I had alot of blood work done, checked for a bazillion things... I got online results that I could read via mychart

there were no mention of hormone levels either there or in person

I didnt ask as I just didnt think of it... ok, I was so freaked out that I just wanted to get the all clear and get out so thats my fault... but is it odd that they were not mentioned?

everyone seems to know where they started, but me... I was asked recently and realized I dont know... surely the dr checked them, right?

thanks

I wonder if we go to the same clinic because I had the exact same experience. I went through all the blood tests results online and tried to figure out if any of it referred to hormone levels. When I went back for my one month follow up I asked about it. The doctor at that one month check up doubled my doses of spiro and estradiol and sent me for more blood work and made another follow up appointment in three months. He said at that appointment would be the first time he checks my hormone levels because it just didn't matter where I started. He wanted to get my hormone levels into a feminizing range before testing to see what tweaks may be needed with my meds. When I said that I was just curious he said, "Yeah, we don't usually run medical tests just because the patient is curious." Touché. He's actually super sweet and it was actually pretty funny. Still though, a bit bummed not to have the starting numbers.

It just goes to show you that not all endocrinologists are the same. My doctor asked me to have a full array of bloodwork done, including testosterone and estradiol levels, before my first appointment.

Terri

My doctor doesn't really go over my levels in that detail either.  When I have a checkup after blood work he'll let me know if I'm within normal range and that's about it.

If I ask, he gladly shares the information but I guess I'm ok with a thumbs up or down.

I feel your pain! When I went to my first doctor about starting HRT, we didn't test my blood levels, just went straight into it. I started at a low dose. 4 months went by and she still didn't bother with blood tests. That didn't sit well with me, and contradicted everything else she told me prior to starting with her. When I switched over to another medical provider, I had it tested immediately, so we could find the right dosage for me.

It really depends on the provider but I like minimizing blind guessing as much as possible. Less wear on my body and nerves that way. Good luck!

I have all my medical records and the first time my hormone levels were checked was a couple of months ago. Actually only the testosterone levels were checked. As I am post surgical and have been off HRT, my estrogen levels would be so low they didn't matter and testosterone was check to be sure I wouldn't need a blocker. There isn't much point in checking what you already know and I suspect in the future, my testosterone levels will not be checks and only estrogen levels will be checked.

Now had your body shown little sign of masculinization, it might have been a good idea to check both T and E levels before starting HRT.

Places like Planned Parenthood are moving towards doing less (if any) bloodwork regarding HRT. I made them check my levels before I started just in case I ever needed to de-transition or something I'd know where I'm supposed to be naturally. And then I made them check at my second followup (third total) appointment, just to make sure my body was handling everything okay and I wasn't destroying my liver or something.

The not running medical tests just because the patient is curious is kind of a dick thing to say. I mean, I see his point but knowing your hormone levels (and metabolic and thyroid functions) before starting HRT is some pretty important information to have in my opinion, though from the doc's perspective it's irrelevant and all that matters is where you're trying to get to. And I think they're even trying to move away from that and just give everyone they see a standard dose. I can see the justification for that too, cis females all have ranges and variances in their hormonal levels, but eh. I'd prefer more fine-tuning than that, so I've made an appointment with a foreal endocrinologist.

PP is great for getting started on a short time table, but I think eventually, if you can afford it, you want an actual endo.

It does sound odd not to test as you go.  I got my test and prescription on the same day, but had a clean health history, so there were no concerns starting.

My dr advised that if we change dosage, we will test at about 8 weeks. If no change required, 12 weeks.

Seems like a reasonable way to safely tune dosage based on each patient, and be in a position to smartly change between pills patches or injections if necessary.

I wonder... For places that skip the blood test, is it a cost thing?

At the clinic I go to, the regular blood work was about $10, regardless of insurance.  I had my last test done remotely, waiting to see how that turns out from an insurance standpoint....


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My endo is like some kind of vampire. Blood tests before I started HRT with him, and many many times after.

What possible reason is there not to do a blood test as standard? You're about to make some major changes, and in my case it did actually pick up a serious problem. I'd never have know otherwise, until perhaps too late.

Doctors do it many different ways, and they can't all be right. So some must be in the wrong. I'd rather be wrong in doing unnecessary tests that the other way around. I value my life and I'd be looking for another doctor if he didn't want to take that level of care.

When i first started my provider ordered CBC, BMP, LFT and thyroid function. She didnt discuss hormone levels either and it was ONLY that I asked her that she went ahead and ordered the T test since she pretty much told me at the get go that it was pointless since it was later in the day already, but I was still curious about my baseline nonetheless. Plus she also told me she doesn't monitor the effectiveness of HRT by hormone levels, so yeah, every provider is different. But if you really wanted to know and your insurance covers the tests, then by all means be an advocate for yourself and ask since it is YOUR right to know your health info.

