To low dose or not...??

[Elli.P]

that is the question. Is there a down side to low dose other than making you want to go full dose? Will it affect results once I start full dose? I'm 48 years and will not be in a place in life that I can transition for about 4 years from now. Looking for advice from people that started low for a couple of years and then went full.


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[Denise]

This is a case of YMMV (your mileage may vary).

Some people it helps and it does little, others get DD in a few years.  It depends upon your genetics.

[AshleyP]

I don't think anyone's experience will be a good predictor of what your results might be. Whatever your decision might be, I'd suggest that you consider starting with beard removal if you're considering transitioning. If you don't transition, at least you won't have to shave anymore.

All the best,
--AshleyP

[AnonyMs]

I don't think anyone's experience will be a good predictor of what your results might be. Whatever your decision might be, I'd suggest that you consider starting with beard removal if you're considering transitioning. If you don't transition, at least you won't have to shave anymore.

Keeping my beard is probably the only thing that lets me present as a normal male these days. I was on low dose for 5 years, then a transitioning dose for the last 3. I needed the HRT to keep my sanity, and luckily the beard doesn't cause dysphoria.

[JeanetteLW]

   I am 64 and taking what I would consider is a low dose of estradiol but can't say if it is a "low dose" as on this site talk of actual dosages is not permitted and I believe it to be an appropriate rule for the reasons given. I think I can say i take a dose at the lower end of published ranges I've seen elsewhere.
  I am seeing what I think are pretty good results after 3 1/2 months but that didn't stop me from lobbying my doctor for a higher dose or advocating for an additional prescription of progesterone.  His response was basically "Have patience, grasshopper" Okay okay he didn't say that but he did use other words to that effect. I haven't even had my labs taken yet to see where my levels are at this dose.  I'm sure mine will be increased eventually.

   You can't blame a girl for trying.

  Hugs,
   Jeanette

[Dena]

I was effectively on low dose for many years and in the last year, I have been moved up to half dose. I am experiencing many of the things that that the new girls are feeling. My  body shape is changing, my face is changing and for the first time in my life, my breast are itchy. There is no penalty to low dose other than some body development.

[RobynD]

Lower dose brought me immediate physical changes including fast breast growth, so whatever you decide between now and then, have a plan in mind.

[Dani]

so whatever you decide between now and then, have a plan in mind.

That is what I did.

1. make a plan
2. work the plan
3. don't look back

I am much happier now!

[Artesia]

Apparently I am on a low dose.  Looking at another site that discusses doses, I am at about 1/3 of the average dosage range for one of them, and right in the middle of the range on the other.  Maybe that is why I am having so little movement on feminization.

[Pisces228]

It depends.  Some people low dose will cause some changes.  I was on a low dose my first three months of hrt and had started growing some noticeable boobage by the end of the third month.

[Artesia]

Funny thing happened.  After posting my complaint about not getting good enough feminization here this morning my Endo called and told me to up my dose of the pill from 1/3 less than the average dose to 1/2 the average dose.  she was confused about my blood test, the first test was a lot higher than the second.  I told her it was probably because the first test was done at around the 3-4 hour mark, and the second was done nearly 9 hours later.  I take my meds before work, and I go to work at 6:30 am.

I wonder if she is stalking me?  Not really, just a coincidence.

[laurenb]

Hey Rach- You're in control. There's very little down side if you are in reasonably good health to try a couple months of low dose. As my therapist says: you can slow it or stop it whenever you like. Listen to your body. If you have dysphoria you'll feel the relief within a week or two (some say a day or two). If you don't you won't feel comfortable and can just stop right there. I've been on lowish dose for 3+ months and am not socially transitioning anytime soon. I feel the effects but I'm not instantaneously taken for female. Geez too bad, but at least I feel good enough to get me through. And as we all know - whatever gets ya through - L

[boheme]

Funny thing happened.  After posting my complaint about not getting good enough feminization here this morning my Endo called and told me to up my dose of the pill from 1/3 less than the average dose to 1/2 the average dose.  she was confused about my blood test, the first test was a lot higher than the second.  I told her it was probably because the first test was done at around the 3-4 hour mark, and the second was done nearly 9 hours later.  I take my meds before work, and I go to work at 6:30 am.

