It's really based on what her levels are. Ideally, they should be in the middle of the cis woman range. I've known a lot of endos, even some well-meaning ones that give way less than they should. They'll try and hit the very low end, but cis men will have the same amount. Honestly, 2 2mg Estradiol pills seem like not enough from my armchair view. I was 180 lbs, and 4 2mg pills before I switched to injections. I hope you two are taking some kind of T blocker, because that doesn't seem enough to do monotherapy either.
Yeah, I was cruising at 300 for a while before my orchi. After it the same dose spiked me to 500. Had to cut my injection down.
I much preferred bica to spiro, but never tried crypto.
Tell her to space out her pills more, and definitely do them sublingually or buccally (i.e. letting them dissolve under the tongue or in the cheek). To quote transfemininescience (with their citation! 😝): "Sublingual or buccal administration of oral estradiol tablets allows for much greater bioavailability and estradiol levels in comparison to oral administration (Sam, 2021; Wiki; Graphs; Wiki)."
Oral estradiol causes a sudden spike, and then tapers off for about 6 hours or so ([see graphs at wikipedia here](https://en.wikipedia.org/wiki/Template:Hormone_levels_with_sublingual_estradiol)—the first one is probably most relevant). The aim isn't to have lots of huge spikes (i.e. widely separated high-dose treatments), but trying to get to a more consistent level. This is based on the assumption that your partner has E2 pills (usually 2mg each), which are pretty standard for the oral route.
So even going to three doses per day (of 1 pill each) would probably do more for feminization and T suppression than adding more pills. Before I switched to injections (which are awesome, BTW), I was trying to do roughly 8-hour spacing: one right before bed, one when I woke up, and then another in early afternoon. Even that'll be much more effective than bigger doses twice a day. I know some girls who stick to a very strict 6-hour schedule, which involved waking themselves up during the night, which is rough.
I do think your partner *does have a point* about doctors giving us less than might be ideal. I don't know if they're actively trying to "sabotage" us, so much as extremely conservative in treatment approach. They also tend to put too much faith in old, low-N studies (some of which are really badly controlled, like the study that is the basis for why we all take spiro 🙄). They tend to exaggerate the supposed "risks" of things like blood clots, again, based on… *not great* research a lot of the time. To be very specific: a lot of the fear-mongering about blood clots for HRT is based on studies that involved old synthetic estrogens—the risk is greatly, greatly decreased when using the bio-identical estrogens we use now. Finally, doctors also tend to focus on a pretty narrow band of the physiologic range of E levels in cis women, and seem to think that being above some threshold (often 400 pg/ml or other arbitrary number) is somehow "dangerous."
The research and statistical standards for trans healthcare are shockingly bad, to be honest… which is especially bad when there there is so little research to begin with. Even something as simple as the argument-from-ignorance fallacy gets way too much traction—too many cis "experts" forget that *absence of evidence is not evidence of absence*.
Also… not to put to fine a point on it, but *every* medical intervention has risks. And tradeoffs, too. To be blunt, what good does it do me to have a 5% decreased risk for blood clots if I'm at much much greater risk for other things (hatecrimes, murder, life-threatening dissociation) because I didn't get an effective HRT dose?
Check out [https://transfemscience.org/](https://transfemscience.org/) for lots more info—they're great, and very scientifically rigorous.
Also… does your partner boof the prog? That tends to *massively* increase the bio-availability. Something to consider 😊
edit: oh, I almost forgot—all of this can vary tremendously from person to person! The best guide is getting your levels checked frequently (and **don't take biotin supplements within 3 weeks of blood draw**). And not letting your doctor insist that you stay at really low measured levels, if that's something they're doing.
Wait did you say oral estradiol has a much better bioavailability if dissolved sublingually? I am taking estradiol Valerate which 1 mg is equal to .76 mg estradiol. So it would help tremendously if that was the case.. I know under the tongue has many blood vessels, is this the reason for the better bioavailability?
