So my endo didn't order any test before starting HRT. I had 3 months on low dose Estradiol oral, Spiro, and Finasteride.
The next 2 months at 4x the estradiol and added medroxyprogesterone. Here's my blood test results.

Testosterone 31 ng/dL
Estadiol         55 pg/mL
progesterone  <0.5ng/mL

Now I know hormone levels fluxuate but my blood draw was about 4 hours after my morning estradiol (cheeked) and spiro pills. Seems like my Estradiol target should be higher shouldn't it?

The testosterone levels look right where they should be however the estradiol for low dose would be good. If you desire a transition dosage, 4 hours after taking you pill I would expect it to be higher. It's possible your estrone levels are sufficiently high that it will convert to estradiol as you consume estradiol. If so, that might be the level your body attempts to maintain when excessive estradiol isn't available. If you have a total estrogen number and if that's much higher than your estradiol number, then you have estrone to convert back to estradiol.

Estrone converts weakly to estradiol so don't expect much from estrone. Levels will spike rapidly with sublingual, perhaps not as rapidly with buccal but due to fluctuations of level in time, levels can be misleading. Instead focus on physical results (i.e. feminization, breast growth) and how you feel, these will let you know if you are on the right dose for YOU.

I wouldn't advise medroxyprogesterone acetate as it has been associated with breast cancer, vascular/clotting problems, can trigger depression in some, even up to suicidal tendencies and is mildly androgenic (triggers androgen receptors). Several studies, like SEVERAL, have shown how harmful it can potentially be to the human body. It also won't increase progesterone levels as it does not metabolize to progesterone, the hormone produced naturally in our bodies.

I'm not a doctor. I am basing myself on studies alone. You could perhaps ask the doctor to switch you to a safer progestogen such as progesterone (Prometrium).

Thanks both of you.

Kay, my doctor would give me bioidenticle progesterone if I ask him to. I took his suggestion of the MPA because it was cheap. $6 month. If I have him switch me (about 2 weeks left before I need to get new script) I'll have to do some careful shopping around. The bioidenticle I've seen from $70 to over $100 for a months supply. Also I haven't tried that with my insurance yet.

The other issue is I hurt my back now at work the second time in a year so I don't know if I will ever go back. Everything's up in the air right now. I want to get another laser treatment for my face but the dr charges $300 for that and I don't know if I should spend it or not right now.

So far MPA seems to have evened out my moods. The only negative is I'm always so hungry. I gained 10 lbs in 2 months on it.

I think I will ask him for the bioidenticle P. My long term health should be the most important anyway.

Or if you don't have the money for it, better no MPA than some, IMO. You can definitely do without. I'm saddened though to see that doctors still prescribe this drug when the risks have been clearly noted in studies. I guess money over health, right? 

I agree on the medroxyprogesterone vs micronized progesterone.  Micronized is the way to go

Dont worry too much about levels.  Mine go up and down depending when my appointment is and depending when I last dissolved an E tab sublingually.  My levels of estradiol have never been super high ( but are in the female range) and my total estrogen is usually higher (meaning there is estrone to convert to estradiol in my body).  Also, look at your changes.  Are they what you want?  Are you feminizing?  Are you happy with them?  Effects and changes are better indicators than levels.