The world according to Sarah

[Courtney G]

NOT MEDICAL ADVICE: always follow your doctor's instructions

My understanding is that the 150 pg/ml "limit" was established for levels when using premarin, which was problematic due to increased risk of blood clots. Trans healthcare is severely understudied, but newer studies like this one from UCSF are looking to update/revise recommendations to reflect the lower risks associated with bioidentical estradiols: https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy 🔗

These quotes/summary stolen from a post by Doc Impossible:

"A general approach for titration would include increasing of both estrogen and antiandrogen dosing until the estrogen dose is in the female physiologic range. Once this has been achieved, titration efforts can focus on increasing androgen blockade. There can be several approaches to titration of androgens. One approach is to continue increasing estrogen until it reaches the upper limit of the female physiologic range. The drawback for this approach is that patients may begin to experience estrogenic side effects as described below."

UCSF doesn't define those ranges, since they're outside of its purview to do so in this document. Per Mt. Sinai 🔗 [Link: mountsinai.org/health-​library/tests/estradiol-​blood-​test/]:

Normal Results

The results may vary, depending on the person's sex and age.

Male: 10 to 50 pg/mL (36.7 to 183.6 pmol/L)
Female (premenopausal): 30 to 400 pg/mL (110 to 1468.4 pmol/L)
Female (postmenopausal): 0 to 30 pg/mL (0 to 110 pmol/L)

I just had labs done and am at 222 pg/mL (trough). My doc had told me I was too high at 634 pg/mL, so this level should make us both happy, but based on the above information, the level wasn't really high.

[Lori Dee ✅]

based on the above information, the level wasn't really high.

Healthcare providers focus on risk management, not on our intended results. That's where the conflict comes in. When my doctors told me 400 was too high, I said: "Not if I'm pregnant."
You don't see a lot of women suddenly experiencing blood clots, strokes, and DVTs just because they are pregnant. There is usually some other risk history. I am not going to overdose on estradiol.

Then I tell them to revisit Human Biology 101:

During pregnancy, estradiol levels rise significantly from non-pregnant baselines and continue a steady upward trajectory across all three trimesters to support fetal development, placental growth, and maternal changes.

Typical Estradiol Ranges by Trimester:

First Trimester: ~150 to 3,250 pg/mL (initially produced by the corpus luteum)
Second Trimester: ~1,250 to 7,200 pg/mL (increasing contribution from the placenta)
Third Trimester: ~3,400 to 15,000+ pg/mL (peak levels supporting final development and lactation prep)

So, which female range are we trying to achieve, Doc?

🤣

[Devlyn ✅]

Okay, but you (probably) don't have the same structures in your body that pregnancy levels are there for. With all due respect, that is a bit of a moot point.

I understand that it's wise to be your own advocate, but I've left the doctoring to the doctor. I turned out fine. 😜

Hugs, Devlyn

[Lori Dee ✅]

Okay, but you (probably) don't have the same structures in your body that pregnancy levels are there for. With all due respect, that is a bit of a moot point.

I understand that it's wise to be your own advocate, but I've left the doctoring to the doctor. I turned out fine. 😜

Hugs, Devlyn

Agreed. My point was not "I should be here." It was a counterpoint to their "you are too high" argument. It is unnecessary to go that high. It is also a waste of medicine when a lower dose will do just fine.

[tammy753]

Are you getting your levels checked? I'm curious whether you would have had a high level like mine when you wer on 8mg? I wish I had come clean about it to my GP years ago. Apart from one GP who was clearly uncomfortable talking about trans issues and their refusal of scared care the experience has been amazing and she was the one who requested the hormone blood panel when I asked her to. I'm not that bothered about the shared care side of things if they are willing to do bloods as I know my T is fully supressed now I'm happy to go the cheaper route with spiro until I've got enough for an orchie.

I go next months for blood tests. They want me to be on regulated hrt for 90 days first. I know that I am sleeping way more now and I think that is the Progesterone. So I will be interested in the results.

[Captain.Val]

Are you planning on going legit soon, Sarah?

[Stottie Girl]

Are you planning on going legit soon, Sarah?

Not soon Val, no. I have a plan in place but it's probably not going to happen until later next year I think. My life is too up in the air right now.

It's tough when you have zero support in place. I want to be able to make the transition as seamless as possible. For me that means voice, ideally electrolysis and orchiectomy. Everyone is different and I think if I had people to lean on I might be braver but that's where I am. I'm getting close to being moved in now which will be the catalyst to start my plan. I will have my privacy back then and can do the necessary video assessments for the diagnosis and endo and start voice therapy with a vocal coach. I just can't do any of that when I'm hiding my true self in my parents bedroom.

I had a bit of relief yesterday as my parents went away for an overnight stay. I was able to get some of my real clothes and makeup out again and just relax and be myself, it was so so welcome. I have now discovered that a lot of my clothes are now too big for me and I no longer have any bras that fit. I'm going to need to do some serious shopping when I get moved in! But hey, It confirms the diet is working!

