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[Rumbaba]

sorry, if I seem obtuse, but I am really confused.

So, I have been on HRT for years now.  At first I seemed to absorb well, and when I needed to adjust my dose, I got a sone side effects like spotting (checked out) and sore lumpy boobs, which did settle.  But it seems that I have suddenly struggled to absorb, and am not on a horrific dose.  When I add another pump, nothing seems to happen, suggesting that I am absorning poorly.

My question is, what affects the absorption that it could change like this?  Is it something to do with our oestrogen receptors or something?  Ive been on gel, patches (two types) and a combination of the two.  I also have testim for libido and muscles.

I just want to understand whats changed, and if there is anything I can do about it?  anyone else in the same boat please?

Thank you

Rumbaba xxx

[joziel]

It's a bit difficult to say without knowing if you really are struggling to absorb. The way to determine that, is via a blood test. If you test estrogen and it is X amount (usually low) and you try to increase and test again - and it isn't any higher, then you're not really absorbing it.

It's not really possible to know if the problem is absorbing it without doing blood tests.

However advice is to treat symptoms up to 100mcg patch - then do a blood test to check absorption if symptoms don't improve. If you are 'not on a high amount' or whatever, then you probably should increase your estrogen in the first instance until you get to 100mcg or 4 pumps of gel. And see if that addresses symptoms.

[Rumbaba]

Thank you for replying

Sorry, I should have explained a bit more.  Under the supervision of the clinic, I am on 2 x 100 patches, and have topped that up with a pump of gel  .  Ive also been having blood tests about every 4 months, and despite the eye watering dosage, my level is not very high, and has stayed fairly low for some time. In desperation, I have sometimes added another pump, but nothing changes

Hence me wanting to understand what affects absorption, as in the early days, I was on 2 pumps and any fluctuation brought side effects, so I knew it was getting into my system

Thanks again, I do appreciate it 

[laszla]

Rum I'm also a poor absorber, being closely monitored by the Chelsea & Westminster clinic and like so many aspects of the interplay of hormones with other factors, it's not clearly understood what might hinder absorption.
That said, in my case it's been hypothesized that it could be my low weight which is hampering absorption. I'm on about 5 pumps daily of estrogel.
When you say low, what are your blood levels of estradiol?

[joziel]

Yes, what are your blood results? That's a lot of estrogen to be taking!

Perhaps you would absorb the gel only better, if you took that by itself?

[Peana]

This is all very interesting. Laszla, you mentioned that low body weight can affect absorption. Does anyone know if rapid weight loss affects absorption? A combination of factors has led to my weight dropping quite quickly, but I didn't even think about how that might impact my absorption. I need another review with the gp soon, so will try to remember to ask about this. Thanks

[laszla]

Hi Peana, I'm not specifically sure about rapid weight loss but I was told that because oestrogen is not only absorbed but also produced in our body fat, low weight will decrease absorption and overall levels.
I would think that the speed at which you get to that lower weight would not be that important - eg. you had a rapid weight loss, mine was gradual - but I would speculate that the end result of being a lower weight would impact your absorption.

[Joaniepat]

Willing to be corrected, but doesn't body fat produce estrone rather than estradiol? Estradiol is the one that's measured. I wonder why low BMI would hinder absorption of estradiol. If true, it's intriguing. I have always had a low BMI and can't increase it, much as I'd like to.
JP x

[laszla]

Joaniepat, my understanding is that all estrogens - estradiol, estradiol and estrone - are produced and absorbed by body fat as are other sex hormones. Your point about not being able to increase your bmi reminds me of a half formed thought I've been having about a similarity between difficulty in absorbing estrogen and difficulty in absorbing food calories to gain weight as I've tried but failed to do despite eating some very calorific foods such as nuts/seeds and oilve oil.
 

[Joaniepat]

Thanks laszia. It's certainly a mystery. Wonder if there's a gut microbiome link to the low BMI issue?
JP x

[laszla]

JP a link between the gut biome and BMI is very possible (and the consensus now seems to be that the gut biome affects affects every system in the body).
Giulia Enders' book Gut explains that some people's gut flora extract much more energy/calories from the same amount/type of food than others (explained from p174 in the revised edition in case anyone wants to follow up). A diversity and good balance of bacteria is ideal - perhaps in our case we have too many of the calorie-discarding type.
And of course the whole digestive tract has oestrogen receptors so as usual there's probably a far more complex interplay of between the body's systems than research has managed to identify as yet.

[Joaniepat]

Thank you laszla. The gut microbiome is so intetesting - every day's a school day  !
JP x