2022-10-13

Earlier this week I got back some similar lab results:

T = 500 ng/dL
E2 = 100 pg/mL

This profile results from a total of 4 mg of oral E2 (2 mg twice a day). No anti-androgens or other medications were taken. This is an abnormal sex hormone profile, as both primary hormones are at normal levels for their corresponding sex. As far as hormones are concerned, I am both female and male at the moment. Some may consider this a non-binary profile, or even an intersex profile.

Earlier this year I decided to reset my HRT as part of an experiment to gather insights into better treatment. My goal is mimic the natural menstrual cycle with E2 and P4 levels corresponding to the follicular, mid-cycle, and luteal phases of the cycle.

My hypothesis is that doing this has important benefits:

• minimizes long-term exposure to abnormally high-levels of E2 (which from experience, I suspect are bad)
• encourages breast growth, including Tanner Stage 5, via hormone oscillation
• mimics the inclusion of P4 post-E2 peak (which we don’t fully understand)
• T suppression using lowest amount of total hormone possible

Three objectives need to be met to accomplish this:

1. Establish a baseline E2 level
2. Recreate mid-cycle E2 spike
3. Recreate P4 cycle

My first objective with this reset is achieving a consistent baseline E2 level. E2 levels around 100 pg/mL are within normal range for pre-menopausal cis women at the follicular phase. This alone, dropped my T level to over half my pre-HRT levels, and under half my reset maxima.

My second objective is to mimic the mid-cycle spike in E2. This can be achieved easily with a intramuscular injection of E2, particularly E2 valerate, which has a stronger spike than the other common E2 ester, E2 cypionate. The key point here is control the maxima for E2 peak, which really shouldn’t be higher than 800 pg/mL. The peak for an E2 valerate shot is usually two days post-shot.

An optional part to the secondary objective is mimicking the secondary spike in E2 after the initial one. I think this could be difficult to do in a controlled matter. It could be accomplished in one of two ways: increasing the oral estradiol temporarily, or with an additional injection. I think controlling for this second spike make this more complicated, so I will not try to mimic for now.

My third objective is to mimic the P4 cycle that occurs in the follicular phase. This can be accomplished with bioidentical P4 in the form of sublingual tablets or suppositories. I think P4 is extremely important for (my) mental health, but there may also be risks from being on it at all times.

The following labs are recommended:

• immediately before mid-cycle E2 injection (baseline E2, peak T)
• 48 hours after mid-cycle E2 injection (peak E2)
• at end of P4 cycle (baseline/peak P4, trough T)

It’s a good sign if my T levels register lower after first full cycle. This means there was even more suppression earlier in cycle, and that a subsequent cycle may result in further suppression.