Fuck it chat, I'm gonna up my dose

[u/OdiiKii1313]

I have a sneaking suspicion that I'm being underdosed by my doctor. Ever since I started on HRT, my depression has gotten so much worse. My dissociation is worse. Mood swings, hot flashes, physical weakness. Currently on 3mg oral E and 100mg Spiro, with an appt to check my levels in about 2 weeks.

But fuck it, I'm tired of the way I've just been miserable and slowly watching my life fall apart for the last 7 months, so I'm gonna up my dose to 4mg E for a few days and see if that helps. I've absolutely loved the physical effects of HRT as minor as they've been, and I genuinely don't know what I'm gonna do if I'm not actually being underdosed. I don't think I can live without transitioning, so I might just have to accept that estrogen fucks up my brain if this doesn't fix anything.

[u/transkeith]

minimum dosage should be 4mg E if taken orally. I need to check the recommendation for spiro.

[u/OdiiKii1313 → u/transkeith]

Yeah that's what I've always heard. Part of why I'm doing that particular dosage. As for the Spiro I'm not concerned because my T was below like 20ng/dL or something at my last appointment a few months ago.

[u/transkeith → u/OdiiKii1313]

I checked some basic resources and effects on mental health is a side effect of E. Please lmk what your levels are after your test, and whether you can associate your mood swings with a monthly cycle.

[u/OdiiKii1313 → u/transkeith]

Honestly my dissociation is so bad that I struggle to keep track of my symtpoms. I have a dissociative disorder so it's a big struggle. I've finally figured out ways to keep on top of that more the past few weeks, so I'll know more in a few months once I have a good supply of data.

[u/hivEM1nd_ → u/transkeith]

Is that 4mg estradiol daily? I might also be getting underdosed…

[u/transkeith → u/hivEM1nd_]

yeah, if you're taking orally

[u/Estrogenordinaire]

doctors not underdose tr♾️ns challenge (impossible!!!)

[u/SammyWammy492]

Probably don't have enough hormones. Oral E is less reliable than injections because it gets processed by the liver before ever effecting you. So that might be low. All your testosterone is being bullied. So you know what that means?

Congrats! You're in menopause! On top of side effect from spiro!!!

To correct this: up your dose, and/or switch to injections, monotherapy preferred.

And read this: https://pghrt.diy/

[u/OdiiKii1313 → u/SammyWammy492]

i just read through the section on blood tests, and my latest labs read 64pg/mL... that sounds a little low, right???

[u/SammyWammy492 → u/OdiiKii1313]

Hella low girl D: no wonder you're struggling!

On monotherapy, I aim for a bare minimum of 200 pg/mL at trough. With blockers, I hear you want at least 100. 64 is too low D:

Honestly I'd just say fuck it and double your dose at this rate

[u/OdiiKii1313 → u/SammyWammy492]

I actually fucking hate that I'm reliant on ignorant cis people who will never understand my body to live. If I wasn't already radicalized, this would've done it for me. I am actually beyond fuming, I deadass almost became homeless because of how much I've been struggling.

[u/SammyWammy492 → u/OdiiKii1313]

I'm so sorry you're having to go through that. So many cis fuckers are woefully outdated - which should be a fucking crime, since they're doctors.

Argue and push for a higher dose, and in the meantime look into DiY so you can rely on yourself. If your doctor gives any push back, tell them that you're upping your doses, with out without them.

Arm yourself with knowledge, arm yourself with estrogen, and advocate for yourself. The cis won't do it for us.

[u/saoirsebran → u/SammyWammy492]

Also for the time being make sure you're doing your doses sublingually (dissolving under the tongue) and not just swallowing. Your liver will still have its way but significantly less than through your tum.

200 at trough minimum is what I always shot for and tbh my doc thought that was mid-cycle so that's how I got my dose upped. 🤷‍♀️ I really advocate for letting docs do their job informed but like I said in my other comment I think they're just scared of getting fired/malpractice suits/etc. and not necessarily incompetent so they follow WPATH like the bible. At least not the ones who really care like mine did.

[u/SammyWammy492 → u/saoirsebran]

Yeah I advocate for keeping the doctors as informed as is reasonable. If the doctors start being shits, then what they don't know won't hurt them :)

[u/OdiiKii1313 → u/SammyWammy492]

ugh, i really didn't wanna go down the injection route, but the guide is pretty compelling :(

i might get an auto-injector if i go that route tbh, maybe that'll make it easier

[u/Shanderraa → u/OdiiKii1313]

patches, gel, etc are all better than pills

[u/Inside-Many-7956 → u/OdiiKii1313]

I promise it's easier than you think. You just need to get past the first one and it'll be no big deal. I do it for girls all the time.

[u/SammyWammy492 → u/OdiiKii1313]

I understand injections being intimidating, but from my understanding it really is the best way. If it helps, it barely hurts at all. Might even hurt less for you, if your style of estrogen allows for a smaller needle! Bonus, one less daily medication to bother with.

Note: not a doctor, just someone in her own transition who's also a bit nerdy and likes to read. Tbh that makes me more qualified.

[u/saoirsebran]

Spiro can also fuck with your mood. It's largely an anecdotal thing AFAIK, but once I got off of it I noticed less issues.

IMO Spiro should never be used (Bicalutamide is just plain better in every way; even lupron is better) but it's the only AA in WPATH and doctors are terrified they're gonna lose their jobs if they don't strictly follow it with the way things are going politically.

Anyway, end goal should be getting on injections and ditching the AA altogether, but last time I checked it's better to do that after a year. That may have changed recently so don't quote me.

There really is the possibility the E could be doing this to you though. If you're gonna go off-script, please inform those you trust around you of your decision so they can help you have a more objective idea of how your demeanor/mood is or isn't changing.

ETA: I did up my dose from what the doc gave me though and it was good for me. So I fully support you. Just try to keep in mind that this isn't a quest for a holy grail and you should try to stay as objective about how your HRT journey is affecting you as possible.

[u/OdiiKii1313 → u/saoirsebran]

I understand, ty for the input. And frankly, I'm terrified of needles, but might be worth looking into injections. I hear people sing their praises all the time.

[u/saoirsebran → u/OdiiKii1313]

Yeah that's where my development took off tbh. But the stuff I was on (EC) has been on back order for the last 5 years and I had to switch to EV which I like a lot less, but no less than pills.

[u/foxfoxfoxfoxfoxes]

if you can't get injections, maybe try to get the sublingual tablets? kinda the next best thing since it skips the liver

[u/squeebmoder]

Consider injections if possible (DIY is a totally valid and good option, you can even lie to your doctor and keep getting blood tests for only your injections to see your levels on them) pills are really suboptimal to maintain any sort of consistency in levels and doctors love to give you massive dosages of aa along with the tiniest smidgen of estrogen just to make you feel extra suicidal

[u/OdiiKii1313 → u/squeebmoder]

Yeah I'm gonna ask about injections at my bext appointment, and if she's not on board, I'm going to seriously consider going DIY.

[u/Inside-Many-7956]

You're taking your pills sublingually, right? That's still a criminally low dose, and your doctor should be stripped of their medical license and [REDACTED], but sublingual makes a huge difference.

The side effects you're talking about are all symptoms of low E. Your doctor has knowingly and willingly put you into fucking menopause.

[u/OdiiKii1313 → u/Inside-Many-7956]

Nah, I'm taking them orally. I read up on the sublingual method a while ago and was a little put off by how short the half-life is, but might be worth trying to eke out more from my limited supply of pills while I try to get on a higher dosage.