Susan's Place Transgender Resources

We've discussed this topic before, but it's been awhile and there's new faces around, so I thought it would be nice to revisit the subject. 🙂

I started HRT at 56, and  was put on a puberty inducing dosage, as most of us are. After awhile I asked my doctor if my dosage should be reduced to more appropriate levels as I age. After the magic was done, of course 🙂

She said "Great question, Devlyn. There hasn't been much research done on this. I'm happy with your levels as is, but if you want to reduce your dosage at any time we can figure out a way to safely do that without putting you at risk of osteoporosis."

Some of my reasons for asking were:

• Being a granny in perpetual puberty is worrying to me. I don't want to be a senior citizen with the emotional range of a fourteen year old. 🤣

• Safety. As my doctor said, there's little research being done on our small cohort. But generally, older women don't have elevated hormone levels. Is that safe for us long term? I'm aware that the hormones themselves are viewed as safe...but again, there's not much research about the effects on an aging population.

So far, I have stuck to my relatively low dosage. My body has responded well to HRT over the last seven years, and I am past any apparent physical changes now. In the words of Pippin: "Though I'm not likely to grow anymore... except sideways". 😁

Don't get me wrong, it's nice to look younger than you are. But I'd rather live longer than look younger.

So where do you stand? Have you thought about whether you should lay off the "candy" at some point? Do you want to eventually age more naturally?

Hugs, Devlyn

I love being on estradiol but mostly I'm fearful of the "damaging" effects of testosterone on my body hair, skin and body shape. I've not yet had an orchiectomy so I have to work to get/keep that T suppressed.

Also, I've been running on E for a little over 4 years but just switched to injections 4 months ago. I have a long way to go for the bottom half of me to get closer to the desired shape so I feel I need at least 5 more years of solid E levels.

If I could achieve a fully fem body shape and keep T suppressed I'd be ok lowering E levels a bit.

I'm 60 years old.

I will ask my prescribing doctor what she thinks about this the next time I see her.  More estrogen does not necessarily mean more development and body changes.  Less may make more sense over time.  I have been on my one tablet a day schedule for a while now. 

I have never understood that mindset. To me, that doesn't make sense.

True, the protocols should aim for estradiol levels within the puberty range to effect the necessary physical changes. Puberty in ciswomen starts in their teens and lasts into their twenties, so about ten years.

After that, the goal is to maintain levels corresponding to "reproductive age."

There is no protocol that says levels should be maintained at the post-menopausal range. The cause of menopause is the age-related decline of the ovaries' production of estrogen and progesterone. Although it is considered "natural," so are other age-related issues. There is a reason that ciswomen are given hormone supplements to combat the effects of menopause.

I have been on hormones for six years, so even at 68 years old, I should continue in puberty for another four years or so. Then adjust to the maintenance level.

Aiming for a lower level makes no sense to me. It's like saying all of the women my age have gray hair, so I should dye my hair gray. Or women my age have arthritis, so maybe I should have some too. And sign me up for osteoporosis while we're at it.

No, thank you. I am not going down without a fight.

Hormones control many things in our bodies besides their shape. If I keep my hormone levels in a healthy younger range, perhaps I can prevent the age-related decline that affects the other organs as well.

Quote from: Lori Dee on March 09, 2026, 11:02:09 AMI have never understood that mindset. To me, that doesn't make sense.

True, the protocols should aim for estradiol levels within the puberty range to effect the necessary physical changes. Puberty in ciswomen starts in their teens and lasts into their twenties, so about ten years.

After that, the goal is to maintain levels corresponding to "reproductive age."

There is no protocol that says levels should be maintained at the post-menopausal range. The cause of menopause is the age-related decline of the ovaries' production of estrogen and progesterone. Although it is considered "natural," so are other age-related issues. There is a reason that ciswomen are given hormone supplements to combat the effects of menopause.

I have been on hormones for six years, so even at 68 years old, I should continue in puberty for another four years or so. Then adjust to the maintenance level.

Aiming for a lower level makes no sense to me. It's like saying all of the women my age have gray hair, so I should dye my hair gray. Or women my age have arthritis, so maybe I should have some too. And sign me up for osteoporosis while we're at it.

No, thank you. I am not going down without a fight.

