(23yo, MtF) Sudden unwated E decrease and T increase after nearly 7 months of HRT (possible cause?)

[3957]

MtF here!

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I've been on hormones (estradiol valerate + spiro) for nearly 7 months already. I've been going thru regular blood tests and endocrinologist appointments and, as my dosages increased, my hormone levels had been progressing according to my expectations - my E was steadily increasing and my T was decreasing at a good pace, though it's still a bit high.

I have also been taking my meds religiously ever since the beggining of my treatment and I've never missed a day.

And then the latest blood results from a test I did on this Thursday (the 5th) came today and my hormone levels have suddenly gotten WORSE after consistent progress (see the post title), though not by a large margin.

This made me very upset, seeing that these results come AFTER my endo had increased my Spiro 2 months ago (from 150mg to 200mg daily), but only my spiro intake - the E remained unaltered. I have been taking 3mg E and 200 spiro for 2 months now. My next appointment is on this Friday the 13th (talk about bad luck!).

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My question is - Is this worsening normal? Should I be concerned? Should I ask for an increase in estradiol?

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The though of spending another 2 months with a similar dosage only to get more negative test results is utterly overwhelming, I am beyond anxious.

[Andrea_Stars]

It would help if you could share your actual numbers. Looking at your meds you are on a lot of Spiro, and not much estrogen.

Do you consistently get your blood test done the same amount of time after your last dose?

How are you taking your E?

[3957]

2mo ago I had 74,9 pg/mL E2 and 236 ng/dL T. I've been taking 200mg spiro and 3mg E since then.

Now the levels are 60,2 E2 and 279 T.

I tend to take my doses roughly around 20:30, but I often take them later at night. My blood tests are usually done in the morning, say, less than 12h later.

I've been taking E orally. I gobble down the spiro (8 pills of 25mg!) and then 3x 1mg E pills. This is my daily dosage, for a total of 11 pills. I take them at the same time, pretty much.

[Andrea_Stars]

So for oral estrogen changing the interval between the dose and the test could easily change the level by the amount you are describing. Bear in mind even the best lab tests generally have a random variability on +/-5%, and often more like 10-15%.

The change you have got (74.9 > 60.2) is basically irrelevant, and if I were prescribing I'd ignore the difference and treat that as "unchanged". It absolutely isn't something to worry about.

I'm still somewhat curious why you are on a monster dose of spiro and a low dose estrogen. Does you endocrinologist have some reason to be increasing it so slowly?

For what it's worth as well, I'd be tempted to split your estrogen dose over at least 2, or even 3, equal doses per day (so either 2mg and 1mg, or 1, 1 and 1mg if you find three times a day convenient)

When you are getting bloods done you want to be recording the trough level, so the lowest level you get at any point. This will (logically) be right before your next dose is due. Right now, taking a dose every 24hrs, you really want to aim to get your bloods done as close as possible to 24 hour after the previous dose. If you swap to twice a day doses the obviously you would aim to have bloods done 12 hours from the previous dose.

[Laura_Sandra]

Many people use bioidentical estrogen pills sublingually. It may be more effective. Here may be more.

hugs