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[SarahED]

Hi all,

I’m off to my GP this morning to have a repeat blood test of my estrogen and testosterone levels. Panicking a bit as I had a test about a month ago that showed very high levels of both (estrogen 3107 pmol/L, testosterone 9 nmol/L).

When I had my levels checked in August 2024 they were ‘low/normal’ (estrogen 279 pmol/L, testosterone 1.1 nmol/L). After those results my meno GP switched me to a higher dose of both estrogen and testosterone.

Since receiving my very high results a month ago I have had a transvaginal ultrasound - endometrium looks ok at 4.2mm and ovaries are good. But booked in for a hysteroscopy next week for an endometrial biopsy, polypectomy as a small polyp was found, and to have the Mirena coil fitted.

I’m so anxious about getting my repeat blood results, especially the estrogen ones. I think I’m more anxious about that than getting the biopsy results in a couple of weeks 

Since my blood test a month ago I have reduced my estrogen and testosterone dose, and for the past 24 hours have not applied my gels at all. Have done this as my meno GP is convinced the blood sample a month ago was contaminated as I applied both gels about 3-4 hours before the blood test. Intending on using my left arm for the blood draw today as I’ve been applying the gels using only my right hand the past couple of weeks.

I’m just so worried the repeat blood test is going to show continuing high levels, and what the health and HRT implications of a result like that might be. I’ve been convincing myself that I’ve got some terrible endocrine condition or something, or that I might have to come off HRT altogether. Though that might just be the rampant health anxiety talking… 

I know realistically it’s unlikely the results from the blood test today will show continuing very high levels, especially as I’ve had a recurrence of some peri symptoms since reducing my dose. I also had absolutely no symptoms of high estrogen or testosterone in the weeks leading up to my previous blood test, just pretty decent peri symptom control.

I also found this really interesting study recently that showed just how much estrogen levels vary across women using transdermal estrogen. In this study, some women were found to have very high estrogen levels that reduced significantly upon a repeat blood test, even in the absence of a change to their estrogen dose: https://pubmed.ncbi.nlm.nih.gov/39689249/

Not sure what I’m asking you ladies for, I guess some reassurance and also for the experiences of anyone else that has previously had something similar happen to them.

Going to be obsessively checking my Patient Access app for the repeat blood results over the next couple of days 

Thanks all  XX

[bombsh3ll]

There's no point checking plasma estradiol levels on gel.

There is frequently contamination from the skin, and if you look at the pharmacokinetics of gel there is very rapid absorption with a high peak in the plasma before disappearing.

Depending on when the sample is taken, having an inexperienced practitioner adjusting your doses based on plasma estradiol can lead to either under or over treatment.

In my opinion gel can only really be dosed clinically, and/or following other markers such as SHBG or FSH.

Testosterone is often measured in those on treatment, and the same issues apply to an extent but the general consensus is to not apply any the day of the blood test (and shower to make sure no residue is on your skin).

[SarahED]

There's no point checking plasma estradiol levels on gel.

There is frequently contamination from the skin, and if you look at the pharmacokinetics of gel there is very rapid absorption with a high peak in the plasma before disappearing.

Depending on when the sample is taken, having an inexperienced practitioner adjusting your doses based on plasma estradiol can lead to either under or over treatment.

In my opinion gel can only really be dosed clinically, and/or following other markers such as SHBG or FSH.

Testosterone is often measured in those on treatment, and the same issues apply to an extent but the general consensus is to not apply any the day of the blood test (and shower to make sure no residue is on your skin).

Thank you so much for this, your rational words are really appreciated at the minute

I think I’m having a bit of a spiral this morning. My husband has also just been to hospital for a chest CT scan, so that plus the stuff going on with me is just a bit overwhelming (he’s fine, just had a persistent cough that’s now resolved, but consultant erring on side of caution).

Really can’t wait for all our health stuff to be resolved in the next couple of weeks, it’s all dragging on somewhat. It’s hard not to catastrophise at the minute, so thank you for the dose of sanity  !

[bombsh3ll]

Good luck with your appointment and husband's scan.

The most important thing is how you feel clinically on the dose of gel you are taking.

If checking plasma estradiol level is important to you, for example if you have no symptoms and are on it for osteoporosis prevention, you may be better with patches or tablets which give more stable (albeit still not perfect) plasma levels.

[SarahED]

Good luck with your appointment and husband's scan.

The most important thing is how you feel clinically on the dose of gel you are taking.

If checking plasma estradiol level is important to you, for example if you have no symptoms and are on it for osteoporosis prevention, you may be better with patches or tablets which give more stable (albeit still not perfect) plasma levels.

Thank you 

Tbh I absolutely ascribe to the philosophy of going by symptoms, especially for estrogen, I just think possibly my private meno GP like to demonstrate to my NHS GP that she’s monitoring my blood levels. Not sure though…

Really hoping to see Estradot available again soon as I’m intending on switching from gel to patch asap! 

[joziel]

If you're going to use gel, it's really best to apply it to your thighs for this reason. Much lower risk of contaminating any blood draw sites.

I was on up to 12 pumps of gel at once point, 6 pumps to each leg and butt cheek. No need to use arms at all...

[SarahED]

If you're going to use gel, it's really best to apply it to your thighs for this reason. Much lower risk of contaminating any blood draw sites.

I was on up to 12 pumps of gel at once point, 6 pumps to each leg and butt cheek. No need to use arms at all...

I do apply both gels to my thighs, but apparently even just using one of your bare hands to rub the gel in can cause elevated levels in that arm, it’s crazy! Though like a doofus I’m pretty sure I did apply my testosterone to my forearm the morning of the blood test (I tend to do that on days when I’m rushing out of the front door and grab my testosterone out of the fridge at the last minute). Definitely won’t be making that mistake again  !

After this recent debacle I’ve made the decision to definitely switch to patches as soon as Estradot is available again. Might submit another post (or search the forum) to see what alternatives to Estradot members can recommend so I can switch sooner 

[SarahED]

Just checking back in as I’ve already had my estradiol result back even though I only had the blood test this morning (thank god for the NHS!).

Estradiol now 93 pmol/L down from 3107 pmol/L four weeks ago  !!

That last blood sample must have been contaminated, I’ve only reduced my Sandrena from 5mg to 3mg recently. Had a 24 hour break just prior to the blood test today, so that may account in part for the massive difference.

Be interesting to see my testosterone result when it’s available…

[joziel]

I would not have believed a result in the 3000s and acted on it, without at least 1-2 more confirming tests.

You don't need to use your hand to spread gel. I use a small silicone spatula to avoid getting it on my hands.

[AKatieD]

Or a glove...

[joziel]

The gloves get pretty gross or you have to keep throwing them away, though. Phew, I hate the gel. I would love to try patches only at some point in the near future, once I've got my thyroid dosage sorted.

[SarahED]

I think I’m going to book a second follow-up bloods in another four weeks. Have increased my estrogen gel back to usual dose in past 48 hours. Planning on applying my gel using latex gloves in the two weeks leading up to the second follow-up bloods. Intrigued to see what the blood serum estradiol level will be in those conditions