Aging and hormone levels

[Devlyn ✅]

We've discussed this topic before, but it's been awhile and there's new faces around, so I thought it would be nice to revisit the subject. 🙂

I started HRT at 56, and  was put on a puberty inducing dosage, as most of us are. After awhile I asked my doctor if my dosage should be reduced to more appropriate levels as I age. After the magic was done, of course 🙂

She said "Great question, Devlyn. There hasn't been much research done on this. I'm happy with your levels as is, but if you want to reduce your dosage at any time we can figure out a way to safely do that without putting you at risk of osteoporosis."

Some of my reasons for asking were:

• Being a granny in perpetual puberty is worrying to me. I don't want to be a senior citizen with the emotional range of a fourteen year old. 🤣

• Safety. As my doctor said, there's little research being done on our small cohort. But generally, older women don't have elevated hormone levels. Is that safe for us long term? I'm aware that the hormones themselves are viewed as safe...but again, there's not much research about the effects on an aging population.

So far, I have stuck to my relatively low dosage. My body has responded well to HRT over the last seven years, and I am past any apparent physical changes now. In the words of Pippin: "Though I'm not likely to grow anymore... except sideways". 😁

Don't get me wrong, it's nice to look younger than you are. But I'd rather live longer than look younger.

So where do you stand? Have you thought about whether you should lay off the "candy" at some point? Do you want to eventually age more naturally?

Hugs, Devlyn

[Courtney G]

I love being on estradiol but mostly I'm fearful of the "damaging" effects of testosterone on my body hair, skin and body shape. I've not yet had an orchiectomy so I have to work to get/keep that T suppressed.

Also, I've been running on E for a little over 4 years but just switched to injections 4 months ago. I have a long way to go for the bottom half of me to get closer to the desired shape so I feel I need at least 5 more years of solid E levels.

If I could achieve a fully fem body shape and keep T suppressed I'd be ok lowering E levels a bit.

I'm 60 years old.

[ChrissyRyan]

I will ask my prescribing doctor what she thinks about this the next time I see her.  More estrogen does not necessarily mean more development and body changes.  Less may make more sense over time.  I have been on my one tablet a day schedule for a while now. 

[Lori Dee ✅]

I have never understood that mindset. To me, that doesn't make sense.

True, the protocols should aim for estradiol levels within the puberty range to effect the necessary physical changes. Puberty in ciswomen starts in their teens and lasts into their twenties, so about ten years.

After that, the goal is to maintain levels corresponding to "reproductive age."

There is no protocol that says levels should be maintained at the post-menopausal range. The cause of menopause is the age-related decline of the ovaries' production of estrogen and progesterone. Although it is considered "natural," so are other age-related issues. There is a reason that ciswomen are given hormone supplements to combat the effects of menopause.

I have been on hormones for six years, so even at 68 years old, I should continue in puberty for another four years or so. Then adjust to the maintenance level.

Aiming for a lower level makes no sense to me. It's like saying all of the women my age have gray hair, so I should dye my hair gray. Or women my age have arthritis, so maybe I should have some too. And sign me up for osteoporosis while we're at it.

No, thank you. I am not going down without a fight.

Hormones control many things in our bodies besides their shape. If I keep my hormone levels in a healthy younger range, perhaps I can prevent the age-related decline that affects the other organs as well.

[Devlyn ✅]

I have never understood that mindset. To me, that doesn't make sense.

True, the protocols should aim for estradiol levels within the puberty range to effect the necessary physical changes. Puberty in ciswomen starts in their teens and lasts into their twenties, so about ten years.

After that, the goal is to maintain levels corresponding to "reproductive age."

There is no protocol that says levels should be maintained at the post-menopausal range. The cause of menopause is the age-related decline of the ovaries' production of estrogen and progesterone. Although it is considered "natural," so are other age-related issues. There is a reason that ciswomen are given hormone supplements to combat the effects of menopause.

I have been on hormones for six years, so even at 68 years old, I should continue in puberty for another four years or so. Then adjust to the maintenance level.