[tammy753]

Not soon Val, no. I have a plan in place but it's probably not going to happen until later next year I think. My life is too up in the air right now.

It's tough when you have zero support in place. I want to be able to make the transition as seamless as possible. For me that means voice, ideally electrolysis and orchiectomy. Everyone is different and I think if I had people to lean on I might be braver but that's where I am. I'm getting close to being moved in now which will be the catalyst to start my plan. I will have my privacy back then and can do the necessary video assessments for the diagnosis and endo and start voice therapy with a vocal coach. I just can't do any of that when I'm hiding my true self in my parents bedroom.

I had a bit of relief yesterday as my parents went away for an overnight stay. I was able to get some of my real clothes and makeup out again and just relax and be myself, it was so so welcome. I have now discovered that a lot of my clothes are now too big for me and I no longer have any bras that fit. I'm going to need to do some serious shopping when I get moved in! But hey, It confirms the diet is working!

Its great you found some relief even if it was temporary. Just remember the clothes don't make you who you are. You are always Sarah even when you have to pretend to be your other self.

I wish I could say the same about my diet but I think I have other issues to work on first. Keep going you are making a new life yourself that sounds amazing!

[Stottie Girl]

Its great you found some relief even if it was temporary. Just remember the clothes don't make you who you are. You are always Sarah even when you have to pretend to be your other self.

I wish I could say the same about my diet but I think I have other issues to work on first. Keep going you are making a new life yourself that sounds amazing!

Thanks Tammy, I think I've totally clicked into weight loss mode now. I try and fail, try and fail, try and fail and then something just clicks in my mind and I'm off and I go on a roll. I'm finding I am eating way way less calories than I used to last time I lost significant weight and I guess maybe it's the estrogen but I'm just not feeling hungry.

I'm curious, if you aren't happy with your weight, what's stopping you starting a diet? Can't you loose weight AND do the other things? Mind unless you can get into the right mindset it's a bit pointless. I'm a fine one to talk though, my brain makes up excuse after excuse while the weight piles on, then I'll reach a tipping point and it just clicks. It would be a lot easier if it clicked 7 or 8 stone earlier ha ha!

[tammy753]

Thanks Tammy, I think I've totally clicked into weight loss mode now. I try and fail, try and fail, try and fail and then something just clicks in my mind and I'm off and I go on a roll. I'm finding I am eating way way less calories than I used to last time I lost significant weight and I guess maybe it's the estrogen but I'm just not feeling hungry.

I'm curious, if you aren't happy with your weight, what's stopping you starting a diet? Can't you loose weight AND do the other things? Mind unless you can get into the right mindset it's a bit pointless. I'm a fine one to talk though, my brain makes up excuse after excuse while the weight piles on, then I'll reach a tipping point and it just clicks. It would be a lot easier if it clicked 7 or 8 stone earlier ha ha!

You know I have a lot of mental health issues and I have tried to start a diet multiple times and am watching the calories again. I started Progesterone last month or so and that made me crazy hungry and add to that I also start Lexapro. Those to made me crazy hungry, I am past the side affects now and can finally get back on a diet. When you start Progesterone you will see what I mean I was so hungry. I also have moved my evening pills to 8pm so that I don't have to eat something when I take them. All this to say is yes I am trying again, no its not easy for my with my depression and current medications but I am hopeful I can work out my agoraphobia this year and maybe be able to go do more.

[Stottie Girl]

@tammy753 I hope you didn't think I was getting at you there Tammy, I was trying to be encouraging!

Yeah the Progesterone is on the way so I hope it won't knack up my diet! Fingers crossed!

There's no point trying to start diets until you are in the right frame of mind to be fair. All of my weight is there due to comfort eating when I was suffering with depression. It's the second time that has happened to me too so I know exactly where you are coming from. The last time I reached over 24 stone!

[tammy753]

@tammy753 I hope you didn't think I was getting at you there Tammy, I was trying to be encouraging!

Yeah the Progesterone is on the way so I hope it won't knack up my diet! Fingers crossed!

There's no point trying to start diets until you are in the right frame of mind to be fair. All of my weight is there due to comfort eating when I was suffering with depression. It's the second time that has happened to me too so I know exactly where you are coming from. The last time I reached over 24 stone!

I was not offended. I was just explaining or making excuses, its one of those. I feel more in control of my appetite than when I first started this combo of meds. I am also a comfort eater and so I do go after those high fat foods I should avoid. I will just say this when you start it give your self some time to adjust to it. It will take a few weeks you may feel out of control until your body adapts.

Or you can eat pickles those always kills my appetite.

