Hey everyone, the amount of hormones I've been prescribed seems a little low, so I wanted to check with you all and see if you have the same as me.



I'm to take one of each morning and night, is this normal?

Were not allowed to post dosage's on the forums.

Anyways, the dosage isn't the main factor in feminization as the goal for being on HRT is to have your blood hormone levels in the typical ranges that a woman in your age range will have. Most endocrinologists start their patients out on a low dosage regiment to start getting their hormone levels to where they need to be after 1 or two checkups.

Also congrats on starting HRT!

Thank you. and oops my bad . edited. and thanks for letting me know I totally forgot

That seems normal. When I started it was just estradiol at first, then we added the spiro after a month. In addition to adding the spiro, the dose has gradually been raised. At this point I am at my full dosage according to my doctor and will continue it for about 18. Blood tests were key in finding the right dosage, and once my testosterone got to within female levels, I really started noticing the changes.

If you have just started then yes your dosage will be low. The human body doesn't take kindly to extreme hormonal u-turns. Usually there is an initial six to eight week period to make sure your body is responding well to the new hormone landscape before they start the process of increasing the dosage. If you have been on HRT for some time you should discuss with your endo why you feel it is low.

Quote from: Megumi on December 06, 2014, 12:51:35 PM
Anyways, the dosage isn't the main factor in feminization as the goal for being on HRT is to have your blood hormone levels in the typical ranges that a woman in your age range will have. Most endocrinologists start their patients out on a low dosage regiment to start getting their hormone levels to where they need to be after 1 or two checkups.

My understanding is that different people need different levels to attain different goals. The desired end-result for many people, myself included, is to present as female and look fully feminine - not to match our hormone levels to typical cis-female levels, a difficult task anyway given their monthly fluctuations. Due to past damage from testosterone, it is often necessary to exceed cis-female levels to attain full feminization. While there are other means besides hormones to accomplish that goal, hormones definitely help. Some people are more sensitive than others to estrogens, so an 'ideal' level - and thus dosage - is something that is best determined through individual consultation with an endocrinologist.

Quote from: Ms Grace on December 06, 2014, 01:05:09 PM
If you have just started then yes your dosage will be low. The human body doesn't take kindly to extreme hormonal u-turns. Usually there is an initial six to eight week period to make sure your body is responding well to the new hormone landscape before they start the process of increasing the dosage. If you have been on HRT for some time you should discuss with your endo why you feel it is low.

My dosage for the first 8 weeks was so low that I do not even count that time when speaking of how long I have been on HRT. My 'starting dose' was mainly to keep E at the male level, since the T suppressor I was on also suppresses E production. Starting slow does make sense, to determine how much is really necessary, as well as to adapt to any changes. Unfortunately, I have been on a given routine for 3 months now, and have had no additional feminization in the last month, so I plan to follow that suggestion, telling the doctor on Monday why I need more.

My doctor started me low and didn't change it til the 3 month checkup. At that point he wasn't satisfied that enough was happening so he upped the dosage. Then at 15 months, he changed the form from one oral to another oral delivery. That step started to get some results where the prior 15 months had been pretty minimal.

Be patient and work with your endocrinologist on this. It's not a cut-and-dried science but more of an art, and the doctor has to respond to what they see your body doing or not doing, so it takes time.

A few appiontments after the doctor prescribed me my pills he suggested I take higher amounts of my hormone pills. Soon after I began getting really sick on the tummy, I would stress out really quickly and my skin really puffed up ( as mum said " I looked like a snake"). Mum, who is a nurse got me to take much lower amounts of pills and that has worked for me perfectly.

The right dose is the one which produces feminization at a pace both you and your doctor are comfortable with, and to be honest neither your doc nor you really have that much control over how your body reacts to HRT.  For me, a fraction of a "normal" dose is producing far faster feminization than many girls on much higher doses.  Bodies react differently, and I've learned that it's an utter waste of time to compare doses and think that more is better.

