# HRT / Estrogen

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NONE OF THIS IS MEDICAL ADVICE.

Please do not hurt yourself in eagerness or by taking this information as wholly truthful and complete.

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## Injections



### Guides
- <https://stainedglasswoman.substack.com/p/what-to-expect-when-youre-injecting>



### Supplies
- 25G 25mm/1" LDS needles: https://www.exchangesupplies.org/product/orange_total_dose_25mm_low_dead_space_needle
- 21G 38mm/1.5" LDS needles: https://www.exchangesupplies.org/product/green_total_dose_40mm_low_dead_space_needles
- 1ml LDS compatible syringe: https://www.exchangesupplies.org/product/TDC1_1ml_syringe_white
- Estradiol Valerate: https://astrovials.com/
- BTCPay/Paybis: https://paybis.com/user/login/



## Tests
- <https://www.medichecks.com/products/testosterone-and-oestradiol-blood-test>
- <https://www.nomadtravel.co.uk/health-tests/testosterone-and-oestradiol-blood-test>
- <https://vitall.co.uk/test/testosterone-estrogen>
- <https://www.medichecks.com/products/testosterone-blood-test> what I used to check my levels pre-E
- <https://www.medichecks.com/products/female-hormone-check-blood-test/> this is what https://diyhrt.wiki links to
- <https://www.medichecks.com/products/trt-check-plus-testosterone-replacement-therapy-blood-test> recommended by <https://thegenderhormoneclinic.com/blood-tests/> "for all patients"

> Test for:
> - estradiol (E2) and total testosterone (T);
> - if cyproterone, also liver function test (LFT) and prolactin (PRL);
> - if bicalutamide, also liver function test (LFT);
> - and if spironolactone, also test urea and electrolytes incl. potassium (U&E)
> 
> Below is a general guideline, however, if your dose and hormone levels aren’t stabilised, get a blood test every three months until it is, before reducing the frequency.
> - Baseline test before starting hormone treatment: an initial blood test before starting HRT is beneficial for establishing your baseline hormone levels and screening for morbidity (illnesses)
> - Three months: after three months of hormone treatment, get your second blood test
> - Six months: after six months, get your third blood test
> - Twelve months: after twelve months of hormone treatment, get your > fourth blood test
> - Every year after: get a blood test every six to twelve months for as long as you take hormone treatment
> - Change in dosage: get a blood test one to three months after any change in dosage to monitor the effects
> 
> [<https://transharmreduction.org/blood-tests>]



## Tablets
I'd prolly use spiro as antiandrogen, or <=10mg cypro

Dosing info: https://diyhrt.wiki/transfem#dosing

> Escalating estradiol dose has been associated with increased VTE risk in some studies [8]. This is an important consideration, given that the estradiol doses administered as feminizing hormone therapy can be significantly higher than those used for menopausal hormone therapy. [<https://pmc.ncbi.nlm.nih.gov/articles/PMC7513447/>]

> For example, avoiding ethinyl estradiol might make the use of hormone therapy in trans feminine individuals safer than oral birth control. Data from both cis and trans groups _suggest additional VTE (venous thromboembolism) risk associated with the use of progestins_ [<https://doi.org/10.2147/JBM.S166780>]



> however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. **CSHT in the United States** typically includes estradiol with the **antiandrogen spironolactone**, whereas **in Europe** estradiol is prescribed with the **progestin cyproterone acetate**. ... From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based **CSHT** for a total of 1,286 years of hormone treatment and a mean of **1.9 years of CSHT per patient**. Only one individual, or **0.15% of the population, sustained a VTE**, for an incidence of 7.8 events per 10,000 person-years. [<https://doi.org/10.1016/j.jsxm.2016.09.001>]



### Linkies
Aggregated lists for places to buy from:
- <https://hrt.coffee/pills/>
- <https://hrtcafe.net/Estrogen/estradiol_pills.html>

I'd check these as a starting off point (but idk what dose you'll want/need):
- <https://dashpct.io/goods?code=04508742549>
- <https://otkph.am/product/estradiol-oral/> (at least one thing going for them is their DIY HRT vials test well as of 2023 and 2022 <https://transharmreduction.org/hrt-testing>)
- <https://www.unitedpharmacies-uk.md/Progynova-Oestradiol-Valerate-2mg-3-x-28-Tablets-p-1005.html>
- <https://favskinhouse.com/product-280458-progynova-2-mg-buy-10-packs-get-1-pack-free.html>


Info
- <https://diyhrt.wiki/transfem>
- <https://hrtcafe.net/>
- - <https://hrtcafe.net/Estrogen/estradiol_pills.html>



