HRT Introduction

Wiki Index

Resources on HRT

There's a lot of discussion/argument about the proper HRT protocol, to the point that its hard to work out what's correct. An article by Beverly Cosgrove nicely sums up the disagreement, What Went Wrong With MTF Hormonal Therapy?.

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Facebook

Facebook groups

Dr Will Powers

Dr William Powers is very popular US doctor with 1500+ trans patients who has developed and documented "The Powers Method of Hormonal Transitioning".

Discord

Papers

Other


Estradiol

Estradiol vs Oestradiol vs E2 vs 17β-estradiol

These are all the same thing. E1, E3, and E4 are different.


Injections

Look here


Fertility


Injectable Estrogen


How Much, How Often

TBD.


Manufacture of Injectable Estrogen

It can help to know what is in injectable estrogen as some people have problems with some formulations and changing to a different one may help, or a change in supplier may cause unexpected problems. A very few make their own injectable estrogen, although this kind of thing seems a lot more common in bodybuilding and there are numerous websites and suppliers dedicated to this purpose.

There are 4 main components

Reactions to the ingredients

Estradiol Esters

Injectable Estradiol Valerate (EV) comes in various strengths, including 5, 10, 20, and 40mg/ml. The more concentrated it is the less needs to be injected to achieve the desired blood levels.

The interactive Injectable Estradiol Simulator on Transfeminine Science shows idealized curves of estradiol levels after injection of different estradiol esters in women, and its quite fun playing with it.

Further information on Transfemscience here

See the reddit post announcing the simulator

Beverly Cosgrove describes a number of different injectable estrogens and their properties

There are various different esters of estradiol, however due to availability and cost you may have not choice in what you can use. The different esters have different half-lives, leading to longer or shorter times between injections. Estradiol Valerate (EV) is typically injected every 5 days to minimize large (and unpleasant) swings in blood levels, but a few people inject more frequently if they still have modd swings. If your doctor wants you to inject every two weeks you should probably try to find a new doctor (or halve the amount and do it every week).

Carrier Oils

TBA. https://www.reddit.com/r/transgenderau/comments/gu9r6j/lenas_shipment_finally_arrived/fslertr/

reddit

Ii is possible to make a aqueous (water) injection rather than using an oil, but its difficult to find out much about it.

DIY Compounding

Depending on country, injectable estrogen may be available from a pharmaceutical manufacturer or compounding pharmacy. A small minority of trans people DIY with HRT from online sources, and a tiny subset of those compound their own HRT. There seems to be vastly more men doing this for bodybuilding than there are trans women.

Subs with information on compounding

reddit

YouTube

Other

Papers


Long Term Storage

Some people are concerned with long term supply of hormones and want to build a stock of hormones in case their supply gets cut off. Apart from obtaining the HRT the issue here is the shelf-life of pharmaceutical HRT is limited, and quite short.

Ultimately the only thing you can rely on is what's written on the label regarding shelf-life and storage conditions. Past that its guess work and you're taking a risk.

I don't have any expert knowledge of this, and I'm only reeating what others have said on reddit and other sites - don't trust me with your health.

Most drugs keep longer the lower the temperature – i.e. in the refrigerator or freezer, and freezing should slow down the oil going rancid. Note however, there are drugs that are damaged by cold. I would guess estradiol valerate tables last longer cold, but I don't know. Progesterone capsules with oil is perhaps not so good.

However injectable hormones will likely crystallise out of solution in the cold, becoming unusable unless you can get it to dissolve again - either at room temperature, heated in a water bath, or an autoclave. Higher concentrations of estradiol in oil are more difficult to dissolve. Note that injectable estrogens are, at least sometimes, sterilised at around 120C for short periods in an autoclave. Don't do that unless you know what you're doing. Freezing a bottle of water will break the bottle due to expansion when water turns to ice - it shouldn't happen with oil as the coefficient of thermal expansion is small. Heating a vial in an over can burst the cap due to the increase in internal pressure, hence the autoclave (according to what I've ready in DIY compounding forums).

Lena of DIY fame says her injectable estrogen have a 5-year shelf-life, limited by the oil going rancid. This is far longer than pharmaceutical vials of estrogen. I don't know how you can tell if the oil is rancid or the vial has become dangerous (or more dangerous since this is homemade).

Patches lose their stickiness when very old, speaking from personal experience.

Raw estradiol/estradiol valerate powder probably has a very long shelf-life, especially when stored below zero. I would assume if you compound your own HRT (e.g. pills, gel, injections) this could last decades (and very cheap). Obviously there's additional health and possibly legal risks doing this and very few do. There's relevant links elsewhere on this page.

Some people are prescribed injectable estrogen in a vial that lasts 1 month after the first injection. Some build a stock of vials by using the vial until its finished (which is far longer than a month), not telling the doctor, keep the excess vials of estrogen, and always use the oldest vial first. These vials should probably contain antimicrobial or preservative chemicals, typically Benzyl Alcohol, but they probably do with a life of 1 month. There will still be a limit to the life as the oil will eventually go rancid.

reddit

Articles

Papers


Low Dose / Microdosing HRT

Susans


DIY

A few people buy their HRT online without using a doctor. Even fewer compound their own.

reddit

Other info sites

Estradiol suppliers

reddit

The Baffler

Papers

Blood Tests

Biotin effects the results of blood tests for estrogen (and other things), and is contained in some suppliments.

reddit

Papers

Estradiol Synthesis

No one except labs and industrial manufacturing plants synthesize esdtradiol. Its not practical nor within in the reach of the non-professional. Everyone who makes DIY HRT buys the raw estradiol online, typically from China.

https://en.wikipedia.org/wiki/Chemical_synthesis - "As a topic of chemistry, chemical synthesis (or combination) is the artificial execution of chemical reactions to obtain one or several products.[1] This occurs by physical and chemical manipulations usually involving one or more reactions. In modern laboratory uses, the process is reproducible and reliable."

reddit

Papers


Cis Gender taking Opposite Sex Hormones

Cis Male

David Reimer

Alan Turing

Papers

Cis Female

Susans

Norah Vincent - not hormones, but relevant


Cis Women HRT

Some cis-women require HRT and suffer many of the as trans-women - both medically and in access to treatment.

