The Menopause Question and When to Reduce Estrogen?

[Tills]

If you are not having any ill effects, I wouldn't worry about it.

"For adult women, the typical total testosterone range is roughly 15–70 ng/dL, though this can vary by lab, with postmenopausal levels potentially ranging from 7–40 ng/dL. Free testosterone levels in adult women are lower, with some sources suggesting a range of around 1.2–6.4 pg/mL"

My last two labs had my T at <12 ng/dL. I was on Eligard (leuprolide) and Casodex (bicalutamide) for almost two years. That stopped T from competing with my Estradiol, and once the E was high enough, it suppressed the T. (I am pre-op).

Now I am waiting to see if my new endocrinologist suggests I should supplement testosterone.

Thanks so much for posting up these ranges Lori Dee: that's a very helpful reference point.

I had my bloods taken again yesterday as they want to see if my T dose is having any effect on slightly raising the level. I can tell anecdotally that it already is.

So here's something I still don't understand. My endocrinologist always wants my Estradiol to be taken in the 4-6 hour window after dosing. That's fine. I always stick to it, so yesterday's blood draw was at the 5 hour point after my morning dose.

But Testosterone? No. They always want a trough reading, so it's 24 hours after my previous dose i.e. just before my next one.

I've never really understood that tbh?

xx

[Lori Dee]

So here's something I still don't understand. My endocrinologist always wants my Estradiol to be taken in the 4-6 hour window after dosing. That's fine. I always stick to it, so yesterday's blood draw was at the 5 hour point after my morning dose.

But Testosterone? No. They always want a trough reading, so it's 24 hours after my previous dose i.e. just before my next one.

I've never really understood that tbh?

Mine wanted to see my levels at the trough, so we did labs the day before dosing. After several tests like this, she switched to watching the middle of the dose so she could see an average of where my levels were. Since my symptoms were abated, the highs and lows were less important and she focused on where the average woud be over time, then adjust from there.

And when she tests, she looks at both T and E. She wants to see them together so she can figure out how they are affecting each other. Every provider has their own method and what they want to see to make decisions. Some strictly follow the outdated Endocrine Society guidelines. But she had additional training for two years in Europe studying Transgender Medicine, so I am sure she has her reasons for wanting labs done at certain times in the cycle.


 

[Lori Dee]

@Tills

Another thought I just had. It sounds almost like a "biological bias".

I don't know your providers or much about your healthcare system over yonder ways, so I am not accusing anyone of anything.

BUT...

When the lab returns my results, they include a note of whether the reading is High or Low. Normal is not noted. They consistently note my Estradiol as High and my Testosterone as Low. Then the reference ranges they list are for adult males, even though my records show female.

This has created more than one argument when a new doctor decides they want to arbitrarily reduce my dose. Then I do a quick query to the All-Knowing Dr. Google and show them the lab is referencing the wrong ranges. My levels are squarely within the range for ovulating females.

What I am wondering in your case is similar. Nobody seems to care if a male has high testosterone, but they do care if he has low T. I assume they know you have had an orchiectomy, so perhaps they just want to make sure that you have at least some T in your system. They don't care how high it is but where is the bottom?

The outdated guidelines also warn of the dangers of high Estradiol, yet no one panics when a pregnant women's levels increase by ten-fold. That is normal. The same with Progesterone, but providers still freak out when I tell them I take 100mg three times a day. They say it is too much and I say it is not enough.

Just something to think about.

[Tills]

@Tills

Another thought I just had. It sounds almost like a "biological bias".

I don't know your providers or much about your healthcare system over yonder ways, so I am not accusing anyone of anything.

BUT...

When the lab returns my results, they include a note of whether the reading is High or Low. Normal is not noted. They consistently note my Estradiol as High and my Testosterone as Low. Then the reference ranges they list are for adult males, even though my records show female.

This has created more than one argument when a new doctor decides they want to arbitrarily reduce my dose. Then I do a quick query to the All-Knowing Dr. Google and show them the lab is referencing the wrong ranges. My levels are squarely within the range for ovulating females.

What I am wondering in your case is similar. Nobody seems to care if a male has high testosterone, but they do care if he has low T. I assume they know you have had an orchiectomy, so perhaps they just want to make sure that you have at least some T in your system. They don't care how high it is but where is the bottom?

The outdated guidelines also warn of the dangers of high Estradiol, yet no one panics when a pregnant women's levels increase by ten-fold. That is normal. The same with Progesterone, but providers still freak out when I tell them I take 100mg three times a day. They say it is too much and I say it is not enough.

Just something to think about.

Thanks Lori Dee and wow. That is really bad of them.

Fortunately for me, and I hope others, in the UK they always have female reference ranges. I'm down as female and no-one in the NHS has queried that once.

So for example my most recent estradiol E2 reading of 499 pmol/L came with a reference range of 400-600 and marked as 'Normal.'

That is extremely good point about always testing Testosterone and Estradiol together. When I asked to have my T measured again my Dr said the same thing: 'we should re-test E to see if they're interacting.'

xx

[Tills]

Arrrggh

The inevitable has happened, but I want to thank you Lori-Dee for drawing my attention to the possibility of this.

Yep, my Testosterone has risen from undetectable to 0.5 nmol/L on a stated reference range of 0.4 - 1.2 nmol/L. I assume that's the correct female reference range. Serum Sex Binging Globulin 44.2 nmol/L against a reference range of 11.7 - 137.2 nmol/L. Free androgen 1.1% against 0.5 - 4.7%

But, arrrrgggh, this increased dose of Testogel appears to have severely knocked my Estradiol level. For a longtime I've had a steady state E reading of 500 pmol/L. However my blood test on Monday showed this down to 200 pmol/L.

I will nudge my Testogel down again.

These hormones 'eh?

Any thoughts gratefully received.

xx

[Lori Dee]

But, arrrrgggh, this increased dose of Testogel appears to have severely knocked my Estradiol level. For a longtime I've had a steady state E reading of 500 pmol/L. However my blood test on Monday showed this down to 200 pmol/L.

I will nudge my Testogel down again.

Your levels appear to be within normal range. Even the T is not much higher and is still at the low end of the range. T is much stronger than E, but it is not much higher, so I am not sure if that is the culprit.

Are you able to raise your E dose? You said you have symptoms with low T, so I would not rush to lower it now that it is within range. Raising E could knock it back down, with the added benefit of the higher E.

I am not a doctor, so I am not giving advice. I am suggesting questions to pose to your doctor about how to proceed. It seems you are at the point I was at, where everything was close, but just not quite balanced.

Hormones fluctuate throughout the day, so tweaking them with precision adjustments can get frustrating. The most important part is not to micromanage them, but instead to focus on symptoms. If they are close and you are feeling well, maybe leave them for a month or so and see what happens. If you start having symptoms again, see where the levels are and go from there.

An old troubleshooting trick I used as a technician: Reduce the number of variables in the problem. If you make a bunch of changes, you won't know which one worked or which one caused the problem. Adjust one thing and look for results. Then adjust it again, or something else, but only one at a time.

You're doing alright, just don't get frustrated.

[Tills]

What wonderful, steadying, advice Lori-Dee.

Thank you so much.

I will do as you suggest. I have an appointment with my clinic on 01/12 which isn't that long off either so we can also discuss it further then.

xx