### Estradiol
> a maximal oral dose is of 8–10 mg daily. Target levels are individualised as previously discussed and monitoring bloods should be taken 4–6 h after taking the tablet [<https://www.sciencedirect.com/science/article/pii/S1521690X24000757>]



### Cyproterone
- 6.25-12.5mg/day [<https://diyhrt.wiki>], 25-50mg top I think
> The usual starting dose is 25–50 mg daily (but it can be started at 12.5 mg) [<https://pmc.ncbi.nlm.nih.gov/articles/PMC6370611/>]

> We found that 25 mg of CPA daily was effective at suppressing testosterone levels to within normal female range when used in combination with recommended estrogen therapy in transgender women. [<https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1290566>]

> Compared with higher doses of CPA, a **daily dose of 10 mg** is equally effective in lowering testosterone concentrations in trans women, while showing fewer side effects. [<https://academic.oup.com/jcem/article/106/10/e3936/6298578>]

> Cyproterone is a very effective antiandrogen when combined with estrogen.
> 
> High doses should be avoided due to a harsher risk profile.
> 
> Keeping under a certain dosage is important, especially considering that cyproterone is usually sold in dosages 4-8 times that of recommended dosages for transfeminine individuals (get a pill cutter!). [<https://diyhrt.wiki>]


#### Possible side effects
> Rare cases of fulminant hepatotoxicity have been reported with cyproterone use for treatment of metastatic prostate cancer. [<https://pmc.ncbi.nlm.nih.gov/articles/PMC6370611/>]

> slightly increase blood clot risk
> 
> Cypro may increase the risk of B12 deficiency and slightly increase depression risk
> 
> **test prolactin and B12** [<https://diyhrt.wiki>]



### Spironolactone
100mg dose, one to two times a day, max 400mg daily

Monitor blood pressure and potassium concentrations.

> Spironolactone is a weak antiandrogen, albeit quite safe.
> 
> it's very safe, but common side effects include increased thirst, salt cravings and frequent urination due to it being a diuretic
>
> known to reduce blood pressure, which can make it hard for some people to attain erections. [<https://diyhrt.wiki>]



#### Possible side effects
> increased thirst, salt cravings and frequent urination. [<https://diyhrt.wiki>]

> polyuria, polydipsia and postural hypotension, particularly at higher doses. Hyperkalaemia is also possible, particularly in patients with impaired kidney function or taking potassium-retaining drugs such as ACE inhibitors. [<https://pmc.ncbi.nlm.nih.gov/articles/PMC6370611/>]



### Bicalutamide



#### Possible side effects
> In cis male prostate cancer patients, bicalutamide has about a 1/4000 chance of causing either severe liver or severe lung toxicity. All published case reports of either severe liver or lung toxicity have been in cis men over 59 years of age. Despite this, it's likely that trans women still face a much lower but still present risk.
> 
> It's **strongly recommended** to get liver function tests every 3 months if you take bicalutamide.
> ...
> The main risk of bicalutamide is severe liver toxicity and lung toxicity. The chances of either happening are about 1/4000 in cis male prostate cancer patients [<https://diyhrt.wiki>]


> Bicalutamide is a non-steroidal anti-androgen, that is used in the UK chiefly in the management of prostate cancer or hirsutism in women, however, *concerns around liver toxicity* typically preclude its use in this setting [28]. Despite these concerns about hepatotoxicity it is used in some other countries. [<https://www.sciencedirect.com/science/article/pii/S1521690X24000757>]



### Progesterone



#### Possible side effects
> In postmenopausal cisgender women, combined HRT (oestrogen and progestogen) is associated with increased risk of breast cancer and cardiovascular morbidity [36], [37], [38]. Meanwhile, oestrogen-only HRT is not associated with an increased risk of breast cancer in cis-women without a uterus. 
> ...
> Micronised progesterone has also been showed to be safer than synthetic progestogens when used as part of HRT but would not necessarily completely remove risk[39]. There is no data indicating that the extent of these risks can be extrapolated from post-menopausal cisgender women to TW
> [<https://www.sciencedirect.com/science/article/pii/S1521690X24000757>]



### References n shi'
_I'm really sorry I don't have the time to actually read all this. I would like to but I'm tired and 2 stupid_
- <https://pmc.ncbi.nlm.nih.gov/articles/PMC6370611/>
- <https://pmc.ncbi.nlm.nih.gov/articles/PMC7513447/>
- <https://www.bmj.com/content/364/bmj.k4810>
- <https://www.sciencedirect.com/science/article/pii/S1521690X24000757>
- <https://doi.org/10.1016/j.jsxm.2016.09.001>
- <https://doi.org/10.2147/JBM.S166780>
- <https://academic.oup.com/jcem/article/106/10/e3936/6298578>
- <https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1290566>