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[laszla]

 After years of poor absorption of T and oestrogen, I have been getting implants since last October. The T one has worked well, I'm finally absorbing a decent level - it initially went high after the second was implanted in February but has now settled to a good level.

Meanwhile, my oestrogen level following my first implant in February had shot up to 870 three weeks later, bearing in mind that for those 3 weeks I was still using the oestrogel albeit at a lower dose and gradually tapering off. Following that test of late February I have used zero gel and am dependent on the implant alone.

I tested again this week and my oestradiol has plummeted to 470; I am thinking that perhaps the initial 870 figure was the result of implant and gel accumulating  (I did not feel good at that level btw).

477 is a level I have achieved with the gel and it does not seem to be enough for me, I was advised to aim for 600-800 and so far the implant does not seem up to the job - bearing in mind that they give you a 50mg implant which is about half of the 3-4 pumps of gel I was taking - it is normal to prescribe this level for an implant.

Meanwhile, as per a separate post, since the implants, my Follice Stimulating Hormone (FSH) and Luteinsing hormone (lh) have crashed to negligible, pre-pubescent (!) levels (0.4 and less than 0.3).

I've always fixated on the E2 and T values but since FSH and LH have plummeted (previously they were dramatically higher), I feel that this drop could provide clues as to what is going on, not so much for nerdy scientific interest but to feel better, which is far from the case now.

Very low FSH and LH can be a sign of something called Hypogonadotropic hypogonadism "a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus" (of which I know nothing and haven't found much yet).

But as these low numbers coincide with the implants being inserted, I feel there might be a link and desperately need to connect the dots.
I'd be really grateful for any suggestions or leads. I'm not due back at Chelswest til June.

[treeoflife]

Hi Laszia

I am also on the E and t implants at the chelwest hospital.

I can relate to drops in estrogen on the implant.

I have had my first implant in Jan last year. My levels have been up and down. My levels in Jan 23 were in the 200’s and then in September still only in 200’s.
Likewise good level with T implant.

They finally went up in Dec last year to 766. I felt great. Like you they have now plummeted to 541 (blood test 06.03.24) since my T was lowered. I don’t feel right at all. Not sure if you have seen my other post but I’m struggling.

I’m having to still use a patch on the implant and I have had 4 so far.I am on 50mcg of Everol at the minute, but not really noticing any benefit.

Waiting to see if I hear from my Gp as I was advised you have to go through the ers

Just thought things would be more stable on the implant.

Sorry I’m not any help on FSH levels.

X

[laszla]

Many thanks for your input tree of life - you might have seen another poster had to go through a few implants in order to get some stability so hopefully we will get there eventually though I know how hard it is in the meantime with no certainty and sporadic support.

Was your E2 implant 50mg? I know they also come in 100 mg and wonder whether chelsea are willing to increase if the 50 one persistently fails to increase levels sufficiently...

You have reminded me that one can top up with gel/patches if the implant isn't sufficient.

Am still really hoping someone can suggest something re my rock bottom FSH/LH as being so extreme I feel it could provide a helpful clue.

[treeoflife]

Yes if it’s the same poster, it took her three years!

It is so hard. Be nice to have some normality. I was out running three times a week, walking every day and doing yoga. Just not had any energy, motivation or inspiration. Along with a list of other symptoms and Struggling to get out of bed. 

That is a good point. Yes iI am on the  50mg. E. I was on 100mg T but now 50mg. I’m not sure if that is the cause of all the symptoms Ive been having. Just wish they would leave as is if feeling benefits. My T was 2.4. Before Mr Panay retired he was happy with that level.  Hee said as long as it doesn’t get excessive.

X

[laszla]

T at 2.4 is fine, it doesn't sound as if they had good reason to give you the lower dose implant. So far I've found the T much more helpful than E.
But I still need to get to the bottom of the mega low FSH.
I hope you feel better.

[treeoflife]

Hi Laszia

Thank you.

I agree. The nurse didn’t give any reason.

I will be asking the question why at my next appointment. I can’t go through this hell again. Hasn’t felt like I’ve been  on any hrt.

I will be questioning it as to why? That level obviously is right for me. It hadn’t risen since April from 2.4. So that was in 9 months.

The last time I felt well was a month today ☹️

Hope someone comes along with some knowledge on FSH.

Take care.

Jenny x

[Hollyboll]

Hi - Sorry to hear you are both still struggling. 

