Starting dose of HRT and impacting how much we change?

[ToxicFox]

I know we aren't allowed to say our dosage so I hope this is alright. I was started on an extremely low dose of estrogen to start with and half dose of spiro for the first two weeks. After 2 weeks I'm supposed to up my dose to a full dose of spiro and that is supposed to take my T to female levels. The reason my endo gave for the low dose of estrogen is because "Mimicking a cisfemale puberty by starting low and building into higher doses results in more physical changes such as more breast development". It does make sense to me but I was curious what some of the folks who have been on estrogen for a while thought about this?

Right now it's way too soon for me to see any changes on HRT and I don't expect any soon. Just knowing that I'm on hormones now is enough for me.

[Devlyn]

Your post is fine, don't worry about that.  All doctors have different approaches because they all have different patients. The magic will happen! Hugs, Devlyn

[evecrook]

I started full dose more then two months ago and I'm pretty happy with the change. I'm not sure this is my own philosophy but maybe some doctors just slow down the change so it's not so abrupt. I'm just guessing though

[MadeleineG]

I'd understood the "start low and then ramp up" philosophy to be more-or-less universal. Then, I received what I understand to be a typical terminal dose of E to start, without an AA. When I probed the Endo for rationale, he indicated that he preferred to let the E reduce T before adding an AA. I'm very curious to see where my levels are when I have my six month follow up.

In terms of changes, everything has been in line with my understanding of the expected progression. Going forward, we shall see. 

[Missy~rmdlm]

I have heard the using the ramp up is specifically the most successful and starting at a high dose can be counter-productive. I started quite low, and have elevated doses to robust regimen.

Here's where I'm at:
Mind you this is all oral and the estradiol serum level is rather spiky. This is an update from a lab I posted a couple months ago.
I am female in the health system so normal values are shown as female, a normal T level for male my age might be 400.

[Jenna Marie]

I think it varies from individual to individual, but I'm evidence that it *can* work : I started on a very, very low (like, within menopausal HRT range) dose of E and nothing else, and within 3 months had my T levels within the normal female range and was a C-cup at 4 months (now 42DDD by four years in). So the worst that can happen is it won't be as effective as higher doses, and you'll still get there; the best is that you don't need to take more and do terrific on cis-woman-tested safe low levels!

[KittyKat]

I think it varies from individual to individual, but I'm evidence that it *can* work : I started on a very, very low (like, within menopausal HRT range) dose of E and nothing else, and within 3 months had my T levels within the normal female range and was a C-cup at 4 months (now 42DDD by four years in). So the worst that can happen is it won't be as effective as higher doses, and you'll still get there; the best is that you don't need to take more and do terrific on cis-woman-tested safe low levels!

Can I be the first to say, super jeally atm.

[Cindy]

I've said before, getting two endocrinologists to agree on anything is an impossibility, if you bring in a third Goddess help us!.

[Tori]

My doc does his own endo work. It is kinda' cool. He works with many trans patients. It is quite convenient.

That said, docs like to do what they like to do. Many are set in their ways, others are set in advice from specific mentors. A doc does what they do. If they try something once and it works, they will keep doing that until something goes wrong or they learn differently.

People think docs know everything. There is a good chance that we know more about being trans and medical options. You can work with a doc. You can suggest other options. Be prepared for them to disagree. Sometimes it will be for a good reason but do not be surprised if they simply disagree because they fear leaving their comfort zone... or needing to study something new.

[Ltl89]

Since I've started hrt (June), my estradiol dosage has been changed twice.  Each time I was given a higher dose than before.  In my experience, dosages do make a big difference.  Perhaps the time issue is part of it, but I have seen a lot more happening ever since my hormones were increased to their latest dose (October).  In my opinion, that increase made a huge difference. So, maybe low dose Estradiol works for some, but it doesn't seem to compare for me.  In any case, I wouldn't fear.  Most doctors start you slower and move you up in time.  The goal is to get your body adjusted to the hormones before exposing it to a high level.  And of course, there are also safety concerns involved with hrt, so they probably want to monitor you and start you off slowly to make sure you're okay.  I know it's frustrating, but the changes will happen.   It just takes time. 

[kathyk]

My doctor, therapist, and the psychiatrist all work through a specializing Transgender Clinic in a major healthcare system.  They firmly believe in starting slowly, and ramping up from that low point because each individual processes estrogen differently, and early on it's possible for your body to process a sudden shock of E to convert some of it to T. 

As you move further into your transition you'll know when you're E level is low.  You can feel it, and it changes your mood.  Before my wife went through menopause I saw her mood shift about four days before her period started.  Now she says the same kind of things about me nearly every Thursday when my estrogen is at it's lowest (just before my Friday injection).  And I feel that drop through anxiety.

[Jayne]

I've been on the lowest possible level of E for 3 months now, I have started breast development even if most people can't see it unless I lean forward to let gravity assist whilst a cold south westerly wind is blowing but from my perspective as I look down it's very noticable, I just hope my right breast catches up with the left one sometime soon or i'm going to end up off balance within a few months, I guess i'll have to buy a large handbag & put bricks in it to keep me from toppling over 

I was due to have my dosage increased 2 weeks ago but the NHS screwed up my blood tests, I'm seeing the GP in the morning as he has now recieved the correct blood test results.
My Endo does the increase after 3 months so I was suprised to hear about the E levels going up after 2 weeks, I guess that as people here have said it all depends on who you see.
Even on the lowest dosage I started seeing slight changes by the end of the 1st month

[Ltl89]

I've been on the lowest possible level of E for 3 months now, I have started breast development even if most people can't see it unless I lean forward to let gravity assist whilst a cold south westerly wind is blowing but from my perspective as I look down it's very noticable, I just hope my right breast catches up with the left one sometime soon or i'm going to end up off balance within a few months, I guess i'll have to buy a large handbag & put bricks in it to keep me from toppling over 

I was due to have my dosage increased 2 weeks ago but the NHS screwed up my blood tests, I'm seeing the GP in the morning as he has now recieved the correct blood test results.
My Endo does the increase after 3 months so I was suprised to hear about the E levels going up after 2 weeks, I guess that as people here have said it all depends on who you see.
Even on the lowest dosage I started seeing slight changes by the end of the 1st month

I noticed changes early on with a lower dose, but it was fairly minimal and much slower than it is today.  Everyone is different and should listen to their doctors; however, I firmly believe dosage plays an important role.  It's just important for you to find what's right for your own body and that takes time and frequent monitoring.   For me, a higher dose was needed and has been working very well.  Believe me, I noticed changes at 3 months in too, but they are nothing compared to where I am today.  And I'm hoping where I am today is nothing like a few months from now. 

[RosieD]

it's possible for your body to process a sudden shock of E to convert some of it to T. 

Hiya Kathy, I am curious to know where you found this information. I have seen it on this site before but have never been able to find any medical or scientific papers that mention it. I have found the armoatase process but that only works the other way; converting testosterone to estrogen. Do you have some more info you can point me towards please?

Rosie.

[Jamie D]

I do not think there exists a human biological mechanism to convert estrogen to testosterone.  However, testosterone can be converted to estrogen through aromatization.