The better endocrinologists seem to approach HRT more conservatively than those who just throw high doses of hormones at people and hope that things work out.  Low doses at first, adding drugs one at a time - all signs that you're working with an expert who wants to achieve the best, safest results for you in the long term.  I'd be far more worried if my doctor just handed me the "internet" doses of estradiol and spironolactone and told me to come back in six months; that's lazy medicine, and HRT is far more of an art than a science.

Yeah, I agree with BrendaE both that the best dose is the one that works for you personally and that a good doctor is cautious.

My endo started me off at a level that's considered very, very low, something within the range of what's given to menopausal cis women... and it was still too much, and my 3-month checkup showed liver damage! The intent was to ramp up to a more typical dose, but obviously that wasn't happening for me. I've since had fantastic results on a dose that is half of that starting point, but I was VERY grateful that the endo didn't try a "full transition level dose" right off the bat as it could literally have killed me.

Quote from: Brenda E on December 06, 2014, 06:14:56 PMFor me, a fraction of a "normal" dose is producing far faster feminization than many girls on much higher doses.

That was what I thought at first. If I am feminizing on a low dose, why take any more? Then suddenly, my feminization stopped and I had to work so hard just to maintain what had already happened. It became painfully clear that my dosage was too low. I am very unsatisfied with my physical progress and I recall you saying not long ago that you too were unsatisfied. Even my rather conservative doctor agreed with me that I need an increase, and I think you would benefit too if you are still unsatisfied with progress on a low dose.

QuoteBodies react differently, and I've learned that it's an utter waste of time to compare doses and think that more is better.

I agree with this, but it is hard to see how a masculine form could feminize at levels too low to induce proper feminization in a cis girl.

QuoteThe better endocrinologists seem to approach HRT more conservatively than those who just throw high doses of hormones at people and hope that things work out.  Low doses at first, adding drugs one at a time - all signs that you're working with an expert who wants to achieve the best, safest results for you in the long term.

I can't say I agree. Just because a doctor seems very knowledgeable, having answers to every question, does not mean the doctor is always right. I learned that the hard way. The best endocrinologists are those who provide a full range of treatment options to attain the best possible outcome. That means operating under the principle of 'informed consent' rather than the Hippocratic dictum of 'first, do no harm.' Failure to offer a sufficiently strong prescription to induce feminization is itself harmful, even potentially fatal to those of us with suicidal thoughts. Given the rarity of hormone-induced problems in people under 40, together with recent scientific findings casting doubt on many of the alleged 'risks' of estradiol, I would be wary of any doctor who is unwilling to move beyond low doses due to the risk of side effects. Such a doctor can hardly be considered trans-friendly.

Quote from: Steph34 on December 09, 2014, 09:36:04 AM
That was what I thought at first. If I am feminizing on a low dose, why take any more? Then suddenly, my feminization stopped and I had to work so hard just to maintain what had already happened. It became painfully clear that my dosage was too low. I am very unsatisfied with my physical progress and I recall you saying not long ago that you too were unsatisfied. Even my rather conservative doctor agreed with me that I need an increase, and I think you would benefit too if you are still unsatisfied with progress on a low dose.

You're right - I am unsatisfied, but aren't we all?

My dose has recently been upped, and hopefully this'll produce faster feminization.  For the physical changes I want, my dose was way too low (and probably still could be).  Mentally, the tiniest amount of estradiol produced amazing effects, and increasing my dose progressively has not made any change to how I feel.  My dose should reflect the fact that physical changes are top of my transgender wish list now.

QuoteI agree with this, but it is hard to see how a masculine form could feminize at levels too low to induce proper feminization in a cis girl.

You could be right on this too, although there is a wide range of sensitivity levels to hormones.  Some need more, some need less, but I think from a biological standpoint, the human body does need something approximating female levels of hormones (ballpark, at least) in order to reliably feminize.

