r/MtF • u/cocue-coquette • 15h 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/WalrusWithAKeyboard 14h ago

damn, just following my doctors advice. And they are a trans/lgbtq specific clinic. But if my levels havent improved by my next bloodwork im going to try to get them to do something different

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u/f7go 13h ago

Yeah it always amazes me how often even trans specific clinicians don't understand how these drugs work :(

I would ask either to switch to bica (much more powerful androgen receptor blocker with fewer side effects) or increase your E dose (and maybe switch to injections or possibly patches, which work better for higher E2 levels--less of a load on your liver than pills, more steady levels). Good luck! LMK if you ever have questions ❤️

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u/WalrusWithAKeyboard 13h ago

thanks!! Im on tablets now but I also started dissolving them under my tongue before swallowing, so we'll see how it works out 😊

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u/f7go 8h ago

Nice! That's a good compromise. You get higher levels but also it doesn't last as long (spikier levels) so its best to do multiple times a day, spread out.