sublingual + high level might just be the timing: you did your test during a peak. sublingual peaks can fall rather fast, though. i would recommend patches or injection for monotherapy.
this post was submitted on 07 Jan 2025
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Adding Progesterone can help get the Testosterone levels down considerably without adding Estrogen. The administration route doss matter a lot. You just need to decide if it's too early to start. I attached a screenshot of my own levels and what I was taking at each point. Keep in mind the top graph is log scale and these are just my personal results.
Edit: There are no units listed because this was for me to show my doctor asking with my labs and not for the Internet. The important thing is how the levels changed. Estradiol Valerate strength was 5mg/mL.
You don't generally do monotherapy by oral route, you would switch to injections. Monotherapy with injections is pretty safe, they shouldn't be worried about large doses unless it's oral.
Your estrogen was surprisingly high pre-HRT, have you tested for intersex conditions?
I've successfully reproduced. A friend who took a class on the subject said that I wouldn't have been able to if I was intersex.
There are so many intersex conditions and not all of them prevent fertility. Having successfully reproduced might help narrow the diagnostics, though!
EDIT:
https://www.advocate.com/commentary/2019/10/26/8-misconceptions-myths-about-being-intersex-debunked
myth #6:
6. Intersex people can't have sex, get pregnant, or have children.
Many intersex variations include mostly typical internal reproductive anatomy. Everyone is different. There are intersex people who can have periods and carry children, and intersex people who can produce sperm. There are some who can't. There are intersex people who find out they have both ovarian and testicular tissue after having given birth.
Sex development is so complicated.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2190741/
We report herein a remarkable family in which the mother of a woman with 46,XY complete gonadal dysgenesis was found to have a 46,XY karyotype in peripheral lymphocytes, mosaicism in cultured skin fibroblasts (80% 46,XY and 20% 45,X) and a predominantly 46,XY karyotype in the ovary (93% 46,XY and 6% 45,X).
This is a first great comment, welcome to Lemmy!! 💝
Thanks. I've been on .world for awhile, recently decided to switch to sh.itjust.works.
Ah, in that case, congrats on the switch! 😅
Your levels are already too high for monotherapy. 250-300 is more than enough. Higher levels don't produce better or faster results.
In my experience it was more like I needed to maintain a minimum of 300 to get adequate suppression, not everyone responds equally and the monotherapy dose required for adequate suppression varies somewhat:
... studies in cisgender men and transfeminine people have found that estradiol levels of around 200 pg/mL (734 pmol/L) suppress testosterone levels by about 90% on average (to ~50 ng/dL [1.7 nmol/L]), while estradiol levels of around 500 pg/mL (1,840 pmol/L) suppress testosterone levels by about 95% on average (to ~20–30 ng/dL [0.7–1.0 nmol/L]) (Gooren et al., 1984 [Graph]; Herndon et al., 2023 [Discussion]; Wiki; Graphs).
In one large study in transfeminine people, the rates of adequate testosterone suppression (to testosterone levels of <50 ng/dL or <1.7 nmol/L) were 24% of individuals at estradiol levels of <100 pg/mL (367 pmol/L), 58% at 100 to 200 pg/mL (367–734 pmol/L), and 77% at >200 pg/mL (>734 pmol/L) (Krishnamurthy et al., 2023).
from https://transfemscience.org/articles/transfem-intro/#gonadal-suppression
More relevant, however, is the fact that the testosterone is still at those levels indicates it's not suppressed, esp. since they've been on that dose for three months. Probably because it's an oral route the blood levels are just spiking when she got blood work done, but not remaining consistently that high throughout the day.
I did not take my daily dose until after my blood was drawn. Blood draw was already 24+ hours since last oral dose.
Even so, that snapshot is probably not accurate to your blood levels most of the time, since such high E should thoroughly suppress T production if it were consistently that high. There are probably still periods where your E drops enough for T production to be happening, the other main way to explain such high T is that maybe there was an error / inaccuracy in the labs. My endo shared that he is particular about which lab does the blood work and that it makes a big difference in the accuracy.
Besides your blood labs, have you noticed physiological changes that might indicate T suppression or lack thereof?
EDIT: I know a transfem IRL who after 3 mo. of oral estrogen had blood levels around 340 pg / mL and T around 95 ng / dL - so this isn't the first time I've seen something similar (adequately high estrogen, but not fully suppressed testosterone).
It's hard because I started with injections, not oral, so my own experience was that T was immediately suppressed. My T was 305 pre-HRT and E was 30. After 2 months my T was 23 and E was 325. That was with a variable dose schedule, but averaging around 5 - 7 mg per week (usually split up into every 5 days or every 3 days during that time).
The only physiological change I've noticed is my areolas having pain when bumped. Have not noticed anything indicating T suppression.
Will be curious to see how this progresses - keep us posted! 😊
Not doing monotherapy, but my doctor wants me to lower my dose because my level is over 300 5 days after injection. How long did you pause treatment before your blood work? Not sure what the equivalent for sublingual is given how spikey it tends to be.
Also, are oral prescriptions over 6mg/day common? I thought at that point, usually people are expected to try a different route.
I have an 8mg oral prescription lol
...But that's because I'm stockpiling it
Gotta love doctors trying to help people out like that. My doctor tried to request that I get 3 months supply of oil instead of 1-month-at-a-time for the first time this last appointment, and I suspect it was because politics rather than convenience (unfortunately insurance said no). At least injectables are easy to stockpile if you are willing to use the vial for more than 4 doses
I did not take my daily dose until after my blood was drawn. Blood draw was already 24+ hours since last oral dose.