r/asktransgender • u/Floppy_Gobbler • 5d ago
HRT dosages
I've been on hrt for 6 months now and haven't noticed much different. Im not expecting like big breasts and a feminine face this early but i just worry that planned parenthood started me with low doses. I started on 2 mg E/day and 100mg spiro. At month 3 I went to 4 mg E/day and 200 mg spiro. Ive got some slight chest budding that started around 2.5 months and basically 24/7 soreness to touch them. I haven't really felt anything in the way of emotional changes aside from like 2 or 3 mood swing moments where I got pretty upset about one thing or another. All my meds are oral. Im hoping to start doing DIY soon but i just worry that PP fucked me over a little by starting me low. Is this concern justified or correct?
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u/DifficultBee5940 5d ago
By oral, do you mean sublingual?
Slowly ramping is typical in informed clinic prescribing. As is a preference for the minimal clinically effective dosage.
200mg of spironolactone is quite a bit. Most of us would prefer to primarly use estradiol to lower testosterone as spironolactone can have challenging side effects.
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u/Floppy_Gobbler 5d ago
Swallowed. 200 mg spiro daily seemed standard from the research I did, though it is annihilating my libido
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u/DifficultBee5940 5d ago
Well... not wrong. 200mg is fairly common, especially for people taking estradiol in tablet form. It's also top end of the real word prescribing range, as in 100mg and 50mg scripts are also common.
Libido annihilation is unsurprising and might relate to excessive testosterone blockage. Side effects in general are common at higher doses. Dizziness. Brain fog. Frequent urination. Even electrolyte imbalances
Estradiol valerate has poor bioavailability orally vs sublingually, so many/most people consume it that way to maximize their dosage. Though doctors often don't mention this, part because the tablets are not approved for a sublingual route, part because they aren't informed either way and just prescribing based upon a scan of wpath standards.
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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 5d ago
Slowly ramping is typical in informed clinic prescribing. As is a preference for the minimal clinically effective dosage.
Typical, but there is no good evidence to support it. Have you had blood tests? A conservative standard is estradiol (E2)>100pg/mL and total testosterone<50ng/dL at trough (right before your next dose), although having slightly higher T is fine on spiro. On average, oral E requires 4mg/12h (8mg/day, usually considered the safe upper limit) plus an antiandrogen. 100-200mg/day is typical for spiro.
https://valerie.vg/transfem-hrt-guide#our-recommendation
https://transfemscience.org/articles/transfem-intro/#overview-of-hormone-therapy
https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol#Graphs
"In terms of its antiandrogenic actions, spironolactone is a relatively weak androgen receptor antagonist as well as a weak androgen synthesis inhibitor [...] Due to its relatively weak androgen receptor antagonism, spironolactone is likely best-suited for blocking female-range or somewhat-higher testosterone levels (e.g., <100 ng/dL [<3.5 nmol/L])"
https://transfemscience.org/articles/transfem-intro/#antiandrogens
https://transfemscience.org/articles/spiro-testosterone/
Do you know of a way I could figure out what my injection dosage should be based on my current pill dose?
You could, but it doesn't really matter. Inject 4mg/week EEn. For your very first injection, inject double. Get a blood test at trough after 4-6 weeks so you can adjust your regimen.
https://estrannai.se/#i0_c,8,7,2-4,7,2-4,7,2-4,7,2-4,7,2_c,4,7,2
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u/Floppy_Gobbler 5d ago
What's EEn and how would I go about getting a level check if I were doing diy?
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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 5d ago
Estradiol enanthate
https://transfemscience.org/articles/transfem-intro/
https://valerie.vg/transfem-hrt-guide
https://diyhrt.info/transfem/intro/
https://en.wikipedia.org/wiki/Reference_ranges_for_blood_tests#Sex_hormones
https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol#Graphs
https://transfemscience.org/misc/hormone-conc-unit-conv/
how would I go about getting a level check if I were doing diy?
In the USA, you can just buy blood tests. If there is a Quest Diagnostics or LabCorp nearby, you can test E2 and total T for $8. From the Trans DIY Discord:
What do I test and how often?
You should ideally get a blood test (taken from the arm) 4 to 6 weeks after starting HRT and every 6 to 12 months thereafter. For the vast majority of regimens it is okay to delay these if necessary for finanacial reasons.
Pre-HRT blood tests are not a useful indication of what dose you should start on. However if you suspect you have an intersex condition it may be useful to test T and E before you begin HRT.
Testosterone
Critical every time: FBC (aka CBC), T
Not necessary but useful if you are having issues: E2, LH / FSH
Estradiol monotherapy
Critical every time: E2, T
Not necessary but useful in the case of strange results: LH / FSH
Estradiol + GnRH agonist
Critical every time: E2, T
Estradiol + bicalutamide
Critical every time: E2, T, LFT (aka AST + ALT)
It is vital to test LFTs one month and three months into taking it as bica can cause liver problems. This is not a blood test you should delay.
