Gender Identity Disorder Information


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It is a good idea to be a partner in the management of your hormonal health. The more you know about it the better off you will be. One thing that can be of enormous assistance in understanding what your doctors are talking about is to simply know what the "normal" reference ranges are for the various hormones often discussed when talking about HRT therapies.

Be aware, however, that every laboratory establishes its OWN reference ranges that compensate for calibration errors in equipment or for their own methodology. What is frustrating is that, instead of adjusting their results and rendering them in some "standardized" fashion, each lab, instead, establishes an "adjusted reference range." This effectively makes direct comparisons of results from one lab with another impossible!

The numbers provided here are "ballpark" figures. When you get test results for hormone levels from your doctors make sure you ask what the normal reference ranges are (for both male and female). That way you can determine for yourself if you are in the upper, middle, or lower portion of those ranges and you'll be armed with the information to discuss adjustments to your medication with your doctor. A knowledge of what each hormone's role is would also be helpful, so I am including a brief description for each hormone of the relevance to an IS or TS patient. The following all refer to serum (blood) test levels.

You may also notice that most of the hormone levels are the same range for both males and postmenopausal women. Most male-to-female transsexual patients essentially are starting from the postmenopausal/male range. The goal of their hormone therapy is to simulate levels within the normal FOLLICULAR phase range for a woman. There is no health advantage in simulating a woman's menstral cycle and chemically inducing PMS-like symptoms. The goal should be a stable level within the target reference range. Female-to-male transsexual patients would obviously be shooting for the postmenopausal and/or male ranges.

Dihydrotestosterone (DHT). This is a more potent form of testosterone that is metabolized by the body from other androgens. In men most is made from testosterone, while in women the main source is androstenedione (which is first converted INTO testosterone). Current research indicates that DHT is responsible for male-pattern balding and excessive, unwanted hair in both sexes. In males it is also responsible for non-cancerous prostate swelling (BPH).

Premenopausal 24-368
  Postmenopausal 10-181
Males: 250-990

LDL - this is the so-called "Bad cholesterol" and may be a factor for some people. Estrogen therapy tends to lower the LDL level while testosterone therapy makes it go up. If you have a high LDL level and are on TRT therapy, you may have to make adjustments to diet or take other medications to address it.
160 mg/dL or more HIGH
130 to 159 mg/dL BORDERLINE
100 to 129 mg/dL NEAR OPTIMAL
Less than 100 mg/dL OPTIMAL
source: National Cholesterol Education Program

Estradiol (E2) - this is the main "female" hormone. There are two others, Estriol and Etrone, that are also sometimes tested, but they are metabolized from Estradiol, so it is usually the main one checked. The full name is 17-beta-Estradiol, which is also available in several medications for ERT therapy. Current research indicates that, in some people, this hormone may play a role in the loss of bone density, prevents male bodies from clearing DHT out of the prostate gland, and can stimulate estrogen-sensitive tumor growth (if estrogen-sensitive cancer cells are already present).

Women (> 18 years old)  
Follicular Phase 30-120
  Ovulatory Peak 130-370
  Luteal Phase 70-250
  Post-Menopausal 15-60
Male 15-60

Progesterone (Pg) - This steroid hormone is a female sex hormone which, in conjunction with
estrogens, regulates the accessory organs during the menstrual cycle and it is particularly important in preparing the endometrium for the implantation of the blastocyte and in maintaining pregnancy. In non pregnant women progesterone is mainly secreted by the corpus luteum
whereas in pregnancy the placenta becomes the major source. Minor sources are the adrenal cortex for both sexes and the testes for males. Current research indicates it balances agaisnt overactivity of both testosterone and estrogen, and effectively blocks 5-alpha-reductase enzymatic conversion of testosterone into DHT. Progesterone also plays a role in stimulationg Osteoblast (bond building) enzymes, lowering cholesterol levels, stimulating growth of epithelial tissue and lobule-alveolar systems in the breasts, and upregulation of the P-53 cell-division gene, thus offering an anti-carcinogenic effect against run-away cell division in hormone sensitive tumors.

Follicular phase 0.2-1.4 0.64 - 4.45
  Luteal phase 4 - 25 12.7 - 79.5
  Post-Menopausal 0.1 - 1 0.32 - 3.18
Males 0.1 - 1 0.32 - 3.18
Conversion factor: 1 ng/ml = 3.18 nmol/l

Testosterone (T) - one of the most important male sex hormones. In men it is mainly synthesized by the testes, in women both the ovaries and by the adrenal cortex; it is secreted into circulation. Testosterone is transported in the plasma by a beta-globulin, called testosterone binding
globulin. It is estimated that about 98 % of the circulating testosterone is bound. The remainder, present as free testosterone, is assumed to be the metabolicly active portion. In the target organ, it is transformed by 5-alpha-reductase into the physiologically effective androgen DHT. In men the determination of testosterone is used as an indicator for the function of the testes: low hormone levels are found in cases with Klinefelter's syndrome, cryptorchism or anorchia. Male or female patients with an androgen producing tumor (ovaries, adrenal cortex, testes) show
increased values. Measurement of testosterone is used to confirm hirsutism in woman. The determination of free or not specifically protein-bound testosterone can be helpful in cases of hyperprolactinemic women or hyperandrogenism. It promotes the burning of fat and the building of lean muscle mass. It also appears to be the fuel for the libido in both sexes. The role of testosterone in cardiovascular health is still hotly debated, but it appears that it may have a detrimental effect over the long term. Testosterone, like progesterone, upregulates the P-53 gene to turn off rampant cellular division, so in that sense is anti-carcinogenic. Testosterone also stimulates oil production in the skin, which can lead to acne problems.

