So a little background info on my MTF hormone therapy, before starting hormones my estradiol level was 37 pg/ml and testosterone (T) level was 714ng/ml. I started taking Spiro, of increasing doses to 200/day a month before starting estrogen therapy in June 2015.  I was only on the Climara 0.1 for a couple months as it did not stay in place well after exercising even with extensive skin prep. I asked my endo to put me on Estradiol Valerate injection q2weeks which was easy for me as I'm an ER RN. In March of 2016 my estradiol and T levels did a complete reversal with my T level <3 ng/ml and estradiol at 704 pg/ml, my endo was OK with those levels though the estradiol seemed high to me and the T level was too low. Just in case some out there may be thinking... she must be taking extra medication to accelerate changes, I don't! I take the exact prescribed doses as I want the best end results possible not the fastest. MY last set of lab work in September was shocking - an estradiol level of 931pg/ml OMG, and my dose of Spiro and estradiol valerate remain unchanged! From everything I have read on medical websites, other TG sites, and on Susan's these levels are extremely HIGH! I am starting to think my endo may not be as experienced with transgender care as he claimed.

I have not been as happy as previously, my libido is nearly nonexistent, and I have noticed that my hair seems to be falling out at an increased rate which seems paradoxical as I have almost zero T to convert to DHT to cause hair loss. I do however like that I now fill a 38B bra though so it is not all bad:) I am going ask my endo to decrease both my spiro and estradiol valerate to increase my T level to around 30 ng/ml (normal female is 30-100ng/ml) hopefully giving me back some sex drive, and slowly start bringing my estradiol level to about half its current level to avoid any harmful effects. What do you all think? Am I worrying for nothing? I am open to any suggestions or info you all may have.

Kristen<3

i would wait for next blood work. since your on e. your sex drive is mostly in your mind . i would not be too concerned if one reading is soo high. remember your body is still producing its own e as well. going to 30 t is a great idea for bone strength and all the other benefits from having low t


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These levels are not unusual for estradiol valerate.  That particular ester of estradiol gets converted from an ester into bioidentical estradiol pretty fast, and more quickly passes out of your system.  If you're concerned, remember that pregnant women have serum levels in the tens of thousands.  If you go with lowering your dose, you might get deeper "valleys" in the cycle of your dosing schedule.  Estradiol cypionate, on the other hand, takes longer to "cleave" and so lasts longer while producing milder peaks and valleys. 

You might want to look into adding finasteride to your regimen to combat hair loss.

I also take estradiol valerate and my levels range anywhere from 1,300 pg/ml to 4,000 pg/ml. I feel good, have had good overall feminization except for breast growth. I've had several blood tests done and every single time, everything comes back normal (liver enzymes, clotting times, lipids, insulin, C-reactive protein, etc.). I know other transwomen on such high levels whose test results came back normal.

Consider pregnant women whose levels can go as high as 75,000 pg/ml and whose risk of blood clots is less than 0.2%. All verified by studies.

Then, you have male prostate cancer patients, between the ages of 45(49)-91 yrs old, who, when treated with high doses of estradiol, had levels in the range of 400-approx. 700 pg/ml. Despite this, there was no increase in thromboembolic or cardiovascular complications except for one study where the rate was only 2.2%. Considering these men are at an advanced age, have a greater risk of DVT (due to having cancer also), these results are quite positive.

Finally, there are studies (Horm Metab Res. 1994 Sep;26(9):428-31 AND Adolesc Pediatr Gynecol (1995) 8:20-23) where pseudopregnancy levels were attained with very high doses of estradiol valerate in ciswomen, some around the age 45-55 yrs old. Levels ranged from "3226 +/- 393 pg/ml after 3 months and to 2552 +/- 254 pg/ml after 6 months" in one group and in the other from "3028 +/- 728 after 3 and to 2491 +/- 684 pg/ml after 6 months."

Their statements:

"We have experience with therapeutic pseudopregnancy in about 200 patients with mammahypoplasia (Lauritzen 1992). Its rate of objective and subjective tolerance is excellent."

"Investigations of lipids, liver enzymes and haemostasiology to be published later will show the absence of unwanted metabolic effects of this regimen."

"In conclusion, our data show, that the treatment (...) by means of high parenteral estrogen-progestogen depot injections is effective. Virtually no side effects occurred. The therapy is well accepted by the patients."

In the other study, estradiol levels ranged from 920 – 6789 pg/ml, in women aged 16-30 yrs old. Despite this,

"High-dose intramuscular injections of estrogen and progestogen were well tolerated. (...) All six patients completed the treatment and some were eager to continue therapy."

Hum Reprod. 2002 Mar;17(3):825-9.

"We examined metabolic parameters in cohorts of women with and without subcutaneous estrogen therapy with concomitant supra-normal concentrations of estradiol (SE)."

Apparently from 400-1,000 pg/ml.

