So helpful, especially the fine print. My pharmacy keeps giving me one of two different patch brands (neither are included in your chart I believe) and I’ve often wondered if I’m getting the same absorption. I see you say not just to shrug at this, but I feel like I have no choice but to take what they give me during a supply shortage.
So great! We need more in depth studies that actually track testing peak vs trough, SHBG along with FSH when using these deliveries. We don't even have a reasonably priced free estradiol lab test. I will say that when I used oral estradiol I tested between 4-6 hours after I took my dose. If I tested much later levels would be low. I feel that way about transdermal as well. It doesn't stay long in serum so testing trough really doesn't tell us much. We want to know how we absorb. And then when we rely on symptoms low and high can mimic each other. It takes a really good practitioner for sure and knowing what it actually feels like to be too high or too low and not purely focus on a "number". I currently use femring so timing definitely matters when testing.
Thank you! Scrambling to find alternatives for my ladies during the patch ( & now gel??) shortage. Once you start feeling almost human again the idea of being w/o HRT has brought the panic and flood of MyChart messages!
Thank you so much for the precious information that you keep sharing with us.
I am post menopausal and on HRT ( patch ,50 and 200mg progesterone)for two years now . I hear everywhere that we should have our estrogen levels checked. So I did. But from what I understand, the number I see can be completely different because of how much SHBG’s are present.
My SHBG’s are really high and my doctor says that It likely means that the number I see for my oestrogen level is way lower than what I’m seeing!
I follow a few of you docs out there and no one ever talks about the SHBG’s.
Am I to believe that my oestrogen levels are lower than what the results are?
I see more and more doctors talk about SHBG. It is a very important variable. The question is why is yours high. Maybe it could be just genetically/naturally high but usually it gets pushed up by something exogenous like birth control pills and oral estradiol.
Thanks ! Mine must be naturally high. I am not on birth control pills ( I am 58)and on Estrogen patch. I just don’t know how to read my estrogen levels!They are perfect if I disregard my high SHBG’s.
I wrote an article on FSH a few months ago. I think it's worth checking - certainly it may help know how much estrogen is reaching the organs but also FSH has its own actions on receptors that were just starting to understand.
Thank you so much for this valuable resource. You answered my previous question in the chat about how to test levels when taking oral estradiol (drawing mid-way between doses). So helpful!
Thank you for sharing your experience and knowledge with us! I have been taking oral estradiol as it's the only form(haven't tried injections yet)that my body absorbs. Does the conversion through the liver to estrone result in fat gain? I've definitely noticed an increase in cellulite in my thighs and abdomen.
Thank you, Dr Killen! This post is so helpful! My generic patches contain estradiol hemihydrate. Is this still considered bio- or body identical? Anything we should know about the hemihydrate version? I don’t know what the brand name equivalent is, the box and pharmacy printout don’t say. Thank you again! 🥰
Great question that I hadn’t thought of! I found this on an AI search, it lists the NIH as the source: “Estradiol hemihydrate is a bioidentical form of 17β-estradiol, the primary human female sex hormone, crystallized with water molecules. It is widely used in medicine for menopausal hormone replacement therapy (HRT), treating estrogen deficiency symptoms, and in gender-affirming hormone therapy.” The hemihydrate has half molecule of water added, once absorbed it is identical to plain estradiol patches.
Interesting that I have 2 boxes of patches from 2 different brands, one lists “estradiol” as the main ingredient, the other says “Estradiol hemihydrate”, the hemihydrate is the one I get the most effect from, the first brand I had my hot flashes return and loose patches. It really is all about what you absorb best, so I’ll be looking for the hemihydrate brands in the future!
This is an incredibly helpful resource. Thank you for taking the time (and brainpower!) to share this information with so many of us. 💕
You're very welcome
This. Is. Amazing. ❤️
THanks so much!
So helpful, especially the fine print. My pharmacy keeps giving me one of two different patch brands (neither are included in your chart I believe) and I’ve often wondered if I’m getting the same absorption. I see you say not just to shrug at this, but I feel like I have no choice but to take what they give me during a supply shortage.
This is so incredibly informative thank you!
Thank you for this!! Very helpful.
Thanks for sharing!