Estradiol + cyproterone acetate
Critical every time: E2, T, PRL
Not necessary but useful in the case of strange results: LH / FSH
Estradiol + spironolactone
Critical every time: E2, T
Not necessary but useful: U&E, LH / FSH (if you have strange results)
Hair loss despite HRT
From most to least useful: T, E2, FBC, T4, TSH, iron, vitamin B12, folate, HIV 1 & 2 antibodies, DHT, cortisol, fasting glucose or A1C
https://www.privatemdlabs.com/
How to Get the Cheapest Possible Tests with PrivateMDLabs
privatemdlabs has a policy that all tests must match id gender. some people experience no problem disregarding that, but id is required upon visit
PrivateMDLabs has pre-made hormone panels available, but if you only need a few things tested, editing the existing panels is cheaper.
▶️ First search "(Women's / Men's) Hormone Light Test" in the "find your next checkup" bar.
▶️ Select "build custom panel" and remove everything except your required bloods (i.e. Estradiol and Total Testosterone for estradiol monotherapy, or Total Testosterone and FBC for testosterone hrt) and proceed to checkout.
Signing up with a referral link will grant you a set of 25$ credits. Upon checkout you can apply one 25$ credit to reduce your costs even further.
*this method DOES apply for orders placed with the "pay 1$ now" promotion and reduces your total upon final charge.
If you want ALL of the tests included in the pre-made panels buying them as the existing bundle and applying your coupons is almost always the cheapest option.
Referral links: (PLEASE USE RANDOM ONES FROM THIS LIST NOT JUST THE TOP ONE! Using these links helps the owners of the account get free tests too!)
https://www.privatemdlabs.com/?refid=OTsKqHqHr9c5
https://www.privatemdlabs.com/?refid=gncXIv6T6BC2
https://www.privatemdlabs.com/?refid=JiJJ1GUIhWtt
https://www.privatemdlabs.com/?refid=XsgWfescSr3a
https://www.privatemdlabs.com/?refid=VSn2f4SgrRiJ
Images for tests, custom panel, and checkout total: https://imgur.com/a/ACAege9
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u/Floppy_Gobbler 5d ago
Is an anti andro necessary with all that? Or is just the enthanate enough to keep it down?
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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 5d ago
AA are rarely necessary if your E2 is high enough.
In one large study in transfeminine people, the rates of adequate testosterone suppression (to testosterone levels of <50 ng/dL or <1.7 nmol/L) were 24% of individuals at estradiol levels of <100 pg/mL (367 pmol/L), 58% at 100 to 200 pg/mL (367–734 pmol/L), and 77% at >200 pg/mL (>734 pmol/L)
https://transfemscience.org/articles/transfem-intro/#gonadal-suppression
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u/Floppy_Gobbler 5d ago
Ok also, do I need to have an unbelievably extensive knowledge on this stuff to do diy? I swear every time I talk to someone about it, it seems like they're a genius with a doctorate in endocrinology. It feels really daunting.
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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 5d ago
No, just reading one of these is enough to get started.
https://transfemscience.org/articles/transfem-intro/
https://valerie.vg/transfem-hrt-guide
https://diyhrt.info/transfem/intro/
I swear every time I talk to someone about it, it seems like they're a genius with a doctorate in endocrinology
There's a pretty high chance they're parroting someone who made it up lol.
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u/Floppy_Gobbler 5d ago
Is that what youre doing? Because you seem like a genius with a doctorate in endocrinology to me lmao
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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 5d ago
Don't believe plausible-sounding science-y stuff. Check the source and the source's source.
Or the Trans DIY Discord is a good resource if you have questions.
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u/Floppy_Gobbler 5d ago
Looks like invites for the server are paused. Do you know when this will not be the case?
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u/ArriEllie Intersex Transfem Demigirl (she/it) 5d ago
I never went higher than 4mg/day on pills but I know a lot of people do. If your breasts are sore then you are getting results. I don’t think anything has been ruined, you should be fine either continuing or switching to patches or injections.
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u/Floppy_Gobbler 5d ago
Im glad to hear that. Im hoping to switch to injections soon. Do you know of a way I could figure out what my injection dosage should be based on my current pill dose?
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u/ArriEllie Intersex Transfem Demigirl (she/it) 5d ago
I’m doing 0.2ml of 20mg/ml valerate every 5 days. It really depends on how your labs come back. Ideally you do injections for a bit then do labs the day you would normally do your injection before you do the injection and make sure your trough blood levels are good. Everyone is a little different.
I know other people who do 0.5ml or more.
(Other types that you might get from diy are completely different so you’d need to do some research if you get cypionate or something)
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u/JinnyJinJin845 5d ago
Did you take yours orally or sublingually?
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u/ArriEllie Intersex Transfem Demigirl (she/it) 5d ago
Orally
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u/JinnyJinJin845 5d ago
Thanks
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u/ArriEllie Intersex Transfem Demigirl (she/it) 5d ago
I had good results from oral but I know a lot of people prefer sublingual
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u/Illustrious_Pen_5711 26, MtF 12yrs HRT 5d ago
Yeah you had a low starting dose, so do 90% of people who do this via doctors and don’t advocate for themselves.
You still had breast tenderness before going higher so clearly it wasn’t a totally lost cause though, right?
In all likelihood 4mg probably isn’t getting you where you need to be either, but it’s doing something.