Cis women take HRT many reasons

As doctors who are experienced in cis and trans women's HRT have similar skills (both may use implants for example), I intend to include information relevant to cis-women who use HRT here.

Other resources


Puberty Blockers

https://transfemscience.org/articles/puberty-blockers - "Puberty blockers are medications used to pause puberty in both cisgender and transgender youth. For the latter, significant evidence suggests that they improve well-being, psychological functioning, and risk of suicidality, both during puberty and in later life. Their effects are reversible upon discontinuation. ..."


Ethinyl Estradiol

There are still some doctors who prescribe Ethinyl Estradiol and it's available in birth control pills such as Microgynon 30, Microgynon 50. While it works its unnecessarily dangerous and should be avoided if at all possible.

https://en.wikipedia.org/wiki/Ethinylestradiol - "Ethinylestradiol (EE) is an estrogen medication which is used widely in birth control pills in combination with progestins... It has been estimated that at least 300 to 400 healthy young women die each year in the United States due to VTE caused by EE-containing birth control pills."

It has long been known that Ethinyl Estradiol raises the risk of blood clots. The Endocrine Society's 2017 paper "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline" refers back to a 1997 Dutch paper. The same advice is in their earlier 2009 guideline.

An update to the referenced Dutch Study in 2011 "A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones" in the European Journal of Endocrinology says

In the 2008 paper Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. "Regarding morbidity, with ethinyl estradiol, there was a 6-8% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens."

More recently, in the Annals of Internal Medicine, Care of the Transgender Patient in 2019

The Endocrine Society guidelines recommend against use of ethinyl estradiol because data suggest that it is especially thrombogenic.

https://www.nps.org.au/australian-prescriber/articles/prescribing-for-transgender-patients

The reference to conjugated equine estrogens means Premarin. The last I heard of that in Australia was more than 10 years ago at Taylor Square, and I don't think they prescribe it anymore.

The WPATH Standards Of Care state

Use of oral estrogen, and specifically ethinyl estradiol, appears to increase the risk of VTE. Because of this safety concern, ethinyl estradiol is not recommended for feminizing hormone therapy.

Dr Will Powers says I would gouge out my eyes with a rusty spoon before I use ethinyl estradiol for trans HRT.


Finasteride

reddit subs

reddit

Vice

Reuters

Other

Papers


Growth Hormones

reddit


Testosterone

Testosterone is a Schedule III controlled substance in the USA (and much the same elsewhere) and there are serious penalties for getting possesion without caught with it without a prescription, or worse, selling it.

After a series of scandals and publicity in the 1980s (such as Ben Johnson's improved performance at the 1988 Summer Olympics), prohibitions of AAS use were renewed or strengthened by many sports organizations. Testosterone and other AAS were designated a "controlled substance" by the United States Congress in 1990, with the Anabolic Steroid Control Act.

https://en.wikipedia.org/wiki/Testosterone_(medication)

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Testosterone for Trans Women

I'm still researching this, and what's here would no doubt be against a normal medical advice.

Max initial dose of Testosterone Undecanoate for women is apparently 50mg/month, or 25mg/2 weeks (this needs checking).

Reandron 1000 (Nebido) is Testosterone Undecanoate 1000mg in 4ml vial, castor oil, and benzyl benzoate.

Dose

A 50mg dose from a 1000mg vial is 50/1000 = 1/20 of the vial. The vial contains 4ml, hence 1/20 of the vial is 4ml/20 = 0.2ml injection. Half that dose, or 25mg would be 0.1ml. Ideally a 0.3ml insulin syringe would be used to inject subcutaneously, but castor oil is too thick for such a fine needle on these syringes, hence a 1ml Luer Lock (preferably) syringe is required.

As someone who doesn't like needles I'd much rather do a subcutaneous injection instead of intramuscular, but the Reandron instructions specifically say "Special care must be taken to avoid intravenous injection and injections must not be given subcutaneously", however see the 2021 paper on subcutaneous injections below which appears to suggest that's it's not only ok, but has benefits.

reddit

Preservative

Reandron does not contain a preservative and its not supposed to be stored after first use. A female level dose of this is a very small amount, leaving most of the vial to be discarded.

If we don't want to waste it all, then we might consider refrigerating the vial and being very careful with sterile procedures when using it. However, reusable vials normally contain a preservative such as Benzyl Alcohol so we could add some, but how and how much?

2% of 4ml is 0.08ml, giving a concentration of approximately 1.96%. Adding 0.081633ml gives exactly 2%, although its not possible to measure so accurately. Measuring 0.08ml is most accurately done the smallest syringe possible, which is a 0.3ml insulin syringe, and it's a bit less than one third of that syringe.

The benzyl benzoate in the Reandron vial is no doubt there as a solvent.

Papers


Australia

In this Wiki HRT in Australia.

The Australian transgender sub /r/transgenderau contains information on HRT in Australia


Japan

Links


USA

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