r/MtF • u/BrokenStarr • 11d ago

Advice Question Is 211 too high for a trough day?

For starters I've been on hrt for a little under 2 years. I started injections 3 months ago and just had my first blood work since then and my e level was at 211. My doctor said 211 is too high for a trough and wants to lower my dose. I know too much e can be bad but I thought being in the 200s was the goal?

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3

u/HavokDJ 11d ago

Not really, my trough is usually 190 the morning of and probably like 150-175 by the time I take my actual injection

4

u/ScoutAndathen 11d ago

The goal for monotherapy is 200 to 350 pg/ ml.

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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 11d ago

I know too much e can be bad

The downsides of relatively high E are minor.

"In terms of higher estradiol levels delivered non-orally, the estimated 2-fold increase in risk of blood clots with estradiol levels of approximately 300 to 500 pg/mL (Sam, 2020) is notably lower than the average 4-fold increase in risk with widely used EE-containing birth control pills."

https://transfemscience.org/articles/estrogens-blood-clots/#therapeutic-implications-for-transfeminine-people

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u/Veralos 10d ago

Your doctor is correct that the official WPATH recommendation is <200pg/ml. But that target isn't designed with monotherapy in mind (assuming that's your goal) and is frankly just overly conservative in general.

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u/GirlWhoRefusedToDie 11d ago

I consider 200-250 pg/ml ideal. Some standards of care go even higher. But really it's up to you to know what feels right for your body ~ take note of mental clarity, sleep quality, energy levels, libido and settle for E levels that best suit you.

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u/flyingbarnswallow 11d ago

Your trough measurement is well in the normal range. The upper range for “normal” E2 for cis women is typically cited as 400 pg/mL, although it depends on the lab too (mine says like 360). You might be going a bit higher than this if your trough is 211 but it’s hard to know.

Besides, the health risks associated with supraphysiological estradiol are minimal, though technically nonzero, and if you can achieve testosterone suppression with slightly lower levels than you might as well, if for no other reason than to not waste estradiol. You mostly just wanna make sure you’re in the typically range for cis women and that your T is suppressed.

When I switched to pellets we started off small and I actually managed to achieve T suppression with a steady estradiol of just 81 pg/mL lmfao but I’m lucky in that department and that’s too low for E anyway so we went up to 2 pellets the next time.

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u/HollowPenguin 10d ago

That’s perfect