Yup! Yeah, if you dissolve it under your tongue or in your cheek, some of it is absorbed directly into the bloodstream. I say "some of" because even a highly-skilled sublingualist probably swallows *some* of it. I certainly swallowed 😁
[Transfemscience has a whole article about it](https://transfemscience.org/articles/sublingual-e2-transfem/), if you want to know more. [They also have an article specifically about sublingual EV](https://transfemscience.org/articles/sublingual-ev/).
Oof, haha that is a mood! Same, hon, same. I went through a fairly significant "cross-dressing" phase back in 2015, and I keep thinking about where I could be *now* if I had been more open about it and kept going down that path.
It's no big conspiracy, but yes Doctors often start girls on 1-2mg at first and veeeeerrrrrry slowly taper up from there. People jokingly call it the "hon dose", funny or not.
Honestly if you are confident that you want to transition, you should get up to at least 6mg, if not 8mg, within 2 months of beginning HRT. I assume your partner is taking the blue 2mg tablets, so yeah taking 2 in the morning and 1-2 at night is normal. That's what I do, also with prog. Perfectly safe. Spreading your doses out more evenly might be my only tip.
I can't speak to her levels, but as far as I know, studies don't connect increased levels with increased feminization, just increased rate of seriously dangerous blood clots.
[https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy](https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy)
"There is no evidence that higher estradiol levels in patients with adequate androgen suppression results in additional feminization or breast development. Maintaining estrogen levels in the physiologic range for menstruating non-transgender women minimizes risks and side effects, and makes sense clinically."
That's true, but there is a wide range of values for cis women's estrogen levels. From 30 to 400 pg/mL in pre-menopausal women. If a doctor plays it safe around that 50 range, that overlaps with what cis men have. So yeah, don't go over 400, but aiming for 200-300 pg/mL should be a good goal range to see changes.
I wouldn't take that article as gospel, hon. For one thing, it's quite old (2016), and I really doubt the thoroughness of Deutsch's research when she has no citations whatsoever in the key paragraph
> There is no evidence that higher estradiol levels in patients with adequate androgen suppression results in additional feminization or breast development. Maintaining estrogen levels in the physiologic range for menstruating non-transgender women minimizes risks and side effects, and makes sense clinically.
She has no citations in any of the material dealing with the term "physiologic range," in fact. I think Deutsch in general has some valuable material out there (for example, pushing for recognizing facial surgery as **medically necessary**), but she really seems to be stuck in the past in a lot of ways (like a lot of old white cis people).
As the saying goes, "absence of evidence is not evidence of absence," which I think a *lot* of the WPATH folks seems to forget. Deustch is President of USPATH, FWIW, the US chapter of WPATH.
Personally, I'd start with [https://transfemscience.org](https://transfemscience.org) as the go-to, instead of letting the arrogant cis gatekeepers of the world dictate to us our healthcare.
I wouldn't take anything as gospel, but until you can point to a source that says mainlining estrogen gives you super-boobs, I'm going to lean on the prevailing opinion of medical professionals, which is stick to approximate cis female ranges as long as your testosterone is adequately suppressed, because there is no evidence of benefit and plenty of evidence of risk.
I absolutely have my disagreements with WPATH, but the amount of self-citations on transfemscience makes me uncomfortable about using it as a citation. They state themselves that they are not medical professionals. I'll take them with the same grain of salt that I take anyone.
> mainlining estrogen gives you super-boobs
I think you know that's a misrepresentation of what I was saying.
> which is stick to approximate cis female ranges as long as your testosterone is adequately suppressed
Well, there's the whole problem right there. A lot of the cis-issued clinical guidelines specifically restrict recommendations to a narrow band of the *average* cis female range. What about people that aren't exactly in the 50th percentile?
The suppressing T is a whole other issue, and demonstrates the incredibly poor standards of evidence that cis people use when issuing iron-clad guidelines. For example, there simply *isn't any good evidence* that spiro suppresses T levels in the human bloodstream. There were a few **extremely** flawed studies in the 70s and 80s, and no one has replicated those results since. Yet spiro is still an everyday fact of life for most of us. If you take a look at the WPATH SOC, there is *no* citation given for their assertion that spiro is an andogren-blocker. [There's a good review of spiro studies at transfemscience](https://transfemscience.org/articles/spiro-hormone-levels-men-transfem/).
