Hello you all,

do you mind taking a look at this weird thing that occured to me?
I am hoping to get some feedback on a situation for which I currently have no explaination.

For four years post op I used estrogene gel but recently discovered that my levels are too low, around 100 pg/ml. I had some chronic hair and skin issues and I found out that they were linked to the low estrogene levels.

After a discussion with my endo he put me on tablets, and since November I took a relatively high dose sublingually. Honestly I was a bit worried because I was told by other people that this dose must be too high to go on with and I asked for blood levels to be checked in February to see things clearly. I expected estrogene to be sky high but today I got the printout and was rather shocked. Estrogene was now 108 pmol/L  which equals roughly 30pg/ml.

Despite the big increase in estradiol and the sublingual administration, my levels dropped to a fraction of what they should be. I expected them to be more in the 300pg/ml range.  Now I dont wonder why my hairline started to recede recently.
On the morning when the levels were measured I forgot to take the pills because I was in a hurry but I think this cant account for such a drop in blood levels.

I have no explaination for this. I recently moved to the UK and the GP here refuses to refer me to an endo because she says she knows enough about HRT. Hm...obviously not. She pointed out that my levels are ok. I feel left alone with this. Gel did not work (maybe the dose was just too low)
and tablets were a disaster. Really, I dont know what to do next. Also I dont have much money at the moment and cant afford to go private.
Do you have an idea why the tablets did not work at all and what to do now?

Every educated opinion on this is highly appreciated!   Many thanks

With sublingual administration, levels peak and drop quite quickly, thus fluctuating alot, hence no point in measuring levels. Gels are not all made the same, it appears. Some may prove to be more effective than others for some.

Not quite the same, but I was using patches for a long time and had low blood levels. When I finally saw an endo he said that skin absorption varies between people. I was one of the unlucky ones.

My estrogen level last test was around 1000pmol/L, but I'm using implants now.

I'm in Australia, but I understand the system in the UK is difficult. Can you register with another GP? Without much money I'd guess its going to be difficult to do much else. You could try arguing with doctor, asking for a second opinion, making a complaint, and so on, but you'd have a problem if they refused to see you any further.

I usually refer to this chart on Wikipedia for estrogen blood levels (I've noticed doctors get upset if you say you read something on Internet, so not sure I'd mention it)

http://upload.wikimedia.org/wikipedia/commons/e/e2/Estradiol_during_menstrual_cycle.png

Thank you two for the answers and thanks AnonyMs for the chart. It is very helpful to get an overview over E levels and to convert them from ml to mol.
Ill have an appointment with my current GP as soon as possible to discuss the situation with her but I am not that positive she will change her mind. If not I will try to switch to another. The NHS cant really refuse to treat you, can they?  I must have to possibility to go to another doc since I need medical care. At least thats what I am thinking.

E levels with sublingual Estradiol really fluctuate that much? Does that mean that my levels are normally much higher than 108 mol/L but just dropped to a fraction because I missed a dose on the day of measurement? This would also mean that you should take the doses as evenly distributed during the day as possible, for example 1x morning, 1x noon, 1x evening to minimize peaks and valleys. Is that so?

My understand is subliminally that levels drop quite fast a few hours after taking them.  I don't know what the recommended regiment is, but I do understand your thinking in spreading it out evenly.

Quote from: melanie on March 08, 2015, 04:58:13 PM
E levels with sublingual Estradiol really fluctuate that much? Does that mean that my levels are normally much higher than 108 mol/L but just dropped to a fraction because I missed a dose on the day of measurement? This would also mean that you should take the doses as evenly distributed during the day as possible, for example 1x morning, 1x noon, 1x evening to minimize peaks and valleys. Is that so?

There are a number of factors to consider

1) You are not using the pills the way they are designed to be used. They are designed to be swallowed to allow them to work properly and deliver the correct dose. Swallowed they have a half-life of 16 hours and so only need to be taken once per day. This gives a much better response than the see-saw of subligual use.

2) To get consistent results your blood should be drawn at the same time after you have taken your dose for the day. Obviously if you have blood taken an hour before you take your pills, you will get a very different result than if you have your blood taken an hour after your dose. Endos in the UK like blood to be drawn 4 hours after ingestion of the daily dose so try for mid-morning / afternoon appointments and time your dose to allow 4 hours.

If you take a consistent dose and have bloods taken at a consistent interval then you will get a much better idea of how effective the HRT is.

You are right, I dont use the medication as it is  designed. It is highly recommended to take Estradiol pills sublingually since this avoids metabolism through the liver. Oral use will come with higher health risks and less efficiency as 90% of Estradiol is broken down by the liver, so no need to consider that.
..E levels on sublingual pills really drop that fast? I mean I had only 1/6 of my usual level 1o hours after I took the last dose on the evening before. Is that really possible or was my level very low in general? I wouldnt wonder then why many here go for implants as they deliver a much more continuous dose. If they just werent so expensive.

Yes, E levels fall DRAMATICALLY when taken sublingually from very high to much lower within 2-4 hours. Studies confirm this, again and again.

I also have a question about what are desirable levels.  I just got blood work back, and I have a testosterone of 6 and an Estrogen of 1113.  I think that puts me at lower testosterone and higher estrogen by far than even the low and high ends of the female range. Is this something I should worry about? I'm on spiro and E injections.

Tori_chi,

To be honest if you want answers to those sort of questions only your medics can give sensible replies! We are all so different.

That is why we pay medics to look after us.

And no it is nothing to worry about

Quote from: Tori_Chi on March 11, 2015, 02:06:58 AM
I also have a question about what are desirable levels.  I just got blood work back, and I have a testosterone of 6 and an Estrogen of 1113.  I think that puts me at lower testosterone and higher estrogen by far than even the low and high ends of the female range. Is this something I should worry about? I'm on spiro and E injections.

What is desirable for one is not for another. Individuals VARY. Levels tested also fluctuate in time so aren't reliable especially when on injections. Doctors disagree about what is too high or too low. I personally think that the dose of hormones that produces changes and that you feel good at is the right dose for YOU. This is my opinion though, based on common sense...I'm NOT a doctor.

My levels, last tested, just out of curiosity, were close to 4,000 pg/ml, 3 days after the injection. Total T was around 15-20 ng/dl.

I take micronized sublingual estradiol, and this thread got me thinking about fluctuating E levels. I've been taking the pills once each day, in the morning.

After a Google search, I found this study, which concludes:

QuoteSublingual administration of micronized 17 beta-estradiol results in a rapid, burst-like absorption into the systemic circulation, yielding high E2 levels that fall rapidly over the first 6 hours.

So yeah. Guess I'm going to spread them out a bit...

At Last!!!  Something I have been waiting for for such a long time, people listing estradiol serum levels (not dosages). My last test showed it at 881 pg/ml, this was after an almost 3 week bedrest due to surgery.  Reason told me that thigh injections plus zero activity across 2 1/2 injections was the causal factor, and that I would probably settle into a number around the 600's after walks etc. resumed, for now a good place "for me".

The above was very welcome information, and it will be a good thing for our community once doctors finally understand old ways and old studies need to be renewed.  I believe bio-identical studies strictly focused within the our realms over time will give so many people the relief and assurance of fact rather than trying to guess our way through an already difficult situation.  Having only 'one' route toward resolution being to speak to our doctor, where are we if that doctor is operating under bias?   Dani