As regular readers of the blog know, I’ve been struggling with chronic illness this year. This month I may have found a way forward to recovery: I’ve been diagnosed with chronic tonsillitis, and will have my tonsils removed in late September. I’m both excited and a little scared at this development. Adult tonsillectomy is supposed to be a hard recovery, and there’s no guarantee that this surgery will solve everything. Still, I feel confident in the ENT who diagnosed me, and worst case the surgery removes a source of pain that I’ve been experiencing regularly.
In the process of trying to figure out my symptoms I started wondering if there was a connection to my cycle ala “period flu.” Tracking my bouts of sickness on a calendar seemed to indicate a 31 day cycle from start to start, and I experience big mood drops during most bouts that can be remedied with an additional milligram of estradiol. Up until this point I had been skeptical of transfems having periods, since not many people report cramping etc. The more I looked into it though the more convinced I became that transfem menstrual cycles seemed possible, whether or not my illness in particular was linked to a cycle.
Something I think that everyone on hormone replacement therapy should know about is the body’s system called the HPG Axis. HPG stands for hypothalamus, pituitary gland, and gonads. To give a quick and dirty explanation of the axis, the hypothalamus regulates the production of sex hormone in the gonads via signals to the pituitary gland by checking periodically to see if the bloodstream has “enough” sex hormone. The hypothalamus doesn’t care which sex hormone is present, just that there is enough. If sex hormone levels are low, the hypothalamus and pituitary gland activate sex hormone production in the gonads. HRT works by constantly keeping sex hormone of a type not produced by the gonads in the body at adequate levels in the bloodstream, preventing the body from producing sex hormone itself. When people talk about “suppressing T” in feminizing HRT, for instance, that means making sure estrogen levels are high enough that the HPG axis doesn’t kick into action and activate androgen production in the testicles.
In addition to regulating sex hormone production, the hypothalamus also regulates the menstrual cycle. I started wondering, what if I could find a way to identify and measure my hypothetical cycle? Would I see a link to my bouts of illness? I brainstormed with Lindsey on the issue, and she floated a potential approach: monitoring my body’s responses to HRT using a fertility tracking kit. Theoretically, if I have a period, I should see fluctuations in hormone levels in response to my steady intake of estradiol and progesterone. Right?
I ordered a fertility test kit that provided me with 30 tests to play around with. 15 measured E3 (estriol, a metabolite of estradiol), and the other 15 measured a combination of LH (luteinizing hormone) and PdG (a progesterone metabolite). You dip the tests in urine like a pregnancy test, then lines show up in a window indicating the concentration of hormones. The kit comes with an app that scans the test and does some sort of computation to determine hormone concentration. For 27 days I measured my hormones every other day. I held my oral E2 and rectal (cough) progesterone dosages stable over the entire period. I made sure to never measure my first pee of the day since it’s usually the most concentrated, and tried my best to test at the same time every day. I would have added a 28th day, but I screwed up one of the LH/PdG tests and had to throw it out.
Here are my results from 7/31 to 8/26. First, you can see that my estriol remained high and mostly stable. The crash towards the end of the measurement period corresponds with one of my sickness bouts - I can confirm I was having severe mood swings while feverish. For comparison with estradiol levels, I did an E2 blood test this week that puts me at around 200 pg/mL, which is what I expected. A cis body that produces estrogens would most likely have a much less constant level of E3, so that’s a clear difference for someone on HRT.
My luteinizing hormone results might be more noise than anything. Concentrations remain quite low for the typical range, and there’s not a clear peak like occurs typically before ovulation.
Oddest of all was my progesterone data. At the start of the collection period there’s what looks like a steady increase, like I’m maybe entering the luteal phase of my cycle, but then everything gets fucky towards the end. Some of that is, like the E3 results, probably tied to my sickness. There might be other factors, like how reliable boofing prog is in practice, and I also have some suspicions around how accurate the app's image processing of the test strips really is. Anyhow, there’s clear variation in my progesterone metabolism over time, which is worth considering.
I can’t confidently say that I found a cycle, but I did find something in that my hormones fluctuate over time and especially when my body is fighting infection. If I were to continue the experiment I would probably buy a kit just for progesterone, since the E3 and LH variation didn’t appear particularly interesting, and space out measurement to every 3 days to capture a bigger window to continue looking for a cycle. It’s been an interesting experiment, and I can’t say I’ve heard of anyone else trying something like this before.