Aiming for a lower level makes no sense to me. It's like saying all of the women my age have gray hair, so I should dye my hair gray. Or women my age have arthritis, so maybe I should have some too. And sign me up for osteoporosis while we're at it.

No, thank you. I am not going down without a fight.

Hormones control many things in our bodies besides their shape. If I keep my hormone levels in a healthy younger range, perhaps I can prevent the age-related decline that affects the other organs as well.

That was the point I was making.

What do you consider the maintenance level to be? I think this is where my doctor's point about research kicks in.

[Lori Dee ✅]

From what I have read, the typical estradiol ranges are:

Premenopausal women: 30–400 pg/mL (varies across cycle due to ovulation cycles)
Perimenopause: fluctuates widely, often 20–300 pg/mL (levels start to decrease)
Postmenopause: usually below 30 pg/mL

When I started HRT, my doctors targeted 100 pg/ml. We found that this level was too low because I am a fast metabolizer. After making numerous adjustments over four years, I switched to injections, and my levels range from 195 - 300. My levels hit 400 one time, and we adjusted my dose from every week to every ten days, and they now hold steady around 195.

In my non-medical opinion, our protocol should slowly ramp up to 100 over the first year, then continue into the upper range (300-400) until changes slow or stop. At that point, maintaining close to 200-300 should be appropriate.

That all changes post-op. Estradiol no longer competes with testosterone, so lower levels are appropriate (100-200) indefinitely.

The reason that I believe this is that estradiol is the tool for breast growth and fat distribution. Most HRT protocols are very conservative and rarely reach these levels. Consequently, studies have shown that 70% of transgender women are dissatisfied with their breast growth, and more than half of those undergo breast augmentation. Perhaps, if the protocols actually followed what human biology does normally in females, development would happen in the same way, making BA surgeries unnecessary.

I have used this same argument concerning progesterone (also produced by the ovaries and also important in breast development). My gynecologist agreed, but endocrinologists seem too focused on protocols that were established in 2017.

Again, I am not a medical professional, so this is not medical advice. I have done my homework, and I understand what these hormones do and how they work together in humans.

[Devlyn ✅]

My doctor brought my E levels up to 196, and I've been right around there the whole time.

[Lori Dee ✅]

My doctor brought my E levels up to 196, and I've been right around there the whole time.

If it ain't broke, don't fix it.

🤣

[CosmicJoke]

I was dying on my bedroom floor of a pulmonary embolism about two years. My E level was at 600 pg/ml at the time but I have lost weight since then. I now treat this issue with anticoagulants and being more physically active. My E level was 255 pg/ml last I got it checked. According to my PA-C that is perfect.

I'm very fortunate to have survived that, but I just treat my situation differently now because that's what I personally have to do.

I have to concur with LoriDee that unless there is actually some medical reason for you to go off E then "if it ain't broke don't fix it."

[big kim]

Been taking HRT since January 1990 age 32. Now 68 and have a spray HRT, Lenzetto I use daily.

[Courtney G]

My E level at trough just tested at 234 pg/mL and T at 17 ng/dL. My doc requested I make an appointment, stating "despite your lab work not revealing any immediate dangers, there are some results that need attention soon."

This suggests that they (Plume) feel my E level to be too high. I hate to do it but I could play a game with this in which I lower my E dose a couple of weeks before scheduled testing, but I'd rather have them accept that having that much E at trough seems acceptable. Actually, if we agree that 150-175 at trough is acceptable I'd be fine with that. We might lower my dose of estradiol valerate from 6 ml/week to 4 ml/week. But I'd only stay there if T remains suppressed AND I can drop my 50 mg of spiro per day. That's the ultimate goal.

[Allie Jayne]

The issues in this topic are the lack of medical research on trans people, and the misinformation to doctors from the discredited Women's Health Initiative.

Trans people have a range of different needs depending on our family histories, individual health issues, age when we started hormones, pre or post orchie, lifestyle, and culture. There simply is not a level which is appropriate for everyone, and the bottom line is that we need to have honest discussions with our doctors, who know our medical histories, to determine the hormone plan appropriate to us.

