Which is more important for feminization? Lower T or higher E?

[Brenda E]

While a common goal of HRT is to reduce T levels and increase E levels to that of a cis-female, which has the most feminizing effects?  Low T or high E?  My endo is focusing hard on reducing my T levels to the female range (despite my level already being way low for a guy), rather than focusing on bumping up my E levels to female numbers.

After reading some of the "boob" threads, it seems that many girls here have experienced the most growth when their T levels hit rock bottom, and not necessarily when their E levels were raised; this leads me to wonder whether T blocks the effects of E in some sense.

Thoughts?  Anyone know the science behind this?

[accidentallyhipster]

I'm sorry I can't answer anything, but thank you for asking the question. I am curious to this as well.

[Stephanie2]

I am surely one who is interested in an answer to that, also. Right now I am doing both. Trying to raise the E and reduce the T, but if it can be accomplished with just less T, that would possibly save money and give more results.

[Brenda E]

It goes without saying that it's unhealthy to have low levels of both T and E; we do need certain levels of T and E to avoid issues such as osteoporosis.  But is successful MtF HRT more than simply raising E levels to speed up changes, or is it equally (or more) important to get T levels down to a female level so the more subtle, delicate changes caused by E can show through?

[Carrie Liz]

Really it's both, but if you had to have either one or the other, lower T would definitely be the choice. I believe I read somewhere that DHT>T>E in terms of hormone strength, that one blocks the effects of the other. There's a reason why trans men generally don't have to take estrogen blockers when they go on T shots, usually the T alone can overcome the effects of the E and masculinize them, even though they still have E in their systems, where we have to take T-blockers for the E to do anything.

The widely-reported notion that most people attain a burst of feminization following SRS supports it, because the only thing that changes after SRS is that your T levels hit rock bottom.

The thing is, though, honestly I don't think the difference is that great. My T levels crashed to the ground, all the way down into the basement of the female range (22 pg/dl, average=25-95,) within only 2 months on HRT, and yet it took me a good year and a half before I consistently started seeing a girl in the mirror. Some of my friends whose T still isn't in the female range after over 2 years, they're still hovering around the 150-200 range because their doctors are way more conservative, got way better results way faster than I did. There are also a few who got no results at all no matter where their T levels or E levels were.

HRT is pretty much a crapshoot. You give yourself the best chance of feminizing when your T is as low as possible and E is over at least 100ish, but I don't think it really matters as much as we like to believe it does. If you're pre-programmed to respond to estrogen, you're going to feminize and do it quickly whether or not you're in the "ideal" range or not. Same with those who aren't. I'm starting to think that genetic predisposition is more important in determining the effectiveness of HRT than hormone levels. If you're from a family of more-masculine straight-framed angular-faced women, or women who went through very late puberties, you're probably not going to get boobs or a butt quickly no matter where your hormone levels are at. Likewise, if you're from a family of very feminine round-faced curvy women, or women who went through puberty very early, get ready, you're likely going to feminize and do it quickly.

[Brenda E]

Carrie Liz, thank you so much for your detailed reply.  Makes perfect sense from a scientific standpoint when you think about it really, although like you say, the range of "normal" responses to HRT are so diverse that it's hard to predict how anyone will react.

Reassuring to hear that my endo's approach (focusing first on reducing T to low female levels) is not some crazy plan.

[Jenna Marie]

My endo doesn't even test E levels, believing that getting T down to the female range + enough E added for feminization (and she basically asks each appointment "are you happy with the changes so far?") is sufficient.

I am on super low dose E but my T is and has always been in the middle of the female range, suppressed by E alone, and I've had excellent results nonetheless.

[Brenda E]

My endo doesn't even test E levels, believing that getting T down to the female range + enough E added for feminization (and she basically asks each appointment "are you happy with the changes so far?") is sufficient.

I am on super low dose E but my T is and has always been in the middle of the female range, suppressed by E alone, and I've had excellent results nonetheless.

Thanks Jenna Marie - interesting to hear that other docs are getting great results by getting the T to where it needs to be for a cis-female rather than the E.

