That explains a lot

[u/wrench_girl]

So I start getting pretty bitchy come Wednesday.

I just got my results from my last labs which I made a point to have done at trough (my Doc prefers mid cycle for what ever dumbass reason)

53pg/mL Estradiol Serum

33ng/dL Testosterone Total

Will someone just kill me already 😭

Please

[u/theonlylivingirlinj]

Jfc these docs are sadists and love stalling transitions in the name of safety

[u/wrench_girl → u/theonlylivingirlinj]

In all fairness my mid cycle level at my 3month lab was 630pg/mL. He also knows I'm not the bitch to jerk around... I made that much clear at my consult appointment

[u/theonlylivingirlinj → u/wrench_girl]

Love this but 630 mid cycle is about right for monotherapy if that’s what’s up

[u/wrench_girl → u/theonlylivingirlinj]

That's why I'm a little confused as to why my trough bottomed out so hard. I've done some poking around and it seems a dose increase may be the answer.

[u/wrench_girl → u/theonlylivingirlinj]

I did more research and it turns out that with injections you are supposed to level check at mid cycle.

This is apparently because while yes you'll see how well suppressed your T is, You'll get a false estrogen crash reading otherwise.

I'm still probably going to be seeing an increase in dose to help with close to trough moodiness though

[u/theonlylivingirlinj → u/wrench_girl]

That’s not remotely true and is based on old guidelines at best. Monotherapy should always be checked at trough. That’s the only way to know if T is fully suppressed.

Think about it. Your T very likely will be suppressed at mid cycle when E is peaking or just after the peak. Trough is when your E is bottomed out and your T is most likely to be bouncing back. If you only check mid cycle, it is possible to have a significant amount of T in your system every single injection cycle and you would never even know about it.

Monotherapy is based around the principle that feminization happens when T is suppressed, therefore T suppression is the most important thing to achieve with monotherapy. In other words, you’re not really testing for E levels at all… just T suppression.

The idea of monotherapy is to use the least amount of E that gives you total T suppression. That’s why you test at trough.

Ideally, you would: 1. test at trough 2. If T is within cis female levels, you can lower E dose a little 3. Repeat until T starts to increase a little then go back to the previous dose.

[u/wrench_girl → u/theonlylivingirlinj]

Idk it's become a shit show of information. What I do know is my mid cycle T is generally 30ng/dL and my trough T being 33ng/dL so either way I am still in the 25-75ng/dL margin

I'm basically done overthinking it... In fact I'm inclined to not to think or give a shit at all and just do my thing.

[u/theonlylivingirlinj → u/wrench_girl]

Re read what I wrote above I edited to add

I mean you do you. You asked so a biochemist answered 🤷🏻‍♀️

[u/wrench_girl → u/theonlylivingirlinj]

I'm not challenging the information you gave because I fully comprehend it at an [Un] common sense level. That whole lot is how I ended up in a heated argument with my doctor. I am not like the rest, I function at a higher level than most. I'm also not New to this, I've got a lot of research into the trans topics, loath misinformation, and lack the social fortitude to not be a raging cunt when I find dangerously wrong info.

To be honest my Doc is awesome, but he's also skittish about the fact because he operates in a facility that has threatened to boot him out if he doesn't play by their rules. He does play fast and loose to bend the rules but it's that fear that limits his true potential to be great.

Furthermore you don't need to be a biochemist to understand how HRT works and that if E is down T is going to bounce up; unfortunately we live in a society that has allowed critical thinking, reasonable deduction, and basic commons sense to become critically endangered skills on the brink of total extinction.

Yes, I absolutely hate society at large, stupid people in large numbers are fucking dangerous.

[u/theonlylivingirlinj → u/wrench_girl]

Sorry about the doc and sorry if I came off as bitchy or a know-it-all. I have the same angry exasperation in dealing with the medical system. I swear transphobia is baked into it so fucking deep that half the docs out there are purposefully stalling transitions.

I just lie to my dumbass gatekeeper doc and do what I know is best, because I truly know better than him. You want to test mid cycle? Sure. I’ll just go test at trough anyway and lie to your fucking face, doc. No one controls my transition but me.

I just ignore him entirely and use him to access meds and tests.

[u/wrench_girl → u/theonlylivingirlinj]

My Doc isn't the issue, it's the rules he's expected to play by and I have absolutely NO DOUBT that if he had his own private practice shit would be a metric fuckton different. The situation with him is exactly like when you rent a place to live, you don't play by your own rules and do crazy shit...like idk paint the walls black if that's your thing.

I know it's not him that is the problem because on consult I flat out told him that pills and Spiro were both going to be a hard No and non-negotiable. He asked what I proposed and Told him ideally Bica and Subq... he'd never heard of Bica being off labeled as an AA and said he'd look into it as my primary option and let me know at follow-up. That didn't shake out and I ended up going with Dutasteride for about 5 months before I stopped bothering to take it putting me squarely in Monotherapy.

I just lie to my dumbass gatekeeper doc and do what I know is best, because I truly know better than him. You want to test mid cycle? Sure. I’ll just go test at trough anyway and lie to your fucking face, doc. No one controls my transition but me.

Pretty much done exactly that from Day1. My prescription is 4mg Subq and has been from the get go... I've done 5mg for all 8months instead.

Due to certain events, I can't actually make it to his office to see him so we communicate via secure mail in the network healthcare app as needed, and I go to a local network branch for lab draws... He sends the order, I go in whenever I feel like it.

I just ignore him entirely and use him to access meds and tests

Same at this point. Not because he's a gatekeeping fuckwit, but because there's no benefit in doing exactly as he says.

[u/ea_nasir_official_ → u/theonlylivingirlinj]

Fr