QuoteI can't say I agree. Just because a doctor seems very knowledgeable, having answers to every question, does not mean the doctor is always right. I learned that the hard way. The best endocrinologists are those who provide a full range of treatment options to attain the best possible outcome. That means operating under the principle of 'informed consent' rather than the Hippocratic dictum of 'first, do no harm.' Failure to offer a sufficiently strong prescription to induce feminization is itself harmful, even potentially fatal to those of us with suicidal thoughts. Given the rarity of hormone-induced problems in people under 40, together with recent scientific findings casting doubt on many of the alleged 'risks' of estradiol, I would be wary of any doctor who is unwilling to move beyond low doses due to the risk of side effects. Such a doctor can hardly be considered trans-friendly.

Sure, and you justify your points well.  My own endo is conservative in her approach, but offers the full range of treatment options.  She prefers to start her patients off slowly if there's no urgent need to transition.  If I was having suicidal thoughts because of my gender issues (which I have in the past, and still do, but that's another story - not urgent, and only thoughts), then I'm sure she'd work in conjunction with my therapist to ensure that I received the HRT equivalent of emergency care: lots of them, right away.  I'm by no means an HRT veteran yet - like you, it's been low dose for all but the last couple of months, and I almost don't even consider those initial low dose months as being actually on hormones.  There were changes - big ones - but it was like riding a bicycle with training wheels.

I think the overall point I was making is that there's a broad spectrum of doses for well-administered, safe, effective HRT, and the guidelines we can all see online are merely that: guidelines.  The actual best dose, types of medications, and manner of treatment will be determined in careful collaboration with an experienced endocrinologist.

I get the whole idea behind informed consent.  For some people, it works.  For some, it's absolutely necessary, and anything that breaks down barriers to getting basic gender care should be encouraged.  I don't know enough about the actual care received when going the informed consent route, but I suspect (and please correct me if I'm wrong) it's far less personal, and the prescribing physician takes a more hands-off approach.  I like the contact with my endocrinologist (apart from the finger up the you-know-what ever other visit).  I like the way my chart is thoroughly reviewed every couple of months, my blood tests done regularly, and the fact that she is genuinely doing her best to help me become the girl I so desperately want to become.  I value her opinions and expertise, and she's presented me with every possible option I could ever want and will gladly tailor my medical care to meet my needs.  I feel like we have a partnership, and not that I'm merely using her as someone to sign off on a prescription.  I have this impression that informed consent is more like, "Ok, whatever doc, here's the signed form saying that I don't need your help, so give me my meds.  See you in six months."

But...like you say, I think docs are still somewhat cautious when it comes to trans care.  Public policy is still against us, and that affects how willing docs are to help.  It's still a fairly new subset of medical care too, and no doc wants to be the one handing out hormones like candy, only to find that in thirty years he's been personally responsible for causing hundreds of cases of some form of cancer.  Sadly, though, the docs and policy makers are looking at the small print and missing the big picture.  It really doesn't matter if a few of us develop blood clots from taking estrogen when hundreds of us are killing ourselves because we're not given proper access to it.  And screw the minor side effects when one of the side effects of not being properly medicated is having to live in the wrong body.

A rambling response, I know.  But I agree with you.

Quote from: Steph34 on December 09, 2014, 09:36:04 AM
That was what I thought at first. If I am feminizing on a low dose, why take any more?

Estrogen does a lot more than trigger development of secondary sexual characteristics. It has mental effects and it regulates body temperature. If you're having hot flashes or feeling cold your dose may be incorrect (usually too low). You should tell your endo if you feel any of these things. In my case low dose makes me feel cold in a normal office building air conditioned environment. Taking a higher divided dose made me feel normal temperature wise again.