I've been on a fairly low dose of E too, and I've had some pretty good results so far.  I've always been worried, however, that my E levels are just insanely low and whether raising them would produce faster and more pronounced changes.

Also helps explain why my endo was so adamant that I add medroxyprogesterone as an additional means to lower my T.  Already taking spiro and finasteride and the T levels were not quite as low as they needed to be, so with any luck the MPA will push things in the right direction.

Again, thanks for the anecdotal data - it's good to read that my treatment regimen isn't out of the ordinary and that it works.

[Steph34]

Blocking T and DHT had no feminizing effect on me whatsoever, neither physically nor emotionally. Speaking from my own experience, I first blocked DHT, then blocked T, and then started a meaningful dose of E. My T was reduced by almost 90 percent, to only slightly above the female range (the elevated level being mostly because of dutasteride, which raises T by preventing it from turning into DHT. That is actually an anti-androgenic effect because DHT is more potent).

I had to take enough E to bring my level over 50 before noticing any feminizing effect. At that level, the estradiol shifted at least an inch of body fat from my waist to my butt and also caused emotional development that for me personally, is essential to my transition.

I read you are dissatisfied with your figure. It stands to reason that having more E could help, since it is the presence of E (and not the absence of T), that feminizes cis females.

[Brenda E]

I had to take enough E to bring my level over 50 before noticing any feminizing effect. At that level, the estradiol shifted at least an inch of body fat from my waist to my butt and also caused emotional development that for me personally, is essential to my transition.

I read you are dissatisfied with your figure. It stands to reason that having more E could help, since it is the presence of E (and not the absence of T), that feminizes cis females.

Hmmm.  Interesting.  I am dissatisfied with the physical effects (or lack thereof, especially fat redistribution) thus far.  The mental effects - awesome.  Even adding just a tiny bit of E did wonders for my psychological wellbeing, but to be honest, the improved mood only goes so far before it starts to become frustrating once again that I don't appear in the mirror like the person I feel I am inside.

It seems, though, that the presence of T - even in small amounts for a guy - really puts the brakes on feminization if the T levels are still above those for a cis-female.

[Jenna Marie]

Brenda : Glad to help. The other factor, which is more frustrating because it's less often documented, is that of course it also depends on how much E someone's body is producing naturally AND how receptive their body is - that could explain why two people get two very different results from the same regimen. For someone who's very susceptible to estrogen and/or makes more than usual themselves, suppressing T + relatively small E will still bring about dramatic changes; for someone else whose body is either less responsive or has less natively or both, it takes a much higher dose of E to get good results. More E doesn't help, of course, once someone has achieved the maximum effective dose; after that it's just wasted. The only way for you to find out what the max effective dose is, though, is by endo-supervised trial and error.

(Personally, I don't think I'd want faster or more dramatic changes; I was already outed to people by HRT alone, while still dressed as a guy, at about 3 months into it. And I am, literally, on a dose so low it's within the range prescribed to menopausal cis women. Incidentally, if it helps, I found fat redistribution *really* slow - I was generously endowed up top and still seeing only the tiniest increase in hips and butt.)

[Stephanie2]

My lady doctor at the VA hospital, after hearing me talk about my gender dysphoria, simply said not to mess with hormones. Great help she was. So, now, I have to stick with the B.O. and keep taking the finasteride that is actually prescribed for the shrinking of the prostate, but will do the DHT thing with the testosterone, just the same.

[Brenda E]

Time for a new doctor, Stephanie2?

[Rachel]

My T had been 20 to 26 ng/pmole for 17 months and  I was on 2/3 E oral for 3 months the full E oral 13 months then IM full dose E 9 weeks. I also take finasteride and progesterone. I think IM injections are making a big difference but that may be wishful thinking.

I am  definitely increasing in bust growth. Today I was in a meeting with 4 guys and they looked at my boobs. The shirt I was wearing was a bit tight and getting tighter.

Last month I had to show my ID to buy something and the guy said it did not look like me in the picture. Then he said He looks like the person I am buying x for. It felt good. So over time small changes add up. I still see mostly the same person but at times I get a glimpse at someone else in the mirror, odd when it happens.

[Indoctrinated]

Prescribing antiandrogens is nowhere as straightforward as it does with E. It may take some attempts and dose adjusting before getting things right.