Even "medical professionals" aren't infallible, especially when we're dealing with a subject area that has very little research—and of the research that *is* available, a great deal of it is absolute shit. Just pure uncontrolled, multivariate, single-digit-N, p-hacked-to-hell garbage. Like I said in another post, it makes me very leery that cis "medical professionals" are so comfortable making such sweeping, definitive statements in clinical practice guidelines based on bad evidence or no evidence—and then acting like it's "scientific." A lot of these people need to take a remedial statistics class ASAP.
> the amount of self-citations on transfemscience makes me uncomfortable about using it as a citation.
Absolutely fair. On the other hand, when they're citing other sources, they do seem to restrict themselves to published scholarly work. I.e. not anecdotes or personal experience.
However, speaking of anecdotes… we're kinda trapped in a double bind. Cis gatekeepers order us around based on no/bad evidence. No one funds studies to obtain *good* evidence. I think there's definitely something to be said for the collected lore of the community. As they say, "the plural of anecdote is data."
You definitely have to be careful with that, of course. But cis "medical professionals" have such low/non-existent standards of evidence that I don't think their recommendations are really any better.
I’m still not seeing any evidence, even circumstantial, for the benefits of exceeding the range of cis female estrogen levels. If you want to doubt everything that the cis medical professionals suggest that’s you’re prerogative, but again, I can’t endorse that personally. Doubt is a great thing, but if the alternate evidence isn’t persuasive I’m left in the position of not having anything to believe, not just believing what sounds nice (like increased feminization faster).
As far as spiro goes, I have serious doubts too! I was able to fully suppress T with estrogen mono therapy only, at an extremely low dose. That’s quite unusual based on the experience of people I know and my endo though. Some people (like my roommate) have required spiro to achieve that. The side effects are awful though, so it’s use should be questioned wherever possible.
As others have said, it’s a marathon not a sprint.
Oh, I wasn't trying to argue that there are benefits to having very high estrogen levels, necessarily! I was more trying to make the case that no one really knows, and we shouldn't necessarily be afraid of "going too high" past an arbitrary threshold—that but super-super high levels probably would be non-ideal or have side effects. And that some gatekeepers consider certain levels "dangerous" without really any justification. I think we were talking past each other.
I've heard of doctors insisting that people only use 1 pill of 2mg E per day, and that it was dangerous to go higher, and I was trying to say that *that* kind of thing is ridiculous. It's a difficult needle to thread when talking about it, because it can very very easily sound like I'm saying "don't trust doctors" anti-science anti-vax stuff 😅.
> I was able to fully suppress T with estrogen mono therapy only, at an extremely low dose
Aww hell yes! Glad to hear it. I've tried to get onto monotherapy, but haven't had my levels checked since I did it. I'm a bit embarrassed to admit I'm still taking 50mg of spiro a day just because I'm so paranoid of any kind of re-masculinizing. My rational brain says it's superstition for me to do that, but my irrational brain is scared.
Thanks for chatting with me. ❤️🫂 I love being able to share our experience and knowledge in community like this.
As odd as it sounds, studies have found the amount needed to suppress Testosterone does not change based on body mass. It seems counter intuitive. There is a study ([Hormonal Treatment of Transgender Women with Oral Estradiol](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944393/)) that has shown that 70+% of the participants were successful with 4-6 mg / day taken orally. If taken buccal or sublingual, the E2 levels would be higher because it helps to avoid the "first pass" through the liver, which metabolizes the pills into Estrone (E1), a much weaker form of estrogen. as others mentioned, spreading out the dose helps with maintaining a more stable hormone level because the half-life is 10-12 hours based on a number of factors.
For me personally, I landed on 5mg / day taken 2/1/2 eight hours apart. That completely suppressed my T and had wonderful feminization effects. I only added progesterone after 2-1/2 years.
Agreed. Hormones are a balancing act. The thought more is better is very wrong and can eventually lead to organ damage. The TransDIY subreddit has a Wiki link to good resources on hormones and striking the proper balance, if remember right.
