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[pepperminty]

Hi Ladies,

this term is used frequently, but exactly what does it mean? Someone may feel fabulous on a lower dose and someone else may need a higher one. Therefore, can you take estrogen as optimised just by the way you feel or does it have to be measured? Increasing doesn't suit us all.

Can you be optimised on a lower dose?


PMxx

[Gill67]

Hi Pepperminty, to be honest, I don't know! I can't say I've come across any mention of optimising Oestrogen in my readings about HRT, and I've been doing lots of reading recently since experiencing a return of symptoms and changing my type of HRT.
Hopefully someone more knowledgeable will come along, now that my reply has 'bumped' this up the page

[Marchlove]

Another bump 

[pepperminty]

 Hi Ladies ,

Heather Currie said that my estrogen should be optimized before testosterone - I am not sure that the experts know either. After all some are great on a low dose and other require much higher.

PMXX

[laszla]

Slightly in haste but briefly the consensus seems to be that for the purposes of longer term protection, especially for bones, blood levels of about 300 pmol of estradiol are necessary.

On the other hand to feel well in the immediate term, depending on their symptoms, some women may need much more than this - I fall into this camp.

My meno specialist has advised that I need to reach 600-800 pmol though my lousy absorption makes that a bit of an unattainable goal I fear. Some might find that too high for their immediate wellbeing.

I have previously linked to some references for this, mostly from Professor Studd's site, drawing on the research he and later Nick Panay did.
As long as it's tolerated in the immediate term I would try to aim for around 300 - have you had yours measured?

[Clarella]

I’ve asked this question lots 😂 I don’t really understand it!

I even asked a mum friend who’s a Gp recently and she said testosterone gets metabolised into oestrogen. She couldn’t answer though if when you’ve reached your own right level, if your own testosterone could return (as it’s not being metabolised!)

Going to see if I can find your links laszla!

[laszla]

Clarella the back and forth of oestrogen and testosterone is indeed complicated and DHEA also plays a role.
There's also the effect of SHBG (Sex hormone binding globulin) which if we have elevated levels reduces our absorption of tesosterone but also of oestrogen to a lesser extent from what I've read.

A couple of these Professor Studd pages refer to desirable plasma oestrogen levels and have references at the end of the pages:
Eg https://www.studd.co.uk/implants.php says:
"There is good evidence that a plasma oestradiol level of 300 pmol/l is necessary to ensure the improvement of bone density in nearly all women.(2) There is also evidence that plasma oestradiol levels of 800 pmol/l may be necessary for the improvement of depression in the climacteric woman"
Also here https://www.studd.co.uk/osteo_oestro.php

[Marchlove]

I’m an ex patient if the Studd clinic and all I can say is that his regime of high dose estrogen did absolutely nothing for me.

That’s not to say all that estrogen was helping my bones but at the expense of my mental health!

I’d rather feel sane now and anyway testosterone is bone protective, so I’m happy with my decision to keep my estrogen dosage low.

So, no I’m not an optimising estrogen fan, whatever that means!

M x

[pepperminty]

I’m an ex patient if the Studd clinic and all I can say is that his regime of high dose estrogen did absolutely nothing for me.

That’s not to say all that estrogen was helping my bones but at the expense of my mental health!

I’d rather feel sane now and anyway testosterone is bone protective, so I’m happy with my decision to keep my estrogen dosage low.

So, no I’m not an optimising estrogen fan, whatever that means!

M x

I totally agree  xx

[margherita]

I’m an ex patient if the Studd clinic and all I can say is that his regime of high dose estrogen did absolutely nothing for me.

That’s not to say all that estrogen was helping my bones but at the expense of my mental health!

I’d rather feel sane now and anyway testosterone is bone protective, so I’m happy with my decision to keep my estrogen dosage low.

So, no I’m not an optimising estrogen fan, whatever that means!

M x

I totally agree  xx

Studd's regime was the now totally standard and moderate 2 pumps oestrogel, with leeway to increase to 3-4 if necessary. And optimising oestrogen to around 300 (and one must differentiate between intake and absorption which are totally different things) also very widespread with recognition that *some* women may need more to feel well in the here and now and have long term protections.
Thanks for providing the links Laszla

[Gnatty]

I love that website, I find the articles Professor Studd wrote are always reassuring. Particularly those for women who have had hysterectomy/ oophorectomy. He highlights how important it is for those of us in that position to have testosterone as well as oestrogen. And certainly for me that has made all the difference. When I take an adequate amount of testosterone ie optimise it then I feel really really well. So maybe sometimes we spend more time worrying about oestrogen levels when maybe it should be testosterone levels that should be sorted..... Just a thought.

[Kathleen]

Hello ladies.

My Oestrogen levels were never mentioned or measured when HRT was prescribed by my GP, testosterone wasn't mentioned either.

When I became a patient of Newson Health I was introduced to blood tests, Androfeme and terms like SHBG. I have to say though that this extra information didn't translate into me actually feeling better. At one time my Oestradiol levels were 600 pmol/L and the NH doctor said that I should have been feeling great but I wasn't. Not long after that blood test I developed swollen and tender breasts and heavy bleeding. Clearly my body found this level too high.

If there is one thing that I have learned on this journey it's that managing hormonal changes are more complicated than just adding lots of Oestrogen.

Take care ladies.

K.

[pepperminty]

Hello ladies.

My Oestrogen levels were never mentioned or measured when HRT was prescribed by my GP, testosterone wasn't mentioned either.

When I became a patient of Newson Health I was introduced to blood tests, Androfeme and terms like SHBG. I have to say though that this extra information didn't translate into me actually feeling better. At one time my Oestradiol levels were 600 pmol/L and the NH doctor said that I should have been feeling great but I wasn't. Not long after that blood test I developed swollen and tender breasts and heavy bleeding. Clearly my body found this level too high.

If there is one thing that I have learned on this journey it's that managing hormonal changes are more complicated than just adding lots of Oestrogen.

Take care ladies.

K.

Hi, Yes I think that as others have said the current trend for high levels, does not translate to always feeling great. I wish that they would do some in depth research and be able to tailor individually.  It will happen, but not in our lifetime.

PMxx

[Clarella]

Thank you *so* much for the links and discussion. It’s very helpful for me right now.

I’m not convinced that more oestrogen is what I need as when younger periods were lighter than they are on 100! Though I could have had more prog I suppose. I think I perhaps need to try testosterone next.

Elsewhere someone said that thyroxine can cause issues with testosterone and a binding hormone; does anyone know more? I’m on thyroxine, 125. Libido is poor and aches and pains and fatigue is challenging.

When I first started hrt I felt great but I’m wondering if I still had more testosterone being pumped out. Something went v down hill 3 months after covid earlier this year

[Clarella]

On 75 my oestrogen was 260 ish so I’m guessing it’s over 300 now. Still had periods unbelievably!