Hormones control many things in our bodies besides their shape. If I keep my hormone levels in a healthy younger range, perhaps I can prevent the age-related decline that affects the other organs as well.

That was the point I was making.

What do you consider the maintenance level to be? I think this is where my doctor's point about research kicks in.

From what I have read, the typical estradiol ranges are:

Premenopausal women: 30–400 pg/mL (varies across cycle due to ovulation cycles)
Perimenopause: fluctuates widely, often 20–300 pg/mL (levels start to decrease)
Postmenopause: usually below 30 pg/mL

When I started HRT, my doctors targeted 100 pg/ml. We found that this level was too low because I am a fast metabolizer. After making numerous adjustments over four years, I switched to injections, and my levels range from 195 - 300. My levels hit 400 one time, and we adjusted my dose from every week to every ten days, and they now hold steady around 195.

In my non-medical opinion, our protocol should slowly ramp up to 100 over the first year, then continue into the upper range (300-400) until changes slow or stop. At that point, maintaining close to 200-300 should be appropriate.

That all changes post-op. Estradiol no longer competes with testosterone, so lower levels are appropriate (100-200) indefinitely.

The reason that I believe this is that estradiol is the tool for breast growth and fat distribution. Most HRT protocols are very conservative and rarely reach these levels. Consequently, studies have shown that 70% of transgender women are dissatisfied with their breast growth, and more than half of those undergo breast augmentation. Perhaps, if the protocols actually followed what human biology does normally in females, development would happen in the same way, making BA surgeries unnecessary.

I have used this same argument concerning progesterone (also produced by the ovaries and also important in breast development). My gynecologist agreed, but endocrinologists seem too focused on protocols that were established in 2017.

Again, I am not a medical professional, so this is not medical advice. I have done my homework, and I understand what these hormones do and how they work together in humans.

My doctor brought my E levels up to 196, and I've been right around there the whole time.

Quote from: Devlyn on March 09, 2026, 12:55:51 PMMy doctor brought my E levels up to 196, and I've been right around there the whole time.

If it ain't broke, don't fix it.

🤣

I was dying on my bedroom floor of a pulmonary embolism about two years. My E level was at 600 pg/ml at the time but I have lost weight since then. I now treat this issue with anticoagulants and being more physically active. My E level was 255 pg/ml last I got it checked. According to my PA-C that is perfect.

I'm very fortunate to have survived that, but I just treat my situation differently now because that's what I personally have to do.

I have to concur with LoriDee that unless there is actually some medical reason for you to go off E then "if it ain't broke don't fix it."

Been taking HRT since January 1990 age 32. Now 68 and have a spray HRT, Lenzetto I use daily.

My E level at trough just tested at 234 pg/mL and T at 17 ng/dL. My doc requested I make an appointment, stating "despite your lab work not revealing any immediate dangers, there are some results that need attention soon."

This suggests that they (Plume) feel my E level to be too high. I hate to do it but I could play a game with this in which I lower my E dose a couple of weeks before scheduled testing, but I'd rather have them accept that having that much E at trough seems acceptable. Actually, if we agree that 150-175 at trough is acceptable I'd be fine with that. We might lower my dose of estradiol valerate from 6 ml/week to 4 ml/week. But I'd only stay there if T remains suppressed AND I can drop my 50 mg of spiro per day. That's the ultimate goal.

The issues in this topic are the lack of medical research on trans people, and the misinformation to doctors from the discredited Women's Health Initiative.

Trans people have a range of different needs depending on our family histories, individual health issues, age when we started hormones, pre or post orchie, lifestyle, and culture. There simply is not a level which is appropriate for everyone, and the bottom line is that we need to have honest discussions with our doctors, who know our medical histories, to determine the hormone plan appropriate to us.

It is important to know if your doctor is working to standards based on the WHI. These standards are for the older synthetic hormones which came with elevated risks, and it is appropriate to lower levels of these. Most countries (not all!) use bio identical hormones now, which have the same risk factors as natural hormones. There is also some misunderstanding of the DVT risks. Many studies state that higher hormone levels increase the risk by as much as 3 to 5 times average levels, but the UCSF hormone paper points out that the background incidence of DVT is 1 in 10.000 people, unless there are genetic risk factors. This means people are 99.999% safe, and if the risk increases five fold it just lowers that to 99.995% safe. The difference is practically insignificant!

