Estradiol monotherapy. Started HRT 3 months ago with 2mg Estradiol oral tablets. Have a doctor appointment in a few days and wanted to ask to double my oral prescription, split up 4mg into 4 doses sublingual every day. Not sure if my Estrogen levels are too high and my doctor will deny my request.

  • Pre-HRT Estrogen (TOTAL IA): 181 pg/mL
  • Pre-HRT Testosterone (Total IA): 246 ng/dL
  • Levels this week Estrogen Total IA: 438 pg/mL
  • Levels this week Testosterone Total IA 115 ng/dL

From what I understand I feel like I’m definitely not achieving Testosterone suppression. https://transfemscience.org/ recommends T levels around 10 ng/dL. But having E levels of 400 pg/mL is the right range for E.

Can I convince my doctor to double my dose if my E is already at >400 pg/mL?

Edit 01: I did not take my daily dose until after my blood was drawn. Blood draw was already 24+ hours since last oral dose.

  • mjsaber
    9·
    2 days ago

    Your levels are already too high for monotherapy. 250-300 is more than enough. Higher levels don’t produce better or faster results.

    • dandelionEnglish
      3·
      14 hours ago

      In my experience it was more like I needed to maintain a minimum of 300 to get adequate suppression, not everyone responds equally and the monotherapy dose required for adequate suppression varies somewhat:

      … studies in cisgender men and transfeminine people have found that estradiol levels of around 200 pg/mL (734 pmol/L) suppress testosterone levels by about 90% on average (to ~50 ng/dL [1.7 nmol/L]), while estradiol levels of around 500 pg/mL (1,840 pmol/L) suppress testosterone levels by about 95% on average (to ~20–30 ng/dL [0.7–1.0 nmol/L]) (Gooren et al., 1984 [Graph]; Herndon et al., 2023 [Discussion]; Wiki; Graphs).

      In one large study in transfeminine people, the rates of adequate testosterone suppression (to testosterone levels of <50 ng/dL or <1.7 nmol/L) were 24% of individuals at estradiol levels of <100 pg/mL (367 pmol/L), 58% at 100 to 200 pg/mL (367–734 pmol/L), and 77% at >200 pg/mL (>734 pmol/L) (Krishnamurthy et al., 2023).

      from https://transfemscience.org/articles/transfem-intro/#gonadal-suppression

      More relevant, however, is the fact that the testosterone is still at those levels indicates it’s not suppressed, esp. since they’ve been on that dose for three months. Probably because it’s an oral route the blood levels are just spiking when she got blood work done, but not remaining consistently that high throughout the day.

      • Florencia (she/her)OPEnglish
        2·
        18 hours ago

        I did not take my daily dose until after my blood was drawn. Blood draw was already 24+ hours since last oral dose.

        • dandelionEnglish
          1·
          9 hours ago

          Even so, that snapshot is probably not accurate to your blood levels most of the time, since such high E should thoroughly suppress T production if it were consistently that high. There are probably still periods where your E drops enough for T production to be happening, the other main way to explain such high T is that maybe there was an error / inaccuracy in the labs. My endo shared that he is particular about which lab does the blood work and that it makes a big difference in the accuracy.

          Besides your blood labs, have you noticed physiological changes that might indicate T suppression or lack thereof?

          EDIT: I know a transfem IRL who after 3 mo. of oral estrogen had blood levels around 340 pg / mL and T around 95 ng / dL - so this isn’t the first time I’ve seen something similar (adequately high estrogen, but not fully suppressed testosterone).

          It’s hard because I started with injections, not oral, so my own experience was that T was immediately suppressed. My T was 305 pre-HRT and E was 30. After 2 months my T was 23 and E was 325. That was with a variable dose schedule, but averaging around 5 - 7 mg per week (usually split up into every 5 days or every 3 days during that time).

          • Florencia (she/her)OPEnglish
            2·
            17 hours ago

            The only physiological change I’ve noticed is my areolas having pain when bumped. Have not noticed anything indicating T suppression.