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Pre-HRT Blood Work Question


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So last Monday I went for my consult with my new PCP. Great news we're starting HRT (the wait is killing me) very soon and she was amazing, supportive and happy to help me! When I got my results from my Pre-HTR blood work my estrogen total serum was flagged as high. Normal range listed from 60-190, mine was 272! I'm actually sort of excited by this and it feels oddly gender affirming to me!

My question for all my sisters on HRT is; Is this really all that high or and I'm just excited over nothing? What impact for my treatment might this have?

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  • Admin

You are not alone among Trans women in having the higher than absolutely normal male range of Estrogen .  It is still the subject of study as to what it really means as far as our bodies and minds go however.  A Trans person I know who is a PhD that tracks scientific work about theories as to why we physiologically are Trans has the higher natural production of body hormones as a subject that keeps being bounced around but that has not been pinpointed as to effect on us.  Cis males are not checked for Estrogen levels enough to give us a comparison that could mean something for us as signaling that our levels have a real cause and effect in our lives.  It may mean something different to each of us.  The trick is to get the Estrogen triggered to actually have visible effects on us since, as my Endocrinologists have pointed out, it is not the level of E in our blood that counts as much as the amount being absorbed by receptor cells and put to work in making us real people.  

 

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35 minutes ago, VickySGV said:

You are not alone among Trans women in having the higher than absolutely normal male range of Estrogen .  It is still the subject of study as to what it really means as far as our bodies and minds go however.  A Trans person I know who is a PhD that tracks scientific work about theories as to why we physiologically are Trans has the higher natural production of body hormones as a subject that keeps being bounced around but that has not been pinpointed as to effect on us.  Cis males are not checked for Estrogen levels enough to give us a comparison that could mean something for us as signaling that our levels have a real cause and effect in our lives.  It may mean something different to each of us.  The trick is to get the Estrogen triggered to actually have visible effects on us since, as my Endocrinologists have pointed out, it is not the level of E in our blood that counts as much as the amount being absorbed by receptor cells and put to work in making us real people.  

 

Thanks!! That's an amazing answer and it's extremely helpful!! I never had my estrogen checked in my life but it did feels like it makes sense that it would be higher than an cis male range for me. Also I'll take any good news or information while I wait!!!.

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I'll back @VickySGV on this one; there are several theories being investigated about how E & T levels affect our gender development throughout all stages of our lives, but the lack of information - like E levels in men - are rarely available unless another ailment causes those types of tests to be done. That being said, I always thought there was a correlation between my naturally (very) low T and slightly elevated E results and being transgender, and my endocrinologist said its possible until proven otherwise. My body also adjusted pretty quick to HRT... it eats it up and spits out low T - high E levels with very little effort. Despite having any medical training or evidence to the contrary, I see that as a sign my body wants to fit my gender too, it just needed a bump to do it. So to answer your questions; yes, you should be excited about test results going the way you want, and yes, it probably will affect your treatment in that you may have to take lower doses to get you over the hump. Make sure to celebrate and save the date when you start! 😀

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4 hours ago, Kathy2020 said:

I'll back @VickySGV on this one; there are several theories being investigated about how E & T levels affect our gender development throughout all stages of our lives, but the lack of information - like E levels in men - are rarely available unless another ailment causes those types of tests to be done. That being said, I always thought there was a correlation between my naturally (very) low T and slightly elevated E results and being transgender, and my endocrinologist said its possible until proven otherwise. My body also adjusted pretty quick to HRT... it eats it up and spits out low T - high E levels with very little effort. Despite having any medical training or evidence to the contrary, I see that as a sign my body wants to fit my gender too, it just needed a bump to do it. So to answer your questions; yes, you should be excited about test results going the way you want, and yes, it probably will affect your treatment in that you may have to take lower doses to get you over the hump. Make sure to celebrate and save the date when you start! 😀

Thanks!! This gives me so much hope!!!

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I had my pre-HRT bloodwork done one day and an appointment with a GP the next day, so he had the results before I had heard anything about them yet. 

 

He asked if I was already on HRT or had done it in the past, because the estradiol number was beyond the high end of the range it was supposed to be for males. And my T was low, but in the range. 

 

I do throw that anecdote in there when talking to the cis who seem to think it's all just something wacky in our brains that make us do this 'trendy' transition thing. 

