Hi all,

First of all I'd like to really thank everyone for their info, it really helps to have something to read to compare.

I think after reading up everything, that the ranges given were most likely male ranges

Though I was confused as well, by the seeming mis-match between the Testosterone and Estrogen ranges, and the comparative results.

Mine I guess is something of a unique situation in that the Hormones are being prescribed by my local psych, and before I've had my assessment at Claybrook.

As the local Helath Comission had refused to fuind an assessment, my local psych in liaison with PFC and also Sheffield GIC, took the responsibility of arranging the hormone treatment.

So it was arranged that I would have blood tests via my GP, and that the results would then be passed to my local psych, who I guess is then in contact with Sheffield GIC to check the details and adjust doseages accordingly.

The problem is that whenever I go to see my GP to get the form for the Path lab, I always end up seeing a different GP who isn't aware of which tests to ask for, so I always end up having to tell them what to ask for.

I normally take a copy of the guidelines with me which details the required tests.

I've asked my GP to send me a copy of the results, but they are being awkward and using the Data Protection Act saying that they can't send them out... that they've got to be collected in person, which is difficult for me as I am also disabled at the moment after fracturing my spine, (Long story..!!)

I really want to see the results myself so that I can see the units etc... as I feel there will be benefit to be gained in the short term from seeing and knowing about the chages in the blood levels etc, whilst still waiting to see/feel more physical changes in the long term....kind of a - good to know that something is happening type of thing.

I'm not sure at the moment wether its pg/ml or ng/dl that they are using, so trying to look up info on the results is difficult at the moment as well, I was concerned when the GP told me the results as he said that in his opinion nothing needed doing which really worried me.

I'm leaning more toward the ranges being male levels as this would make more sense to me, as having only been on the lowest dose of Estradiol for 3 months and no Goserelin as of yet, it would explain why, the E level would be slightly elevated above the normal male range, and that the T level would be unaffected and still be in the normal male range.

But then the other info I get is that the female normal range is as la_glitch says is 24-149, with mine being 167.... Which is kind of a confusing result.....

So its kind of a mixed bag of results, with nothing making any sense to me, and no-one being able to tell me any answers, I spoke to the GP again on the phone to query again the ranges, and asked him again if the nomral ranges were noraml male or normal female, and this time he said "Good question, I don't know, but I presume that as the test had been submitted in your current name - Karen - that the ranges were female values" , so its pure speculation on his part what the ranges reflect....

I'm still wating to start the GnRH agonist ( Goserelin ) as my psych being unfamiliar with it all, wants to take things slowly and wants to get the E levels right first, so the plan is, as I understand it, to start on the lowest dose of Estradiol, then monitor the levels, then increase the dose, monitor etc...until the correct E level is reached, then to start the Goserelin and repeat the process.

What I'm unsure about though is that when the T inhibitor starts woudn't this have an affect on the E level then, as wouldn't the T in my system be countering the estrogen to an extent, so that any E levels gotten now with a normal T level, will be all changed again once the T level is reduced...??

I guess the only person who would be able to answer these kinds of questions would be an endocrinologist, but apparently, there's a 6-10 month waiting list to see an endo where I am, so I'm just going in blind really....

On the postive front I have after a lengthy fight against the Health Commission gotten funding approved, so I'm now waiting to hear from Claybrook Ctr, for an assessment appointment....

It only took 3 years of writing, appealing, appealing the appeal, complaints to numerous health watchdogs, and finally getting a solicitor to commence legal proceedings, which took another 6-7 months of my solicitor trying to get information from the Health Commission.

Oh and I almost forgot about the Information Commissioners Office Tribunal into a complaint I made about Health Commission Wales failing to provide information under the Freedom to Information Act. HCW had said to me and to the ICO that they didn't hold the information and so couldn't provide it, the ICO took it to Tribunal on my behalf, and the Tribunal ruled in my favour and demanded that HCW release the information requested, which they duly did.....

Subsequently HCW at the last minute before Court proceedings were due, contacted my solicitor to say that they had "suddenly" introduced an interim policy of granting 4 cases funding, and that mine was one of the four cases to be approved under "Exceptional Circumstances", though my previous application, internal appeal & external appeal, were all declined on the grounds that I did not meet the criteria for "Exceptional Circumstances", though there's been no change in my circumstances since then other than the pending legal case.

Just go's to show I guess that there really is no point in following the route they lay down in their so called policies, best thing to do is to forget about getting a GP to submit an application for a referral, may as well just get solicitors to do it, and get their notice straight away, or at least make things a bit quicker.