Females 6 - 86 0.1 - 1.2
Males 270 - 1100 2.4 - 12
Conversion factor: 1 ng/ml = 3.47 nmol/l

Free or Unbound Testosterone ("Free T") - As mentioned above, about 98% of the testosterone in a man or woman's body is bound to blood proteins. This means that only a small portion is actually "bio-available" and acting on the body's tissues. A healthy percentage for either men or women is around 2.5%. One thing that sometimes frustrates gender patients is that the measurements for the biologically significant free testosterone are not easily compared between men and women. Labs often will state the percentage free for men, but give a measurement in pg/ml for women. Or the male measurements will be in ng/dl requiring a mathematical conversion for direct comparison to the "normal" range of the opposite sex. The percentage is usually higher in adolescents (up to 5%) and quite low in elderly people (around 1%). Many doctors believe that any reading below 2% means the patient should take testosterone supplements, and that any reading below 1% indicates a completely absent sex drive. The level readings between men and women are so vastly different because the number represents a percentage of the TOTAL testosterone. Women naturally start with a lower total amount, so 2.5% of 40ng/dl is going to be much less than 2.5% of 800ng/dl in a man.

% Free Range
0.6 - 6.8
0.4 - 2.4
1.6 - 2.9
Total Free Range is 0.3 - 5% ( 2% average )

CLICK HERE for sample reference ranges for other free/bioavailable hormone levels.

DHEA-S (Dehydroepiandrosterone sulfate) is secreted by the adrenal cortex. DHEA-S
is thought to be a biologically weak androgen, but because of its high concentration in blood, it contributes significantly to the androgenization process. The physiological role of DHEA-S is not well known, but it seems to be intricately involved in adrenarche (axillary and pubic hair growth). DHEA-S appears to be an excellent indicator of adrenal androgen production. Elevated levels of DHEA-S have been reported in states of excess androgen production such as cystic acne, hirsutism, infertility, enzymatic adrenal defects, Cushing's syndrome due to bilateral adrenal hyperplasia, and virilizing adrenal tumors.

Premenopausal 0.8 - 3.9 2.1 - 10.1
  Pregnancy (3. Trimenon) 0.2 - 1.2 0.5 - 3.1
  Postmenopausal 0.1 - 0.6 0.3 - 1.6
Newborns (both sexes) 1.7 - 3.6 4.4 - 9.4
Males 1.0 - 4.2 2.6 - 10.9
Conversion factor: 1 µg/ml = 2,6 µmol/l

Androstenedione - this hormone is produced by the adrenals and gonads. Therefore, the determination of the level of androstenedione in serum is important in the evaluation of the functional state of the glands. Androstenedione is a precursor of testosterone and estrone. Besides the adrenals, in females, the ovaries have been shown to be an important source of androstenedione during the ovulatory cycle.The principle production of testosterone in females is from the conversion of other related androgens, especially androstenedione. An abnormal testosterone level in women should be accompanied by the estimation of serum androstenedione. The use of serum testosterone determination in conjunction with Enzyme Immunoassay of androstenedione can be used to determine if source of excess androgen production is adrenal or ovarian.

Mean [ng/ml]
Absolute Range [ng/ml]
Females (18-49 years)
0.70 - 3.50
Females (50-80 years)
0.20 - 3.40
0.35 - 3.15
Conversion factor: To convert to nmol/L: ng/ml x 3.45 = nmol/l

Leutenizing Hormone (LH) -LH stimulates Leydig cells in the testes to produce and secrete testosterone (T). As the testosterone travels through the bloodstream it passes through the anterior pituitary gland and hypothalamus it creates a "negative feedback loop" that triggers a decrease in GnRH and LH. LH also stimulates the adrenal gland to produce androstenedione and progesterone. A problem with LH levels alone is rarely seen, so testing is only needed if testosterone level is abnormal, for example, if the patient is suspected to have been born with Klinefelters Syndrome. In women a normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS.

Females (follicular)
< 7
Females (Surge 48 hours before ovulation)
> 20
2 - 18

Follicle Stimulating Hormone (FSH) - In women FSH is often used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS. Basic hormone testing for males often only includes testosterone and FSH. However, in cases such as Klinefelters Syndrome doctors will usually look at both FSH and LH levels. In males FSH stimulates the Sertoli cells in the testes to produce androgen-binding proteins, testosterone, and a protein called inhibin. Inhibin, in turn, travels in the blood back to the pituitary gland whre it creates a "negative feedback loop" that decreases the output of FSH. Since FSH stimulates testosterone production, and testosterone can be converted to DHT and estradiol, an increase of any or all three can also create a "feedback loop" that decreases FSH secretion.


Sex Hormone Binding Globulin (SHBG) - this is the principle blood protein that ties up the bulk of the steroids the body produces. For example, it bind with about 98% of the total testosterone, but also binds with other steroids as well. As androgen production increases, available SHBG decreases.


Note: source for most of this information on reference levels, unless otherwise noted, comes from data sheet inserts accompanying ELISA Assay kits manufactured by Immuno Biological Laboratories (IBL), Hamburg Germany. Other resources for this information included FertilityPlus, Web Heallth Centre, University of Iowa Department of Pathology Laboratory Services Handbook.

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