I know Estradiol levels vary wildly from person to person and even individual's levels vary wildly over time but what I'm trying to figure out is the correlation between levels and changes in dosing.
I'm particularly concerned with oral adimistration.

If your Estradiol level is X pg/ml and you double your E dosage does than mean your levels should go to 2X?

Conversely if you double your T blocker does your Testosterone levels go from X ng/dl to 1/2 X ng/dl?

I saw my Endo last Wed and she increased my E dosage by 50% and doubled my T-blocker. I had my blood drawn while there and the results came back after I left. My E is 24 pg/ml and my T is 427 ng/dl. Which is pretty dismal considering I was on a pretty average dose of standard HRT meds.

Should I bother my Endocrinologist with my concerns? Or do the levels scale nonlinearly with dosage?

Absolutely voice your concerns. But you know the answer. There are too many variables to consider. That's why it's prescribed and tweaked according to results.

Try to spend less time thinking about HRT and more time enjoying it. 

Hugs, Devlyn

Hi Polly,

  I am no authority on HRT but I believe that the dosage matter but what is more important is the level it builds up over time in your blood stream. It takes time to lower your Testosterone and raise Estradiol levels. I've been on HRT for over a year and just have my level tested. I did not take my morning E and AA meds until after the test so the level would better reflect the base levels since it was about 12 hours after my last dose. My T was <.1 ng/dL and E was 193.6 pg/mL months ago they were T .7 and E 74 if I remember right. I am pretty happy with where my levels are now and with the results I have been seeing which is the important part.

Your doctor should be willing to talk to you about what they want to see for your levels.

Hugs,
   Laurie

From what I understand there is a relationship between the blocker and the estridiol.  If you don't have enough blockers you body will take the estrogen and convert it into testosterone. 

so for example say you have some dosage x of estridiol and y of a blocker. you get the blood work back and it shows that your T is a bit higher than desirable, and your E is a bit low (but close to female range). if you up the estridiol you will see an increase in T but no increase in E because of what I said earlier. but if you increase the blocker and leave estridiol alone E will go up (since its no longer being converted) and T will go down. An experienced Doctor will be able to hone in on optimum levels and may adjust both at the same time (mine did, I thought she was crazy but she got me spot on).

Again no expert but with those levels, especially if T was up from pre hrt blockers look like the right call. remember each levels are just one point on the graph, and you have to find the curve that fits your body in order to figure out dosage. I'm pretty sure each person is different when it comes to how their body reacts.  I suspect that the relationships aren't linear but rather exponential.

My best advice is be patient, trust your doctor and if you don't find a new one If you alter your dosages the levels will reflect that and your doctor won't get the information they need to adjust how much of what you need.

<3 Jess

There doesn't seem to be a one to one difference between dosage and levels. Doubling your estradiol dosage tends to result in less of an increase in your levels. I suspect it has something to do with the short half life estradiol has in the body. On the other hand, blocker seem to have a threshold and once exceed, your T levels are under control. In addition, after your levels have been suppressed for a while you can back off on the blocker and maintain low T levels. Doctors who work with this a lot should know how to control the dosage for maximum effect but it may take several adjustments to find what works for you.

Quote from: esphoria on February 19, 2018, 02:51:37 PM
From what I understand there is a relationship between the blocker and the estridiol.  If you don't have enough blockers you body will take the estrogen and convert it into testosterone. 

T can convert to E, but it doesn't work the other way.

I have measurements data on this as I've been dosed at 3 different levels since starting HRT just over 2 years ago. Changes in dosage resulted in very linear changes in levels.

Caveat lector:
this data is just from me, ymmv;
I haven't needed any blockers, for my body very small doses of estradiol completely suppress T
I'm prescribed estradiol valerate for intramuscular injection
This site doesn't permit discussion of dosage levels.

Here are my unitless dosage and levels. My endo started at dose X, and we reduced it by half twice to arrive at a number she was comfortable with.

Time frame     dose (no units)     level
Jan-apr '16            X                       702
May-aug '16         ½X                     353
Sep'16-aug'17     ~0.32*X.            210-260

The last row in my data below reflects that my my injection dose is small enough to be difficult to administer accurately and i choose to err on the high side. The prescribed amount would be ¼X, 0.32 is my best estimate of what I average.