As pointed out, post menopausal hormone levels are associated with aging, and the increased medical conditions which come with that. This is why many cis trans people are on HRT, as they don't wish to welcome the effects of aging. We need to objectively assess our risks, and our expectations, particularly in regard to cancers, and cardiovascular health, and decide on the levels of hormones appropriate to us, and be prepared to advocate these to our doctors.

Hugs,

Allie

Here's some guidance from the NHS on HRT for cisgender women.

https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/

Quote from: Courtney G on March 09, 2026, 03:20:39 PMActually, if we agree that 150-175 at trough is acceptable I'd be fine with that. We might lower my dose of estradiol valerate from 6 ml/week to 4 ml/week. But I'd only stay there if T remains suppressed AND I can drop my 50 mg of spiro per day. That's the ultimate goal.

Be aware that both Spiro and Finasteride affect hormone levels. That's the reason I got off them. The way they work is to modulate the 5α-Reductase, which affects all hormones, including estrogens and progesterone. Hormones interact with each other, so raising one or lowering another has system-wide effects.

In my (again) non-medical opinion, they should not be prescribed for transgender HRT protocols. There is no reason for it. They are not designed to reduce testosterone; that is a side effect. There are better options now, so we need to use better tools.

Leuprolide (Eligard) is specifically designed to stop testosterone production at its source.

Bicalutamide (Casodex) is specifically designed to block testosterone receptors, and it has no hormonal activity. That means it won't interfere with any other hormones.

The combination of these two meds is the equivalent of chemical castration. It is used in chemotherapy and, in the past, was given to registered sex offenders.

I was on them for about a year, which allowed my estadiol levels to rise without competing with testosterone. Once T was suppressed, I stopped taking them. The estradiol alone is enough. My last two labs showed my T levels at less than 12.

Good morning from the UK.

I think I'm with @Devlyn on this. The question needs to be posed, hence my asking it last autumn https://www.susans.org/index.php?topic=252160.0 .

A good friend of mine in her 70's who transitioned decades ago now takes no supplementary hormones at all. She has a prescription for some calcium supplements, that's all. Her GP told her that there's no need for her to be taking any supplementary hormones now.

Once our bodies have completed their feminisation, if you have no naturally occurring testosterone left, then they're not suddenly going to return us to a male physique. So the point of taking high doses of HRT is what exactly? Youthful looks? Perhaps. But at what cost and side-effects?

Generally speaking I like to keep things natural. I'll take medication, of course, when it's genuinely necessary. But there's no evidence that maintaining high levels of estradiol into your 70's and 80's does you any good and it might well do harm.

Without meaning to be too contentious I wonder if there's a bit of a difference in attitude between the UK and US? Americans pill pop a lot, pushed by a vested lobbying pharma industry. Brits tend to be a lot more cautious about such things. The US with 4% of the world's population consumes 8% of global prescription drugs.
See https://www.lif.se/contentassets/a0030c971ca6400e9fbf09a61235263f/international-comparison-of-medicines-usage-quantitative-analysis.pdf


People say I act and look young for my age but we surely do have to be realistic? We are all going to die. Atrophy is a part of life.  And I like the natural approach. My focus is increasingly on healthy eating and lifestyle. I gave up alcohol 7 years ago, whilst in the US as it happens, and I try to eat very healthy food and avoid sugars and garbage. I hike at least 10k, and usually 15k, every day in the fresh air.

Growing old gracefully, rather than disgracefully, is becoming an important truth for me. ;)

xx

(Just putting an alternative perspective and I could well be wrong!)

Quote from: Tills on March 09, 2026, 10:51:29 PMGood morning from the UK.

I think I'm with @Devlyn on this. The question needs to be posed, hence my asking it last autumn https://www.susans.org/index.php?topic=252160.0 .

A good friend of mine in her 70's who transitioned decades ago now takes no supplementary hormones at all. She has a prescription for some calcium supplements, that's all. Her GP told her that there's no need for her to be taking any supplementary hormones now.

Once our bodies have completed their feminisation, if you have no naturally occurring testosterone left, then they're not suddenly going to return us to a male physique. So the point of taking high doses of HRT is what exactly? Youthful looks? Perhaps. But at what cost and side-effects?