For instance, my first AA prescribed was finasteride but I had disgusting side effects... My DHT didn't drop much and I had body hair growth!

[judithlynn]

Hi Brenda

I agree with Carrie and Jenna Marie;

I am only on a low dose of Progynova (for nearly 2 years) and my T levels are basically negligible (at the bottom end of CIS Female range (less than 0.5), but all my mothers side of the family were best described as curvy and voluptuous. My mother was 38DD and I am now a B cup going on small C, with  rounded butt and 2" on the hips. My problem though is my tummy. Although my waist is appearing I still weight tpo much (112Kg) and although I go to the gym twice a week, HRT  and my now slow metabolism and all the years of excess as a male  means I am just carrying too much weight. Oh I wish I could shed 25Kgs!
JudithLynn

[Steph34]

I was afraid it might be the harmful testosterone that is holding me back. My level has been near the top of the female range (whether it is abnormally high depends on the reference range used; there is some disagreement as to that. The lab that performed the test seems to say yes, it is abnormally high.) Since I am also blocking DHT, however, my DHT level should actually be in the lower part of the female range, although the blood test I received is not sensitive enough to find any DHT. Since DHT is much more androgenic than T, my total androgenic activity (from T and DHT) should be within the range that is considered normal for females. As such, I am still inclined to blame insufficient E levels for my slowing progress; I think I should try to bring it over 100 after I come out in January. At $575 per month on medications alone, I will be soon be broke, and I still have too much T and too little E. I will have to talk about this with my doctor at my next appointment in December. It is very distressing.

[Brenda E]

At $575 per month on medications alone . . .

Ouch!  Is that for HRT alone, or for other conditions unrelated to being trans?  (No need to go into specifics - just interested because that sounds like a crazy amount if it's for HRT only.)

[Stephanie2]

Time for a new doctor, Stephanie2?

Yes, if I can find another one at the VA hospital. The co-pay there is a lot better than paying it at the regular cost at another hospital.

[KayXo]

There's a reason why trans men generally don't have to take estrogen blockers when they go on T shots, usually the T alone can overcome the effects of the E and masculinize them, even though they still have E in their systems, where we have to take T-blockers for the E to do anything.

The reason why most often transgirls take blockers and transguys don't is because transguys for the most part take their T by injection and transgirls don't so that a high concentration of either E or T suppresses the other hormone. When you inject E pre-op, most likely you don't need a blocker like transguys who inject.

The widely-reported notion that most people attain a burst of feminization following SRS supports it, because the only thing that changes after SRS is that your T levels hit rock bottom.

I got less feminization and poorer results following SRS, despite my T levels being quite low. I had to take very high doses of E to help quickstart feminization again and some progesterone. Some girls report the same. It is not my experience that many report increased feminization after SRS. It seems to depend.

HRT is pretty much a crapshoot. You give yourself the best chance of feminizing when your T is as low as possible and E is over at least 100ish, but I don't think it really matters as much as we like to believe it does.

With the right combo of E and P, hormones made a significant difference in how I looked and felt. Took several months but it can make a difference.

If you're pre-programmed to respond to estrogen, you're going to feminize and do it quickly whether or not you're in the "ideal" range or not.

I don't think there is an ideal range within which we all best respond. It depends on each case. I respond best to high levels of E and some P, some may do better with much less or even more or no P, etc. There is also what you started with, how masculine you looked like before HRT. The dose of hormones and what you take is important and can make a difference as I've learned. Most definitely!

Same with those who aren't. I'm starting to think that genetic predisposition is more important in determining the effectiveness of HRT than hormone levels.

I think both are as important. Some doctors may be too conservative with levels/doses, mine are not, luckily for me. Genetics are very important, yes but so are hormones. Don't underestimate what they can do.

it is the presence of E (and not the absence of T), that feminizes cis females.

I think it is the presence of E, the lack of prior masculinization and the low levels of T. Genetics, ethnicity also play a part, of course in how sensitive one is.

I am just carrying too much weight. Oh I wish I could shed 25Kgs!

Try eating less carbs while increasing fat intake. It works wonders for many.