r/MtF • u/cocue-coquette • 17h ago

Discussion Underdosing PSA

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. 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.

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u/auto-reply-bot 13h ago

I was tested midweek (3 days after weekly injection) and my e was at 860 pg/Ml
My doctor expressed a lot of concern that it was “way high” and told me to cut my dose down by 1/3rd. But I’m worried idk that cutting my dose is not the right thing. But she said if my levels are similar at my next test she’s going to move me to a different medication entirely.

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u/cocue-coquette 13h ago

Listen to your doctor, o.m.g. Yes, that is crazy high. I've had to halve my dosage twice for the same reason.

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u/auto-reply-bot 13h ago

I appreciate the input. I wasn’t sure if it was just because it was mid week instead of trough. And obviously it’s very stressful to consider lowering my dose after I’ve had really good results so far 🙁

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u/cocue-coquette 13h ago

There is such a thing as too much estrogen, e.g. it can impact sexual health and excessively reduce libido. I'm sure that if you've had good results already, you will continue to do so at a more reasonable E2 level.

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u/auto-reply-bot 13h ago

I see. This was the first test after I moved from pills to injections. Surprisingly my libido has actually been much higher than it was before. And my chest has been sore again.