I wonder if she is stalking me?  Not really, just a coincidence.

It's bizarre that doctors never tell you this! but if you look at the major guidelines for HRT (e.g. Royal College) they state that blood tests should be taken when your levels are at their lowest; i.e. immediately *before* you take your pills. Any other time will give your doctor a false impression that your estrogen levels are higher than they really are, and thus, make it difficult to accurately determine what your hormones are actually doing.

Of course, that might not be practical for you, depending what time your local lab is open! If not, I'd at least try and make a regular time to do your bloods, preferably as close to your next dose as possible -- your doctor will be much less confused! 

[boheme]

Hi Rachel,

I was "full dose AA, low dose E" for about 18 months before ramping up my E dose, and I'd highly recommend it if you're wanting to keep things under wraps for a while!

From my experience, the rate of physical changes is proportional to your estrogen levels; if you keep your E levels low, you probably won't get too much happening, although your skin will probably become a lot smoother / less oily (one of my docs told me that skin texture is actually one of the most dimorphous secondary sex characterisitics in humans).

For me, though, the impact of lowering my testosterone was huge, and for that reason alone, I'd say go for it, as long as you're comfortable with the effects that AAs will have on your libido, etc. I will always remember the morning I woke up, about three days* after starting HRT, and realised that the "noise" I'd had buzzing in my head for the last sixteen or so years had finally gone. It was a truly magic moment

* I will add that I take cyproterone acetate, which is a very powerful AA. Until recently, I'd been taking only half of the "low" standard dose quoted in many places, and my doctor has just cut my dose in half again -- in her words, if I were a cis-female, she'd be concerned that my T levels were too low!

[KayXo]

It's bizarre that doctors never tell you this! but if you look at the major guidelines for HRT (e.g. Royal College) they state that blood tests should be taken when your levels are at their lowest; i.e. immediately *before* you take your pills. Any other time will give your doctor a false impression that your estrogen levels are higher than they really are, and thus, make it difficult to accurately determine what your hormones are actually doing.

I personally believe it's useless to measure estrogen levels as they fluctuate in 24 hours and tests just don't give an accurate indication of what's really going on. The right/"ideal" level also varies as a function of the individual's lifestyle and predispositions and cannot determine health risks on its own. These sorts of tests can be misleading, I think.

My 2 cents...

[Dani]

I personally believe it's useless to measure estrogen levels as they fluctuate in 24 hours and tests just don't give an accurate indication of what's really going on. The right/"ideal" level also varies as a function of the individual's lifestyle and predispositions and cannot determine health risks on its own. These sorts of tests can be misleading, I think.

My 2 cents...

I agree somewhat. Let me explain.

The first lesson I learned in Pharmacy school is something called "Variability of Response" That is we can make reasonably accurate predictions of how a large group of people will respond to a given medicine and dose, based on statistical data. However any one individual may or may not respond as predicted. Some will require a higher dose to get the required response and others will respond with a much lower dose. All individuals will be more or less sensitive to any given medicine.

What this means for us is that blood levels are just a guide to help your Physician to determine the correct dose for you. You may have a very favorable response to low doses or require a higher dose. Blood levels just get you a dose that is "in the ballpark".

Appearance of secondary sex characteristics are so slow and the single most important advice I can give is be patient. But also keep in mind, that some of us will have a dramatic response and others, less so.

[KayXo]

The first lesson I learned in Pharmacy school is something called "Variability of Response" That is we can make reasonably accurate predictions of how a large group of people will respond to a given medicine and dose, based on statistical data.

