Susan's Place Transgender Resources

Went to first endo appointment last week. Asked to be put on low dose. She said there's no such thing, you either take a transition dose or you don't. You are either ready to transition or you're not. She said no estrogen because YMMV with every person and even the lowest of dose could be enough to transition.

So, is low dose real or is it something made up by the people that self medicate?

Does anyone have a website I can give the doctor for in site into what it is?

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I don't think it's a myth.  As long as your testosterone is in the female range and your estradiol is over the normal male range I would think you'd see some results.   My testosterone hasn't dropped super low yet and my estradiol hasn't been super high, but they are both smack dab in the middle of the female range and I have had lovely results.  I am on a moderate dose of E.

Your doctor is correct in saying any dose can bring changes however the rate of change will vary depending on the dosage. I have spend a fair amount of time on quarter dosage because of treatment standards and I continued to develop. I am now at half dosage and seeing additional development that didn't take place at the previous dosage.

You should discuss when you want to go public and that may give your doctors a better estimate on the rate of development you desire.

If you have youth on your side and a highamount of HGH you can get some stuning results on a low dosage of E and AA. On the other hand, if you're older, I think a low dosage is completely plausible. A small amount to ease the dysphoria could be used and no one would probably be the wiser for some time, if not in perpetuity.  It's true that YMMV, but it's a little easier to predict outcomes with HRT one you're of a certain age.

Its not a myth.

https://www.susans.org/forums/index.php?topic=130268.0

My endo does it, and he has literally 3500 trans patients. I'm pretty sure he knows what he's doing.

Saying you're either ready or not is also gatekeeping. I've been on HRT 8 years, and not transitioned. If a doctor said I'm not ready I'd just fire him and get another one.

I have been on low dose spiro for the last half year or so and on a really low dose of E for three months.
Didn't think there would be much of a change but there has been. Quite a lot actually so that my plan to be in male mode at work for the next year is going to be difficult. So i guess that your endo could have a point in her saying that a small dose of E would be enough for (slow) transition.
One unexpected reaction after starting E  has been that i want to speed transition up.

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This is purely my observation from others that have posted here,  but low dose does seem more like a stop-gap thing. It can buy you months or even years,  but does not appear to be an option 'forever'. I used it myself as a diagnostic tool,  but only to help validate that a full transition was something I needed to try.

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Quote from: jentay1367 on May 16, 2017, 01:42:01 AM
If you have youth on your side and a highamount of HGH you can get some stuning results on a low dosage of E and AA

I recently came across one such study where young transgirls were put on a low dose of E and a potent AA with disappointing results in terms of breast growth. In author's words "with objectively small and subjectively unsatisfactory breast volume in most cases." And later they state "it has been hypothesized that breast growth might be more pronounced when CSH treatment is started earlier.24,27 This could not be confirmed in our study, because the obtained breast volume was limited in many trans-girls, or at best moderate in some, and most trans-girls expressed a desire for later breast augmentation surgery. This is similar to results in adult transwomen.24"

Time and time again, I've seen much older gals having much better results compared to younger ones.

Quote from: KayXo on May 16, 2017, 09:55:10 AM
I recently came across one such study where young transgirls were put on a low dose of E and a potent AA with disappointing results in terms of breast growth. In author's words "with objectively small and subjectively unsatisfactory breast volume in most cases." And later they state "it has been hypothesized that breast growth might be more pronounced when CSH treatment is started earlier.24,27 This could not be confirmed in our study, because the obtained breast volume was limited in many trans-girls, or at best moderate in some, and most trans-girls expressed a desire for later breast augmentation surgery. This is similar to results in adult transwomen.24"

Time and time again, I've seen much older gals having much better results compared to younger ones.

Frankly, I don't measure femininity by a big rack. YMMV.

All this talk of "quarter dose", "half dose", "low dose", "full dose" etc <seems silly>.   One Dr's low dose may be another Dr's standard or vice versa.  It's impossible to compare experiences<mod edit>.


Moderator Edit: This post has been edited.

