Even so, that snapshot is probably not accurate to your blood levels most of the time, since it should thoroughly suppress T production with such high E. There are probably still periods where your E drops enough for T production to be happening, the other main way to explain such high T is that maybe there was an error / inaccuracy in the labs. My endo shared that he is particular about which lab does the blood work and that it makes a big difference in the accuracy.

Besides your blood labs, have you noticed physiological changes that might indicate T suppression or lack thereof?

There are so many intersex conditions and not all of them prevent fertility. Having successfully reproduced might help narrow the diagnostics, though!

EDIT:

https://www.advocate.com/commentary/2019/10/26/8-misconceptions-myths-about-being-intersex-debunked

myth #6:

6. Intersex people can’t have sex, get pregnant, or have children.

Many intersex variations include mostly typical internal reproductive anatomy. Everyone is different. There are intersex people who can have periods and carry children, and intersex people who can produce sperm. There are some who can’t. There are intersex people who find out they have both ovarian and testicular tissue after having given birth.

In my experience it was more like I needed to maintain a minimum of 300 to get adequate suppression, not everyone responds equally and the monotherapy dose required for adequate suppression varies somewhat:

… studies in cisgender men and transfeminine people have found that estradiol levels of around 200 pg/mL (734 pmol/L) suppress testosterone levels by about 90% on average (to ~50 ng/dL [1.7 nmol/L]), while estradiol levels of around 500 pg/mL (1,840 pmol/L) suppress testosterone levels by about 95% on average (to ~20–30 ng/dL [0.7–1.0 nmol/L]) (Gooren et al., 1984 [Graph]; Herndon et al., 2023 [Discussion]; Wiki; Graphs).

In one large study in transfeminine people, the rates of adequate testosterone suppression (to testosterone levels of <50 ng/dL or <1.7 nmol/L) were 24% of individuals at estradiol levels of <100 pg/mL (367 pmol/L), 58% at 100 to 200 pg/mL (367–734 pmol/L), and 77% at >200 pg/mL (>734 pmol/L) (Krishnamurthy et al., 2023).

from https://transfemscience.org/articles/transfem-intro/#gonadal-suppression

More relevant, however, is the fact that the testosterone is still at those levels indicates it’s not suppressed, esp. since they’ve been on that dose for three months. Probably because it’s an oral route the blood levels are just spiking when she got blood work done, but not remaining consistently that high throughout the day.

You don’t generally do monotherapy by oral route, you would switch to injections. Monotherapy with injections is pretty safe, they shouldn’t be worried about large doses unless it’s oral.

Your estrogen was surprisingly high pre-HRT, have you tested for intersex conditions?

That’s beyond fucked - but also incredibly suspicious, bioidentical estrogen especially when injected should carry no risk.

Premarin, the horse estrogen pill, was the only source of the concerns and the studies that found increased risk of blood clots, etc. AFAIK. Was your grandmother using Premarin? What heritable disease prevents taking estrogen?

of course, happy to!

here’s my tl;dw summary:

I can’t tell if this is serious, or a joke I don’t get 😅

+1 for moisturizing after shaving, shaving after a shower, and changing the blade frequently

Are you sterilizing your razor? “ingrown hairs” might be razor burn for example, the follicle getting infected. Try using 70% isopropyl alcohol to sterilize your razor and see if that helps. Also, getting the skin nice and soft with really hot water helps as well, sometimes I wet a rag and put it in the microwave and then put the rag against my face and let it rest there until the skin is really warm. Using a proper shaving soap and knowing how to make a proper lather can also help.

Exfoliation is mostly to prevent ingrown hairs from developing AFAIK, I am not sure if it will actually help once you have them.

🙈

this exactly, I look back and wonder why I waited for three months, I should have started DIY as soon as possible while waiting for my endo visit, or at least gone to a Planned Parenthood if they could work me in sooner. I was reckless with my life, but I guess I was used to being reckless that way in the past. I also just didn’t take seriously the suicide risk, and it was only after HRT that I realized that was unreasonable. I was too accustomed to life that way, I didn’t know it could be any different.

sorry to give the wrong impression, I also live in the U.S. south and my dad physically threatened me and my mom when I was 4 years old and was gender exploring by trying on my mom’s heels in her closet … I had to hide most of my cross-dressing from people in my life but especially from my dad, and every exploration was a calculation of risk. The first time I bought skirts as an adult, I felt panicky while checking out, terrified they might think I was buying them for myself. Looking back, that was a silly fear considering nobody would think that.

That said, nobody that did know about my cross-dressing ever thought I might be trans. However, I didn’t want to be read as gay either, just like you, I just knew it was safer to seem gay (and I didn’t seem capable of not being seen as gay, people just assumed it from the way I looked and sounded, even if I did nothing to feminize).

I will say, socially transitioning before medically transitioning taught me that literally 99% of people don’t care at all, you can wear a dress and paint your nails and wear jewelry and still look like a man, and you might get some stares or looks, but that’s about it for the most part, even in the south. I think people just tend to mind their business. There are obvious exceptions to this, and it’s good to avoid aggressive men, but it’s nothing like I thought it was going to be (I guess in my head I figured I would be attacked on day one, and that the reactions would be more violent or angry).