The problem in transsexual women is that this data is still sparse and weak due to the size of our population and interest in us. We also haven't tested enough varying doses in large enough numbers of TS women to know, at least as far as bio-identical estrogen (and progesterone) goes, to know how we will respond to x amount of a dose of oral or non-oral bio-identical E or P. Recommendations are not really evidence based, are not always followed by doctors as they may have their own opinions/thoughts about the whole matter and so, there isn't much to go by.

As far as health risks, we can look at several studies and get a pretty good idea of what they are. I have, on several occasions, provided these studies before.

What this means for us is that blood levels are just a guide to help your Physician to determine the correct dose for you.

A blood level cannot be a guide because 1) the ideal level that is recommended for transsexual women is not evidence based and is arbitrarily chosen, on a premise that does not take into account several factors 2) levels constantly fluctuate in time so that even if the level is "ideal" at time X, it may be way above it at time Y and way below it at time Z, etc. No studies in transsexual women have determined with accuracy what the ideal range is for most transsexual women. We just assume that the average level in premenopausal women during a menstrual cycle is good enough for all of us. I think this is wrong, personally.

Blood levels just get you a dose that is "in the ballpark".

That "ballpark" is based on ciswomen's average levels without taking into account how wide the range is in ciswomen (or that women also go through pregnancy when levels go much higher) and that during puberty, growth hormone levels are several fold higher with no previous exposition to high levels of T so that using ciswomen as a guide is misleading and incorrect. We just don't know when it comes to transwomen and rather than guess or assume, I think it would be best to take one case at a time while understanding the risks and benefits present with certain medications and hormones and their relation to estrogen and progesterone levels. Doing this requires more time, somewhat operating in the "unknown" which may be frightening and uncomfortable for many physicians and in depth understanding of the matter at hand which many doctors don't have the time to acquire given their busy train of life.

[AnonyMs]

What this means for us is that blood levels are just a guide to help your Physician to determine the correct dose for you. You may have a very favorable response to low doses or require a higher dose. Blood levels just get you a dose that is "in the ballpark".

I have very little confidence that physicians in general know they they are doing in this area. Most seem to have a standard dosage they prescribe, or standard blood levels they target, and its quite variable among different physicians. Its also doesn't appear to be based on any serious evidence, just trust me, I'm a doctor.

I'm very happy with my current endo, but If I had to find another one I'd go looking for one that agreed with what I wanted rather than the other way around.

that is the question. Is there a down side to low dose other than making you want to go full dose? Will it affect results once I start full dose? I'm 48 years and will not be in a place in life that I can transition for about 4 years from now.

Back to the original question, I don't think it matters because you only do low dose when you have no other choice. Unless you're non-binary, its better than nothing.

[Janes Groove]

There is no penalty to low dose other than some body development.

Are you sure about that Dena? I have heard/read that most of the physical changes that one can expect with HRT occur within the first two years.  If that is so, then if one's first two years are spent on a low dose vs. a full dose will the transitioner get the most out of their hormonal transition or will the body mostly stop responding to more changes after the magic "two year period" is over.  Even on a low dose.  Even if a change to a full dose occurs after two years or at a later time.  Personally, I'm not sure I would want to take that chance.  If that is the case then if one is looking to get the most out of hormonal transition then it would seem that a full dose would be preferable right from the start.  Are there any studies on this?

[luna nyan]

If you're feeling mental from GID then low dose may give you some relief for a while.   The main danger with low dose is that it may accelerate your plans before you have things in place for a controlled transition.

Are you sure about that Dena? I have heard/read that most of the physical changes that one can expect with HRT occur within the first two years.

I had substantial changes switching from oral medication to implant with simultaneous increase in effective dosage after two years or so.  It is likely degree of stimulus over time is the ultimate determinant.

To be honest re: studies - if you read them properly half of them are bunk.  Abstracts that people can freely access are not indicative of what the data may actually say - on some studies some very important data points are excluded because it didn't suit the research team's axe to grind so to speak.