I started HRT a bit over a month ago, but I seem to have been set at this from another angle, so I have some questions about the variation in HRT.

My doctor ( not endo ) does HRT for numerous TG patients. At the time of starting, he made me aware that he prefers to suppress T using E only.

Before starting HRT, my T was 11 ( in whatever unit that is where the normal male range is 8 - 30 ). I don't recall what my E and other things were, but it was all rather normal for a male body... For starting out, he put me onto a low dose Estradiol to see how my body reacts. After a month, bloods showed that there was no change at all in my T level. From there, I was asked to double the E dose. He did mentioned the use of blockers if my T doesn't come down during my last visit, but again says he prefers not to prescribe them unless absolutely necessary.

So, I really appreciate that my doctor is looking out for my health, but is an E only HRT effective generally? I've an aggressive goal for going full time, and would like the biggest bang for my buck from HRT to help me along. Otherwise, I have another check of levels in about 4 weeks booked.

Also, since starting HRT, body hair on my tummy and chest has actually increased in growth rate, colour and size. I used to have nothing but sparse vellus type stuff, but is now getting longer and has colour .  My therapist says that this may be a side-effect of hormone changes. Is this common? Could it be caused by an E only HRT? Is it likely to disappear back to vellus what it was once T is suppressed?

i have heard that over time estrogen presence can cause your body to stop producing testosterone, or to diminish it and in itself thus estrogen can work as an anti androgen...however there is also the strong conviction amongst medical providers and tgs that testosterone is the dominating hormone and will beat out over estrogen...I don't know where the truth lies, maybe somewhere in between. I have heard that estrogen alone will work, but it takes longer. That the end result is the same, but it might take twice as long to get there...Again - these are all things I have heard on the internet from trans women. Personally, I wanted my tesosterone eradicated asap and was able to accomplish that with a low/moderate dose of anti androgen medication, spironolactone. I have seen a few women on susans who are on E only regimens, so hopefully one of them will see your thread and offer some  insight...I understand not wanting to wait on your levels this way - and if you asked my DR who works at a TG clinic, she would tell you anti androgens are a must...different perspectives I guess

I think it depends on the person - and it does sound like you may need blockers, since your T isn't responding much at all.

I was and am on a fairly low dose of E only (*not* listing specific amounts, just that it's considered low) and saw my T drop to squarely in the middle of the female range within three months... but it was off the bottom of the male charts before J even started, so there's that. I have seen good changes from estrogen only, too, but again, people are different.

It does depend on the person. I started on E only and got some reduction in testosterone but not nearly enough. Then I had some blood pressure issues. Now that the BP issues are resolved, my endocrinologist and I discussed things and he's placed me on spiro in addition to estrogen. But he, like your doctor, preferred to try with just estrogen first. In some cases it works and in some cases it does not.

My T was 14 when I started, I was E only, T went to <1 in 6 weeks.

I went on spiro much later to change hair distribution.

It is very person specific, your Dr sounds experienced I would trust him.

Cindy

Hehe. I believe that I'm the only TG patient of my specific doctor, although the clinic specialises in the area of HRT etc.

As my doctor has mentioned numerous times, there are colleagues to get advice from as needed. So I'm actually really quite fine with the situation. There are skilled people behind the curtains, and I think my doctor gets to learn a thing or two about HRT and TG peoples in general. It's a win-win as far as I can tell.

So aside from the current E-only HRT, when I see them later in May, I'll ask about progesterone and blockers... I've done bunch of reading since the OP in terms of therapy options etc. I'm after as much change as possible in the short term... And if I ask, the worse they can do is say no... And I'm certain that they won't do that without a good reason.