Ok, so I have an endo appt on 1/17. I need to get a full blood panel before I go, within the next 2 weeks. This will be my second one in 7 months. I called the Endo to find out if I need to wait to take the test (I just took my Estrogen shot last night) or if I'd be ok taking it now. The nurse said it may effect the levels a little bit, but it'll be ok.

I don't know about that. I mean, if I got my blood tested today, like 18 hours after a shot of E, wouldn't my E levels be much higher than if I waited until next week? My question is, does anyone know of any research or recommendations they've heard concerning the right time to get a blood test following an every other week shot of E? Any help/guidance/opinions would be greatly appreciated. Thanks Meghan

I think your endo's office will be in a good position to understand the results of the blood test.  They are the ones who gave you the prescription, right?

Sarah L.

Injections create big E spikes and a long decline. So, you're never actually getting
a near stable level. That's why I dislike them. My feeling is you should test just before the next injection to see if your lowest level is too low (that way, the endo could boost it). Though, if the level falls really low, its obvious since you don't feel good at all. But, it could be getting too low even before this happens. The response, boost E, or inject more often. The preferred one is to inject more often that way you don't create even bigger serum level spikes in E.

The problem with injections is to make sure the levels are sufficient at the end, you have to have bigger than needed levels initially. This makes you wired initially, and at the end, anxious when E levels go down.

My endo always tested me day before and day after injections. That way they got both trough and spike. They apparently have some sort of formula worked out for avgs or some such. Depending, I found, on amount of time on hrt the spikes lessened their highs after about twelve months and the troughs were higher in the same frame.

So, although Keira is right about the injectables not maintaining a constant level, the overall level rises and the spikes and troughs level up and down toward a median level with some time in hrt.

My personal experience with injectables is that the feminization is faster, although those early trough days can be intensely PMS-like for two or three days! As in really quite irritable. 

Nichole

Injections don't feminise faster if you take the equivalent in another format.
Often though, doctors don't give enough E in pill form, patches or gel.

Even in injections, often the dose is too low.

They don't realize we are not of puberty age and we need a higher serum level.

Doctors, even those who have TS,
are overtly conservative, considering how begign estrogen is unless megadoses
alike pregancy are used.

You are correct. That's why anyone needs to go in with lots of factual information. My endo began that way as well, until I just told him: "I think that's too low." He asked why and I told him, referring him to trans-health and some other websites which he called up on his desktop while I sat there.

He apologized, said I was right and he had gotten behind and gave me what I asked for. He was also unaware of dustasteride. Again, a website; again, a read. Again, he gave me what i asked for.

Do your homework. If you have a good endo she or he will admit they might be being too conservative.

In addition to sites like trans-health there are other websites that can be googled and give you good info. Follow links as well when you get the sites.

Go in knowing what you are talking about.

Nichole

Yeppers, doctors can be pretty conservative on what they give and how much (and sometimes have no idea what they are doing!). I don't even know what "levels" one should be at. I know that a lot of doctors will treat you as a post-menopausal woman in regards to dosages and levels, etc. But we're not post-menopausal women, of course.

I went through a couple of doctors before I found one that I liked and seemed to be pretty good.

I started on oral estrogen, a daily dose, as prescribed by my doctor.  I had read where it must be metabolized by the liver and I was not crazy about that idea.  I don't drink or do anything to tax my liver, nor has it ever been compromised.

The other problem that ***I*** had with oral estrogen was how little actually was absorbed across the small intestine and into the bloodstream.

I asked my HRT doctor to look into injectable estrogen for me.  After he did his research he gave me a prescription that I tried for a few months.

After looking at my e-level and t-level he raised the dose of the e to where it was quite effective for me at my age.  I am 56 and totally satisfied with the results.  I have the soft facial features, fat on my tummy, hips, bum, thighs, and the backs of my arms; hair that grows faster; almost no body hair (just soft, downy hair),  a body scent instead of whatever guys have, the mind, heart, and emotions of a woman as I see them to be;  I also have a face with a chin and forehead for only a medical examiner or anthropologist to determine as male (lots of women have forehead bossing).

I am not being conceited here, not at all, but when I look in the mirror, I like who I see.  OK, I need to lose a few pounds but I like who I see!

Wing Walker

I do the estrace under the tongue thingy. It seems to work for me, and I break up my dosage for that as well.

Wing Walker, little is absorbed across the stomach, but your taking much higher doses.
In general, everything that goes through the stomach takes into account the
stomach's absorbtion. As for taxing the liver. First pass effect for a bio-estrogen
like estradiol is rather weak unless taking very very very high doses (which
would be very expensive).

The problem with orals start with very hard to metabolise ethinil estradiol and
premarin (the former is much worse). Metabolism of both creates some
byproducts which can promote clotting and DVT. The liver itself is not really
affected unless you take big doses of Ethinilestradiol, which is possible since its
so concentrated.

By taking orals sublingually, you can bypass the stomach  and have the same
direct injection in the blood as injections.

I get pms regardless of my hormones.

*smile* me too, Nat. It's just no longer heightened by the troughs and peaks.

Quote from: Renate on January 03, 2008, 08:37:32 AM
I take oral estrogens, split between morning and evening.

And, last I checked, my liver hasn't fallen out.

Be careful though and make sure your doctor keeps an eye on things, as the liver strain thing isn't a myth. I take orals (and patches), and my liver enzymes have been steadily rising since beginning HRT, although they're still within bounds.

~Kate~

Two events happening together doesn't mean cause and effect Kate :-).

Patches should not cause any liver problem unless your plastered with them.

Orals unless your really pumping the dose, should not cause any problems either.
Women have E in their system which is taken out by the liver also and there is
no problem. Our liver is no different.

Quote from: Keira on January 04, 2008, 11:20:24 AM
Two events happening together doesn't mean cause and effect Kate :-).

LOL, it's a good guess though: my liver was fine in every yearly physical prior to HRT, including my baseline a few months before HRT.

Then I start HRT. Next physical three months later and viola! Raised liver enzyme levels. And higher the next time. And a little higher the next time.

Same with sodium (dropped) and potassium (increased).

~Kate~

Quote from: Renate on January 04, 2008, 12:44:49 PM

Quote from: Kate on January 04, 2008, 11:27:56 AM
Same with sodium (dropped) and potassium (increased).

Does that mean that you're on spironolactone?

Yep!

My sodium is actually literally at the border (low) value. Potassium is still well within bounds, but definately higher than the baseline tests.

~Kate~