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[bombsh3ll]

Hi joziel I just wanted to respond to your concern about SHBG being increased;

Are you on any androgen replacement because that lowers SHBG.

I am on Zoely (1.5mg oral estradiol) and take dhea.

My SHBG is 40 which is near the bottom of the female reference range.

Also that 240pmol/L from a 75mcg patch doesn't suggest poor absorption to me, it's perfectly reasonable (assuming most of it wasn't your own estradiol - I am not sure where you are in peri/menopause)

Don't forget these patches, developed in the wake of WHI when everyone was petrified, are only designed to give us enough estradiol to keep us off the floor, not to thrive.

You may be able to achieve a therapeutic level by wearing 2 or 3 x 100mcg patches, assuming you can keep them on and don't itch with them!

[joziel]

What is an androgen replacement?  Is that testosterone? Yes, I'm also on testosterone.

Good to know you are okay with SHBG on Zoely. Unfortunately thyroid hormones really increase SHBG, especially T3 (which I'm on a hefty whack of at 45mcg at the moment). So I'd be worried to add oral E into that. I mean, if it doesn't seem to work, is it really 'not working' or am I just not able to use it... I'm due to transition off thyroid meds (they were an experiment to see if it could be responsible for my terrible night time symptoms, but they haven't helped) so once I get off them, I would try oral if patch and gel combo hasn't helped.

I just re-checked my records and I didn't test on 75 patch, only on 50. On 50 patch it was 198pmol on one test, and 230pmol on another. I guess I made extra myself... But none of that is high enough for this 450-650 range I'm supposed to be trialling - to see if getting there fixes the night time symptoms. I agree HRT is not designed to give women optimal pre-menopausal levels but seems very conservatively dosed with worries about estrogen driving that.

I didn't itch with Estrodots before....

I am hoping to reduce my gel back down to 6 pumps and also increase patches up to at least 2x 100 and then re-test bloods. Dependent on what the results are there, I could continue to decrease gel and increase patches further. I'll ask my Newson doctor for 100 patches as I can cut them in half when I need 50. I made an appointment for a week's time.

At least I am not working this August 

[Kathleen]

Hello again Joziel

Yes my one sachet of Sandrena dries in about 25 - 30 mins. I probably have particularly porous skin lol.
 I assume that you are spreading the contents of each sachet over an area of about two palm widths. I'm not sure where I learned that, it may be even have been on the patient information leaflet!

Wishing you well and take care.

K.

[bombsh3ll]

That's really not awful for a 50mcg patch.

Are you still producing your own estradiol or is all/most of that from the patch?

Regarding the thyroid hormone - if your levels are normal on treatment, I can't see how this affects SHBG differently than if you were producing the T3 and T4 endogenously?

And yes by androgen I meant testosterone although I get mine from dhea due to both cost and absence of safety data for using testosterone with a combined pill whereas this does exist for dhea.

[joziel]

It's not high enough (230) even for bone protection or whatever the minimal amount needed for that is. So it's pretty bad.

I have no idea how much estradiol I'm producing but yes, I am still peri and that was a couple of years ago now so some of that would have been mine too. Although I did test during my period to try to get an accurate idea.

With thyroid, it's well known that taking T3 raises SHBG. Don't ask me how, thyroid is very complex.

[bombsh3ll]

No I know 230pmol/L isn't bone protective, and I wouldn't accept that level for myself either, but I meant if you could get that from a 50mcg patch, it's conceivable that you could achieve a therapeutic level with patches if you wore one or more 100mcg patches.

But you're right if you're not yet menopausal a significant proportion of that probably wasn't from the patch.

[joziel]

Even if it was during my period? Actually, I don't remember if that test was. Early on, I hadn't figured out that was when it was best to test.

I'm just too worried to totally switch to patches now, after what just happened with Sandrena. I'd rather do a phase out of gel and a phase in of patches I think. Test when I'm about 50/50 and decide whether to keep going or hold there...

My task for this summer was to get off thyroid meds and if spend the whole time mucking around with estrogen, I'm not going to get around to that (as I don't want to do both at once!). Things are not perfect on 12 pumps of gel and a 50 patch but they are better than they've been before...