It is important to know if your doctor is working to standards based on the WHI. These standards are for the older synthetic hormones which came with elevated risks, and it is appropriate to lower levels of these. Most countries (not all!) use bio identical hormones now, which have the same risk factors as natural hormones. There is also some misunderstanding of the DVT risks. Many studies state that higher hormone levels increase the risk by as much as 3 to 5 times average levels, but the UCSF hormone paper points out that the background incidence of DVT is 1 in 10.000 people, unless there are genetic risk factors. This means people are 99.999% safe, and if the risk increases five fold it just lowers that to 99.995% safe. The difference is practically insignificant!

As pointed out, post menopausal hormone levels are associated with aging, and the increased medical conditions which come with that. This is why many cis trans people are on HRT, as they don't wish to welcome the effects of aging. We need to objectively assess our risks, and our expectations, particularly in regard to cancers, and cardiovascular health, and decide on the levels of hormones appropriate to us, and be prepared to advocate these to our doctors.

Hugs,

Allie

[Devlyn ✅]

Here's some guidance from the NHS on HRT for cisgender women.

https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/ 🔗

[Lori Dee ✅]

Actually, if we agree that 150-175 at trough is acceptable I'd be fine with that. We might lower my dose of estradiol valerate from 6 ml/week to 4 ml/week. But I'd only stay there if T remains suppressed AND I can drop my 50 mg of spiro per day. That's the ultimate goal.

Be aware that both Spiro and Finasteride affect hormone levels. That's the reason I got off them. The way they work is to modulate the 5α-Reductase, which affects all hormones, including estrogens and progesterone. Hormones interact with each other, so raising one or lowering another has system-wide effects.

In my (again) non-medical opinion, they should not be prescribed for transgender HRT protocols. There is no reason for it. They are not designed to reduce testosterone; that is a side effect. There are better options now, so we need to use better tools.

Leuprolide (Eligard) is specifically designed to stop testosterone production at its source.

Bicalutamide (Casodex) is specifically designed to block testosterone receptors, and it has no hormonal activity. That means it won't interfere with any other hormones.

The combination of these two meds is the equivalent of chemical castration. It is used in chemotherapy and, in the past, was given to registered sex offenders.

I was on them for about a year, which allowed my estadiol levels to rise without competing with testosterone. Once T was suppressed, I stopped taking them. The estradiol alone is enough. My last two labs showed my T levels at less than 12.

[Tills]

Good morning from the UK.

I think I'm with @Devlyn on this. The question needs to be posed, hence my asking it last autumn https://www.susans.org/index.php?topic=252160.0 .

A good friend of mine in her 70's who transitioned decades ago now takes no supplementary hormones at all. She has a prescription for some calcium supplements, that's all. Her GP told her that there's no need for her to be taking any supplementary hormones now.

Once our bodies have completed their feminisation, if you have no naturally occurring testosterone left, then they're not suddenly going to return us to a male physique. So the point of taking high doses of HRT is what exactly? Youthful looks? Perhaps. But at what cost and side-effects?

Generally speaking I like to keep things natural. I'll take medication, of course, when it's genuinely necessary. But there's no evidence that maintaining high levels of estradiol into your 70's and 80's does you any good and it might well do harm.

Without meaning to be too contentious I wonder if there's a bit of a difference in attitude between the UK and US? Americans pill pop a lot, pushed by a vested lobbying pharma industry. Brits tend to be a lot more cautious about such things. The US with 4% of the world's population consumes 8% of global prescription drugs.
See https://www.lif.se/contentassets/a0030c971ca6400e9fbf09a61235263f/international-comparison-of-medicines-usage-quantitative-analysis.pdf 🔗


People say I act and look young for my age but we surely do have to be realistic? We are all going to die. Atrophy is a part of life.  And I like the natural approach. My focus is increasingly on healthy eating and lifestyle. I gave up alcohol 7 years ago, whilst in the US as it happens, and I try to eat very healthy food and avoid sugars and garbage. I hike at least 10k, and usually 15k, every day in the fresh air.