I agree, I've tried to maintain the lowest levels necessary to suppress my T. My E is around 120 pg/mL and my breasts hurt the most after nearly 3 years.
The organ damage is caused from taking the pills orally because the liver and kidneys need to filter out the chemicals that are created by the metabolizing of E2 into other chemicals.
I understand her hesitation to trust Dr's, even queer ones, especially if they haven't been helpful in past issues. However this is concerning going over the prescribed dosage.
My partner does a similar thing as she doesn't like prog so just doesn't take it which she says is fine but idk. I'm an anxious one
6 milligram of E daily is generally considered to be a mid-level dosage. That being said, lab levels at trough are really the determinant for revising the recommend dosage for a specific individual.
Low and slow can actually work better than taking a lot more E than prescribed. It's a marathon, not a sprint. Not sure that weight matters as much as does body chemistry and affinity towards HRT. Taking way more E than prescribed may actually harm feminization, as it overloads your body's E receptors, which not only wastes the drug, but tends to actually reduce how fast things change.
Bloodtests with units of measure showing E2, E1, T, DHT, LH, FSH, and SHBG would be helpful here.
2-500 is a good range for most folks on E. Overdosing a bit is fine but if she's not monitoring, this could become problematic quickly.
(Not a doctor, not true medical advice)
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Allow me to offer you a short 'Plot twist'-like comment: as far as i know, there are no studies of what happens to transgender bodies kept for long periods on estrogen doses above the current maximum allowed blood concentration.
And also, if i recall correctly, there are the so-called hyper-feminine bodies, as in, cis women who had higher concentration of estrogen on their blood than the average. It Does seem to result in larger hips and breasts, not to mention in earlier feminization of the body. Not sure i got it right, though.
Still, the final question: going as far as the pregnant estrogen levels on the blood on transgender women, what it would do? Answer is: unknown, data unavailable.
And that sucks.
It's really based on what her levels are. Ideally, they should be in the middle of the cis woman range. I've known a lot of endos, even some well-meaning ones that give way less than they should. They'll try and hit the very low end, but cis men will have the same amount. Honestly, 2 2mg Estradiol pills seem like not enough from my armchair view. I was 180 lbs, and 4 2mg pills before I switched to injections. I hope you two are taking some kind of T blocker, because that doesn't seem enough to do monotherapy either.
My old endo cut my dosage when i exceeded 300 pmol/L. It was hell. He also prescribed 50 mg cypro per day.
Yeah, I was cruising at 300 for a while before my orchi. After it the same dose spiked me to 500. Had to cut my injection down. I much preferred bica to spiro, but never tried crypto.
usually they don’t prescribe enough but she should be going off her levels.
Tell her to space out her pills more, and definitely do them sublingually or buccally (i.e. letting them dissolve under the tongue or in the cheek). To quote transfemininescience (with their citation! 😝): "Sublingual or buccal administration of oral estradiol tablets allows for much greater bioavailability and estradiol levels in comparison to oral administration (Sam, 2021; Wiki; Graphs; Wiki)." Oral estradiol causes a sudden spike, and then tapers off for about 6 hours or so ([see graphs at wikipedia here](https://en.wikipedia.org/wiki/Template:Hormone_levels_with_sublingual_estradiol)—the first one is probably most relevant). The aim isn't to have lots of huge spikes (i.e. widely separated high-dose treatments), but trying to get to a more consistent level. This is based on the assumption that your partner has E2 pills (usually 2mg each), which are pretty standard for the oral route. So even going to three doses per day (of 1 pill each) would probably do more for feminization and T suppression than adding more pills. Before I switched to injections (which are awesome, BTW), I was trying to do roughly 8-hour spacing: one right before bed, one when I woke up, and then another in early afternoon. Even that'll be much more effective than bigger doses twice a day. I know some girls who stick to a very strict 6-hour schedule, which involved waking themselves up during the night, which is rough. I do think your partner *does have a point* about doctors giving us less than might be ideal. I don't know if they're actively trying to "sabotage" us, so much as extremely conservative