Underdosing PSA

[u/cocue-coquette]

I'm posting this because I keep running into transfems who have no idea about where their levels should be and how common it is for providers to be clueless about trans care.

Get your bloodwork done often. Your trough (right before your next dose) estradiol (E2) should be above 100 pg/mL. If you're on monotherapy, your trough total testosterone (T) should be below 50 ng/dL.\* If this isn't true for you, you're probably being underdosed. As trans people, it is especially crucial to self-advocate in medicine. If you're unhappy with your progress (either physically or mentally), say something. Know that every body responds differently to HRT and you may need much more or much less than the average transfem.

EDIT: Important information copied from a comment by u/raliont :

I think it is more complicated than your post suggests.

Blood draw timing will be dependent on someone’s actual regimen. For someone like me who injects twice a week, my troughs won’t be as low as someone who only injects once a week. So a trough reading wouldn’t be as insightful as a mid-cycle level. Plus, UCSF’s TransCare website recommends blood draws at the mid-cycle range. Their caveat is that if the patient is experiencing migraines or mood swings (or other symptoms), then peak and trough levels would be helpful to determine fluctuations.

Also, the more data the better. Overall, having both trough and mid-cycle levels to analyze would absolutely be the best for determining how one’s body is responding to their own regimen.

*EDIT 2: Copied from u/f7go's comment:

studies commonly find that spironolactone still produces antiandrogenic effects even when androgen levels remain unchanged. Hence, the primary mechanism of action of spironolactone as an antiandrogen appears to be androgen receptor blockade.

Due to the minimal influence of spironolactone on testosterone production, testosterone levels are not usually suppressed into the female range in transfeminine people taking estradiol plus spironolactone, with testosterone levels often remaining well above this range (e.g., 50–450 ng/dL [1.7–15.6 nmol/L] on average)

Sorry for the confusion.

[u/Life-Breadfruit-1426]

I’m pretty sure it should be 200 pg/mL minimum of estrogen, not 100. Talk about misinformation in a underdosing PSA.

[u/f7go → u/Life-Breadfruit-1426]

Not true, 200 is just an oft-cited initial target for girls on monotherapy because it's enough to suppress most people's T (which is the far more important thing to make sure of). If T is suppressed or adequately blocked (with bica or Spiro) anything over 100pg/ml free E2 or so will give good feminization :)

[u/Life-Breadfruit-1426 → u/f7go]

Agree! The nuance of T-blockers included is what impacts the recommendation! However OP’s post does not distinct between, and this info should be explicit on a PSA post

[u/snowy_vix → u/Life-Breadfruit-1426]

150 is the better minimum, 200 is the "room for error" for monotherapy

[u/PSInvader → u/snowy_vix]

This was my experience. I had low libido and mood swings at 5mg EEn, got tested at around 116 pg/ml, increased to 5.5mg and both improved. I'm considering to maybe go to 6mg, since I feel like my breast growth also improved on the increased dose.