QuoteI can't say I agree. Just because a doctor seems very knowledgeable, having answers to every question, does not mean the doctor is always right. I learned that the hard way. The best endocrinologists are those who provide a full range of treatment options to attain the best possible outcome. That means operating under the principle of 'informed consent' rather than the Hippocratic dictum of 'first, do no harm.' Failure to offer a sufficiently strong prescription to induce feminization is itself harmful, even potentially fatal to those of us with suicidal thoughts. Given the rarity of hormone-induced problems in people under 40, together with recent scientific findings casting doubt on many of the alleged 'risks' of estradiol, I would be wary of any doctor who is unwilling to move beyond low doses due to the risk of side effects. Such a doctor can hardly be considered trans-friendly.

Fully agree. I lucked out but I also chose wisely. My doctor is experienced with trans healthcare and the clinic is a LGBT care division of a major NY hospital. The nurse practitioner is trans herself and gets very good reviews. It's really wonderful going there as I not only feel at ease being in an affirming space but I am confident that they will get it right rather than simply play it safe. They also know my therapist and work with her even though I am under informed consent for HRT. They also do my primary care so they can adjust the other meds I take and take care of my other health issues. I'm really confident I'm in good hands and I think I will stay there for the duration.

I was on pills. I started with 2/3 dose then at 6 months full dose. At 15 months I switched to IM because I no longer felt changes occurring. The IM dose is 1/2  the pill dose over 14 days but the effects from IM are very good. In March (after my blood work) I will be on a 10 day cycle or a 30 % increase in meds.

The big issue I am having with IM is the last 3 and first 2 days of the cycle the medicine in my system is ramping down and ramping up. I have swings in mood and a reduction in effect. When I go to 10 days that should rectify and I will be happy (perhaps just for a while).

I have been on HRT 18 months and in March it will have been 21 months.

I will see how the effects are at 24 months and if need be I will push for more medicine. It was explained to me the body needs time to adjust to different hormones and then higher amounts of hormones. I need to trust my PA and follow his lead but with a questioning attitude.

Quote from: Brenda E on December 09, 2014, 10:50:07 AM
You're right - I am unsatisfied, but aren't we all?

Transgendered people and women are often unsatisfied with their bodies, so being both transgender and female must make it doubly hard for us. I notice that even the best-looking among us are at best neutral in their self-image.

QuoteMy dose has recently been upped, and hopefully this'll produce faster feminization.  For the physical changes I want, my dose was way too low (and probably still could be).  Mentally, the tiniest amount of estradiol produced amazing effects,

I am in the same boat as you, there.

Quoteand increasing my dose progressively has not made any change to how I feel.

For me, switching from topical to oral estradiol, and thus attaining a higher level, significantly improved my mood. Indeed, I felt like I was high 15 minutes after my first dose, and my mother was even worried because I seemed like I was high. Now after nearly a week, my mood is stabilizing again, but I crash into despair if my estradiol wears off.

QuoteYou could be right on this too, although there is a wide range of sensitivity levels to hormones.  Some need more, some need less, but I think from a biological standpoint, the human body does need something approximating female levels of hormones (ballpark, at least) in order to reliably feminize.

Whether the body needs to approximate the level of a menstruating female or go even higher depends on age, individual sensitivity, and past effects of androgens. The required levels would vary depending on those individual factors, but in no cases could full feminization occur with LESS than the average amount a cis female would have over time. That is because cisfemales are genetically predisposed to feminize; trying to induce feminization on someone lacking the proper reproductive organs, especially after past damage from toxic levels of T, is much more difficult.

QuoteI think the overall point I was making is that there's a broad spectrum of doses for well-administered, safe, effective HRT, and the guidelines we can all see online are merely that: guidelines.  The actual best dose, types of medications, and manner of treatment will be determined in careful collaboration with an experienced endocrinologist.