Quote from: staciM on May 16, 2017, 11:29:31 AM
All this talk of "quarter dose", "half dose", "low dose", "full dose" etc <seems silly>.   One Dr's low dose may be another Dr's standard or vice versa.  It's impossible to compare experiences<mod edit>.


Moderator Edit: This post has been edited.

I think a "low" dose is the same as an eighth dose, but I'm not sure. :)

All the best,
--AshleyP

Hi folks,
  I thought I would put in my two cents on the dosage subject. There are charts available on the internet that show the generally accepted normal dosage range. As Staci said this is not necessarily what any particular doctor mar consider a "normal" range. Until there is a widely accepted standard you will need to ask your doctor what their definition of it is. I myself have not asked my doctor what he uses for his scale. He has used the term "Full" dose and I do not know what that is. This will change at my next check up on Monday.
  That being said I am taking the lowest dose on the "normal dosage" scale I have seen online. I would think a "low dose" would be a fraction of that.

  Hugs,
    Laurie

I regard low dose as a dose that is less than what you'd take if you were planning on physically transitioning and is less than is fully effective for that purpose.

Typically its just enough to get the mental effects, but no more, to minimize the physical effects.

Thanks everyone for replying and thanks for not listing dosage. I had read about low dose HRT on this forum and other websites but had not really found any medical articles (go figure medical for trans sucks).

I don't know what the deal was with this Doctor. She mentioned "there are legal matters to consider" several times and kept looking at me weird (she has other trans patients and she is LGBT herself). Almost like she thought it was a sting operation or something. Lol, maybe I look like a cop with my long hair, plucked eyebrows and ear rings. I am in Texas so maybe she was worried I was an undercover reporter or something.

IDK, it was my first appointment. She ordered blood work to see where I'm at hormone wise and she said she would call with the results. Maybe the second appointment will go better.

Normally with people like that l kill them with kindness. But, I was nervous. Otherwise, I would have asked her if she was having a bad day and offered support. Or cracked a joke to lighten the tension.

We will see, I guess!

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Quote from: AnonyMs on May 16, 2017, 01:03:46 PM
Typically its just enough to get the mental effects, but no more, to minimize the physical effects.

If this is true then how can one be sure it's not just a "placebo effect?"

Quote from: Jane Emily on May 16, 2017, 02:03:17 PM
If this is true then how can one be sure it's not just a "placebo effect?"

Does it matter?

Definitely not something made up by people who self medicate.

Hugs, Devlyn

Yeah, definitly not made up. There's no doubting when you try it, and even less if you try stopping.

Quote from: jentay1367 on May 16, 2017, 11:24:34 AM
Frankly, I don't measure femininity by a big rack. YMMV.

In this study, not even a decent size was achieved. Feminization includes breast growth but other factors, as well, yes but since you mentioned HGH (human growth hormone) and followed it with stunning results, I thought you were referring specifically to breast growth.

Quote from: rachel.i. on May 16, 2017, 01:08:58 PMhad not really found any medical articles (go figure medical for trans sucks).

In journals, there are at least 100 articles/studies on transsexual hormone therapy, if not, much more. You just have to search on google scholar or pubmed and you will find, if you have the time. Recommended doses are mentioned there or doses used for that particular study and they may vary from one study to another, sometimes quite strikingly.

Quote from: rachel.i. on May 16, 2017, 01:08:58 PM
Thanks everyone for replying and thanks for not listing dosage. I had read about low dose HRT on this forum and other websites but had not really found any medical articles (go figure medical for trans sucks).

I don't know what the deal was with this Doctor. She mentioned "there are legal matters to consider" several times and kept looking at me weird (she has other trans patients and she is LGBT herself). Almost like she thought it was a sting operation or something. Lol, maybe I look like a cop with my long hair, plucked eyebrows and ear rings. I am in Texas so maybe she was worried I was an undercover reporter or something.

IDK, it was my first appointment. She ordered blood work to see where I'm at hormone wise and she said she would call with the results. Maybe the second appointment will go better.

Normally with people like that l kill them with kindness. But, I was nervous. Otherwise, I would have asked her if she was having a bad day and offered support. Or cracked a joke to lighten the tension.

