Hi,

I had labwork done on 9/19, and the result of the estradiol test was 910 pg/ml. That figure  seems very high to me as it is way outside of the normal range. I emailed my endocrinologist on 9/22 to inquire about what we should do, if anything, about the high estradiol level. I'm eagerly waiting to hear back from her. I'm a post op transwoman and take the standard estradiol dosage that is appropriate for me being post op. I've been feeling very depressed and sad (more so than usual lol) the last few weeks because of personal problems. I suspect that my high estrogen level amplifies the severity of my depression and sadness.

That is much higher than normal however the question comes up, are you using pills and if so, how long was it between your last dose and your blood test. Estrogen only has about a 3 hour half life in the body so taking a blood test shortly after a dosage will result in high numbers. In my case, I am 24 hours after my dose with numbers in the 40s.

Hi,

I self inject. I had injected 48 to 24 hrs prior to having the estradiol test.

Then that number might be reasonable as you were near your peak level. A test midway and at the end of your cycle would fill in the gaps and I suspect an end test would be far lower. If you are one a one week cycle the swing would be less than if you are on a two week cycle. Often people on a two week cycle under the doctors direction will half the dosage but inject once a week to reduce the peak and valley levels.

Honestly there might be more going on than you realize, I had a similar problem.   I tend to titrate my amounts of depoestradiol based on subjective sensations (Generally the higher my estrogen, the hornier i am... sounds screwy but I've noticed it before).

That being said I also found my body was producing some as well, so that might be something to look into.   (Off HRT my base estrogen levels is around 50--perimenopausal levels).

If you can 'tell' when you think its getting too much, maybe that's a work around solution.  Just remember post op you need generally the same amounts a woman with a total hysterectomy needs.

Quote from: mistyjensen on October 05, 2017, 07:35:15 PM
Hi,

I self inject. I had injected 48 to 24 hrs prior to having the estradiol test.

Having 910 pg/mL within 24 to 48 of injection is pretty reasonable. My HRT doctor says that is perfectly OK (mine hit higher at 980 pg/mL.) There isn't any real danger, cis women can go as high as 7000 pg/mL during pregnancy. My doctor says she is only concerned if it's going consistently over 1800 pg/mL.

As I read your original post, the real problem you are asking is " does my levels of Estradiol contribute to my depression caused by personal issues?" Am I correct?

In my opinion, Yes, Estradiol does make us somewhat more emotional than without HRT. Anyone's emotional response can go both ways, up or down. Since you mentioned personal issues, I would first work to resolve those issues. Then, if you are still really concerned about reducing your blood levels of Estradiol, then a simple dose adjustment as directed by your Endocrinologist would be in order.

I too, am post-op and there are challenges for us as well as being pre-op. Although most of those challenges are somewhat different than before.

Quote from: Sydney_NYC on October 05, 2017, 10:37:04 PMcis women can go as high as 7000 pg/mL during pregnancy.

As high as 75,000 pg/ml. http://cebp.aacrjournals.org/content/12/5/452.long
Other sources show levels, on average, near the end of pregnancy, to be around 24,000 pg/ml.

QuoteMy doctor says she is only concerned if it's going consistently over 1800 pg/mL.

Mine were consistently over 1,000 pg/ml for about three years, with levels up to 4,000 pg/ml on day 3 after my injection. All three doctors supervising me did not seem concerned and my blood tests showed no anomalies. Studies in ciswomen (as old as 78 yrs old), although short-term, also showed that levels consistently above 1,000-2,000 pg/ml had few side-effects. Pregnant women have levels in the thousands, up to 75,000 for up to 9-10 months, the risk of DVT is 0.1%, of pulmonary embolism 0.01%.

The only thing I can come up with is that perhaps the high amount of estradiol in your blood is having too much an anti-androgenic impact by raising SHBG and reducing adrenal precursors. Androgens are energizing, up-lifting hormones, perhaps more so than estrogen.

