Hi Everyone,

On a recent trip to my doctor (GP) I inquired about starting low dose E.  I've been on spironolactone and dutasteride.   Since I'm looking for a low dose to deal with my dysphoria and not necessarily transitioning, he was concerned he didn't know enough about prescribing for this situation.  He asked me if I had any medical documentation that discussed low dose E as just a treatment for dysphoria.

Would any of you be able to point me to something I could take back to my doctor?  I live in Canada so if it's Canadian it would be even better.

Thanks so much,
Paige
 

Interesting question. From what i have read " low dose" refers to the lower range of what is used for transitioning purposes. So you basically take the lower range of those recommendations. You still of course could feminize a lot on that dosage physically.

If there is any other course of treatment even further below that dosage i've not heard about it, but there are a lot smarter people than me on the subject here.

My reading on the site has left me with a big puzzle as to what low dose really is. Estradiol can be prescribed in some pretty small dosages so I suspect you would want to target blood estradiol levels in the menopause range. As I am on the pill and a half transition dosage, I am still testing in the male range for estradiol but the total estrogen is high. I would suggest levels less than that because I am developing after all these years. Estradiol works far better on me than Premarin ever  did. It would also depend on if you use pills, patches, gel or injection. I would suspect pills would be the cheapest way to do this but it will be up to your doctor.

What is low dose? Everyone is different, I've been on very low dosage of spiro and E first 3.5 months and had a fairly good response, same if not better than others on higher doses, that said, all this is very vague since we never discuss dosages at Susan's, so how to know exactly... actually I was on low spiro alone the first month and saw the changes on my body right then, so if you didn't see anything yet, maybe low dose of E would work slowly, but in the end will probably end up doing the same.

I don't think it has any standard meaning. I'm taking it to mean a level that's only partially effective in transitioning.

To only treat dysphoria and no more I'd think it's the lowest level that works.

Thanks everyone for replying.  As you said nobody reacts quite the same to E but I have read standard beginning and full dosage protocols for transitioning.  I was just wondering if such a thing existed for easing dysphoria perhaps using the beginning dosage.  I was looking for some sort of medical guidelines for a patient who doesn't necessarily want to transition but wants to ease dysphoria.

There seems to a few people on this forum taking low dose but not transitioning.  I wondering how they determined this course with their doctor.

Does that make sense?
Paige

I had a great GP several years ago when I lived in Florida and I discussed this with her.  She put me on a regimen that was like 1/4 of what a beginning transition dosage would be.  It was small enough the physical effects were minimum but psychologically had some good effects.  It kept me calm at a time when I was basically stuck between the rock of being transgender and the hard place of a job I couldn't afford to lose.  As of course with anything your mileage may vary.

Quote from: Paige on June 28, 2016, 10:25:14 PM
Thanks everyone for replying.  As you said nobody reacts quite the same to E but I have read standard beginning and full dosage protocols for transitioning.  I was just wondering if such a thing existed for easing dysphoria perhaps using the beginning dosage.  I was looking for some sort of medical guidelines for a patient who doesn't necessarily want to transition but wants to ease dysphoria.

There seems to a few people on this forum taking low dose but not transitioning.  I wondering how they determined this course with their doctor.

You may be over thinking it. You're not taking too much, which might put you at risk, but too little. Just try it and adjust up or down as you need. You'll know when its working, its quite unmistakable. Then just drop it until you feel bad again, and up till its good. Keep the minimum level that works.

That's not advice from my doctor, as I didn't have one when I did it.

Quote from: AnonyMs on June 29, 2016, 01:48:53 AM
You may be over thinking it. You're not taking too much, which might put you at risk, but too little. Just try it and adjust up or down as you need. You'll know when its working, its quite unmistakable. Then just drop it until you feel bad again, and up till its good. Keep the minimum level that works.

That's not advice from my doctor, as I didn't have one when I did it.

hmm... low dose for me is 1 S pill half 2x daily, i dut daily, & 1 E pill 2x a day and changes are obvious. i do not see a reason to change them. i will be getting a hormone test shortly and i assume no changes. if there are changes it will be small.

fin them dut for about 3 months alone made obvious changes. obvious like peeps introduced themselves as family.
3 months of E & S and i have big changes., like must buy female pants.

ps...
if you are not wanting to transition don't get breast buds. this means that you may want to discuss cycling meds and medicine half-life.