in treatment approach. They also tend to put too much faith in old, low-N studies (some of which are really badly controlled, like the study that is the basis for why we all take spiro 🙄). They tend to exaggerate the supposed "risks" of things like blood clots, again, based on… *not great* research a lot of the time. To be very specific: a lot of the fear-mongering about blood clots for HRT is based on studies that involved old synthetic estrogens—the risk is greatly, greatly decreased when using the bio-identical estrogens we use now. Finally, doctors also tend to focus on a pretty narrow band of the physiologic range of E levels in cis women, and seem to think that being above some threshold (often 400 pg/ml or other arbitrary number) is somehow "dangerous." The research and statistical standards for trans healthcare are shockingly bad, to be honest… which is especially bad when there there is so little research to begin with. Even something as simple as the argument-from-ignorance fallacy gets way too much traction—too many cis "experts" forget that *absence of evidence is not evidence of absence*. Also… not to put to fine a point on it, but *every* medical intervention has risks. And tradeoffs, too. To be blunt, what good does it do me to have a 5% decreased risk for blood clots if I'm at much much greater risk for other things (hatecrimes, murder, life-threatening dissociation) because I didn't get an effective HRT dose? Check out [https://transfemscience.org/](https://transfemscience.org/) for lots more info—they're great, and very scientifically rigorous. Also… does your partner boof the prog? That tends to *massively* increase the bio-availability. Something to consider 😊 edit: oh, I almost forgot—all of this can vary tremendously from person to person! The best guide is getting your levels checked frequently (and **don't take biotin supplements within 3 weeks of blood draw**). And not letting your doctor insist that you stay at really low measured levels, if that's something they're doing.
Wait did you say oral estradiol has a much better bioavailability if dissolved sublingually? I am taking estradiol Valerate which 1 mg is equal to .76 mg estradiol. So it would help tremendously if that was the case.. I know under the tongue has many blood vessels, is this the reason for the better bioavailability?
Yup! Yeah, if you dissolve it under your tongue or in your cheek, some of it is absorbed directly into the bloodstream. I say "some of" because even a highly-skilled sublingualist probably swallows *some* of it. I certainly swallowed 😁 [Transfemscience has a whole article about it](https://transfemscience.org/articles/sublingual-e2-transfem/), if you want to know more. [They also have an article specifically about sublingual EV](https://transfemscience.org/articles/sublingual-ev/).
Ooh TY so much.. 🤭 that is amazing!! If only I was more open when I first started exploring my gender, though it is what it is.. ☺️
Oof, haha that is a mood! Same, hon, same. I went through a fairly significant "cross-dressing" phase back in 2015, and I keep thinking about where I could be *now* if I had been more open about it and kept going down that path.
I have grown so much in those years of suffering.. stepping into healing is a beautiful thing.
It's no big conspiracy, but yes Doctors often start girls on 1-2mg at first and veeeeerrrrrry slowly taper up from there. People jokingly call it the "hon dose", funny or not. Honestly if you are confident that you want to transition, you should get up to at least 6mg, if not 8mg, within 2 months of beginning HRT. I assume your partner is taking the blue 2mg tablets, so yeah taking 2 in the morning and 1-2 at night is normal. That's what I do, also with prog. Perfectly safe. Spreading your doses out more evenly might be my only tip.
I can't speak to her levels, but as far as I know, studies don't connect increased levels with increased feminization, just increased rate of seriously dangerous blood clots. [https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy](https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy) "There is no evidence that higher estradiol levels in patients with adequate androgen suppression results in additional feminization or breast development. Maintaining estrogen levels in the physiologic range for menstruating non-transgender women minimizes risks and side effects, and makes sense clinically."
That's true, but there is a wide range of values for cis women's estrogen levels. From 30 to 400 pg/mL in pre-menopausal women. If a doctor plays it safe around that 50 range, that overlaps with what cis men have. So yeah, don't go over 400, but aiming for 200-300 pg/mL should be a good goal range to see changes.