Growing old gracefully, rather than disgracefully, is becoming an important truth for me.

xx

[Tills]

(Just putting an alternative perspective and I could well be wrong!)

[Allie Jayne]

Good morning from the UK.

I think I'm with @Devlyn on this. The question needs to be posed, hence my asking it last autumn https://www.susans.org/index.php?topic=252160.0 .

A good friend of mine in her 70's who transitioned decades ago now takes no supplementary hormones at all. She has a prescription for some calcium supplements, that's all. Her GP told her that there's no need for her to be taking any supplementary hormones now.

Once our bodies have completed their feminisation, if you have no naturally occurring testosterone left, then they're not suddenly going to return us to a male physique. So the point of taking high doses of HRT is what exactly? Youthful looks? Perhaps. But at what cost and side-effects?

Generally speaking I like to keep things natural. I'll take medication, of course, when it's genuinely necessary. But there's no evidence that maintaining high levels of estradiol into your 70's and 80's does you any good and it might well do harm.

Without meaning to be too contentious I wonder if there's a bit of a difference in attitude between the UK and US? Americans pill pop a lot, pushed by a vested lobbying pharma industry. Brits tend to be a lot more cautious about such things. The US with 4% of the world's population consumes 8% of global prescription drugs.
See https://www.lif.se/contentassets/a0030c971ca6400e9fbf09a61235263f/international-comparison-of-medicines-usage-quantitative-analysis.pdf 🔗


People say I act and look young for my age but we surely do have to be realistic? We are all going to die. Atrophy is a part of life.  And I like the natural approach. My focus is increasingly on healthy eating and lifestyle. I gave up alcohol 7 years ago, whilst in the US as it happens, and I try to eat very healthy food and avoid sugars and garbage. I hike at least 10k, and usually 15k, every day in the fresh air.

Growing old gracefully, rather than disgracefully, is becoming an important truth for me.

xx

Just a note of caution, hormones do much more than affect secondary sex characteristics, they have an essential role in regulating many body functions needed to stay healthy. Trans people who chemically or surgically remove most of their hormone production may need to take some hormones to remain healthy. So it can be more than just avoiding hot flashes! Most of the recommendations written for post menopausal women are for cis women who still produce some hormones.

My testosterone levels are near zero, so my doctor advises me to maintain some hormone levels to stay healthy. Getting educated advice for trans medicine can be difficult, but may have significant affects on your long term health!

Hugs,

Allie

[Tills]

Just a note of caution, hormones do much more than affect secondary sex characteristics, they have an essential role in regulating many body functions needed to stay healthy. Trans people who chemically or surgically remove most of their hormone production may need to take some hormones to remain healthy. So it can be more than just avoiding hot flashes! Most of the recommendations written for post menopausal women are for cis women who still produce some hormones.

My testosterone levels are near zero, so my doctor advises me to maintain some hormone levels to stay healthy. Getting educated advice for trans medicine can be difficult, but may have significant affects on your long term health!

Hugs,

Allie

Oh absolutely Allie and I'm not denying that at all.

I'm just not sure whether maintaining a 'therapeutic transitioning level' of 400-600 pmol/L (110-165 pg/ml) into your 70's is either necessary or wise. That's around 10x to 15x the typical level of a post-menopausal cis female which feels to me jarringly unnatural.

I'd generally prefer to keep my femininity as non-synthetic as possible. That feels like an important goal for my long-term health and well-being.

xx

[Tills]

Is the real issue here not really to do with hormones, or trans this or that, as such but to do with how we all deal with advancing age and ... death? I know I certainly felt differently once I'd passed 60. The days of dancing on stage in a Bangkok bar dressed only in a mini skirt, blouse, and high heels feel like another era whereas in reality it was just ten years ago.

The one certainty of life is death. Atrophy is universal. There's something quite important, to me, in recognising that as the years pass so the goals of being female alter. A healthy maintenance level feels like a good focus.

But maybe I'm wrong?

xx