I hope that someday soon you are able to transition. ❤️ Stay strong.

and it’s also not hard to pick up a polish at the store, watch youtube videos, and do it yourself - though being short on time would be the bigger constraint in that case.

depending on where you live / what is culturally acceptable, you could probably just wear whatever you like - gender non-conforming styles are something even cis-men explore, esp. since the 1960s in the U.S. when feminine hippie styles (long hair, flowy clothes, floral patterns, etc.) took on anti-war significance.

EDIT: you have to remember, cis people are truly clueless, most people won’t question your gender as a man even with jewelry, feminine behavior, etc. - many people will even think there were no signs when you had been feminizing in many ways

EDIT2: some examples from my own life, I wore women’s clothing like skirts whenever I could growing up, yet my parents, friends, and other family never thought I might be trans; my step-mother even gave me her hand-me-down jeans to wear and this was considered reasonable / normal. When I transitioned, everyone was shocked, my mother told me there were no signs growing up. I think feminine traits on a man just reads as “gay”, so just remember your fear that you will be outed as trans based on feminized things like jewelry might be outsized, others almost certainly aren’t thinking that even if it should be obvious.

CW: suicidal ideation

yeah, I socially transitioned three months before I started estrogen. That was because the same day I figured out I was trans I realized I just wouldn’t ever transition if I didn’t force myself out of the closet by being public in that moment. The temptation to never transition and rationalize a way out of transitioning was too great, and I realized I had been doing that my entire adult life.

Needless to say, social transition without any hormones was hell for me. Obviously I should have been on estrogen my whole life, I had awful biochemical dysphoria, and I honestly marvel how I survived and didn’t kill myself. There were previous attempts and lots of suicidal ideation from the time I was 13 years old. When I was 18 - 19 I made very concrete plans and took steps to make that plan happen, but I couldn’t pull the trigger (metaphorically speaking).

During the three month wait for estrogen there was one night I woke up in the middle of the night in extreme distress and had to carefully manage extremely intense suicidal impulses. I just don’t think anyone should go through that, and even though at the time I downplayed how much I was suffering, I look back now and balk.

I suspect many other trans women without estrogen feel the way I did, and it’s incredible to me how much we as a community tolerate this harm. If the problem were diabetes, nobody would be wringing their hands about when or whether they should start insulin, it’s only because of transphobia that we all think it’s reasonable to not address a serious hormone condition. (Though not every trans person requires HRT or has biochemical dysphoria, since so many do and it’s such a low risk for those who don’t need it, I think it’s worth encouraging any trans person to start hormones ASAP as a kind of obvious harm reduction.)

EDIT: also, taking hormones made it more obvious to me that transitioning wasn’t the … optional step I thought it was. I had previously thought it was just a way for me to indulge in the desire to wear women’s clothes and try to be socially accepted as a woman - desires I thought were much less important than other considerations like a career which would have been threatened by transition / being visibly trans. Once I was on hormones I understood that transition was fundamental to my health and well-being, and that by not transitioning I was risking my life. It’s not a choice for me, it truly isn’t - it only seemed that way when I was pre-transition and didn’t know better. Taking estrogen helped clarify the necessity of HRT, which I did not believe in before then. Before I would have thought of estrogen just as a means to an end, something you do to look like a woman so you can live as one socially, not realizing estrogen is an essential hormone to make your body work correctly when you are a woman and that the wrong sex hormones can wreck havoc.

what’s the point of wearing the jewelry if it’s male-coded?

what would you want to wear if you were “allowed” to?

aw, thank you for your response - luckily suppressing T is no longer a problem, as I had an orchi around a week ago, lol

I reduced my dose significantly, trying out 5 mg EV once a week.

Before the orchi I had found the most stability from 4.6 mg EV twice a week (so every 3.5 days, one of the two days in the evening the other in the morning). Even with that twice a week dose, if I injected 4.8 mg I was having symptoms from too much estrogen (fatigue, moodiness, headaches, etc.) and if I injected 4.4 mg I seemed to have increased probability of T not being suppressed enough (increased body odor, aggression, involuntary erections overnight / “morning wood”, depression, anxiety, anhedonia). Even with 4.6 mg it seemed like T would still get produced sometimes (I think having sex for example seemed to cause some T production, even when estrogen was high).

I get that, and you have to make your own choices about that, but estrogen can be supportive without necessarily forcing you to socially transition, there are many people who take estrogen but are in the closet still. Depending on how you dress, speak, and interact, you probably can pass as a male for longer than you think.

It depends on a lot of things how soon you will start to appear as a woman to people. If you have short hair and not a lot of body fat I think it would be easier, since it’s hard to grow breasts without much fat. If you are heavier you are more likely get more breast growth and it might be harder to hide that without a binder, but even that can be managed. If you have facial hair or heavy beard shadow, that heavily skews perception towards male.

You might look back and think waiting for security in your life before starting estrogen was a mistake, especially if estrogen is necessary for your brain to work well like it is for me. Even without that reason, your body will undergo further androgenization, which for me increased significantly in my 20s.

Just worth thinking it through. If you have to keep it secret from family or people you live with, you could always take the DIY route to avoid the paper trail that visiting a doctor causes.

Just don’t underestimate how important estrogen is, I did and I regret it deeply - I would do anything to go back in time and start as early as I could.

+1 to sunscreen every day, find a nice cosmetic sunscreen that isn’t super greasy, most of the good ones are non-U.S. sunscreens (many from Japan and Korea), some of them also work as a makeup primer

here are some recommendations from Lab Muffin (a PhD in cosmetic chemistry turned science educator): https://www.youtube.com/watch?v=p5p72V3Jrg8