Seeking Advice on Confusing EV Monotherapy Lab Results - High E2 and T Increased with EV Dosage Decrease
Hi everyone,
I am a 25 year old trans woman who has been on HRT for almost 3 years.
I switched to estrogen monotherapy via IM Estradiol Valerate injections in mid-January 2026 (targeting 200pg/ml E at trough) and have had very strange lab results ever since. I'm hoping someone has seen something similar and may be able to shed some light on what is happening because both I and my provider are absolutely puzzled.
Since starting HRT, I had been on 4mg oral estradiol split dose (2mg in morning, 2mg in evening) and 100mg Spironolactone daily. My final labs on this method were 219pg/ml E2 and 25.5ng/dl T.
Upon switching to injections, I started at a dose of 5mg every 5 days of Estradiol Valerate injected intramuscularly. I had labs taken two and a half months later at the end of March at trough on the 5th day about 4 hours before my next injection. My labs came back at 764pg/ml E2 and 45ng/dl T.
This was an oddly high E2 result for trough on the EV dose I was taking, so my provider recommended lowering my dosage to 4mg every 5 days and re-testing after 4-5 more injections at that dose.
I switched to 4mg every 5 days of Estrdiol Valerate injected intramuscularly and had my labs re-tested at the beginning of May at trough on the 5th day about 4 hours before my next injection. Despite lowering my dose however, my labs came back even higher for E2 and T at 782pg/ml E2 and 78ng/dl T.
Does anyone have any idea why both my already high E2 and my previously in-range T would have increased after lowering my Estradiol Valerate dose???
According to my provider, the lab results were in pg/ml for E2 and not p/mol and the test ordered was the same CPT code 82670 Estradiol as the final lab work before I switched to injections.
I am worried about lowering my dose further to 3mg or less every 5 days as the previous decrease from 5mg to 4mg already led to my T rising out of the 4-50ng/dl range.
We're arranging bloodwork using a different lab as a sanity check but it will probably be at least 2 weeks until I get those results since my next trough falls on Memorial Day... I will update this post with those results when I have them.
TLDR: EV dose 5mg/5days 762pg/ml E2 and 45ng/dl T -> EV dose 4mg/5 days 782pg/ml E2 and 78ng/dl T = ?????
All questions and hypotheses welcome.