I'm much newer to implants than you (had first E 3 weeks ago) and realising that the complicated and prolonged process of getting my E2 levels safe enough to go ahead meant in my many appointments we were focused on that point, rather than what happened afterwards - which I guess is what we all really need to know here!  So I'm no expert, and these are just a few thoughts in case they help:

- Laszla I think it's very unlikely your implant has worn off in a month - my understanding is (unless it's rejected which happens incredibly rarely for E and a bit less rarely for T) it works within a few weeks (thanks to your helpful post after your high test I asked and was told to taper topup patches to 0 over 3 weeks).  I guess it must taper over time, hence replacing it in a few months, but I've no idea of that slope.  It's much more likely that your high test was because you were doubling on gel - I remember you saying they'd been a bit vague so you'd had to make this up - and that only now are you seeing the actual implant levels.  (I also remember from when I was first reading around about implants an article about one of the risks being people who topped up gel a lot over the longer term going into tachyphylaxis - your levels obviously aren't anywhere  near there, and I don't say that to worry you, but it's clear that top up transdermal can compound the levels from implant). 
- I was categorically told that it's apples and pears to compare a 50 implant with a 50 dose transdermally, because the absorption is completely different.
- My understanding (fwiw) is that 100s aren't used any more for E implants - only 50s and 25s, sometimes combined for 75 but never on first implant.  If that's right I guess that it's for the reason above ...

Treeoflife - your 200ish last September - when was that in relation to implanting?  If it was a few weeks in did they say that's a worry?  If it was before your next one, presumalbly that's how it's supposed to work ie time for a new one?

I've been thinking about the poster who said it took a few until she felt really well on implants.  I  guess that may be a combination of cumulative effects and our own levels and needs changing?

- I was told that T implants don't always give the same stability as E implants do
- I've not had T implant , just trying to sort out E first.  But I'm interested in whether either of you were implanted (100?) at 2.4 ... ie whether Lazla was told it's fine to be at that level but one doesn't want it to go higher or whether that's a fine level and so is a bit higher, which is what putting in a new implant would do?

- LH/FSH - I know nothing about these at all, like you having concentrated on the others. And tbh since in all my million blood tests they've been tested a lot less often, and not focused on when they are, my guess is that's probably right. But I do remember consultant saying to me once in passing that one of them (sorry can't remember which) was 'completely flat' - ie very low and not changing - and that that might be related to E2 levels or it might be 'a clue' as to whether in peri or post.  I'm sorry I can't remember which it was about or which it indicated, but I take from that that it may change as one progresses through this whole 'adventure'.  Sorry can't remember the detail that would actually help here - symptomatic.  It's a lot longer than a month since I felt well!

xx

 

[treeoflife]

Hi Hollyboll

How are you?

Yes I definitely agree with what you say about what happens afterwards. I was told it would be a more continuous method of delivering the hormones!!!!

How it was explained to me was the hormones rise at the beginning and as you say fall as the implant runs out.

In September of last year  when my levels were at the end of my implant I had in May. The level was in the 500’s in July and T was 4.5 (I didn’t feel right) at that time or through August.

I felt well for a week in May.

In December of last year, which would have been four months since having the new one in September my levels were 766 and I felt well.

So they had accumulated after this implant but lowered again. Whether that is connected to lowering the T implant, but that has only dropped from 2.4 to 2.3

Yes I think your right about the cumulative affect with the other poster.

I have not had anger for about 4 years. Had twice with this latest implant. Wondering if that is to do with lowering the T implant.

If anything symptoms have been worse these past couple of months.

I had about 6 days of feeling ok last month. It’s been downhill since 17th March.

Xx

[Hollyboll]

Interesting - when you say you were told they'd go up at the start, do you remember if that was iniitally ie by a few weeks they'd be as high as they would go or if they'd keep rising?

In fairness, it does seem (so far) to have given me a more stable level of E2, it's just that's too low ... but my fluctuations were crazy (weird uptake pattern and very high doses).

I'm as certain as I can be about anyhting (fwiw) that a T reading at 2.4 to 2.3 is no difference at all. 
And also fwiw I don't think anger is a symptom of low T, but of either excessive T or E fluctuations?

xx

[treeoflife]

Hi

I got the impression they would keep rising. The nurse drew a diagram ie a semi circle. How I understood it was if your having the implant over four months  after two months it gets to peak and then starts to drop.

My levels seem to drop before then.

I think it’s basically what we have said it accumulates and we balance eventually…..

For me it’s taking time, but we are all different.

I know what you mean by crazy fluctuations.

That blood test was in March for my T and I had the implant in January.

Be interesting to see what both my levels are now in view how I am now. No energy, motivation, inspiration, low mood, insomnia and generally not feeling right.

By the way to answer your question about the T dose at 2.4 I was on 100mg. Now 50mg.