Yes, but some doctors are too conservative in their approach. My current endocrinologist, for example, is strongly opposed to raising blood levels beyond a certain point, despite little or no scientific evidence to discourage doing so. This doctor is very experienced in transgender care and answers all my questions, yet refuses to provide products that some people, perhaps me next year, need in order to feminize. Furthermore, my own research has led me to conclude that some of what my doctor has told me (for example, the level of T coming from the adrenal gland) is tantamount to lying. My point is that even doctors who seem very well-informed can turn out to be crooks once we do our homework.

QuoteIt really doesn't matter if a few of us develop blood clots from taking estrogen when hundreds of us are killing ourselves because we're not given proper access to it.  And screw the minor side effects when one of the side effects of not being properly medicated is having to live in the wrong body.

Yes, and this is the problem with the 'do no harm' mentality. Doctors are so afraid of hurting someone (and being sued for it) that they are too passive in their approach. Personalized care and communication seemed good to me only until I realized that I am not getting what I need and my doctor does not really know everything despite pretending to.

Quote from: ImagineKate on December 09, 2014, 11:37:43 AM
Estrogen does a lot more than trigger development of secondary sexual characteristics. It has mental effects and it regulates body temperature. If you're having hot flashes or feeling cold your dose may be incorrect (usually too low). You should tell your endo if you feel any of these things. In my case low dose makes me feel cold in a normal office building air conditioned environment. Taking a higher divided dose made me feel normal temperature wise again.

I have never heard of being cold from too low a level. In fact, I have found that increasing my blood level makes me colder. The hot flashes are common, however, and should be seen as a warning sign of insufficient E levels, that another dose is necessary even if it is an hour or two early.

QuoteFully agree. I lucked out but I also chose wisely. My doctor is experienced with trans healthcare and the clinic is a LGBT care division of a major NY hospital. The nurse practitioner is trans herself and gets very good reviews.

That description matches my first doctor perfectly. She sent me away with a prescription for a weak DHT blocker and told me to "come back in 3 months to see how the finasteride's going." Needless to say, that was the first and last time I ever saw her.

I am curious why people are being prescribed Estradiol in pill form.  My understanding is that the pill form carries the most risks of blood clotting and is hard on the liver.  The body also absorbs the least amount of Estradiol from the pill form.

Quote from: jessical on December 15, 2014, 12:50:02 PM
I am curious why people are being prescribed Estradiol in pill form.  My understanding is that the pill form carries the most risks of blood clotting and is hard on the liver.  The body also absorbs the least amount of Estradiol from the pill form.

My guess is that it mainly has to do with user friendliness of pills over other forms and the cost. I could be wrong though.

I can't post numbers due to the paranoia here but all I can say is my doctor started me on what I *think* is a normal dose. I've been going down ever since. My blood levels keep coming back really high. Hopefully this latest decrease will be enough so I can stop going back every two months!!

Edit: I just saw the post about informed consent and I'd like to say that I've had no issues with it myself. Everything seems to be going great and I like both doctor's I've had so far.

Quote from: jessical on December 15, 2014, 12:50:02 PM
I am curious why people are being prescribed Estradiol in pill form.  My understanding is that the pill form carries the most risks of blood clotting and is hard on the liver.  The body also absorbs the least amount of Estradiol from the pill form.

Patches are always falling off.  Needles hurt.  Creams are messy.  I guess it all depends on what people are comfortable with.  Try sticking a needle in me...

Quote from: jessical on December 15, 2014, 12:50:02 PM
I am curious why people are being prescribed Estradiol in pill form.  My understanding is that the pill form carries the most risks of blood clotting and is hard on the liver.  The body also absorbs the least amount of Estradiol from the pill form.

They are cheap.

Dosage can be easily and quickly adjusted and they are easy to stop if you suspect they are causing an issue.

They are easy to transport, especially via air travel.

No needles are needed, less risk of infection too.

They provide a more constant level of the hormone, versus an injection that peaks and drops off.

That said I plan to try injections sooner or later. Not having to worry about it for a week and reported better feminization is appealing to me.