I'm feeling frustrated with the doctors I've been working with on my medical transition. Perhaps it's simply my inexperience, but I'll just dive-in and explain my circumstances: I'm trying to understand if this is normal in Ontario.
TL;DR: My first blood test I was told to take at mid and at peak by two different doctors. My second test I'm being told to take at mid-point. Personally, the number I'm interested in is trough -- I have osteoporosis and a long history of issues with hot-flashes that got terribly worse when I started HRT. What's the deal with Ontario doctors not testing at trough?
When I was given my Rx at my informed consent appointment I was started on 50 mcg patches and they were explicit: Do your blood test two days after you change patch, "we want a snapshot of your serum levels at the mid-point" between peak and trough. This struck me as odd, especially when my research seemed to show that most trans women are testing their serum levels at trough.
Before I'd made it that far in my journey, I switched to gel (and because my clinic refused to discuss injections I found an alternative clinic... while talking to the doctor at the second clinic [and having already switched to gel] they asked me to do my test at peak, 3-4 hours after I put on my gel. ooookay, sure. I did.
Aside: on 1.5 mg/day of gel I was barely reaching 100 pg/mL at peak, when I did the first test.
My GP and GAC at my home clinic were happy with the levels, and gave me no space to discuss my terrible hot flashes (i.e. being held in menopause -- having osteoporosis, I was exceptionally unhappy with this 'outcome').
The GAC at the second clinic also expressed they felt my serum level was fine, but seeing I wasn't satisfied they allowed me to double my dose to 3.0 mg/day of gel. This didn't make much impact, and when I went back and asked for injections they're once again asking for a mid-point test, 3.5 days after injection (starting me at 3.0 mg/week IM EV).
I already know I'm still being under-dosed; I took my first shot (0.3 mL of 10 mg/mL sesame E17b ester) Sunday, and after two nights free of hot flashes they came back... worse on night 4 than on night 3. So, day five, I took my second shot (0.21 ml to maintain ~0.42 mg/day). Surprise, surprise, no hot-flashes last night!
It's a low trough that gives me un-wanted side-effects. Can we test my trough, please! I'm wanting to advocate for this at my next appointment, but also... I'm of half a mind to simply do my next test at trough anyway.... I've done so much research these past five months I'm feeling more qualified to monitor and manage my serum levels than these 'experts' I'm forced to deal with (I'm sure a fat-head from my honors in biotechnology isn't helping, but for real -- what's with all these Ontario doctors seeking peak and mid-point serum levels and never asking for trough? [Or do I just have bad-luck in finding doctors?]).