CLIMACTERIC 2005;8(Suppl 1):3–63

"the estradiol levels were measured in these women to be extremely high (between 400 and
1000 pg/ml)149."

"Women with SE have similar triglyceride and HDL cholesterol levels but lower LDL cholesterol concentrations compared with post-menopausal women not taking ERT. The observations that the SE group showed reduced fasting insulin and WHR suggest that supra-normal circulating concentrations of estradiol, delivered subcutaneously, may beneficially influence insulin metabolism."

Also,

J Lipid Res. 2006 Feb;47(2):349-55.

"This prospective pilot study of 18 men with androgen-independent prostate cancer receiving ADT measured effects of TDE on lipid and inflammatory CVD risk factors before and after 8 weeks of TDE. During treatment, estradiol levels rose 17-fold; total cholesterol, LDL cholesterol, and apolipoprotein B levels decreased. HDL2 cholesterol increased, with no changes in triglyceride or VLDL cholesterol levels. Dense LDL cholesterol decreased and LDL buoyancy increased in association with a decrease in HL activity. Highly sensitive C-reactive protein levels and other inflammatory markers did not worsen. Compared with ADT, short-term TDE therapy of prostate cancer improves lipid levels without deterioration of CVD-associated inflammatory markers and may, on longer-term follow-up, improve CVD and mortality rates."

These men, as previously mentioned, had high levels of estradiol, in this study, mean levels of "460.7 pg/mL (range, 334.6-586.7 pg/mL)."

TDE = transdermal estradiol
ADT = androgen deprivation therapy

Reports also from transsexual women with levels in the thousands, as high 6-7k, with no negative impact on metabolic, cardiovascular markers, some in their 50's.

Two other studies of interest:

Am J Obstet Gynecol. 1993 Dec;169(6):1549-53.

"As serum estradiol levels increased throughout each phase (maximum mean estradiol 739.8 pg/ml)"

"Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event."

Br J Obstet Gynaecol. 1990 Oct;97(10):917-21.

"There is some anxiety about the possible harmful sequelae of supraphysiological estradiol levels but no data are currently available to show any deleterious effects of these levels on coagulation factors, blood pressure, glucose tolerance or the occurrences of endometrial or breast cancer (Hammond et al. 1974; Thom et id. 1978; Studd B Thom 1981; Armstrong 1988)."

Hence, if your concern is health, then the above suggests you shouldn't be too worried, especially considering you're under the supervision of a doctor (I am supervised by three, of whom two are specialists in the matter).

If you find your libido too low, it could be temporary as your body adjusts to the changes. My T is very low, 8 ng/dl, free T undetectable and I have libido, amazing orgasms and do ejaculate although post-op. The hair loss might be due to significant hormonal changes and only be temporary or to the stress that you go through when you go through any change, positive or negative, which is normal. 

Hope this info is helpful. Best of luck.

Quote from: Sophia Sage on October 29, 2016, 09:26:16 AM
Estradiol cypionate, on the other hand, takes longer to "cleave"

Longer to cleave or longer to separate from oil depot because of longer ester which is more lipohilic or both. I have never come across evidence suggesting EC takes longer to cleave relative to EV. The reason for milder peaks and valleys could simply be due to the ester being more lipophilic.

Thank you all for your replies. This is actually comforting information that this is not something I need to worry about just yet, just to monitor with each set of blood work. Thanks again <3

Mine were astronomical too. Doctor didn't seem too concerned. Just roll with it unless there's an issue.

Quote from: KayXo on October 29, 2016, 01:41:45 PM
I also take estradiol valerate and my levels range anywhere from 1,300 pg/ml to 4,000 pg/ml. I feel good, have had good overall feminization except for breast growth. I've had several blood tests done and every single time, everything comes back normal (liver enzymes, clotting times, lipids, insulin, C-reactive protein, etc.). I know other transwomen on such high levels whose test results came back normal.

Clearly YMMV, my initial dose resulted in 700pg/ml estrogen and reduced serum albumin and total protein levels just below the normal range and the research suggests this correlates with some elevated risk of vte. Since adjusting EV to get my measurements down to 200 or so, the protein levels are all back to normal ranges.

As far as I know, correlation does not imply causation. Did you have your clotting times measured? That would usually indicate if your risk of DVT/pulmonary embolism was increased.

Glad things are back to normal. As always, follow your doctor's orders.

First and foremost, when doing a blood test? injection every 2 weeks you do so if you did shortly after the injection is not no wonder that level. I'm doing such a test near the end of the 2 week period and I have a score of 428

Levels fluctuate quite a bit on injections (especially valerate) and studies indicate (high) levels of estradiol don't necessarily correlate with therapeutic efficacy nor health risks. Doctors each have their own opinion about this matter and accordingly, a protocol they like to follow.

We are assuming that the levels are measured in pg/ml. If a different measuring system is used, you number could be in the acceptable range. The units vary from country to country and the standard for the United States is pg/ml.