The latest guidelines advocate for levels equivalent to your "gender peers" and as none of us are getting pregnant and do not have the same metabolism as a cis woman then I wonder how this can be an accurate way of Treating Trans women. My latest Dr has made it quite clear she will be aiming at levels around 300 for me...because apparently 53 year old menopausal women are the ideal equivalency for Trans women of the same age...I don't get it...but these are the latest Guidelines which actually indicate levels <200

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-01658

Quote from: ElizabethK on October 06, 2017, 03:51:12 PM
The latest guidelines advocate for levels equivalent to your "gender peers" and as none of us are getting pregnant and do not have the same metabolism as a cis woman then I wonder how this can be an accurate way of Treating Trans women. My latest Dr has made it quite clear she will be aiming at levels around 300 for me...because apparently 53 year old menopausal women are the ideal equivalency for Trans women of the same age...I don't get it...but these are the latest Guidelines which actually indicate levels <200

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-01658

Oh great, once again the Guidelines are going to be useless for me (and many others) due to old ideas and old data. Suggested long term use of anti-androgens is a sign of that.

I don't understand the love affair some people and doctors seems to have for levels. Levels are meaningless without results. What good is aiming for a particular level if the patient has little to no result? Does it not make sense to increase levels until results occur? In any other area of medicine, that's what happens.. But no, in trans health care we are ruled by the magic numbers - magic in that they were created by magic, there's little real science behind them.

If the goal is to truly mimic ciswomen, then why not aim for estradiol levels typical of those seen at the beginning at thelarche, when girls begin to develop breasts and other female traits (secondary sexual characteristics)? Obviously, we know that if we did that, at those VERY very low levels of estradiol, we would barely notice anything and just this alone should signal to us that transsexual women are DIFFERENT and that we cannot use ciswomen as a reference for hormone levels.

The reason for the different responses in us and in them to pubertal levels of estrogens might be because girls at that age differ from us in terms of growth hormone levels, expression and activity of estrogen receptors, telomere length or quantity of stem cells, size/weight, prior exposition to hormones (very little androgens, thus no male skeleton or male secondary sexual characteristics), including the hormonal milieu in-utero, influencing their sensitivity to sex hormones at a later date, which some studies suggest this is very possible.

In the end, we just don't know what is right for transsexual women and rather than start with ciswomen, I think it would be more logical to start from scratch (i.e. tabula rasa) with every single transwoman. Then, through trial and error, we can find what works best for each and everyone of us, not by measuring estradiol levels but by instead measuring our well-being and overall feminization and let those determine what is the most effective DOSE for us. Some may end up only responding at much higher levels while some do quite well at much lower levels. Every individual is DIFFERENT.

However, IF there is one thing to be learned from ciswomen, it is that starting at the lowest effective dose may be best.

Quote from: mistyjensen on October 05, 2017, 07:35:15 PM
Hi,

I self inject. I had injected 48 to 24 hrs prior to having the estradiol test.

Is that the timeframe before testing that you usually use? I'm guessing the first thing will be a retest to confirm the results.  Good luck!

Hugs, Devlyn

To the OP: hope you get that sorted out soon.  The levels and depression etc.

Makes me wonder. I am going to be having the surgery soon enough.  I am wondering what to expect.  Like would I stop spiro immediately the day after the surgery?   Would I imemdiately cut my estradiol level down to 33% or so of what I am taking now?  I take typical doses of spiro and my free testosterone is in the normal female range.. 3.6 last I checked.

After the surgery, is my estradiol level going to skyrocket even with say 10% of the estradiol dose I am taking now?

Quote from: JennJenn on October 06, 2017, 06:26:08 PM
After the surgery, is my estradiol level going to skyrocket even with say 10% of the estradiol dose I am taking now?

I don't think so.

Ladies, if you have a doctor who really believes in blood levels of 200 pg/ml or about that range, then have your blood drawn just immediately before your next scheduled dose. All routes of all medications have peaks and valleys in their blood level cycles. Get your blood drawn when the amount of Estradiol is at the valley (lowest point) of the drug cycles.