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[MIS71MUM]

Sorry I missed the other replies.

I take 4 pumps - split twice a day and my oestrogen levels are lower now than when not on hrt!

I need to increase to 6 pumps but I don't think it's goung to make much of a difference. Been on 100 patch before and still had with flushes the following day after application.

I'd be interested to know how to change your shbg levels to allow the oestrogel to work more effectively.

[Tc]

So would I. I realy hope someone can help us on this.
MIs7 I  was beginning to think  i might be a rare case but it seems I  have  had the same experience as you. My doc said my levels are as though I'm not on HRT at all.  I couldn't understand it.

[Tc]

Yes its true my levels didnt increase at all  on eastrogel.or on the femseven patch and symptoms were not controlled
 but what  I'm now wondering is  if it might not actually be an absorption problem after all. I'm wondering   whether it might be how the body is metabolizing the easteogen it's getting. Whether If its binding to SHBG in the same way T does and having the same effect I.e.the  low serum levels in blood which is showing in the tests and leading to symptoms not being controlled.
Mis7 has had Shbg test but I haven't yet. Just this experience seems so similar to mine. So I suspect it very heavily that shbg might be an issue.. My next blood test is for the T I have been started on but just  T and not SHBG. So I need to ask for it.
 if this is the case how can it be tackled. Higher levels of E which my doc will not go above 100 patch and as mis7 says how high do you have to go  or can we lower SHBG levels in some way.

[MIS71MUM]

Hi ladies

I'll reply more later but wanted to say to TC, I had my blood tests done by a gynaecologist at a NHS menopause clinic. I asked, no begged, my GP to refer me and she did.

Despite being told that the waiting list was ridiculous and I'd be waiting 6 months, I think I was seen in 2 months.

The gynaecologist was amazing - wasn't to disturbed by my high blood pressure. When I described that my mind howled sometimes and wouldn't stop, she said that's a marvellous way on putting it! Rather than telling me I was depressed.

I think Gynaecologist can increase doses beyond what your GP can, so maybe you could ask for a referral to your local nhs menopause clinic.

[Hurdity]

Sorry I missed the other replies.

I take 4 pumps - split twice a day and my oestrogen levels are lower now than when not on hrt!

I need to increase to 6 pumps but I don't think it's goung to make much of a difference. Been on 100 patch before and still had with flushes the following day after application.

I'd be interested to know how to change your shbg levels to allow the oestrogel to work more effectively.

Hi MIS71MUM - I don't think the effectiveness of oestrogen is affected by SHBG levels. However I don't fully understand it and it is not fully understood anyway - especially with respect to T replacement. Your SHBG levels from that test are low anyway - as well as your oestrogen. Yes your FAI is within range but at the lower end. I wonder if these levels vary daily too just like estradiol ie only prvodie a snapshot eg i wonder what they would be if you had more done tomorrow for example?

One thing I'm not clear about is whether the oestrogen measured by serum tests is total oestrogen (as with testosterone) or just the biologically free estradiol. I haven;t considered this - or rather it has flitted through my mind now and again and gone away again. I have always presumed that because so much emphasis (well sometimes) is placed on serum estradiol levels - that whatever is measured must have biological significance. However estradiol exists in dynamic equilibrium (interconverts from one to the other) with another oestrogen called estrone and various metabolic states ( like estrone sulphate) and all this is subject to hormonal/enzyme control - so it's so complex that I don't think it's as simple as increase one therefore decrease the other if you see what I mean?

In the case of testosterone it does seem to be more clear cut and I think that's because testosterone has a very high affinity for SHBG - but I dont understand whether it will therefore displace oestrogen and then make it (oestrogen) more available for the body.....I wish a bit more was known. There are various studies done at cellular level with animal tissues eg mice or rats but....can you tell I'm flannelling??!!!

I understood that only oral oestrogen has a direct effect on SHBG (increasing it) which binds free testosterone and that transdermal HRT does not have this effect. It's all very confusing!

... and sorry my ramble is probably no help at all!!

Hurdity x