If I had it to do all over again knowing what I now know, I would have gone straight to a solictor after their initial refusal, instead of trying to follow their long drawn out policy of applying, waiting for the refusal, then having to appeal, then wait for the appeal decision, then be told to appeal the appeal, and await that decision.

Talk about the RLT, lol, I think that if after 3 years of fighting for something that if it isn't evident by then that this is something you need to do, then it never will...!!!

Anyway see now, I got up on my high horse, when all I wanted to do was to thank everyone for the info.....I do tend to start to rant on once I get started.....

I'm hopefully going to be getting the copy of the results tomorrow, so will perhaps be in a better position to say what the units are and have a better idea of what is what then.....

Again thanks one and all... and forgive my little rant above, at least I got it off my chest.... lol.

Hugs

Karen

After reading your post Karen, I feel very lucky with the continuity of care i have been receiving. I am still in the very early stages of my journey having only just been refered to my local GIC but i have been visiting my GP for a number of months about my transexualism and some anxiety and agrophobia issues i have and i have seen the same GP every time. She is superb and has been really supportive. I really cant see me having many problems with her.

Hope you dont have to go through all this hasstle every month, i can imagine that if it was me i would have lost my temper very quickly with the situation.

Eric

Hi Eric,

Im really glad to hear that you are getting better care from your GP than I am, its really awful where I am.

I did get the results in the post today, so I've now faxed a copy to my psych so that he can make the necessary changes to my doseages.

The values on the results were pmol/l for the serum oestradiol, and nmol/l for the serum testosterone

so mine were:


Serum Oestradiol

167 pmol/l with a reference range given as ( 28-156 )

Serum Testosterone

18.6 nmol/l with reference range given of ( 9.9 - 27.8 )

So after doing some research on it on the good old internet, it seems that the reference ranges given are male reference ranges, which is a bit odd as theres nothing on the test results to indicate that the sample was a male sample, the test results are in my name, Miss Karen etc..

And theres a bit on the top of the page which says <abnormal>

but its says on the sheet a bit further down:

(Viewed by: BRO)

Which I'm assuming is the person thats carried out the tests, and then where the levels are given theres a bit under each result where it says:

(BRO) - No action, normal

So I can see why the GP would have thought that nothng needed doing.

But its a bit odd how the result says abnormal in one place and yet the testers comments are - no action, normal.

Anyway I'm hoping now that my psych will obviosuly have more info on the correct ranges and levels and will now increase my doseage accordingly.

Waiting to hear now.

If anyone has any more insight into the levels now with the values known, I'd be really glad to hear, as everything I've been able to find so far suggest differnt things, I think that the normal male range for T is the range given on the results so about 9.0 to 27.8, though I've seen some places where its 8 - 38.

So far I've found that the following is what is generally given:

Testosterone

9.9 - 27.8 nmol/l (Male)

0.22 - 2.9 nmol/l (Female)

Oestradiol

55 - 165 pmol/L (Male)

Female levels vary depending on the monthly cycle in natal females:

Early follicular 110- 183 pmol/L

Luteal Phase 550- 845 pmol/L

Ovulatory peak 550- 1650 pmol/L

Post menopausal 73- 200 pmol/L

I'm just wondering if an average level that is used can be worked out from users here reporting on the levels that are regularly seen by them.


I can't seem to find a set value that should be used for m-f transition.

I've read that during puberty/pregnancy that a natal females Oestrogen levels are a lot higher reaching upwards of 2000 - 3000 pmol/L.

So this is what I imagine is generally needed to be the case for m - f trans, i.e. a second puberty hornmonal levels.

As you can tell I've been doing a heck of a lot of reading the last few days, I should maybe have done more of this sooner, but instead had been depending on the Dr's knowing what was best, but I'm becoming more and mre aware that generally GP's and local Docs aren't familiar with the kind of treatments, levels etc that are needed.

I wonder if maybe a new thread could be started for comparing hormone levels doseages, so that there'd be a resource available for people to go and check to see how the different levels and doesages being adminsitered vary from area to area.

Anyone got any thoughts on this....???

Two things:

1) I know the GIC I attend works to a target range of 400 for estrogen. It is probably a little conservative, but I personally have never achieved that yet, and still have experienced suitable changes.

2) GPs know nothing. The level of knowledge among NHS doctors for trans related healthcare is really low, even in the GICs. But GPs, even on non-trans things, are best avoided, and if not, approached assertively. Our GP system, despite what most people think, is a really bad way of providing healthcare, and has basically failed most patients.