[CLKD]

Thyroid is a hormone that we require  so why mess with that?  These hormones have been running along side each other without problems until:  how long ago did U begin to require thyroid treatment? 

I don't think that we can overdose on oestrogen and do go on symptoms rather than testing levels as hormones fluctuate all the while.  If U R finding some improvement on this regime could you add a 50 patch every 3rd dose for example?  Replacement therapy isn't a sudden cure and needs time for the body to adjust to each hike/drop in regime.

If this is helping symptoms why not stick with the current thyroid levels and 12 pumps with the 50 patch for at least 3 months ?

[joziel]

Because I don't need to be on thyroid meds and because there are serious health consequences if you stay on high dose thyroid meds when you don't need them.

Because they were trialled to see if they help my night time symptoms and they don't. I had a very normal thyroid panel with just low but in range T3 and high rT3.

Because they are highly likely creating a lot of SHBG which is binding to my estrogen and could be a huge reason I am unable to use the high doses of estrogen I'm taking.

[CLKD]

Tnx.  Let us know how you get on!

[AmandaJR]

Because they are highly likely creating a lot of SHBG which is binding to my estrogen and could be a huge reason I am unable to use the high doses of estrogen I'm taking.

Hi Jo, I have very high T3 (no thyroid meds), I also have high SHBG of 90- I think this is connected. I’ve now increased HRT to counteract the high T3 and am using 100mcg Estradot Patch plus 6 pumps of Oestrogel gel. So far it has reduced my FT3 from 26 to 20.9 on NHS range of 3.6- 6.8 - but this is only 14 days.
I find the Estradot 100mcg patch’s to be far stronger than 2X 50mcg Estradot Patches AND the Oestrogel equivalent.

I was looking to switch to Sandrena, thanks for posting your info on drying times- they are too long for my lifestyle!

Bombshell - thanks for your info , I’m going to be looking into oral.

[joziel]

Amanda, wow that's interesting on many levels.

Are you saying that increasing estrogen has reduced your T3...?

And with a T3 that high, you'd be hyperthyroid, no? Do you have Graves? (Did you mean high rT3? or T3?)

I am about to transition off T3. I'm currently on 50mcg T4 and 45mcg T3. The plan is to halve my T4 to 25mcg immediately when I start and to reduce T3 by 5mcg every 3 days. This all means it should take me about 3.5 weeks. Then I stop the last 25mcg of T4 at the end (will take a few weeks to fade away).

I'm very nervous about it all. I think I'm worried that I'm going to be hypo on the way off and gain a ton of weight. I'm not going to weigh myself until I'm out the other end and off meds, or I will freak out if I gain weight and drop calories hugely - which will slow my metabolism and make thyroid recovery harder and in the long run. This would just put me back with high rT3, which is the whole reason I went on thyroid meds in the first place. So I just have to be brave and get through it...

I do read that many people do this easily especially if their thyroids function, so I'm hoping I am just worrying about things which don't happen. My thyroid labs are actually low at the moment and yet I'm fine. My T4 is below range and my T3 is the bottom 21% of range. If I was staying on thyroid meds, I'd have been increased on my dose...

Good to know about the Estrodot patches! I am going to ask if I can go back to 12 pumps of gel for a couple more months whilst I get off thyroid meds and then transition off some gel and onto patches... Will update with what my Newson doctor says about this request on Thursday...

[AmandaJR]

Hi Joziel,
Your plan looks good, I totally get you being worried about what could happen as the symptoms have a rapid drastic affect on doing normal daily tasks like working. Hopefully you won’t get the hypo symptoms and if they start can you slow the T3 reduction to say 6 days etc?

RT3 - what a minefield! I’ve not had it tested and it hasn’t been mentioned by the Endo I see. I have an undetectable FT4 so am thinking mine will be low. There appears to be so many causes of high rT3, I used to eat very low carb which I see is now a possible cause so I now eat more fruit. Are you still doing the protein/calorie increase to speed up metabolism? If so how’s it going?

