So, I have been on MTF HRT for 2 months and 12 days now.  Just had my first blood work done the other day since starting. 

Before HRT
Testosterone 836 ng/dl
Estradiol         43 pg/ml

Now
Testosterone 437  ng/dl
Estradiol       727  pg/ml

  I have yet to meet with the endocrinologist again yet since I just barely got the results back right before the weekend.  I am quite happy with the Estradiol level, but feel like my testosterone may still be a little high, and feel that may have something to do with her prescribing me such a low dose of spironalactone. I questioned the prescribed dosage since it seems to be lower than the standard.  But was told that it was well within the norm.  But maybe these numbers will help convince them.  ha ha. 

  Since being on HRT, I have noticed a few small changes.  For one, I've said in previous posts that taking it gives me this amazing euphoric feeling that I was not expecting.  I have noticed my arm hair seems to be a lot thinner.  When I look at pictures of myself from last year, I can already tell that I looked a little different in the face.  My breasts are definitely growing a little bit, and my nipples are constantly kind of tingling lately and they have always been very sensitive, but they are so much more sensitive now.  I still get random uncomfortable erections now and then, and still have no problem having sex with my wife. 

  Any ideas what my testosterone level should be at this point?  I'm mostly just trusting the process, but feel like it's my body, and if I know something should be changed about my dosages to put me closer to where I should be on my levels, then I'm not afraid to tell the endocrinologist that I would feel better about taking more Spiro.  But I don't know.

  Oh, and today I start my very first laser hair removal treatments on my face.  So exciting!!!  I am so tired of my facial hair causing me so much dysphoria and sadness.  Not to mention the incredible hassle of having to shave it all the time.

My testosterone continued to drop for nine months on my initial dosage of spiro.  After that the Dr doubled the dose  and it dropped the rest of the way right to zero.  Right now I'm reducing the dosage to find the right place to keep the T low and to minimize side effects.

My initial T level was about the same as yours.  After 60 days it was below 200.  Maybe you can use that as a data point at your next appointment.

The little boys are resilient, it may take a while to come all the way down.
Your doctor will probably adjust your dosages too. The initial amounts are just educated guesses because everyone is affected differently.

Well, after looking at my lab results, my endocrinologist office called, and sure enough, they are lowering my dose of estradiol, and doubling my spiro.  Not too happy with the decrease in estradiol, but glad they did double the spiro dosage.

Okay....here are few thoughts I am having........The endocrinologist office said that all of my other blood work looks great with the exception of how high my estradiol level is........So there apparently are not any negative health affects manifesting themselves yet......  And she even said over the phone "Well, all of your other levels are just fine, but for safety reasons, we are going to decrease your estradiol dosage."   

  So here's my thought........They do not know that I have been taking it sublingually.  I think they are assuming that I am swallowing the pills, and that my poor liver is having to deal with all of that.  But it's not.  I am saving my liver by taking the estradiol pills under my tongue.  So is it possible, that they are looking at the level, and assuming my liver is having to deal with all of that, and therefore are thinking that lowering my estradiol dosage is a good thing to protect my liver?  Or do they have other reasons?  I am just not at all happy about having to cut that dosage in half.  That means taking only one happy little blue pill per day, and not only is that just going to feel wrong, but it also makes me feel so good to take it, and I love how I feel while taking it.

  I have a trans friend who has done a lot of research into HRT, and she claims that spironalactone is not even necesarry.  That high dosages of estrogen does the same thing for you as taking the spiro.  So I'm wondering what the science is behind that, and if I should be more assertive in trying to keep my estradiol dosage the same.  Should I explain that I am taking it sublingually or would that even make any difference at all do you think?  The whole process is slow enough as it is, I don't want to be wasting months where changes are not occurring sufficiently simply due to incorrect dosages.  I realize it's not a perfect science, and they have to sort it out over time.  But it just sucks to feel down like taking so much less estradiol is hindering my progress.  ha ha

That estradiol level is way higher than most Dr's will allow.  Mine wants it at less than half that.

When you took the meds in relation to your blood test is going to make a huge difference in the result, especially if you take it sublingually.  Very soon after you take the pill the level spikes very high and then begins to fall off.

When I get my blood tested I always do it 12 to 16 hours after my last dose to prevent a false high reading.  On my test last month this resulted in a reading of 137 pg/ml.  With that I was able to convince the Dr to raise my dose even after telling her that the test was 16 hours after my previous dose.


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Quote from: Deborah on September 25, 2017, 06:20:35 PM
That estradiol level is way higher than most Dr's will allow.  Mine wants it at less than half that.

When you took the meds in relation to your blood test is going to make a huge difference in the result, especially if you take it sublingually.  Very soon after you take the pill the level spikes very high and then begins to fall off.

When I get my blood tested I always do it 12 to 16 hours after my last dose to prevent a false high reading.  On my test last month this resulted in a reading of 137 pg/ml.  With that I was able to convince the Dr to raise my dose even after telling her that the test was 16 hours after my previous dose.