So great! We need more in depth studies that actually track testing peak vs trough, SHBG along with FSH when using these deliveries. We don't even have a reasonably priced free estradiol lab test. I will say that when I used oral estradiol I tested between 4-6 hours after I took my dose. If I tested much later levels would be low. I feel that way about transdermal as well. It doesn't stay long in serum so testing trough really doesn't tell us much. We want to know how we absorb. And then when we rely on symptoms low and high can mimic each other. It takes a really good practitioner for sure and knowing what it actually feels like to be too high or too low and not purely focus on a "number". I currently use femring so timing definitely matters when testing.
Thank you! Scrambling to find alternatives for my ladies during the patch ( & now gel??) shortage. Once you start feeling almost human again the idea of being w/o HRT has brought the panic and flood of MyChart messages!
HI Amy!
Thank you so much for the precious information that you keep sharing with us.
I am post menopausal and on HRT ( patch ,50 and 200mg progesterone)for two years now . I hear everywhere that we should have our estrogen levels checked. So I did. But from what I understand, the number I see can be completely different because of how much SHBG’s are present.
My SHBG’s are really high and my doctor says that It likely means that the number I see for my oestrogen level is way lower than what I’m seeing!
I follow a few of you docs out there and no one ever talks about the SHBG’s.
Am I to believe that my oestrogen levels are lower than what the results are?
I find that quite confusing.
I would love it if you could explain this !
Yes, a higher SHBG binds up more free estradiol so you can have less circulating. This may or may not have any actual clinical effects.
I see more and more doctors talk about SHBG. It is a very important variable. The question is why is yours high. Maybe it could be just genetically/naturally high but usually it gets pushed up by something exogenous like birth control pills and oral estradiol.
Thanks ! Mine must be naturally high. I am not on birth control pills ( I am 58)and on Estrogen patch. I just don’t know how to read my estrogen levels!They are perfect if I disregard my high SHBG’s.
Dr. Amy- thank you so much for the charts. Very helpful.
What is your opinion on the goal of suppressing FSH with the estrogen you’re taking?
I wrote an article on FSH a few months ago. I think it's worth checking - certainly it may help know how much estrogen is reaching the organs but also FSH has its own actions on receptors that were just starting to understand.
Thank you for the incredible charts . You put so much effort and time into this . I appreciate you .
Thank you so much for this valuable resource. You answered my previous question in the chat about how to test levels when taking oral estradiol (drawing mid-way between doses). So helpful!
This a f*cking awesome! THANK YOU for doing this incredible work. Clear, concise, useful to any reader.
Ha. Thanks!
Thank you for sharing your experience and knowledge with us! I have been taking oral estradiol as it's the only form(haven't tried injections yet)that my body absorbs. Does the conversion through the liver to estrone result in fat gain? I've definitely noticed an increase in cellulite in my thighs and abdomen.
Too much estrogen in general can cause increased fat in the glutes, butt and thighs but estrone isn't particularly bad at it.
Is estrone the cause as well of the menopausal belly? If not, what is?
Great question
Thank you very much for taking the time to respond, Dr. Killen!
Thank you, Dr Killen! This post is so helpful! My generic patches contain estradiol hemihydrate. Is this still considered bio- or body identical? Anything we should know about the hemihydrate version? I don’t know what the brand name equivalent is, the box and pharmacy printout don’t say. Thank you again! 🥰
Great question that I hadn’t thought of! I found this on an AI search, it lists the NIH as the source: “Estradiol hemihydrate is a bioidentical form of 17β-estradiol, the primary human female sex hormone, crystallized with water molecules. It is widely used in medicine for menopausal hormone replacement therapy (HRT), treating estrogen deficiency symptoms, and in gender-affirming hormone therapy.” The hemihydrate has half molecule of water added, once absorbed it is identical to plain estradiol patches.
Interesting that I have 2 boxes of patches from 2 different brands, one lists “estradiol” as the main ingredient, the other says “Estradiol hemihydrate”, the hemihydrate is the one I get the most effect from, the first brand I had my hot flashes return and loose patches. It really is all about what you absorb best, so I’ll be looking for the hemihydrate brands in the future!
Thank you, Denise! 😊
This is amazing information. Thank you so much for taking the time to put this together and sharing it here. ❤️