 

 

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20 minutes ago, RhondaS said:

the estradiol number was beyond the high end of the range it was supposed to be for males. And my T was low, but in the range. 

 

I do throw that anecdote in there when talking to the cis who seem to think it's all just something wacky in our brains that make us do this 'trendy' transition thing. 

 

Many of us indeed had E & T levels outside the ranges applied against cis test results.  It would be both fascinating and informative if we had E &T averages for MtF and FtM persons just prior to starting HRT for the first time.  

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I find this stuff fascinating, and I'd love to see it get studied better. I'll toss my hat into the ring, too fwiw...

 

My clinic doesn't really do hormone level checks before hrt (too bad, I would have been curious to find out), so it's hard to say in my case, but there was something that made me wonder...

 

My first hormone check was 3 months into my original initial dosage of E (without a T-blocker). By that point, T was around the low end for "normal cis male".  E was right about the very bottom of the "normal cis female" range you mentioned. My understanding is that this E level is much higher than what's expected for "normal cis male" (but of course who can really know for sure since cis-male E is rarely checked?) Without a baseline, I could only guess/assume that...presumably...my E patch brought my T down from "average cis male" to "low cis male" and brought my E up from "very little" to "low cis female". (Or did it? Hmm...)

 

So then they upped my E dose, and now I'm sitting right at another 3 months later, and my E&T levels are pretty much identical to what they were 3 months ago (I'm not complaining! I knew something like this was likely to happen sooner or later without a T-blocker.) But here's what I find curious: That first, original prescription of E...For all I know, it might have brought my levels from "average cis male" to where they are now, and increasing the dosage just wasn't able to make any further headway against my natural T. Oooorrr....for all I know...maybe increasing my E dosage wasn't the only thing that had no effect, maybe my original E dosage also has very little effect and my T was already "low for a guy" and E was already "high for a guy" before I even started.

 

I guess that's a terribly roundabout way of saying "It's possible that my pre-HRT hormone levels might have also been at least a little bit different from average cis male, but I don't really know." 😁

 

What I'm really curious about is any possible intersections with intersex conditions, and what connection that may (or may not) have to transness. (I always found anything intersex to be fascinating too.) I've heard that there are certain intersex conditions that don't necessarily result in any obvious ambiguity in either primary OR secondary sex characteristics. So like, just for example, people who have no obvious reason to suspect they're anything other than cis-male, but turn out to not be XY, or turn out to have a hidden uterus. Or people who have no obvious reason to suspect they're anything other than cis-female, but turn out to not be XX. Just like E&T hormone levels, chromosome types are also not usually tested unless there's some related symptoms trying to be diagnosed. I've heard about college bio-lab classes getting rid of hands-on chromosome-testing exercises because it led to students discovering their own chromosome type was the opposite of what they expected. I also once saw an interesting documentary about an intersex manga author from Japan whose very first clue they were intersex was as an adult when a hormone level blood test revealed their E&T levels were somewhere in between "typical" male and female ranges. Anyway, to once again plagiarize Spock: "Fascinating"

 

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Do keep in mind that in order for the hormones to work at all, there must be receptor cells for them that actually take the HRT and put them to work in our bodies.  The levels in your blood are OK, and maybe some low E levels mean the stuff has been used up by the receptors to get your transition going, the stuff in the blood is just stockpiled waiting for be put to work. 

 

10 years ago when I was only 60 days on HRT, I took part in a genetic sample test by a major university of Trans women.  The sample I gave them was a bit unique since I have a genetic blood problem which they were happy to get.  I was given a sample tracking number which I was able to keep track of on a research web site.  My sample found its way to a study that was done on a group of samples from 4 universities, one of the tests studies found that my sample # had a little quirk on how my T receptors were made, there was a duplicated sequence in the receptors that made my absorption of T wonky.  I was one of 60% of the samples of Trans Women with that problem.  What it meant, they could not fully tell at the time.  Just another good hormone mess to think about.

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Thanks for all the replies! It's an interesting concept that I had not thought about before and It makes so much sense and just "feels" right!!!

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Update: My primary care doc is referring me to an endocrinologist since my estrogen was so high. It's bitter sweet because they said it could take 1 - 2 weeks to get scheduled and the wait was already killing me as is... but on the other hand i'm sure the care will be great and the endo will get me where I need to be!!!

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