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Mine was close to that too.  It was 7 hours after dose, and 185 pg/ml.  I switched to pellets and will have my first lab results from that in a few weeks.  The Dr I have said she wanted to be in the 200-400 zone.  I am pretty sure it's higher than what the pills were as my lips are pink, and I love it:)

Your doctor will make adjustments.  That's their job, and no one is happier when your levels fall in line.

Personally, I started with spiro, then estrogen.  These days I take a lower dose of spironolactone.  It's got some obnoxious side effects, and as others said, estrogen itself will take your testosterone level down in the long haul.

Estradiol levels were high because you drew blood soon after taking tablets sublingually, you should have explained this to your doctor. Had you tested just before your next dose, the levels would have been far lower and probably in the "safe" range although studies (of which few doctors, if any, are aware) have quite consistently shown higher levels to be quite safe, even in the thousands (I had levels as high as 4,000 pg/ml for several years, pregnant women have levels as high as 75,000 pg/ml).

Your still high T levels attest to the fact that your estradiol levels aren't consistently high as if they had been, your T levels would have been in the female range, or even below. Your doctor should have caught that and realized something was off and that your E levels were probably only temporarily high.

Spiro blocks T and many doctors don't realize to what extent that is important so that even if T levels are still high, spiro blocks some of it and blood tests are unable to measure how much is blocked. Men on high doses of Spiro had no change in T levels but clear feminizing effects so that spiro's anti-androgenic effects were clearly due to the blocking of T. On Spiro, it makes no sense to measure T. On top of that, total T is an unreliable measure because much of it is bound to SHBG, which is significantly increased on estrogen so that free or bio-available T would have given a better idea of how much T is really able to bind to receptors but even then, spiro blocks some of it. See why T measurements in this context is of no use?

It's unfortunate all these variables were ignored.

Quote from: KayXo on September 28, 2017, 09:43:06 AM
Estradiol levels were high because you drew blood soon after taking tablets sublingually, you should have explained this to your doctor. Had you tested just before your next dose, the levels would have been far lower and probably in the "safe" range..............

It's unfortunate all these variables were ignored.

Thanks for the reply!  Yes I was afraid that maybe I should have held off on taking my dose that morning until after the blood work was done.  I really should have.  I didn't think it would have time to even really get into my system though that fast.  But apparently it did.  And yes, you are very right.  They should look at the overall picture, and not just the high E levels.  I am going to send an email to my endo and explain that I had just taken that dose sublingually and that that's most likely why the level was so high.  One of my biggest fears, is losing time.  Since the effects of HRT are so slow to develop as it is, I hate the thought of going a long time on too low of a dose just because of a false high reading and that resulting in me being put on a much lower dose.

You could ask the Dr. to retest estradiol right now.  Even if you have to pay for it yourself it shouldn't be much all by itself.


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Quote from: Deborah on September 28, 2017, 12:35:38 PM
You could ask the Dr. to retest estradiol right now.  Even if you have to pay for it yourself it shouldn't be much all by itself.

Yeah, that's a good idea.  There's no reason I have to wait til the next scheduled time to have it tested.  Although, even though I do recognize that my Estadiol level may have spiked because I had just taken that dose, I doubt it would spike by a tremendous amount.  So if your doctor wants you at half the level I was at, then hopefully I would still be good and somewhere around the 400 range or so and that should be a perfectly good level for me to be at.  My wife gets irritated that I fuss about it as much as I do.  Ha ha.  But I just feel like doctors are doing their job, but what if it was my fault for doing something or not saying something I should have, and then they prescribe me something based on a missunderstanding or something.  So that's the mental struggle I go through. ha ha.

Quote from: LaRell on September 28, 2017, 02:20:12 PMeven though I do recognize that my Estadiol level may have spiked because I had just taken that dose, I doubt it would spike by a tremendous amount.

When taken sublingually, the levels do spike up by a tremendous amount, up to ten times the levels seen if the same dose is taken orally. They also rapidly drop, by a tremendous amount.

A level drawn during the surge after dosing isn't wrong, it just isn't representative of your average level.

Over the last 2 1/2 years, I have gotten my levels drawn at a variety of times during my weekly cycle (I inject).  As a consequence I know my peak levels (a day or so post injection), my trough level (just before injection) and a few midpoints.  As my testosterone levels are consistently below the female reference range, I've stopped getting them checked--maybe I'll do one in another year or so.

I got a reply email from my endocrinologist after I explained that I had just taken my Estradiol that morning, and that I took it sublingually..   So she thanked me for the clarification, and decided to keep me on the same higher dose of Estradiol as well as doubling my Sprionolactone.  So that makes me very happy.  I just feel so good taking it, and I didn't want to decrease the dosage if it wasn't necesarry because of a high reading right after taking it that way.  She wants me to have my levels checked again in 6 weeks, so I will be careful of when I take it in relation to having my blood drawn this time, and we will hopefully get a better idea of what my levels really are on average.

Great news!

Yaaaay!  I'm glad the information here was useful in getting that straightened out.


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