Generally speaking I like to keep things natural. I'll take medication, of course, when it's genuinely necessary. But there's no evidence that maintaining high levels of estradiol into your 70's and 80's does you any good and it might well do harm.

Without meaning to be too contentious I wonder if there's a bit of a difference in attitude between the UK and US? Americans pill pop a lot, pushed by a vested lobbying pharma industry. Brits tend to be a lot more cautious about such things. The US with 4% of the world's population consumes 8% of global prescription drugs.
See https://www.lif.se/contentassets/a0030c971ca6400e9fbf09a61235263f/international-comparison-of-medicines-usage-quantitative-analysis.pdf


People say I act and look young for my age but we surely do have to be realistic? We are all going to die. Atrophy is a part of life.  And I like the natural approach. My focus is increasingly on healthy eating and lifestyle. I gave up alcohol 7 years ago, whilst in the US as it happens, and I try to eat very healthy food and avoid sugars and garbage. I hike at least 10k, and usually 15k, every day in the fresh air.

Growing old gracefully, rather than disgracefully, is becoming an important truth for me. ;)

xx

Just a note of caution, hormones do much more than affect secondary sex characteristics, they have an essential role in regulating many body functions needed to stay healthy. Trans people who chemically or surgically remove most of their hormone production may need to take some hormones to remain healthy. So it can be more than just avoiding hot flashes! Most of the recommendations written for post menopausal women are for cis women who still produce some hormones.

My testosterone levels are near zero, so my doctor advises me to maintain some hormone levels to stay healthy. Getting educated advice for trans medicine can be difficult, but may have significant affects on your long term health!

Hugs,

Allie

Quote from: Allie Jayne on March 09, 2026, 11:38:50 PMJust a note of caution, hormones do much more than affect secondary sex characteristics, they have an essential role in regulating many body functions needed to stay healthy. Trans people who chemically or surgically remove most of their hormone production may need to take some hormones to remain healthy. So it can be more than just avoiding hot flashes! Most of the recommendations written for post menopausal women are for cis women who still produce some hormones.

My testosterone levels are near zero, so my doctor advises me to maintain some hormone levels to stay healthy. Getting educated advice for trans medicine can be difficult, but may have significant affects on your long term health!

Hugs,

Allie

Oh absolutely Allie and I'm not denying that at all.

I'm just not sure whether maintaining a 'therapeutic transitioning level' of 400-600 pmol/L (110-165 pg/ml) into your 70's is either necessary or wise. That's around 10x to 15x the typical level of a post-menopausal cis female which feels to me jarringly unnatural.

I'd generally prefer to keep my femininity as non-synthetic as possible. That feels like an important goal for my long-term health and well-being.

xx

Is the real issue here not really to do with hormones, or trans this or that, as such but to do with how we all deal with advancing age and ... death? I know I certainly felt differently once I'd passed 60. The days of dancing on stage in a Bangkok bar dressed only in a mini skirt, blouse, and high heels feel like another era whereas in reality it was just ten years ago.

The one certainty of life is death. Atrophy is universal. There's something quite important, to me, in recognising that as the years pass so the goals of being female alter. A healthy maintenance level feels like a good focus.

But maybe I'm wrong?

xx

Quote from: Tills on March 10, 2026, 12:37:22 AMThe days of dancing on stage in a Bangkok bar dressed only in a mini skirt, blouse, and high heels feel like another era whereas in reality it was just ten years ago.

Well Tills, that's quite the image you concurred up in my head.  It made me smile.

It seems lately, that by the time I get on Susan's at the end of the day, there's a new post with a dozen or more replies.  I'm finding I have to do a lot of quick reading to get through some of them before I need to turn out the lights.  I'm finding I'm missing following a lot of member blogs just out of not enough time at the end of the day.  I'm sorry I can't keep up with all of your updates.

I found this post very interesting.  There's a lot going on in this post although I'm not sure what to make of it.  That's not a criticism of any replies, but more of a statement of my understanding of it all.  My understanding of the whole HRT protocol.  That's even if there is such a thing as "A Protocol".  So much information on the internet, some confirming some contradictory and it's hard to get my head wrapped around it.

There were a lot of interesting replies but I didn't mark any of the replies with a "like" only because I just don't know where I am on this. 

