Oestradiol, Testosterone, SHBG results

[Wid]

Just wondering if anyone might have been in the same boat - I have a GP appt tomorrow re. blood results.
I’m 58, on continuous HRT and have been bleeding for 18 months. so recently had the Mirena fitted.
My lovely GP monitors me closely because my older sister died 2 years ago of endometrial cancer.
I feel crap - my Oestradiol level is 217 although I’m on 3 pumps of Lenzetto, having switched from 4 pumps of gel.
My testosterone has finally increased to 1.0 after a year of taking Testavan (Tostran wasn’t available) but my libido has buggered off again!
My SHBG has nosedived to 21 - it went up to 57, 6 months ago.
The low SHBG means my free androgen index calculation is now 4.8% - above range so GP has to follow up.
Has anyone had anything similar?
I’m convinced my low oestrogen is at the bottom of it all - consultant at meno clinic wants me to maintain oestrogen above 300.
I seem to be a poor absorber - do any NHS GPs prescribe higher doses of Oestradiol or is it only the Newson clinic that does this?
Thanks for reading this far xx

I think I was in the same boat.

(Folkswill tell you not to go by blood tests. And to go by symptoms alone. But like you my doc and I found blood tests a useful guide to back up symptoms. Especially as I'm likely on the other side of menopause. So hormones shouldn't be widely fluctuating.)

I ended up with 2x 100 patches (a slow process of gradually raising the patches in the hope that symptoms would settle) but my oestrogen remained through the floor. (And my symptoms matched!). In the end we've switched to tablets. (Taking into consideration the change in risks). And FINALLY I feel sane again!!

(Surely the risk should be that no one wants super high oestrogen levels. Which ISNT the same as high dose patch. I don't get the augment that a high dose patch is "bad" if you can show that clearly your oestrogen levels remain through the floor. Anyway...)

@Wid I've been told numerous times by an eminent consultant who is a hormone expert working in fertility that blood tests for estrogen are useless around HRT.

This was also raised on the BBC Panorama prog about high estrogen doses (this was the Dr Louise Newson incident with very high doses.)

The doctor on that programme (from the BMS I think) also explained why testing estrogen is pointless. (Something to do with it being converted into another type of estrogen in the body and therefore a useless exercise.)

The main idea with estrogen is to use a dose to control symptoms and keep it as simple as that.

I don't know why there is this variance in the medical profession but it does seem to cause a lot of confusion and anxiety over levels.

Thank you @Wid for posting this.

I've just had a chat with the HRT specialist at my GP practice.

They don't normally do bloods, for some odd reason (hmmm!), but because I was not doing well on patches or gel or anything after trying a lot of variants for years, I asked for bloods to be drawn.

And, wow, were my levels low...

Apparently, bone protection against osteoporosis from HRT occurs when the oestradiol level is over 200 pmol/L. Mine is 30 and I have osteopenia!

Also, my SHBG levels are very high. I goggled and found that "If your SHBG levels are too high, it likely means that less of your total testosterone is free testosterone that's available for your tissues to use. So, your tissues may not be getting enough testosterone." That makes sense to me, as I've been feeling very weak and fatigued recently (not to mention volatile!).

Anyway, as a result I am to start with Lenzetto spray when it comes through.

Thanks everyone. My GP appointment was cancelled and rescheduled for Dec 5 now.
I keep reading that blood tests for oestrogen are pointless but I’ve also read that post-menopause, the test is more reliable.
My experience leads me to believe the oestrogen test can be useful. The consultant at the meno clinic said to keep my level above 300. In January, my level was 320, I felt better and the testosterone was working.
In July I knew my levels had dropped as feeling crap.
Blood test revealed oestrogen had dropped to 204 - no longer absorbing gel.
GP switched me to Lenzetto and recent blood test 217 - still feeling crap and zero libido now, despite testosterone.
I think my symptoms warrant a higher dose of oestrogen and the blood test might help corroborate this - not sure what GP will advise. Does the NHS prescribe higher doses?
The low level of SHBG is still an unknown.

I was on a 150mg patch with a result of 123 pmol/L. Went up to a 200 mg patch (2 x 100 mg). Off licence at this dose. But we talked it through and both agreed. Results were only 196 pmol/L. Plus the symptoms (MH related) were about to send me over the edge. Switched to oral tablets and felt better quite quickly. Tablets might not be suitable for all. But if they spray isn't working maybe a gel or patch would give you a different outcome?

Just to say the high SHBG is likely having an impact on all of your hormones as well as testosterone.

Mine is high (131 - GP says it's fine it's only just out of range 🙄 and I think it's causing many of my issues.

Hi OP.

My GP will dispense higher amounts of oestrogen on instructions from a consultant (private or NHS).

I was still having tons of hot flushes, but everyone agreed this wasn't going to be resolved by more oestrogen.

My blood test showed oestrogen of 600 so I can see their point! (I absolutely understand @JinglingSpringbells point on this, I'd been on HRT for 18 months and private gynae suggested the test - and he is head of obs and gynae at a big trust so I assume he knows what he is doing, but there does seem to be some disagreement).

I still have the night sweats though sadly. However I want to have sex more than I did in my 20s so something is going right with the T at least!

I keep reading that blood tests for oestrogen are pointless but I’ve also read that post-menopause, the test is more reliable.

Just quickly on this...

the tests may be more reliable post meno but that doesn't mean they are if women use HRT. I've been advised that a true estrogen reading requires a 24 hr constant drawing of blood because the level changes all the time on hrt . Pretty sure there are papers out there saying this too.

But at the same time I accept women are being told different things.

If you want to hear this from a BMS dr it was covered in the Panorama programme on Dr Newson and her high doses. The dr who was speaking was female- may have been Paula Briggs.

The other point that's been made after that programme was that giving more of the same sort of estrogen (which isn't being absorbed) doesn't always solve the problem because (so the argument went) trying more of the same doesn't ensure more being absorbed. They suggested different routes like a tablet.

This is quite interesting and covers all the questions about testing levels, when using HRT, including there no agreed level to give bone protection.

www.mymenopausecentre.com/gp-resources/oestrogens-and-blood-testing/

I wonder. It's so difficult to determine, isn't it? Hopefully, the new spray will help, but then again, I've been reading how it's generally a lot weaker than other methods. I know my GP practice won't allow for a daily dose of more than 3-4 sprays, so fingers crossed I start to feel better (I feel so bad I can't do anything and my poor SO is walking on eggshells!)...

@JinglingSpringbells thanks for all the info.
I’ve had patches, tablets, gel and now Lenzetto. I only started to feel better 18 months ago when a GP said I could go up to 4 pumps of gel and I think this is the reason my serum Oestradiol went up to 300. Unfortunately, the extra gel novelty has worn off for my body and my level is back down to 220 and I can feel the dip.
I understand the unreliability of the blood tests but the Meno clinic consultant asked for the test and the GP did the follow up - the test results correlate with my symptoms, so I think I will ask for more than 3 sprays of Lenzetto, based on my test results and symptoms.

Good luck- all the best!