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   CJ Bellwether (siege@octodon.social)'s status on Sunday, 22-Oct-2023 23:32:35 JST CJ Bellwether

   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944393/

   This is most absurd clinical findings ive seen regarding trans females. It states they prescribed "oral estradiol" starting at 2mg and increasing in dose over a year to try and achieve levels above 100 pg/ml with an aim towards monotherapy between 2008 and 2018 looking at 184 trans women in their clinic.

   Looking at their scatter chart they state 1 patient achieved about 90 pg/ml on 1mg oral, 2 patients achieved over 100 pg/ml on 2mg oral, and 14 achieved over 100 pg/ml on 4 mg oral.

   The issue? a patient on 1mg oral will not see estradiol levels above 25 pg/ml at peak, a patient on 2mg oral will not see estradiol levels above 50 pg/ml at peak, and 4mg oral will only break 100 pg/ml at peak at 6-8 hours and then crash below 40 pg/ml after 24 hours.

   So whats going on? well a minority of their patients who somehow magically achieved the impossible, as usual were doing what trans girls in the US do all the time, they take the medication they're given and then took it sublingually (and likely broke up their doses through the day) because you get far higher levels that last longer that way.

   The only other explanation is these patients had their estradiol levels tested incorrectly either not at trough or there was an aberration in the test.