There was no material change in E or T between pre and post op, my best estimate for my pre hrt T level would be low-400s based on my only test prior having been done 18 years before I started hrt, so low end of normal male (5th percentile).

Hope that's useful, I was quite surprised how well dose correlated to observations. Pm if you'd like dosage.

Quote from: Laurie on February 19, 2018, 12:41:21 PMMy T was <.1 ng/dL (...) they were T .7

Is this Total Testosterone? Are you sure the units are right because typical range in females is 6-120 ng/dl, 0.1-0.7 ng/dl seems unusually low.

Quote from: esphoria on February 19, 2018, 02:51:37 PMyou body will take the estrogen and convert it into testosterone.

That is incorrect. The body never converts estrogen back to testosterone. In fact, when my estradiol levels were very high at 1,000-4,000 pg/ml, my T was the lowest it had ever been. Estrogen is prescribed in HIGH doses to men with advanced prostate cancer, if it did convert to testosterone, it would never be prescribed to this population as the goal is to suppress T as much as possible and their survival depends on this!

Testosterone can convert to estradiol, by the aromatase enzyme but there is no enzyme in the body to convert the estradiol back to testosterone. Please refer to chemistry/endocrinology books. That would be indeed be very problematic for us!!!

Quoteif you up the estridiol you will see an increase in T

Just to repeat: I had high levels of estradiol, 1000-4000 pg/ml. T was 3-9 ng/dl.

Quote

Quote from: Laurie on February 19, 2018, 12:41:21 PMMy T was <.1 ng/dL (...) they were T .7

Is this Total Testosterone? Are you sure the units are right because typical range in females is 6-120 ng/dl, 0.1-0.7 ng/dl seems unusually low.

There was a mistake in the units it was ng/mL not ng/dl. Sorry, Kay. Yes it is a bit low no matter how you look at it.

Test Name:    TESTOSTERONE, TOTAL
Result:    <0.1 Low
Units:    ng/mL
Reference Range:    2.8-8
Lab Test:    Testosterone

Interpretation:    ----------------------------------------- Note that for women the reference range is: 0.1-0.8 ng/mL

Quote from: Laurie on February 20, 2018, 01:27:17 AMThere was a mistake in the units it was ng/mL not ng/dl. Sorry, Kay. Yes it is a bit low no matter how you look at it.

Test Name:    TESTOSTERONE, TOTAL
Result:    <0.1 Low
Units:    ng/mL
Reference Range:    2.8-8
Lab Test:    Testosterone

Interpretation:    ----------------------------------------- Note that for women the reference range is: 0.1-0.8 ng/mL

Makes much more sense. So that originally, your total testosterone was 70 ng/dl, well within female range which, according to your lab is 10-80 ng/dl and latest results were below 10 ng/dl.

The reference range 2.8-8 ng/ml is for men and translates to 280-800 ng/dl.

All good. To convert ng/ml to ng/dl, multiply by 100.

If the medical texts are too complicated, this simple graphic explains how steroids convert within the body:

https://www.ceri.com/steroid.gif

If you observe your T increasing it's by some other process than conversion of E to T.  That just can't happen.

Quote from: KayXo on February 19, 2018, 04:37:25 PM
Testosterone can convert to estradiol, by the aromatase enzyme but there is no enzyme in the body to convert the estradiol back to testosterone. Please refer to chemistry/endocrinology books. That would be indeed be very problematic for us!!!

Randi,

Thank you for posting that diagram.

I'm on a low dose Estradiol patch within the range they prescribe to cis women to help with osteoporosis. This low dose patch, replaced every three days, is enough to keep my T levels down at 17 ng/dl for my Total testosterone and 0,100 ng/dl for my free testosterone. My Estradiol is at 114 pg/ml which is nicely into the female range.
I'm happy that I don't have to take Spiro or progesterone.
Replacing a patch once every three days is all there is to my hormone regimen.
I also experience nice breast growth on it, a much bigger bum and my pelvis rotated.
My hip bones grew as well. I started at a young age, early 20s.
I'm happy with the effects hormones had. Especially when I started male-failing all the time.
Really happy and relaxed :-)
Give lower doses a chance and don't ask to be bumped up too quickly.
My doctor likes to use the lowest effective because Estradiol can be cancer-stimulating when given in too high doses long term. She is careful with that.
I have no complaints. Happy with the changes.