I’m undiagnosed, still under investigation. A month ago I stopped high dose Propanolol so expected T3 levels to increase further. It’s not Graves or nodules, the symptoms are the same as hyperthyroidism and have eased over the last 2 weeks. I can’t claim it’s because of an HRT increase as it could be a coincidence. I don’t know why my T3 levels shot up so I can’t know why they are dropping but this is the second decreasing T3 result since increasing so I’ll stick with the increase.

It’s really positive that you feel fine when your thyroid results are low. How has your sleep been since the lower results? My insomnia is off the scale with T3.

Good luck with reducing and can you get the scales out of the house?

[joziel]

Yes, if I get symptoms I can slow down the decrease - only this might just prolong the misery. We need to get my TSH unsuppressed so my thyroid can kick in and start making hormones again. Pootling around and taking ages above the level where my TSH gets unsuppressed could just leave me hypo for no reason. It might be better to get quite low relatively quickly and then pause at a low dose whilst my thyroid gets working again. Body builders routinely use T3 only to cut before shows and the usual body builder approach is either just to stop it dead(!!) or to cut to 12-15mcg and hold there for 2-3 weeks whilst the thyroid gets working again.

I had to get my rT3 tested privately, but if your T4 is below range I don't think you need to worry about that.

Yes, I am still doing the high protein diet and I'm maintaining now around 2100 cals. I'm being very careful as I come off the thyroid meds and tracking everything. I work from home and otherwise I can get a bit snacky around the fridge 

Do you have symptoms associated with your high T3? Like a ravenous appetite and fast metabolism?? Are you losing weight or doing runny poops? Or is this just an anomaly on bloods?

My sleep is a constant work in progress. It's the whole reason I started thyroid meds in the first place. I had a very normal looking thyroid panel before starting meds - except low in range T3 and high rT3:

TSH        1.37        (0.270-4.2)
free T3    3.9        (3.1-6.
free T4    18.6        (12-22)
rT3            32            (8-31)

And we were looking for the cause of my night time symptoms, which were severe insomnia, heart beating hard and fast through the night, hypnic jerks any time I began to fall asleep, inability to get into deep sleep, inner tremors/shaking. Sometimes only 3 hours of light sleep a night. I couldn't function. So it was a bit of a trial to give me some thyroid meds due to that high rT3 and see if it did anything. It didn't do anything to these symptoms after all kinds of dosages (right through to T3 only up to 90mcg!), so it's time to come off now.

I haven't noticed any difference to my sleep on T3 but it is crap anyway because that was my original problem. It has improved a lot because I think I've been able to get my estrogen up a bit (now at 325pmol ish) but I want to try getting it even higher once I'm off the thyroid meds. Or maybe I will suddenly be able to use it better because my SHBG will drop...

With the scales, I seem to either want to weigh myself every day or never weigh myself at all (because I'm scared of what I will see, it's been so long  ) so I think I can do a month without weighing. The other factor is I've put A LOT of muscle on doing strength workouts 5x/wk with heavy dumb bells and eating high protein - I didn't really have much fat anyway but I've lost a lot of what I had too - so if the scale does go up I feel I can reassure myself it's muscle anyway. My body feels totally different. If I fold my arms, I'm distracted by my biceps.    My glutes have become a shelf instead of a pancake    It's hard to imagine being lean and fit and muscular and also 'fat', so if I can focus on this ideal body type instead of an arbitrary number on some scales, I can free myself....

I did the first cut to T3 today, 5mcg reduced. On Weds I will halve the T4.....

[joziel]

Okay, just had Newson Health phone appointment...

Scrapped Sandrena. The goal is some combo of patches and gel. Hopefully more patches than gel, but it depends what I can absorb.

I have to go down on the gel and up on the patches.   

At the moment I'm on 8 pumps of Oestrogel, 2 sachets of Sandrena and a 50 patch. It's quite an estrogen cocktail    (I can't just throw out the Sandrena and the pharmacy won't take it back, so I'm using a sachet AM and PM and hoping this doesn't mess things up. Might need to adjust again when I finally stop it but as I have about 4 boxes of it, this will be ages  )  )

Will increase to 100 on the patch tomorrow.

Meanwhile I'm reducing the thyroid meds, I'm on the 2nd reduction of T3 now. 35mcg T3. And on 25mcg T4.