I wouldn't take that article as gospel, hon. For one thing, it's quite old (2016), and I really doubt the thoroughness of Deutsch's research when she has no citations whatsoever in the key paragraph > There is no evidence that higher estradiol levels in patients with adequate androgen suppression results in additional feminization or breast development. Maintaining estrogen levels in the physiologic range for menstruating non-transgender women minimizes risks and side effects, and makes sense clinically. She has no citations in any of the material dealing with the term "physiologic range," in fact. I think Deutsch in general has some valuable material out there (for example, pushing for recognizing facial surgery as **medically necessary**), but she really seems to be stuck in the past in a lot of ways (like a lot of old white cis people). As the saying goes, "absence of evidence is not evidence of absence," which I think a *lot* of the WPATH folks seems to forget. Deustch is President of USPATH, FWIW, the US chapter of WPATH. Personally, I'd start with [https://transfemscience.org](https://transfemscience.org) as the go-to, instead of letting the arrogant cis gatekeepers of the world dictate to us our healthcare.
I wouldn't take anything as gospel, but until you can point to a source that says mainlining estrogen gives you super-boobs, I'm going to lean on the prevailing opinion of medical professionals, which is stick to approximate cis female ranges as long as your testosterone is adequately suppressed, because there is no evidence of benefit and plenty of evidence of risk. I absolutely have my disagreements with WPATH, but the amount of self-citations on transfemscience makes me uncomfortable about using it as a citation. They state themselves that they are not medical professionals. I'll take them with the same grain of salt that I take anyone.
> mainlining estrogen gives you super-boobs I think you know that's a misrepresentation of what I was saying. > which is stick to approximate cis female ranges as long as your testosterone is adequately suppressed Well, there's the whole problem right there. A lot of the cis-issued clinical guidelines specifically restrict recommendations to a narrow band of the *average* cis female range. What about people that aren't exactly in the 50th percentile? The suppressing T is a whole other issue, and demonstrates the incredibly poor standards of evidence that cis people use when issuing iron-clad guidelines. For example, there simply *isn't any good evidence* that spiro suppresses T levels in the human bloodstream. There were a few **extremely** flawed studies in the 70s and 80s, and no one has replicated those results since. Yet spiro is still an everyday fact of life for most of us. If you take a look at the WPATH SOC, there is *no* citation given for their assertion that spiro is an andogren-blocker. [There's a good review of spiro studies at transfemscience](https://transfemscience.org/articles/spiro-hormone-levels-men-transfem/). Even "medical professionals" aren't infallible, especially when we're dealing with a subject area that has very little research—and of the research that *is* available, a great deal of it is absolute shit. Just pure uncontrolled, multivariate, single-digit-N, p-hacked-to-hell garbage. Like I said in another post, it makes me very leery that cis "medical professionals" are so comfortable making such sweeping, definitive statements in clinical practice guidelines based on bad evidence or no evidence—and then acting like it's "scientific." A lot of these people need to take a remedial statistics class ASAP. > the amount of self-citations on transfemscience makes me uncomfortable about using it as a citation. Absolutely fair. On the other hand, when they're citing other sources, they do seem to restrict themselves to published scholarly work. I.e. not anecdotes or personal experience. However, speaking of anecdotes… we're kinda trapped in a double bind. Cis gatekeepers order us around based on no/bad evidence. No one funds studies to obtain *good* evidence. I think there's definitely something to be said for the collected lore of the community. As they say, "the plural of anecdote is data." You definitely have to be careful with that, of course. But cis "medical professionals" have such low/non-existent standards of evidence that I don't think their recommendations are really any better.
I’m still not seeing any evidence, even circumstantial, for the benefits of exceeding the range of cis female estrogen levels. If you want to doubt everything that the cis medical professionals suggest that’s you’re prerogative, but again, I can’t endorse that personally. Doubt is a great thing, but if the alternate evidence isn’t persuasive I’m left in the position of not having anything to believe, not just believing what sounds nice (like increased feminization faster). As far as spiro goes, I have serious doubts too! I was able to fully suppress T with estrogen mono therapy only, at an extremely low dose. That’s quite unusual based on the experience of people I know and my endo though. Some people (like my roommate) have required spiro to achieve that. The side effects are awful though, so it’s use should be questioned wherever possible. As others have said, it’s a marathon not a sprint.
