consultation to explain their reasons for waiting 6 months & give you a chance to voice your point of view.

I probably started on the lowest dose possible and then moved up to a somewhat moderate dose after a month or so.  It wasn't until 4 months of being on hrt that I got on my current dose which seems to be more common with transwomen. Most of the time, they want to see how your body is reacting to the medication and making sure there are no potential issues.  I understand wanting to go full speed all at once, but they take precautions for the sake of your health and they see how you react to lower doses.   This is a fairly common approach from what I've seen here.  Soon enough you will likely move onto a better dose and you are starting at a great age.    Good luck.

Quote from: Jayne on April 30, 2014, 10:23:16 AM
My Endo advised me that starting on a low dose for a few months means your transition mimics a natural puberty more closely thus giving better results in the long term. When a girl starts puberty her body doesn't instantly produce the higher levels of E that a fully developed woman has.

True that it's always best to start at the lowest effective dose for YOU and that dose may not be the same for all. Different individuals have varying sensitivities. That's something important to consider. Also, that low dose must be, at the minimum, enough to stave off PMS symptoms caused by too low sex hormones. One must remember that if our androgens are suppressed, estrogen must replace it and there is a minimum required to keep problems at bay and that may also differ from one person to another. Once that minimum is found and once the minimum most effective dose that gives some feminization is found, then yes, I agree, that should be where one stays for as long as things are working out well. I'm not a doctor. This is just my opinion.

Quote from: Jayne on April 30, 2014, 10:23:16 AMHere in the UK they do my blood tests every couple of months then they slightly alter my dosages depending on the results

This is where I disagree because what can a blood test for estradiol (or even testosterone) tell you that you don't already know. If you feel good, are seeing positive results in terms of feminization, what's the use? The effective level for one may not be the effective level for another. Individuals vary so much. Measuring estrogen levels also doesn't take account SHBG, the free estradiol levels, that they may fluctuate greatly so that testing once only gives levels at a certain point in time whereas they may be much greater or lower at another point in time, especially when it comes to sublingual or injections. You will also pretty much know when your testosterone levels are low, you will feel it, your sex drive, your skin oiliness, your strength, the thickness of your skin, body hair growth, etc. Some anti-androgens also block testosterone which is not taken into account by the test. There are so many variables and a blood test is far from accurate in determining if you are at an effective dose or not.

And let's say you are not doing well, are not feminizing adequately whilst your levels are good according to doctor, which by way doctors don't even agree on which levels are best (some don't even care so it's quite arbitrary), then what? Accept your fate?

I'm not saying you should go against your doctor. On the contrary, you should do as they say. But, it would also be worthwhile to bring these valid (I think) points to him/her and see what they say. To openly discuss with them. To better understand the rationale behind why they do what they do. I think it's healthy and not rude to question professionals...professionals should encourage this, I think. It shows they are open, willing to learn, are humble and work in the interest of the patient and science first before pride and ego.

thanks a lot everyone. I'm going to try to make a call to the doctor's office and ask more questions about the plans. I have a lot of anxiety about using the phone, so I will have to try my hardest. I have noticed that I've had much worse moods and tiredness and lack of motivation for a few months, but I only just got on E so we'll see how it goes.

I still think I might try to switch doctors if possible, even if it means switching from this endocrinologist to a GP who is involved with trans hormones, because I'm still not very comfortable with this doctor.

thanks again!

edit: I forgot to mention, I'm a bit extra afraid of phoning because while healthcare is covered in Canada, this doctor charges pretty high fees for things that are technically uninsured and I'm broke and jobless. I hope he doesn't try to charge me.

I don't they can charge you for a phone call unless they tell you beforehand.

Oh, and I also have that general fear of making phone calls. On a bad day it'll take me 5 minutes to dial a number and 20 minutes of pacing to hit call.

I hope every goes well with your call!

I have only doctor supervision, so I choose my own doses, and the doctor reccomendation to use a very small dose really has shown results. Most transwomen I have talked to take a out 3 times my current dose. If the goal is to take the lowest dose that leads to adequate feminization then that dose seems to vary a bit between different people.

To be fair I am on bicalutamide and dutasterdie in addition to estradiol, which as I understand it means that the higher level of T in my body aromatises to estrogen possibly meaning I need less of the pills but I was on the same dose of E when I was on spiro and the results were good then too.

I certainly recommend seeing how things go, because your hormone levels could still reach the maximum female level even if the medicine you put into your body is not the maximum dose.

Having the higher doses of hormones is also much more likely to cause side effects, as I noticed from taking mine. Granted, I was on testosterone instead of estrogen so the specific side effects are different, but I was fine for a year and ended up accumulating more and more problems as time went on, even after my dose was cut.

Better safe than sorry - especially because you don't want to end up with a problem that comes across as critical rather than simply inconvenient, which would make getting hormones from any doctor more of a hurdle. Starting on a lower dose, they will always adjust you to something higher if your blood test reveals that you're not at a good range for a female in 6 months' time.

It's that old thing about headaches - don't keep taking medicine until it goes away - take your scheduled dose and then check back in the amount of time it should be taking to work

I think I've mostly come to terms with starting on a low dose. I was probably just really paranoid because of my experience with all the gatekeeping in Canada and how long its already taken. a low dose will take more time, but it won't harm me. I'm going to try to make a call tomorrow! another note: my endo is semi-retired which means I will have to make a switch at SOME point, but probably not soon.

edit: ouch, looks like he only works on Tuesdays. I guess I have to wait until then to call, all that worrying for nothing

Btw, let it be known that estradiol by injection (intramuscular) is available in Canada and can be compounded for you by several pharmacies. You can just let your doctor know of this as this could be an interesting option down the road. Some girls have better results on it, including myself and it is quite safe as it is non-oral.

Quote from: KayXo on May 02, 2014, 01:37:02 PM
Btw, let it be known that estradiol by injection (intramuscular) is available in Canada and can be compounded for you by several pharmacies. You can just let your doctor know of this as this could be an interesting option down the road. Some girls have better results on it, including myself and it is quite safe as it is non-oral.

ahh yes, I've heard about it, but injections just scare me waay too much. wouldn't be a bad idea but I feel better taking pills sublingually

I was afraid too, for a very long time but I'm sooooo happy I switched over to injections. I overcame my fear, for one and have felt much better since. Night and day! Skin is sooo much softer, I look better...so worth it for me!