Puzzling results. I am five months in.

ESTRADIOL            [H]  1937 pg/mL

TESTOSTERONE  17 ng/dL

I am particularly puzzled by the Estradiol. I don't have any symptoms, good or bad from it. No breast pain, no nodular behind the nipples, no mood swings, and my face is still the same old ugly man-mug. She says the Estradiol is way too high and wants to cut my does by more than half. All this is disheartening. I wonder if HRT is going to do me any good.

I have a thought by I hesitate to bring it up at this point because of the short amount of time you have been on estradiol and the extremely high levels you have. Wait a little while after you are at more typical transition levels and if you aren't seeing progress, remind me of this thread.

One idea I have that I will discuss at this time is I suspect estradiol may be self limiting at very high levels acting as a self blocker. I have seen others on the site with high estradiol levels and a failure to develop. This is only an idea I am kicking around in my head and I don't have any real proof of this so lets see what you do on a reduced dosage.

  Hi GrayKat,

  How long after taking the last dose of estradiol was the blood draw done?  That could be a factor. You might discuss this with your doctor.

My estradiol was 158 on my previous labs and this time around 3 months later and a doubling of my dosage it dropped to less than half to 73. My lab draw was about 9:30 in the morning and my last dose was the night before about 8pm. I have not talked to my doctor about it yet.

hugs,
   Laurie

GrayKat is on injectables which makes the levels somewhat puzzling. There are a few ideas I have about that as well but I want to know about the likely causes before I go diving in the the highly unlikely possibilities.

Quote from: Dena on August 21, 2017, 01:00:09 AM
GrayKat is on injectables which makes the levels somewhat puzzling. There are a few ideas I have about that as well but I want to know about the likely causes before I go diving in the the highly unlikely possibilities.

  Ah okay that would negate my idea wouldn't it?

Thanks Dena

Hugs,
   Laurie

On injectables, my levels came back at anywhere from 1,000-4,000 pg/ml, this is perfectly normal and to be expected. How high or low the level comes back at depends on when you go in for testing, the day before the next injection, the day after, 3-4 days after, etc. On day 3, my levels were in excess of 2,000 pg/ml, on day 5, in the low 1,000's.

It is intriguing to me that while the recommendations for transsexual women include high doses of injectable estrogen, high levels which should be expected on such high doses create such a response where doses are reduced immediately. Especially considering that overall, as stated below, the evidence in favor of high estradiol levels causing major health complications is lacking while the opposite seems, in general, true as regards to bio-identical estradiol.

It also seems strange to me that in the first decades of treatment of transsexual women, very high doses of sometimes relatively harmful estrogens were prescribed to our population with no sign of being overly worried because the evidence was lacking and now with significantly safer forms of estrogens and some evidence suggesting they may indeed be relatively safe, even in higher doses, such prudence and caution is exercised.

I personally fared worst (i.e. breast growth) on injectables with very high levels of E2, the why of that remains a mystery.  Lower levels with oral estradiol or gel produced better results as far as breast growth goes.

Yet, in studies where higher doses relative to mine were given to ciswomen by injections, authors noted impressive results in terms of secondary sexual development, including breast growth. Some transwomen also do quite well on injections and higher levels relative to other forms.

As far as health risks, my own test results in the course of three years on high dose E injections and those found in studies using high doses of bio-identical estrogen parenterally (injections, pellets, patches) in cismen, ciswomen and transwomen would suggest that they are minimal to none. Doctors are usually unaware of these studies. 

Also, pregnant women have levels in excess of 1,000 pg/ml (as high as 75,000 pg/ml) for up to 9-10 months. Despite this, the female (and human) population is not dwindling and the risk of DVT in this population is a mere 0.1%.

Putting things in perspective, looking at other studies where high doses of oral bio-identical estradiol were taken by ciswomen, and also taking into account the minimal impact estradiol has on hepatic markers due to its molecular structure and quick metabolization (and other favorable effects it may have on coagulation, as was found in certain studies), the current generalized approach to high levels of estradiol in transwomen merits a re-assessment, I think.

I took my last injection on a Thursday and was tested the following Wednesday. She says my numbers should be around 450 tops. My T level has dropped from my last blood test. It was 35 last time, 17 this time around. She tells me the T level is actually more important in getting results. She treats other trans people, so I know she has experience.

My lack of progress may just be me and my inpatients. HTR changes are like watching grass grow. It's ironic that dysphoria gets worse as transition progresses since we watch more closely for changes. You Tubbers often say they don't see changes, but to an outside observer watching the progression is more evident. So perhaps its the same with me. I don't do videos. I want to keep private. But privacy also means less feedback.

Quote from: GrayKat on August 22, 2017, 12:54:15 AMShe says my numbers should be around 450 tops.

Because she probably, I suspect, believes higher than this increases health risks while some studies show this not to be the case, with levels as high as 3,000-3,500 pg/ml in women aged 45-55 yrs old, given estradiol valerate in the form of injections for up to 6-9 months, not being associated with an increase in health risks. Other studies, for instance, in women aged 29-58 yrs old showed that levels of estradiol, as high as 800 pg/ml, with estradiol implants, for up to 12 years, did not result in any negative side-effects. Finally, transdermal estradiol in men with advanced prostate cancer, aged 49-91 yrs old, resulting in levels of up to 1,000 pg/ml, for up to 12 months, was not associated with any thromboembolic complications.

In a couple of studies, high levels of estradiol, in excess of 1,000-2,000 pg/ml, during ovarian hyperstimulation, did not result in thrombin formation, thus the risk of clots did not appear to increase.

The experts even admit that "The precise concentration of oestradiol that results in adequate feminisation with the lowest risk of complications is not known." (Lancet Diabetes Endocrinol. 2017 Apr;5(4):291-300.). If they knew of those studies, however, they might begin getting a better picture of those risks. Oh well...

QuoteMy T level has dropped from my last blood test. It was 35 last time, 17 this time around. She tells me the T level is actually more important in getting results. She treats other trans people, so I know she has experience.

And yet there is a study in transsexual women showing that regardless of testosterone levels, feminization in transsexual women was equally effective in all groups. I can share that study with you, if you want.