Quote from: Transfused on February 20, 2018, 05:50:53 PM0,100 ng/dl for my free testosterone.

1 pg/ml free T; range in females according to one source 1-8.5 pg/ml, so almost below.

QuoteEstradiol can be cancer-stimulating when given in too high doses long term.

Treatment of high dose estrogen has been deemed just as effective for advanced breast cancer in women as anti-estrogens, this confirmed in an article recently published in a scientific journal. Similar finding in other animal species.

Transsexual women have been prescribed high dose estrogen for decades (1960's - 1990's) and yet papers report no increase in risk of cancer, including breast cancer.

Randomized controlled trials found a decreased risk of colon and breast cancer in women taking estrogen alone but the dose was low.

Pregnant women, who have very high levels of estrogen and progesterone, have been found to, over time, have a lower risk of breast cancer.

Causality between estrogen and cancer to this day never established.

Just reporting what I've come across. Do your research, speak to several doctors.

QuoteHappy with the changes.

Glad to hear.

Quote from: KayXo on February 20, 2018, 08:55:57 PM
1 pg/ml free T; range in females according to one source 1-8.5 pg/ml, so almost below.

Treatment of high dose estrogen has been deemed just as effective for advanced breast cancer in women as anti-estrogens, this confirmed in an article recently published in a scientific journal. Similar finding in other animal species.

Transsexual women have been prescribed high dose estrogen for decades (1960's - 1990's) and yet papers report no increase in risk of cancer, including breast cancer.

Randomized controlled trials found a decreased risk of colon and breast cancer in women taking estrogen alone but the dose was low.

Pregnant women, who have very high levels of estrogen and progesterone, have been found to, over time, have a lower risk of breast cancer.

Causality between estrogen and cancer to this day never established.

Just reporting what I've come across. Do your research, speak to several doctors.

Glad to hear.

Can I ask you something?

Will I have better absorption now that I stick my patches on my penis and scrotum than when I used to stick them on the buttocks?

It was my doctor who said that about cancer and Estradiol being correlated with each other.
Glad to hear that she was wrong.
Each time she tells me that everything above 60 pg/ml could leave me with cancerous cells developing.

Thanks for answering my question. I'm having a horribly bad day. I think I need more Estradiol. I am seeing reversal of some changes. It's killing me. I want to become more feminine, not more masculine. My body hair is growing faster again.

I need maximum absorption of my Estradiol patches. I hope that putting them on the penis will help.

You need to discuss this with your doctor.

Quote from: Transfused on February 23, 2018, 09:23:59 AM
> Will I have better absorption now that I stick my patches on my penis and scrotum than when I used to stick them on the buttocks?
>
> I'm having a horribly bad day. I think I need more Estradiol. I am seeing reversal of some changes. It's killing me. I want to become more feminine, not more masculine. My body hair is growing faster again.

> I need maximum absorption of my Estradiol patches. I hope that putting them on the penis will help.

Hi Transfused, sorry your day wasn't good.   

I am certainly not a doctor but the directions on my patches clearly say these are to be applied to the buttocks or lower abdomen.  Areas that contain a layer of fat.  Not following directions can cause unexpected results...

Edit: I'm deleting the original comment I made here because, as KayXo pointed out below, the information I provided seems to be in error.

Actually, it's been said that absorption is 5 fold higher in scrotal tissue, due to thinner skin and increased vascularity.

Quote from: KayXo on February 27, 2018, 08:18:38 AM
Actually, it's been said that absorption is 5 fold higher in scrotal tissue, due to thinner skin and increased vascularity.

I got that 13 fold figure from a paper called "Transdermal testosterone delivery: comparison between scrotal and nonscrotal delivery systems."

But then after reading your post I went back and kept looking, and it seems you are correct and I was mistaken. Could you take a quick look at the article I mentioned and tell me if I misread it somehow?