[Stottie Girl]

Feeling very down today despite appearences. I am increasingly feeling isolated and alone. I keep bursting into tears at nights. I think I've bitten off more than I can handle with this house renovation on top of the loneliness, it's happening so slowly and I seem to be taking 2 steps forward and one back all the time. I'm aching all over, covered in bruises and scratches and my joints are falling apart at the seams! I did not realise how much physically weaker I am and how easily I bruise now!

Maybe the dieting is not helping but I just don't have any energy, I'm not sleeping much, I'm still upset and raw after a deeply close personal relationship broke down recently. On top of all that I've been referred to a gastro-intestinal surgeon as they are concerned I might need to have my gall bladder removed. I still have edema in my legs and they still have no idea why. Sucks to be me right now. ha ha!

On the plus side I've pretty much finished my new bedroom now, bed is in, wardrobes and chest of drawers too. I'm looking for a nice dressing table to complete the room now. I'm also half way though the kitchen fit now.

I really thought it would bring me some joy reaching this milestone but I am so down.

Sorry for the moaning post. I'm sure once I get a bit more sleep I'll get my spark back. I just don't seem to have a lot of happiness in my life right now.

[KathyLauren]

Don't apologise.  If you can't moan here, where can you?  Listening is what we do best. 

You'll get the house shipshape soon.  When you do, you'll have your independence back.  And your doctors will soon figure out what is going on and get you on the mend.  In the meantime, hang in there and moan all you need to.

[tgirlamg]

Sarah!

I am so sorry you are in the rough patch right now... sounds like you are getting it from all sides!... I hear ya on the not as strong as I used to be part!
The glow of your inner spirit and sense of humor always shines through though and they will carry you on to better and far more manageable days!

Big Hug!!!

A 💕

[Stottie Girl]

Thanks Kathy, Thanks Ashley. You are both always there to pick up my mood! Sorry I'm being such a debbie downer today.

Tomorrow is another day. I think I will just write this one off I think.

[tammy753]

Feeling very down today despite appearences. I am increasingly feeling isolated and alone. I keep bursting into tears at nights. I think I've bitten off more than I can handle with this house renovation on top of the loneliness, it's happening so slowly and I seem to be taking 2 steps forward and one back all the time. I'm aching all over, covered in bruises and scratches and my joints are falling apart at the seams! I did not realise how much physically weaker I am and how easily I bruise now!

Maybe the dieting is not helping but I just don't have any energy, I'm not sleeping much, I'm still upset and raw after a deeply close personal relationship broke down recently. On top of all that I've been referred to a gastro-intestinal surgeon as they are concerned I might need to have my gall bladder removed. I still have edema in my legs and they still have no idea why. Sucks to be me right now. ha ha!

On the plus side I've pretty much finished my new bedroom now, bed is in, wardrobes and chest of drawers too. I'm looking for a nice dressing table to complete the room now. I'm also half way though the kitchen fit now.

I really thought it would bring me some joy reaching this milestone but I am so down.

Sorry for the moaning post. I'm sure once I get a bit more sleep I'll get my spark back. I just don't seem to have a lot of happiness in my life right now.

I look forward to talking with you on here so you have friends here. We have fun and you give me pity laughs at my jokes. So if that isn't friendship I don't know what is. You seem to be going at a very fast pace on the house which is amazing but also really hard on you body. Give your self permission to take a day off once in a while and enjoy what you have done. I am probably the last person that should preach giving your self a break but you deserve one. Also remember that when you are doing a lot of work your body needs more calories to function so the diet might be the problem you might want to add some back to your diet while you are putting in all that physical labor.

Most importantly take care of your self I need someone to pretend like I am funny.

[Charlotte Kitty ✅]

Sending lots of love and hugs. You'll be there and sorted before you know it! You really need that soon so you can relax and have time for you to recharge and recover.

I wish I was nearer as would come and help you. 😥

Love and hugs 🫂

[Northern Star Girl ✅]

@Stottie Girl 
Dear Sarah:
What we do best here on the Forum is that we offer our ears to listen, and we offer
our shoulders for you to lean on. 
We all have good days and bad days and the good news in your specific case is that
right now it is 09:47pm Friday night (your time) and in the morning it will be a new day,
the sun 🌞 will rise in the sky and a better day is likely to be yours.

Good night Sarah. 🌙
I will eagerly look for your update when you post it on Saturday morning!       
      ♥️
Many HUGS... and More HUGS,
Danielle [Northern Star Girl]
Forum Administrator

Thanks Kathy, Thanks Ashley. You are both always there to pick up my mood! Sorry I'm being such a debbie downer today.

Tomorrow is another day. I think I will just write this one off I think.

[Stottie Girl]

@Northern Star Girl Thanks Danielle, You are right I know. I just feel the weight of it all at the moment. I will be bright eyed and bushy tailed in the morning!

@Charlotte Kitty Aw thanks petal! You really wouldn't want to get involved if you saw it ha ha!

@tammy753 Those aren't pity laughs Tammy, they are full on wide grin belly laughs! You have been brightening my days lately, thanks for that.