Quote from: RitaChans on April 12, 2016, 06:33:32 AM
I had alot of blood work done, checked for a bazillion things... I got online results that I could read via mychart

there were no mention of hormone levels either there or in person

I didnt ask as I just didnt think of it... ok, I was so freaked out that I just wanted to get the all clear and get out so thats my fault... but is it odd that they were not mentioned?

everyone seems to know where they started, but me... I was asked recently and realized I dont know... surely the dr checked them, right?

thanks

Your levels will change anyway as soon as you start, yes? They call it a starter dose for a reason. 

Hugs, Devlyn

Quote from: .Christy on April 12, 2016, 07:00:30 PM
she pretty much told me at the get go that it was pointless since it was later in the day already, but I was still curious about my baseline nonetheless. Plus she also told me she doesn't monitor the effectiveness of HRT by hormone levels

I think this approach makes a whole lotta sense. Just seeing how your body responds, you general well-being, you will know if you are getting enough E and if T is sufficiently suppressed.

My levels weren't tested initially. They ran I think 5 or so other blood tests just to see overall where my health was. Levels were only tested after I had been on HRT for 3 months. I get both T and E tested prior to every doctor's visit now though, and we discuss them pretty in depth.

I can understand why a doctor would want to know your levels starting out, especially if you had a pre-existing hormonal imbalance or other issue, but otherwise they're going to change so quickly on HRT that I don't see much of a point.

Quote from: FTMax on April 13, 2016, 10:43:21 AM
I can understand why a doctor would want to know your levels starting out, especially if you had a pre-existing hormonal imbalance or other issue, but otherwise they're going to change so quickly on HRT that I don't see much of a point.

I look at it like insurance. No point when it's all ok, but how do you know without checking? It's such an easy test to do, and it might turn up something you need to know.

One of my blood tests showed up something potentially fatal and I had no idea before that.

Quote from: AnonyMs on April 13, 2016, 11:58:10 AM

Quote from: FTMax on April 13, 2016, 10:43:21 AM
I can understand why a doctor would want to know your levels starting out, especially if you had a pre-existing hormonal imbalance or other issue, but otherwise they're going to change so quickly on HRT that I don't see much of a point.

I look at it like insurance. No point when it's all ok, but how do you know without checking? It's such an easy test to do, and it might turn up something you need to know.

One of my blood tests showed up something potentially fatal and I had no idea before that.

Was it a T or E test that showed you that though? That's what I mean. Obviously we should be doing the whole battery of other tests every time, but to start out, I personally don't see the utility of a T or E test unless you have a pre-existing condition or reason to believe that something may already be off with you hormonally.

My T was very low which is a symptom, but it was one of the other tests that really hilighted it. I did a bunch of other tests after that to find out what it really was.

I had no idea I had any problems before that, and only went to the doctor to get a baseline before I started. I think it's worth doing regardless of starting HRT, you only get one life and there's no harm in getting your health checked (assuming you can afford it). Really, why not?

It seems very irresponsible to me to not look at hormone levels prior to starting the HRT (especially if the blood is already being drawn for other tests). Suppose the patient has an undiagnosed intersex condition, and is hypogonadal? If there's pre-existing hypogonadism, good medical practice would be to properly evaluate the patient to establish the cause (and make sure it's not due to a pituitary tumor or something), and also make sure there aren't other conditions present as a result of the hypogonadism (such as osteoporosis, diabetes or heart disease). Skipping this entire step doesn't seem like good medicine to me.

Aside from that, one thing I can think of immediately in MTF trans HRT, is that the preexisting testosterone level is very important in deciding whether it's necessary to give antiandrogens or not. If the person is already hypogonadal, then there's a good chance that once they start on estradiol, their remaining T production will collapse altogether even without antiandrogens, and so the use of these potentially quite harmful medicines can be avoided altogether. Also, if a person has been hypogonadal for a long time prior to starting on HRT, they're at increased risk for osteoporosis, which makes it important that, post-HRT, their estradiol levels are kept well within the normal female range and not allowed to fall too far.

Mine basically said that because the tests were so expensive, they wait to see if there is enough development after the first year. If not, then they'll test. Keep in mind that this place caters pretty much exclusively to homeless and low income trans patients.

Mine tests testosterone and estradiol and does a complete blood count and comprehensive metabolic panel on every visit.  It's kind of expensive.


Sapere Aude

Quote from: KayXo on April 13, 2016, 09:32:14 AM
I think this approach makes a whole lotta sense. Just seeing how your body responds, you general well-being, you will know if you are getting enough E and if T is sufficiently suppressed.

Yea, that's why I liked her a lot and she spared me the extra needle sticks aside from the routine CBC w/ electrolytes, liver and thyroid functions every 3 months. She basically monitored my HRT regimen based on the changes I was feeling/seeing and I got a lot of freedom in my own plan of care too. So far I haven't had any bad experiences with the informed consent route. Too bad she left suddenly and now Im on a waiting list for a new doc at the clinic I go to.