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.