Can I ask to double my dose with these results?
Can I ask to double my dose with these results?
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.
Edit02: Thank you all for your responses. My doctor approved the prescription doubling. My idiot brain realized after the fact that I didn't even need the doubling in the first place (I guess I get to stockpile now). I intended to follow the 0.5mg four times a day protocol shown here https://pubmed.ncbi.nlm.nih.gov/38130980/ . Really could have just cut my 2mg pills into four pieces.
sublingual + high level might just be the timing: you did your test during a peak. sublingual peaks can fall rather fast, though. i would recommend patches or injection for monotherapy.
Adding Progesterone can help get the Testosterone levels down considerably without adding Estrogen. The administration route doss matter a lot. You just need to decide if it's too early to start. I attached a screenshot of my own levels and what I was taking at each point. Keep in mind the top graph is log scale and these are just my personal results.
Edit: There are no units listed because this was for me to show my doctor asking with my labs and not for the Internet. The important thing is how the levels changed. Estradiol Valerate strength was 5mg/mL.
You don't generally do monotherapy by oral route, you would switch to injections. Monotherapy with injections is pretty safe, they shouldn't be worried about large doses unless it's oral.
Your estrogen was surprisingly high pre-HRT, have you tested for intersex conditions?
I've successfully reproduced. A friend who took a class on the subject said that I wouldn't have been able to if I was intersex.
There are so many intersex conditions and not all of them prevent fertility. Having successfully reproduced might help narrow the diagnostics, though!
EDIT:
https://www.advocate.com/commentary/2019/10/26/8-misconceptions-myths-about-being-intersex-debunked
myth #6:
6. Intersex people can't have sex, get pregnant, or have children.
Many intersex variations include mostly typical internal reproductive anatomy. Everyone is different. There are intersex people who can have periods and carry children, and intersex people who can produce sperm. There are some who can't. There are intersex people who find out they have both ovarian and testicular tissue after having given birth.
Your levels are already too high for monotherapy. 250-300 is more than enough. Higher levels don't produce better or faster results.
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.
Not doing monotherapy, but my doctor wants me to lower my dose because my level is over 300 5 days after injection. How long did you pause treatment before your blood work? Not sure what the equivalent for sublingual is given how spikey it tends to be.
Also, are oral prescriptions over 6mg/day common? I thought at that point, usually people are expected to try a different route.
I have an 8mg oral prescription lol
...But that's because I'm stockpiling it
Gotta love doctors trying to help people out like that. My doctor tried to request that I get 3 months supply of oil instead of 1-month-at-a-time for the first time this last appointment, and I suspect it was because politics rather than convenience (unfortunately insurance said no). At least injectables are easy to stockpile if you are willing to use the vial for more than 4 doses
I did not take my daily dose until after my blood was drawn. Blood draw was already 24+ hours since last oral dose.