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Gender
Identity Disorder Information |
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HORMONE THERAPY: HORMONE REFERENCES << RETURN TO Table of Contents NORMAL MALE & FEMALE REFERENCE LEVELS 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).
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.
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).
Progesterone
(Pg) - This steroid hormone is a female sex hormone which, in conjunction
with
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
CLICK HERE for sample reference ranges for other free/bioavailable hormone levels. DHEA-S
(Dehydroepiandrosterone sulfate) is secreted by the adrenal cortex.
DHEA-S
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.
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. |