I'm struggling with personal HRT protocol at present.  I know I don't want to continue with my present levels forever, but I've made some progress lately and I leaning toward pushing things just a little further.  I see my GP near the end of the month.

Now it's way past time I turn out the lights.
Good night.
Paulie.

Quote from: Paulie on March 10, 2026, 02:28:38 AMWell Tills, that's quite the image you concurred up in my head.  It made me smile.

Hi Paulie,

It really was one of the funniest and, I have to say, best days of my life. I was out in Bangkok with a male friend who has known me since we were at primary school together. Nothing sexual between us I hasten to add.

Basically I went as me i.e. female and it was a mixed bar so there were girls and kathoey. They beckoned me up on stage and I thought 'why not?' which is a very Thai expression.

They offered me a full-time job at the end of the evening!!

My friend still laughs about that evening. Says it was the best night out he's had in Bangkok.

A fun and funny memory.

But to keep this on topic, that was then and this is now. I can't recapture that and I'm beginning to think I shouldn't try.

I am absolutely fine with thread drift in this topic, so feel free to pursue any discussions that come up. 🙂

Hugs, Devlyn

Quote from: Tills on March 10, 2026, 12:37:22 AMIs the real issue here not really to do with hormones, or trans this or that, as such but to do with how we all deal with advancing age and ... death? I know I certainly felt differently once I'd passed 60. The days of dancing on stage in a Bangkok bar dressed only in a mini skirt, blouse, and high heels feel like another era whereas in reality it was just ten years ago.

The one certainty of life is death. Atrophy is universal. There's something quite important, to me, in recognising that as the years pass so the goals of being female alter. A healthy maintenance level feels like a good focus.

But maybe I'm wrong?

xx

Wow Tills, you little minx! 10 years ago? I'm 50, I'm booking a flight to Bangkok, there's a dancefloor with my name on it! ha ha!

Well I will be 71 soon and still on 2x 100ml patches twice a week, not bothered getting levels checked lately as they were on the low side anyway. Chest hair has almost gone, face hair is slowed down so I will keep taking the treatment.

Quote from: Stottie Girl on March 10, 2026, 03:55:36 AMWow Tills, you little minx! 10 years ago? I'm 50, I'm booking a flight to Bangkok, there's a dancefloor with my name on it! ha ha!

Haha!! 😀

Probably helped that I'd had a couple of drinks in the days when I did.

Have you been to Thailand before? It's a place for a lot of fun to be sure.

I remember another occasion before I transitioned when I was meeting up with another old school friend, a pilot who was overnighting in Bangkok. We met up at a bar for a chat and something to eat. But there were a lot of kathoey around and they asked me if I'd like to be made up by them. I must have been giving off a vibe! So I said 'you bet' and they spent about an hour making me up, which was such a lot of fun. They weren't after money, they were just enjoying it. My poor pilot friend just sat there with his face in his hands 😂

xx

No, never been to Thailand it definitely does interest me but I don't do well with humidity which kind of puts me off and there are other destinations further up the pecking order. I like the colder destinations normally but there are exceptions on my list. I definitely want to make it to Japan, Australia and New Zealand some day.

My parents nearly emigrated to Hong Kong when I was a baby (turned down the job at the last minute) so I've always had a desire to go there so I can see what my life might have been! The handover of the territory ceremony is etched into my brain for some reason.

Could fancy a free makeover mind! Sounds like a perfect evening to me!

Thanks to all for bringing up the hormone levels topic again as it's a question for me right now too.  I had the conversation with my GP at my annual exam and left more confused than when I walked in.

I'm not offering this as fact or fear mongering, but in the NHS link I put up above it mentioned that exposure to estrogens may increase the risk of breast cancer.

Imagine if the HRT gave you growth, then took it away. 😥 Just playing Devyl's advocate here.

Thanks again to everyone for joining the discussion. 🙂

Hugs, Devlyn

Some days I wish I had larger breasts.  However, if they are big enough to fill up someone's hand, that may be large enough. 

I am doubtful HRT will ever do much to widen my hips.

However I do think HRT helped my breasts grow.

I will always leave it to the medical doctors to manage my dosage just right for me.


Chrissy

My endo has reduced my prescription due to my family history of strokes. She said this is standard even for CIS females in my age group. I am 72.