Xx

Xx

[Hollyboll]

Thanks - that's interesting about the semi-circle, so hoping I might still pick up!

When Mr Panay was happy with your 2.4, did he put another implant in right then?  Otherwise I can see that at 2.3/2.4 if that's after a couple of months, ie near or at peak, they wouldn't put in another 100 then ...?

My fluctuations were so mad the consultant dismissed the first few tests as clearly wrong, but then got more interested and tested several times a week and sometimes a day - apparently a very unusual uptake mechanism from transdermal.  I'm hoping the implant will stabilise things, and then we can start looking at the levels themselves!

Laszla - how are you doing?

xx

[treeoflife]

Hi

Yes I’m sure you will. Seeing as it’s early days.

Sorry that was in 2022 when Mr Panay said that about testosterone. I was on testosterone gel.

It was also 2.4 at the end of the implant in April and the same in September, but I was given 100mg t implant both times and was fine. The level didn’t change.

Yes I was shocked at your levels how they went from very high and low. From one extreme to another.

I hope the implant works well for you.

Keep us posted.

Yes I wondered how you are doing too Laszia

Xx

[laszla]

Laszla I think it's very unlikely your implant has worn off in a month - my understanding is (unless it's rejected which happens incredibly rarely for E and a bit less rarely for T) it works within a few weeks (thanks to your helpful post after your high test I asked and was told to taper topup patches to 0 over 3 weeks).  I guess it must taper over time, hence replacing it in a few months, but I've no idea of that slope.  It's much more likely that your high test was because you were doubling on gel - I remember you saying they'd been a bit vague so you'd had to make this up - and that only now are you seeing the actual implant levels.  (I also remember from when I was first reading around about implants an article about one of the risks being people who topped up gel a lot over the longer term going into tachyphylaxis - your levels obviously aren't anywhere  near there, and I don't say that to worry you, but it's clear that top up transdermal can compound the levels from implant). 
- I was categorically told that it's apples and pears to compare a 50 implant with a 50 dose transdermally, because the absorption is completely different.
- My understanding (fwiw) is that 100s aren't used any more for E implants - only 50s and 25s, sometimes combined for 75 but never on first implant.  If that's right I guess that it's for the reason above ...

- I was told that T implants don't always give the same stability as E implants do
- I've not had T implant , just trying to sort out E first.  But I'm interested in whether either of you were implanted (100?) at 2.4 ... ie whether Lazla was told it's fine to be at that level but one doesn't want it to go higher or whether that's a fine level and so is a bit higher, which is what putting in a new implant would do?

- LH/FSH - I know nothing about these at all, like you having concentrated on the others. And tbh since in all my million blood tests they've been tested a lot less often, and not focused on when they are, my guess is that's probably right. But I do remember consultant saying to me once in passing that one of them (sorry can't remember which) was 'completely flat' - ie very low and not changing - and that that might be related to E2 levels or it might be 'a clue' as to whether in peri or post.  I'm sorry I can't remember which it was about or which it indicated, but I take from that that it may change as one progresses through this whole 'adventure'.  Sorry can't remember the detail that would actually help here - symptomatic.  It's a lot longer than a month since I felt well!
xx

Thanks for your helpful thoughts Hollyboll. I totally agree with your theory that my 800 ish E reading a month post implant was the result of my simultaneously using the gel - albeit at a much lower dose.

If that's the case, then my recent reading is the 'real' one in which case a 50mg E implant might not be enough for me.
I don't have it to hand but I seem to remember a leaflet they gave me at Chelsea saying that they used E implant also in the 100 mg dose.

I might also have to accept that it is not as straightforward, for me, to attain X amount of serum estradiol or T to feel well. An interesting book called Testosterone Rex maintained that the amount of circulating T (and by extension other hormones) is just one part of a highly complicated system – the one that happens to be the easiest to measure and that there are so many co-factors – how much aromatase to convert to oestrogen, number and nature of androgen and estrogen receptors, their sensitivity etc, social factors, all mean that absolute T in blood is an extremely crude guide to the hormones' effects on the brain and body.

In answer to your T question, before my first implant, and after years on testogel, I never got above around 1. After first implant I got to 2.5, after second implant, carried out 4 months later, it shot up to 7 (the test with the 800+ E reading) and in my recent test it had gone down to 3.8.

I know the FSH/LH factor is a bit niche and thus hard to get feedback on, but because they are so dramatically low, I feel really compelled to find out what it could mean as it might provide a helpful clue rather than my obsessing over increasing E and T which haven't helped at all other than better muscular strength - my sleep meanwhile is the worst it's ever been.
xx