_________________
Hellfrozeover be a pirate and a Transgenderzone moderator.

I don't stand under the TG umbrella anymore, it's way too bitchy and crowded in there but it's sunny out here

okay,

i have heard (word of mouth here, so take with a pinch of salt if you may) that CX likes to get you within a range of 400 to 600 pmol/l post-surgery. i don't know what they like to get you in pre-surgery, because nobody seemed too bothered about my actualy blood levels while i was at the clinic. in fact, it seemed to be driven by a standard dose application and only if that doesn't provide the required developmental changes do they revise it (again, word of mouth, but one of my good friends has had her dose upped by 2mgs as she has seen little development and it turned out that her body was just metabolising the standard dose into nothing).

so, the 'standard' dose that i've noticed people get ramped up too, both me and and several other people, has been 6mg estradiol valerate (either climaval or progynova, the difference is purely brand name and the fact that progynova have a nice sugar coating) daily along with goserelin injections.

so, this is a bit of inference here, so don't hold your breath........ but, if you presume that goserelin effectively chemically castrates you then you can presume that being on it provides a similar effect to an orchidectomy. in fact, i know that my T levels are similar now in comparison to what they were before i had surgery (0.8 nmol/l). i don't have my own blood tests to hand pre-surgery, but i can tell you that i'm on the same dose now as i was beforehand. right now my estradiol levels are about 1100 pmol/l, which is probably a bit high to be honest, but i'm presuming that they've been this high for the last one and a half years. of course, i could be wrong on that last statement and, always remember, everybodies bodies process this differently.

on the other hand, these are just numbers. what you need to do is to interpret them in accord with your own bodily changes and how you feel. more estrogen may not neccessarily be a good thing in all cases (i was reading a paper this morning, while trying to find something that may help you, that suggested if you take more estrogen the benefits don't always increase in a linear fashion). you need to balance out how good your development and state of mind is against putting more drugs through your body (not only is it harsher on your liver but your pituatry might not wind up too happy either. you should always aim for the minimum dose that gives you the physical effects you need).

that said, i remember being ramped up in 2mg steps over the course of about nine months (they origionally told me it was going to be six, but i think green was being cautious to due my past as a filthy crossdresser ) and i never had a single estrodial blood test after my baseline was taken (or maybe i did, but it was eaten up by hammersmith hospital). about a few months after going up to 6mgs (i can't remember exactly) i started goserelin (and the fun began in earnest! gah. i actually think i might have been on too much E at that point, but anyway). so, certainly, your current dose is way too low. your GP, from my understanding, should be building you up stepwise right now and simply keeping an eye on your liver function and pituatry hormone levels (and something else, but i forget which, lipids?) to make sure you're not reacting badly and over the next six to eight months you should just be seeing how you go in terms of breast development, general wellbeing, and other changes. if that's not rolling well, then stress about what your estradiol levels say. right now, though, it's far too early to really have a clue how it's going to go (YMMV, after all).

if i manage to dig out that paper i was thinking of (which was a dutch study, i'm sure, looking at endocrinological management, and it banged on about EV and goserelin shots and had a very similar approach to the endo's in CX, which makes me think he was following it's result) i'll ping it your way so you can beat your doc around the head with it. in the meantime, i think you would certainly benefit from an increase in dosage.



p.s. discrepancies in normal ranges are very common. they depend on which lab does it, which lab kit they use, etc. so if you read slightly different normal ranges in different places then don't worry.

HI all,

Thanks for the replies, as usual theres more information and answers available here than there is from the GP/Docs.

Like you Reenie, my GP's tend to have a policy of get you in and out as quickly as possible, even the pleasantries are left out of the way, no .. Hows life ..."what can I do for you today?"

Then as soon as the first words come out yoour mouth, its like they don't let you finish the question, they just assume what it is you want... and cut you off....

Its laughable really, its like when you see people on quiz shows, who half way through hearing the question think they know the answer and buzz in to answer.......then the quiz host says, "OOhhh so sorry, thats wrong you just lost the £64,000, if you had only waited to hear the full question, the answer is...."

I get this all the time with my GP's, I have a few problems, physically with my back, along with the Trans issues.

So when I go to see him/her, whoever I end up seeing, I've taken up the position now that no matter what happens when I get in that room, I'm not going to be rushed out the door, I'm going to sit and take all the time in the world to make sure I get the answers to my questions, though I think this approach is what has made them get a bit antsy towards me.....

