Quote from: ainsley on February 15, 2017, 02:02:25 PM
Are you saying that attaining and maintaining a pregnancy level is acceptable or that doing so is ideal?
Perhaps ideal in some, not necessary in others. This is up to the doctor to decide. If the person requires higher levels to feel good and have decent results (i.e. breast growth, face feminization, fat redistribution), then studies suggest these higher levels are quite safe. My own experience and lab results as well as those of a few other girls I've come across confirm this.
It's also important to note that on injections, especially when it comes to estradiol valerate, levels fluctuate widely so that one might be exposed to higher levels one day and substantially lower levels several days later. My levels dropped from 2,500 pg/ml to 1,300 pg/ml in only 2 days!
Interestingly enough, in my case, breast growth is better on oral estradiol despite substantially lower levels of estradiol in my blood (although estrone levels are probably way high). This goes to show you that higher may not always necessarily translate to better.
QuoteI've not had a problem with my levels, but I think my Dr. is concerned about sustaining these levels for the rest of my life. I guess the question is how high and for how long should the level be? I take a baby aspirin and run 5k at least 4 times a week.
Why is she concerned? Do studies suggest high levels for a long time have negative repercussions? Many ciswomen experience pregnancy several times, with levels of estradiol several times (up to 75 times) higher than those we get on injections. It used to be (and still is, in some countries) that ciswomen had several children during a lifetime, sometimes up to 10-12 children and if that were unsafe, so many women wouldn't have lived to bear so many children. Remember that this occurred at a time when care and hygiene were also less ideal than today. Studies have even shown an inverse association between number of children and risk of breast cancer. Studies also suggest that estrogen in ciswomen has a cardioprotective effect and the data as it relates to bio-identical hormones (estrogen and progesterone) seems to also move in that direction. Women have far less cardiac problems than men before menopause, when estrogen levels remain somewhat high. After menopause, this trend is slowly abolished.
Indeed, we don't know the long-term effects of high levels in transwomen but based on all the information we have at the moment and which I shared with you, it would seem that the risks are low rather than high. The problem is doctors will often refer themselves to studies where non bio-identical estrogens were used in high doses and think the same risks observed with those hormones apply to bio-identical hormones when the scientific literature has clearly shown this not to be the case. Or doctors will rely on recommendations and assume that because these recommandations were established by "experts", exceeding those levels recommended is risky when there is no evidence-based data to justify this. On the contrary, as I have shown you. I just think if more research had been done and more interest had been shown for our population that perhaps, the scientific community could have come to the same conclusion I have and shared my opinion. But, because our population is so small and so little time/effort has been invested, that knowledge is evolving very slowly, too slowly, in my opinion. I'm seriously considering going back to medical school for this reason alone.
QuoteIs there a period after GRS and HRT that someone over 40 should maintain a lower level of estradiol? The changes to our bodies from the effects of the estradiol are what we want, but do they take 5 years, 10 years, or 20 years in some people? My point was that it was my understanding that estradiol makes significant changes in the first several years, but then it is continued in a maintenance mode level after those changes, which would not be at 1000+ pg/mL, right? I am not medical professional, either. But I tend to advocate heavily for myself in my doctor's office. 
I guess if after several years (10-15 years) where all options have been tried and maximum development has been reached, one could lower levels as long as what was gained and well-being aren't compromised. Why not? Lowest effective dose, I'm all for that! Makes good sense.
QuoteI did plan to speak with her about raising my prometrium dose. I have peeling and brittle nails and am under the understanding that high estrogen can cause that, and increasing progesterone can counter that. Any input on that?
My understanding of the matter is that estrogen reduces sebum production (either directly and/or indirectly through lowering testosterone by stimulating SHBG and reducing gonads production pre-op) and that testosterone has the opposite effect so it should be no surprise that as T goes down and E goes up, we find ourselves having drier skin and increasingly brittle nails (oil produced by skin strengthens nails). As far as progesterone goes, to be fair, the results of several studies are mixed BUT myself and other transwomen have noticed an improvement when progesterone was added. Skin and hair became less dry, even very soft and shiny while nails became stronger. The only way to find out for oneself is to try. One can also add a small amount of testosterone post-op to help with this and other issues like energy levels, mood, libido, skin elasticity and thickness. Every individual is different so the regimen, I believe, must be tailored to them and determined by a doctor who sees us as individuals, not numbers and who is open-minded, interested in the matter and willing to listen and learn.
My 2 cents as a non professional.
As always, follow your doctor's lead.