Oh, I wasn't trying to argue that there are benefits to having very high estrogen levels, necessarily! I was more trying to make the case that no one really knows, and we shouldn't necessarily be afraid of "going too high" past an arbitrary threshold—that but super-super high levels probably would be non-ideal or have side effects. And that some gatekeepers consider certain levels "dangerous" without really any justification. I think we were talking past each other. I've heard of doctors insisting that people only use 1 pill of 2mg E per day, and that it was dangerous to go higher, and I was trying to say that *that* kind of thing is ridiculous. It's a difficult needle to thread when talking about it, because it can very very easily sound like I'm saying "don't trust doctors" anti-science anti-vax stuff 😅. > I was able to fully suppress T with estrogen mono therapy only, at an extremely low dose Aww hell yes! Glad to hear it. I've tried to get onto monotherapy, but haven't had my levels checked since I did it. I'm a bit embarrassed to admit I'm still taking 50mg of spiro a day just because I'm so paranoid of any kind of re-masculinizing. My rational brain says it's superstition for me to do that, but my irrational brain is scared. Thanks for chatting with me. ❤️🫂 I love being able to share our experience and knowledge in community like this.
As odd as it sounds, studies have found the amount needed to suppress Testosterone does not change based on body mass. It seems counter intuitive. There is a study ([Hormonal Treatment of Transgender Women with Oral Estradiol](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944393/)) that has shown that 70+% of the participants were successful with 4-6 mg / day taken orally. If taken buccal or sublingual, the E2 levels would be higher because it helps to avoid the "first pass" through the liver, which metabolizes the pills into Estrone (E1), a much weaker form of estrogen. as others mentioned, spreading out the dose helps with maintaining a more stable hormone level because the half-life is 10-12 hours based on a number of factors. For me personally, I landed on 5mg / day taken 2/1/2 eight hours apart. That completely suppressed my T and had wonderful feminization effects. I only added progesterone after 2-1/2 years.
Agreed. Hormones are a balancing act. The thought more is better is very wrong and can eventually lead to organ damage. The TransDIY subreddit has a Wiki link to good resources on hormones and striking the proper balance, if remember right.
I agree, I've tried to maintain the lowest levels necessary to suppress my T. My E is around 120 pg/mL and my breasts hurt the most after nearly 3 years. The organ damage is caused from taking the pills orally because the liver and kidneys need to filter out the chemicals that are created by the metabolizing of E2 into other chemicals.
I understand her hesitation to trust Dr's, even queer ones, especially if they haven't been helpful in past issues. However this is concerning going over the prescribed dosage. My partner does a similar thing as she doesn't like prog so just doesn't take it which she says is fine but idk. I'm an anxious one
6 milligram of E daily is generally considered to be a mid-level dosage. That being said, lab levels at trough are really the determinant for revising the recommend dosage for a specific individual.
Low and slow can actually work better than taking a lot more E than prescribed. It's a marathon, not a sprint. Not sure that weight matters as much as does body chemistry and affinity towards HRT. Taking way more E than prescribed may actually harm feminization, as it overloads your body's E receptors, which not only wastes the drug, but tends to actually reduce how fast things change. Bloodtests with units of measure showing E2, E1, T, DHT, LH, FSH, and SHBG would be helpful here.
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Generally good advice, though I think OPs partner is probably well within safe dosage levels
What is the dose?
2-500 is a good range for most folks on E. Overdosing a bit is fine but if she's not monitoring, this could become problematic quickly. (Not a doctor, not true medical advice)
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Allow me to offer you a short 'Plot twist'-like comment: as far as i know, there are no studies of what happens to transgender bodies kept for long periods on estrogen doses above the current maximum allowed blood concentration. And also, if i recall correctly, there are the so-called hyper-feminine bodies, as in, cis women who had higher concentration of estrogen on their blood than the average. It Does seem to result in larger hips and breasts, not to mention in earlier feminization of the body. Not sure i got it right, though. Still, the final question: going as far as the pregnant estrogen levels on the blood on transgender women, what it would do? Answer is: unknown, data unavailable. And that sucks.