Title
I’ve been on HRT for 6 months, with 5mg weekly injections for the last 3 of those months.
3 months ago, my E was 22 pg/ml, now it is 333 pg/ml.
Doctor says that is too high and is going to to reduce me to a “maintenance dose”. Just wanted to check with other people if this is consistent with their experiences. Thanks!
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Not sure if anyone else mentioned it, but be sure to stop biotin (can be in supplements, esp. for hair, energy drinks, etc) three days ahead of the blood test. It messes up the E2 blood test results.
E level is higher than it needs to be so dosage should probably be lowered, but the “maintenance dose” terminology is still a red flag imo. just make sure they are dosing you reasonably lower and your levels are within range. also if you arent getting your T levels tested as well then you should do that (just saying this because it was absent from this post)
I had both tested, but the T results are just taking longer. Thanks for the concern :)
Make sure to do a test during peak and a test during trough.
I do that and then average them. They are always significantly different and i use patches which give a more steady dose than injections.
Also, I’m not entirely convinced that the values most doctors who are not specialists use are correct for trans people. If you aren’t seeing an endocrinologist with at least a little specialty in sex hormones, I’d do that and see if they can recommend the right levels for your body rather than the general numbers that were always very conservative, and came from cis women’s levels rather than what trans people need since there’s usually no funding to research trans people.
I was lucky enough to start HRT with a general practitioner with a lot of experience with trans people during her residency and most of her career. But she moved on to another specialty due to the difficulty making ends meet as a good doctor. I’m on the lookout myself for an endo with good experience to consult one of these days.
The range that a typical transgender woman should be aiming for is 100 - 200 pg/mL. 333 pg/mL is above that range.
That said, there’s lots of reasons it could be high. People who take their HRT doses weekly can see swings on the high end early in the week and on the low end late in the week. That’s why doctor’s should be telling you that it’s really important to have your blood tests done right in the middle of your dosage schedule.
As always, consult your physician if you have questions. And if you think they’re bullshitting you, get a second opinion.
That’s a good point. My shot was on a Sunday, and the test was taken on a Tuesday.
For injections, the blood test should be taken on the day of your dose, right before you do your injection. So you should get bloodwork on Sunday, as your blood testing should reflect the lowest point of your E.
The same premise is true for other methods of administration (i.e. for oral, you should get bloodwork done right before/at the same time of day you normally take your pill)
Keep time-of-day in mind as well. If you normally take your dose on Sunday evenings, your appointment for sample collection (ie: blood draw) should be on a Thursday morning.
it’s really important to have your blood tests done right in the middle of your dosage schedule.
id argue its more important to have blood testing done at the very end of the schedule when levels are lowest, but both values are useful to have. even if your peak is a little high, if your trough is too low you should up your dose anyway (though this is unlikely to be the case unless youre taking EV). plus if your peak is a high but your T level is too high and youre doing mono youll want to up your dose anyway. its nice to have but not nearly as valuable as trough levels in managing your dosage.
For context, I know we have this chart
in the transfem literature, but my doctor also provided this table with my results:
Female
Follicular Phase: 12-233 pg/mL
Ovulation Phase: 41-398 pg/mL
Luteal Phase: 22-341 pg/mL
Postmenopausal: <138 pg/mL
Which seems to suggest that my level would be acceptable.yes, your levels are totally acceptable … your doctor is operating on old and limited guidance, showing they don’t know much about trans healthcare
What ester are you injecting, I assume because you’re in the US it’s valerate? I bet your estrogen is pretty low at trough, given valerate’s half life is 3.5 days … When are you getting blood drawn for the labs? The recommendation I have always heard is to always draw blood at trough.
As an aside, my cis-sexual female spouse has levels that exceed 300 pg/mL each month (those being “natural” physiological levels, no HRT or birth control).
I would be concerned if you were taking oral route of administration from the possible tax on your liver, but since you’re using injections, I think they are going to have a harder time proving there is any real risk from having blood estrogen levels like that, it’s totally within normal physiological ranges of cis women.
I’ve had levels in the 500s pg / mL and my endo wasn’t concerned because he know it was a temporary monotherapy approach until I had surgery.
A doctor that is alarmed by seeing 300 pg / mL is probably not a good doctor, and they should be checking how you feel primarily to determine dose, not just the numbers that are read back. The hormone levels a person needs for their health varies, including cis people.
If you are experiencing symptoms from too much estrogen, you might consider lowering your dose - but is that happening?
I would talk to the local trans community and see what doctors people recommend - you want someone who will give you autonomy in your care and who is educated enough to know where the actual risks are.
I wish I had a doctor who could look at a number like 300 and say “this is fine.” I’ve been at more or less baseline E doses for over a year and they mainly increased the spiro, which then got my potassium too high, so I lowered that without consulting anyone because I can’t just email my provider, and for the past 3 months I’ve had no clear picture of where my levels are at. I wish this stuff were in the cereal aisle so I could take care of things based on my own knowledge.
DIY is the cereal aisle option (admittedly with extra steps / more hassle). Still, I agree. In places like Thailand you can buy oral estrogen over-the-counter at a pharmacy!
EDIT: I do think there could be harm in making sex hormones available over the counter, but mostly for cis people who get scammed into believing their son needs extra testosterone to be an alpha male, etc. It would be good for harm reduction reasons for some guard rails be in place for the majority, but access to HRT for trans people (a minority) is still too restrictive.
DIY is of course less common in the US where clinical care is somewhat readily available, but I’m glad it’s OTC in SEA as I may end up working in the region. As for cis people, my father is or was on T for ED, so there are legitimate uses and I generally trust the medical decisions people make for themselves.