But I feel that if I have to wait 3-4 weeks to get an appointment with a GP then the least they can do is take the time to listen to the problems.

I'm just guessing here but they probably feel just as frustrated by the way they have to work..... at least I would hope so anyway.

Anyway gettng back to the bloods, thanks La_Glitch, if you can turn up that paper I would really appreciate getting it, I've found a couple of things online myself, but nothing that go's into specifics.

So I'm going to chase up the doc now to get the doseage upped a bit, I know they do it gradually, so as to reduce the thrombo risks, but at the current rate of 1mg every 3 months its going to take 18 months to get up to 6mg, before they'll start the goserelin, so I think I'm going to have to start getting on their backs again.

I'm having other problems with them with my spinal problems as well, its almost as if they can't get past the Gender dysphoria issue and deal with the spinal problems.

And well because of the way I am, I wonder at times if I'm reading too much into things, or whether its just the NHS...!!

But as an example, when I was first admitted to hospital with my fractured spine, it was before I was openly Karen, and so to them at the time I was average Joe Bloggs, so anyway, they operated on my spine inserted pins and rods, and also diagnosed me with a curvature of the spine which was congenital, so said that I would need future surgrey to correct it, as it was pushing my upper back forwards.

So anyway 9-months later when I go back to have the fractuere and the pins checked out, I was openly presenting as Karen, and had notified them in writing beforehand including a letter from my psych to validate the seriousness of the situation, but this time when I see the orthopeadic consultant this time and ask about the curvature of the spine and what needs to be done about it, he says this time, "oh its all looking normal now theres nothing to worry about", even though all the physical syptoms are to the contrary.

So this "Congenital - i.e. since birth" problem with my spine has remarkably dissappeared now when I present as Karen....????

I'vr got very little faith in the medical profession, at a time when I find myself having to place my life and future in their hands..... its really tough at times... just knowing who to trust and who not to...!!! And then questioning my sanity at the same time, wondering if I'm being paranoid etc....

Anyway todays rant over... .lol..

Thanks again for the replies.

Karen

You're not being paranoid, Karen. I know of another who has said much the same about the services in your area after a similarly testing experience.

I admire your fighting spirit. You've got some serious bottle.

okay, this is a start. it's not the one i'm thinking of, but it highlights the 'standard' dose i was talking about and avarage sex-hormone blood measurements from a sample of transwomen.

Horm Metab Res 2006; 38: 183-187
DOI: 10.1055/s-2006-925198
Effects on the Male Endocrine System of Long-term Treatment with Gonadotropin-releasing Hormone Agonists and Estrogens in Male-to-Female Transsexuals

A. Mueller1, H. Binder1, S. Cupisti1, I. Hoffmann1, M. W. Beckmann1, R. Dittrich1
1 Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany

Abstract
We studied hormonal changes resulting from long-term treatment with gonadotropin-releasing hormone agonist and 17β estradiol valerate in 40 healthy middle-aged male-to-female transsexuals over a period of two years. All of the participants received injections of 3.8 mg goserelin acetate every four weeks in combination with 6 mg oral 17β estradiol valerate per day for cross-sex hormone treatment for male-to-female transsexuals. There was a significant reduction in the levels of serum luteinizing hormone and follicle-stimulating hormone to the hypogonadal stage. Mean testosterone levels decreased by 97 % to 0.52 and 0.59 nmol/l after 12 months and 24 months, respectively. There was a significant reduction in dehydroepiandrosterone sulfate by 37 % after 12 months and 43 % after 24 months, and androstendione by 29 % after 12 months and 27 % after 24 months, respectively. Cortisol levels were reduced by 43 % and 50 %, respectively. Estrogen levels were significantly increased from 77.51 to 677 after 12 months and 661 pmol/l after 24 months. Sex hormone-binding globulin and corticoid-binding globulin levels were significantly increased after 12 and 24 months. There was a significant decrease in all measured androgen fractions and cortisol during long-term treatment with gonadotropin-releasing hormone agonist and 17β estradiol valerate. Apart from suppression of testicular hormone production, one possible interpretation is that treatment with long-term gonadotropin-releasing hormone agonist and 17β estradiol valerate influences adrenal hormone levels in healthy middle-aged male-to-female transsexuals. Cortisol serum levels may be decreased due to estrogen-induced increase in corticoid-binding globulin.

Key words
Transsexuals - GnRH analogues - estrogen - adrenal hormones - testis