So the closest I've got so far is a quote from Sherborne Health Centre in Toronto transgender guidelines. (Thanks Amber)

Quote
When hormones are chosen as part of a care plan, some clients may seek maximum feminization/masculinization, while others experience relief with a more androgynous appearance. Hormone therapy may also provide significant relief for clients who do not wish to make a social gender role transition or are unable to do so.  Both the dose and route of hormone treatments may be individualized to meet a client's specific treatment goals for gender expression and need for relief from gender dysphoria The duration of therapy may also be personalized, as clients who have not undergone gonadectomy may opt to discontinue hormone therapy if the irreversible effects are sufficient to maintain relief from dysphoria If hormone therapy is discontinued, it is preferable to slowly taper the dose over a period of several weeks in order to minimize the side effects that may be associated with a more sudden change in serum hormone levels

It would be nice to have some scientific data to backup this type of treatment for dysphoria, but I'm doubtful any exists.

Thanks all,
Paige

I have no data just my experience.  Depending on what one thinks the max E oral transitional dose is, I started out at about 25% the max E dose for 3 months and I am currently about 37% the max (whatever that means) E dose.    This has worked well for 6 months.   I am going to stay at this level until my 12 month mark then I'll reassess.  I was also on 1/2 of typical spiro transition dose for the first 6 months. Since I'm not going to transition, 6 weeks ago after discussing it with my doc, I stopped the spiro to see if E would be enough on its own.  So far so good but the jury is still out.  I think this is one of those things that is very unique to the individual.  Start out very low and increment up as needed.

Good Luck.

Normally all people start hormones on low dose. Standard practice for safety reasons,  and to protect against any adverse reactions. Then dose is slowly increased over the following months based on blood results and protocol the doctor following. 

With respect, female hormones are not something to take lightly and do cause physical changes as well. I am not sure they are suitable just as mood enhancer.

Not all start at a low dose.  My Dr. started me on a normal transition dose of E, spiro, and progesterone the first day.  So it really depends on the Dr. and their experience and preference.


Sapere Aude

My doctor started me at a low dose of E and spiro and I am about ready to go back and ask for an adjustment to a lower dose.  I am feeling much more at ease, the urge to transition has moderated significantly and that's all good.  I just wanted to moderate my feeling.  But my breast growth is incredible.  After about 4 months I am worried about a male fail situation if I go shirtless. I tried on an old 38C bra that used to be loose in the cups and now I am about to spill out.  Yikes! The nipples are getting smoother and widening some too.  I guess that's why many say -YMMV. 
There are some good side effects - body hair has slowed down and my head hair is much fuller.  My hairdresser noticed the hair effects today.

I'm on a super low dose about 1 month in...wonder if it's too low because, while I feel good, there is still dysphoria (in some ways more, knowing caused by thoughts of what I now have streaming through me).

Quote from: AnonyMs on June 29, 2016, 01:48:53 AM
You may be over thinking it. You're not taking too much, which might put you at risk, but too little. Just try it and adjust up or down as you need. You'll know when its working, its quite unmistakable. Then just drop it until you feel bad again, and up till its good. Keep the minimum level that works.

That's not advice from my doctor, as I didn't have one when I did it.

Not sure I have that unmistakable feeling quite yet - but hope to find the minimum dose that will get me there.

Quote from: AlisonWood on June 30, 2016, 06:01:03 PM
I'm on a super low dose about 1 month in...wonder if it's too low because, while I feel good, there is still dysphoria (in some ways more, knowing caused by thoughts of what I now have streaming through me).

Its possible that some of feeling good is simply because you're doing something. I've had depression lift quite significantly just by deciding to move ahead in transition but before I'd done anything due to the long wait for appointments.

I think you just need to pay attention to how you feel over time and adjust as needed. I was on low dose 5 years or so before it wasn't enough.

Quote from: AnonyMs on July 01, 2016, 02:36:13 AM
Its possible that some of feeling good is simply because you're doing something.

This is something I have wondered myself.  When I started low-dose E, I had a pretty quick reduction in dysphoria and that darn hamster wheel that previously never stopped running in my head over and over, just...stopped one day. 

I have been thinking about this quite a lot and I believe perhaps it's both; a bit of just doing something and a bit of my brain getting chemicals its been deprived of throughout my life. 

I haven't found much "official" suggestions.  I think you need to see your doctor (or one comfortable with trying some things), test regularly, stick to a plan and watch for how you feel.  I have found a supportive therapist to be critical.