Mix, Shake, Repeat ... (or the Trials of Tests)

Over the last 6.5 years, it seems I’ve had every sort of blood test result. T too high, T too low, E too high, E too low, E&T BOTH too high or too low at the same time! Potassium over limits from Spiro AND sodium low (go figure). And always a watchful eye on liver-related results, of course.

The latest is a good example. T was in the tank (excellent!). E was sky-high, about 2x target levels. Some might find that a Good Thing. I didn’t for a variety of reasons I won’t dive into here. The point of the moment is that my doctor immediately reacted by wanting to cut my estradiol dosage. Not that! We finally agreed to re-test in 3 months. I had the draw done recently, and levels were spot on target.

What changed? Well, blood tests - especially hormones tests - have to be managed carefully, it seems. Hormone levels can be tested in a number of ways, plus they can be exquisitely sensitive to both hydration level as well as timing, including both the draw time vs taking HRT meds AND elapsed time between the draw and actual test. (There are high precision tests, but they’re more involved, more expensive, and aren’t often used.)

My former doctor was trans, had a ton of trans patients, and was intimately familiar with the vagaries of hormones testing in the HRT context. My current doctor, while really, really good, has limited experience with trans patients. Interested and eager to learn, but less knowledgeable nonetheless.

What *I* knew with the 1st test was that I took my prescribed 2x/daily E dosage and 2x/daily Spiro dosage in SINGLE doses at bedtime and that I went to bed fairly late. I also had a fasting blood test for cholesterol that day and wasn’t (as usual) paying enough attention to drinking water, so was a little dehydrated (the Spiro didn’t help, naturally). I simply wasn’t thinking as a spike in levels of this sort wouldn’t have fazed my prior doctor.

For the repeat test (also fasting), I took my E and Spiro doses “properly” the day before - one dose each in the morning, one in the evening. And I drank a ton of water. Felt like it, anyway. I also was careful with my diet for a few days prior. The draw and tests were run the same day. This time hormones levels, again, were perfect. Dosage crisis over, there was no more discussion of changing HRT prescriptions and we had an extended talk about best practices in monitoring HRT. A bonus in taking such care was some additional clarity in the cholesterol results that resulted in THOSE prescriptions changing.

So all is well again in HRT land. The moral is to not only know what you are doing, but to actually do it (note to self: stupid)! Then, be prepared to respond to your doctor and actively help manage your care if something happens.

Very good recommendation. Being older than dirt, a rock before it erodes, I have had a lot of late in life surgeries, ills and woes. On one medicine then off onto a different one for a different reason. Your comments on taking medicines as instructed, hydration, accuracy and timing of tests is very valuable for all of us, whether on hormones or not. Thanks for the info.

I do take my hormones and spiro together just once at breakfast. My main reason is whatever effects they do happens during the day. Spiro is diuretic, everybody here knows it, that will disturb your sleep and that spark a chain of event that can produce your erratic unbalance.
Many people don't understand or are unaware of all the processes running while we sleep. They are so important as the food we eat. So don't added extra elements to your body when sleeping.
Just try for some weeks and you'll experience the difference.

Maybe we all have different chemistry, though? My bloods and hormones have not varied in a year now - rock solid on the centre of normal female levels.
Has anyone looked at diet as a contributing factor?

Vanessa, my drill for several years was to take my split dosages during my morning commute and then after dinner. My levels were more consistent. But being absent minded to a fault, I also missed a lot. I eventually started taking them before bed. IN bed, in the case of E, in fact. I’ve gotten so used to sublingual pill taking that if something wakes me up, the pill will still be there.

My HRT meds don’t disrupt or change my sleep at all-unless I miss them. One of the things I am blessed with is gloriously stable sleep patterns. I typically sleep between eight and 12 hours per day regardless of stress, fatigue, events of the day, or anything else.

Interestingly, I hold the opposite view of yours in that it seems to me that letting the meds work overnight is better as they are not eliminated as rapidly. Is one better than the other? I have no idea, but my results are entirely satisfactory.

I am on the fourth month of HT! I take the Spiro in the morning with my other meds! I am on the patches and a Monday/Thursday schedule! I change them after supper but before bed time! No reasoning for that except it works better with my schedule-read work! I am seeing slow but steady results! Just my $0.02! Hugs Lana Mae

Thank you for this thread. Good information.