Ellen

Quote from: Stottie Girl on March 10, 2026, 08:18:18 AMNo, never been to Thailand it definitely does interest me but I don't do well with humidity which kind of puts me off and there are other destinations further up the pecking order. I like the colder destinations normally but there are exceptions on my list. I definitely want to make it to Japan, Australia and New Zealand some day.

My parents nearly emigrated to Hong Kong when I was a baby (turned down the job at the last minute) so I've always had a desire to go there so I can see what my life might have been! The handover of the territory ceremony is etched into my brain for some reason.

Could fancy a free makeover mind! Sounds like a perfect evening to me!

Well taking @Devlyn at her word about drifting off topic, I have also come to dislike the humidity. How I lived in a rainforest on the equator for 6 years without electricity astonishes me now, but I did.

Thailand, especially further north, is neither humid nor too hot in December, January, and February. In fact Chiang Mai and the far north is positively chilly in the mornings during December/January.

But I hear you. I loved New Zealand. Maybe a bit hyped but still gorgeous. I was lucky to fly in a small plane to Milford Sound on a gin clear day and then cruise on the sound before any other tourists arrived. I saw seals, penguins, and dolphins. A mesmerisingly beautiful place. Whether it was any more beautiful than Norway I'm not convinced, or the Canadian Rockies for that matter (Lake Louise is also spellbindingly beautiful). I took trains and boats throughout Norway and went right up into the Arctic Circle, staying on the Lofoten Islands. The northern lights danced every night I was there and it was probably the most beautiful place I've ever been in my life.

Which brings me back on topic (no, really) because 15 months ago before my brother's sudden death I went on a round-the-world trip: London-Singapore-Australia-New Zealand-Fiji-Canada-Iceland-London. I kind of knew at the time that it might be my swansong to long haul and global travel. At the age of 60 after a lifetime of world travel, it felt like the right time to rein it in and alter the way I travel. Hence the Western Scottish Highlands which would also be in my top 5 most beautiful places I've been.

How is that back on topic? Just because I guess I'm feeling that I'd also now prefer to settle into a maintenance level of estradiol, rather than a so-called therapeutic level. Into my 60's and it just feels right for me. But that's me and others have differing perspectives on this :)

xx

OK, I'm officially jealous of your jet setting lifestyle Tills! The stories you must have.

I love the sound of your Norway trip. Norway is in my top 5 to visit in the future alongside Iceland (not the frozen food place!).

I would like to see the fjords of Norway.

I was blown away by Norway. I had a stunning day up the Geiranger Fjord and then train trips including the Rauma Railway and, later, on the train through the snow to Bodo in the Arctic Cirle. I sailed twice from Bodo to Svolvaer in the Lofoten Islands and I honestly don't think I've ever seen anything more beautiful. I wish I could post some photos of Norway. Maybe I'll do something with my google drive and a link if that's permitted. If you can time it with good weather it's so so beautiful. It makes my heart sing just to remember.

The first time I saw the northern lights was a flight from Trondheim to Bodo. I booked a seat on the left, just in case. Then minutes before we took off there was a solar eruption. It was magical in pinks and reds and greens, seeming to dance all around the aircraft. It was if the universe was presenting its very own show above the clouds.

Ah what a country. I'd live there if the culture wasn't so different to anything I know here.

xx

I've seen the northern lights from home but they are dimmer than you see up in Norway (or Alaska, check out Danielle's pics on the photography topic, she's so lucky). One day I'll get up there.

Slartybartfast made a good job of the fiords!

Quote from: Devlyn on March 10, 2026, 09:03:51 AMI'm not offering this as fact or fear mongering, but in the NHS link I put up above it mentioned that exposure to estrogens may increase the risk of breast cancer.

Imagine if the HRT gave you growth, then took it away. 😥 Just playing Devyl's advocate here.

The cancer information is exactly what was presented to me.  I've resigned to the fact that my breast growth has leveled off after 6 years.  I don't want to loose the other benefits of HR, body fat redistribution, brain chemistry and so forth. 

Not sure if my last post reads right.  Replying to someone's post is always a bit confusing for me.

Quote from: Tess100 on March 11, 2026, 09:39:22 AMNot sure if my last post reads right.  Replying to someone's post is always a bit confusing for me.

It was a minor formatting error. I fixed it for you.