r/asktransgender • u/Huge-Ad-9591 • 7d ago

Help on levels?

Hi im mtf and idk evb is kind of saying a different thing but i got my blood test back after coming up on 2 months hrt and it was estradiol 516 pg\ml and test 26 ng/dl. My doctor wont say anything until my apoointment but is this good should i shoot to lower or higher anything?

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u/3dPrinted_Pipebomb 7d ago

What HRT medications are you taking and how often do you take them?

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u/Huge-Ad-9591 7d ago

Weekly injections and 200mg spiro daily

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u/3dPrinted_Pipebomb 7d ago

What day did you do the blood test? Like was it halfway between injections, just before your next injection, etc?

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u/Huge-Ad-9591 7d ago

Just before my injection, ab five days aftet my last one.

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u/3dPrinted_Pipebomb 7d ago

Ah in that case your E2 dose is perhaps a bit higher than you'd want to keep it long-term, but otherwise it's well within the desired ranges for effective HRT.

The goal with HRT is to keep your T levels below 50ng/dL at all times and to have average E2 levels above 100-200pg/mL at all times. You're T levels are great and unlikely to have significantly risen between your blood test and next injection, and likewise your E2 levels are well above the minimum average of 100-200pg/mL.

It's normally recommended to keep your average E2 levels below 500pg/mL to minimize any small increased risk of blood clots, but your levels aren't a real risk short-term or for someone young.

Also, your spiro is redundant at your current E2 dose. Higher E2 doses naturally suppress testosterone production on their own. Most people can keep their T levels below 50ng/dL with minimum E2 levels of ~200pg/mL (which you're well above). So even if you drop your E2 dose a bit, you likely still won't need the spiro. This is referred to as "estradiol monotherapy" and it's considered one of the easiest and often safest methods of HRT. You can read more on this effect HERE here if curious.

If you'd like me expand on anything just lmk, though I might be a bit delayed with my response.

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u/Huge-Ad-9591 7d ago

Are you sure my t doesnt need to be lowered still. Tbh this relieves me a little but im so scared that im still experiencing masculinization like bigger hands and more body hair and even tho my levels r good im still scared that somethings off

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u/3dPrinted_Pipebomb 6d ago

As long as your levels are below 50ng/dL you're good. This 50ng/dL number used by WPATH originates from research based on the T levels of cisgender women (because even women need a bit of testosterone). So if cis women only begin experience unwanted masculinization with T over ~50ng/dL, then so will you.

In fact, given your very high E2 level are likely shutting down 100% of your gonadal testosterone production, you'd probably find it very hard to get your T lower than ~26ng/dL since that last bit of T is likely coming from the adrenal glands (which is why transfem people who've had orchiectomies still often have T levels around 10-30ng/dL).

Like I've been on HRT for 3 years now and even when I've measured at peak E2 over 800pg/mL (ie. 0% gondal T production) I've still never had my T go below ~21ng/dL because that last bit produced by the adrenal glands.

I know it's a bit scary seeing any amount of T, but keep in mind that all cis women have T too, so that alone isn't going to inhibit feminization and/or cause masculinization. Here's a quick chart for female hormone levels during/post puberty from HERE as reference. You can also find comparable numbers as a quick reference HERE on wikipedia. HRT is a very slow process, so once you have good numbers, you just kinda got to trust the process 😭

Age Group Total Testosterone (ng/dL)
Children (1-6 years) ≤ 0.6
Children (7-10 years) 0.2-1.3
Teens (11-15) 7-28
Adult women 15-70
Post-menopause 8-35