We will see, I guess!

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I was started on a low dose and it was increased a little so maybe I'm on a medium dose.


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As Dena said, and I'll paraphrase, it's the rate of change that defines the effects of "low" vs. "high". And rate of change is proportional to dosage over time. The final extent of change (where you end up) depends on lot's of individual variables, i.e. genetics and family history, age, health, co-morbidities, diet, etc. As with any pharmaceutical, it's all about the dose. The standardized (haha, really?) doses for HRT that we read about and that are administered are starting points.
Here's a for instance: I'm on what would be considered the starting doses of Spiro and Estradiol (oral). My first blood test came in after 3 months. The T was a little bit high by cis-female standards and the E in the lower range but still above the minimum. I'm feeling and seeing some slow change and I'm happy. The boobs are sore (slightly fuller but not measurably larger), the body hair growth slower, softer skin, etc. Most importantly for me my dysphoria is much quieter. Now that's subjective, I know, but both my partner and my therapist have independently noticed that I am much more chill now. My doc asked if I would like to have the dose doubled since I'm not in the center of the female range. My answer was no. I'm good for now. Not being out or socially transitioned, this is a good low dose place. If I get dissatisfied with the rate of change, I can bump up the dose. On the other hand if things start to move faster than I am ready for, I can titrate back (lower) the dose. My therapist says all the time: you are in control of your transition. And yes, if you are on HRT, make no mistake, you are in transition but how that happens is up to you. You may, like me choose the slowest rate which is virtually unnoticeable externally to most people or go for it.
I can even change the effects myself over time, not by changing the official dose but by changing the way I take my meds. I currently take the Spiro on an empty stomach in the morning. I can make it more effective by taking it with a meal instead (that'll bring the T down a little more), since Spiro is better absorbed and has better efficacy when taken with food. If I eat some grapefruit or drink the juice during the day it'll bump the E over time since a chemical in it inhibits the metabolization of E thus keeping it circulating in the body longer (well documented). In the other direction, I could skip a dose every so many days to lower the averages.

I think one needs to consider, that these "normal doses" are only suggestions based on average dosing requirements to achieve MtF transition in a timely manner.
Most MtF transsexual hormonal dosing guidelines I've read, assume the patient want's to transition ASAP (to end the gender dysphoria as fast as possible, presumably). There is no consideration of the patient's personal or professional life, nor the results she wishes to achieve. 

That being said, everyone's hormonal baseline is different. This is often affected by genetics, health and gonadal development. For example, my baseline Testosterone was at 1310 ng/dL ("normal" male scale is 300-1100). Therefore I have to take a higher (than recommended) dose of T blockers to get my levels in the female range.

My friend who is also a transitioning MtF, only takes Estrogen. Due to her pubescent development, her T is already low and doesn't need any T blockers.

Also, hormone levels can change, especially after testicles begin to atrophy (get smaller).

This is why it's NOT recommended to self medicate without the supervision of a medical professional that can order blood tests to monitor hormonal and non-hormonal levels.

I was on the lower end of what is generally considered a transition dose and results occurred for me immediately. I have since increased it twice.

It sounds like what she's actually saying is that you need to be prepared for transition and major changes *even if* you take a typically low dose, which is really pretty accurate.

I started on a super low dose (less than half of the bottom of the range for what is generally recommended) with no anti-androgen, and I ended up a C cup within three months and outed at work by the changes within four months. It's uncommon, but you do need to be braced for the possibility that any dose will have that sort of consequences.

Quote from: rachel.i. on May 15, 2017, 08:50:55 PM
So, is low dose real or is it something made up by the people that self medicate?

Does anyone have a website I can give the doctor for in site into what it is?

If low dose is a myth then I'm a unicorn! :D

Never self medicated, even though I was sorely tempted at one point.  Basically dosage at a level so that feminisation rate is very slow or negligible as far as physical is concerned.   On the other hand, the emotional effects are quite significant- especially being a lot more labile (i.e. I'm more laid back and also get teary a lot more easily)

It's been 5 years and counting and I'm yet to transition socially.