HRT

After around a month on HRT some of your ranges in your blood test should be within desired ranges.

Disclaimer

To clarify on dosages, the values mentioned below are rather speculative and most are based on personal experiences or (diy)hrt pages/websites/papers. Therefore it is encouraged to do blood tests and if possible, check with an endocrinologist (we also suggest Doctors that can help with such cases), especially if you have any specific health conditions. 

Pricemaps are there to evaluate prices through galinos.gr (in case something is outdated, look for the green line that says "Λιανική")

We are open to discussion and actively on-going changes in formatting and contents of this Page and Website (in general). The e-mail address to refer to is [email protected]

Transfem

Taking Puberty Blockers (GNRH Agonists, e.g: Arvekap) or any Anti Androgen (e.g: Aldactone, Androcur) without Estrogens is generally discouraged even during youth transitioning (This is non-definitive for Enby folks)

Monotherapy

Type	Commercial Names	Dosage	Notes
Sublingual (E Valerate or Hemihydrate)	Cyclacur (EV), Estrofem (EH, imported), Trisequens (12 pills 2mg EH, 10 pills norgestrel, 6 pills 1mg EH)	>=8-12mg/day	While it is possible, even with a smaller dosage (at least 6mg), it's not that common. Ideally, use your blood tests to minmax your doses.
Injectable Estradiol Valerate (EV)	Neofollin (can be ordered from pharmacies near Czechia, or aptekaapo.com but they’re not on hrtcafe, not tested in Greece), Delestrogen (Vial, unavailable), Progynon Depot (Ampules, unavailable), my honest reaction	5-7mg/5 days	Due to the large spikes in levels combined with the short half-life it is not recommended for dosages to surpass the 5 day mark because it may cause menopause symptoms. Branded versions of this medication are not available in greece. The ampules contain a certain mg and do not allow for larger dosages, they are not re-usable. It is recommended to use a vial with a cap. Look for syringe dead space(*), e.g. if there's 0.05mL remaining after injecting, draw +0.05mL from the vial.
Injectable Estradiol Cypionate (EC)	my honest reaction Depo-Estradiol (US only, unavailable),	5-7mg/7 days	Look for syringe dead space(*), e.g. if there's 0.05mL remaining after injecting, draw +0.05mL from the vial.
Injectable Estradiol Enanthate (EEn)	my honest reaction	4-7mg/7 days 7-10mg/10 days (7.2mg usually, depending on the vial, it's optimal because drawing cents of mL are hard to get right)	You can multiply the weekly dosage by 2, which lasts up to 14 days (as much as the half-life of Enanthate) Look for syringe dead space(*), e.g. if there's 0.05mL remaining after injecting, draw +0.05mL from the vial.
Injectable Estradiol Undecylate (EU/EUn)	my honest reaction	There's not enough information on dosage. The frequency of those may differ according to the oil used (MCT/Castor oil). Indicative Dosages: 15-20mg/2 weeks 20-40mg+/4 weeks	There's not enough information on its half-life, a higher dosage can be administered that can last up to 20-30 days. IM injections last longer so they give better levels during the same period of time per injection. Needs at least 90 days to reach stable levels. Look for syringe dead space(*), e.g. if there's 0.05mL remaining after injecting, draw +0.05mL from the vial.

* = It has been mentioned that syringes account for dead space, although that is not 100% certain.

Sublingual vs Oral

Method	Substance	Dosage	Observations
Oral	Estradiol Valerate in pill form (e.g. Cyclacur)	>=6mg/day (max 10mg as per Dr. Powers)	It is recommended that doses are taken separately on set time intervals during the day for more stable estradiol levels, e.g. for a 6mg dose you would take 2mg per 8 hours. By the oral route the active substance is metabolized by the liver and part of it is converted to estrone (E1), which has much less feminizing effects than estradiol (E2) so the desired effect is essentially prevented. The bioavailability of estradiol by oral administration is very low (~5%) and usually lower levels of E2 are observed in blood tests than other methods of administration. [anecdotal apo to server, wikipedia kai tttt - correct/expand?] It is also necessary to administer anti-androgens to reduce testosterone levels to the female range.
Sublingual	Estradiol Valerate in pill form (e.g. Cyclacur)	>=4mg/day	It is recommended that doses are taken separately on set time intervals during the day for more stable estradiol levels, e.g. for a 6mg dose you would take 2mg per 8 hours. The sublingual way bypasses estradiol metabolism by the liver and has about 5 times the estradiol bioavailability of the oral way. This way, estradiol levels have greater range than orally (higher peak lower bottom), in oral they remain higher for ~12 hours while sublingually they go away after 3-4 hours (This however is from a study from 2005 on cis women)

Medications

For cyclacur: take only the white pills, the brown pills are Norgestrel which have 0.5mg of estradiol but has an androgenic effect and may also cause other side effects.

Estrogens

Brand Name(s)	Substance	Form	Method of Administration	Cost	Cost with Healthcare Coverage	Dosage	Safety	Notes
Cyclacur	Estradiol Valerate (EV)	Pill tablet	Orally or sublingually	2.01€ for 11 pills (Pricemap) ~130.8-328.€/year ~10.9-27.4€/month Prices are indicative, the cost depends on the dosage.	-	6mg-10mg/day (according to Dr. Will Powers) 4mg-8mg/day (according to Greek Endocrinologists)	A	Only white pills are used. Brown pills do have a bit of estradiol but arent taken due to other side effects. You need antiandrogens or GNRH antagonists if you haven't had an orchiectomy.
Progynova	Estradiol Valerate (EV)	Pill tablet	Orally or sublingually	~22€ for 72 pills of 1 mg or ~32€ for 72 pills of 2 mg Prices are indicative, the cost depends on the dosage.	-	4mg-8mg/day	A	There is no reason to use it in Greece since Cyclacur is available in Greek pharmacies. You need antiandrogens or GNRH antagonists if you haven't had an orchiectomy.
Estrofem, Estrifam (german brand name), Trisequens	Estradiol Hemihydrate	Pill tablet	Orally or sublingually	~30€ for 28 pills of 2 mg without shipping costs. Prices are indicative, the cost depends on the dosage.	-	4mg-8mg/day	A	There is no reason to use it in Greece since Cyclacur is available in Greek pharmacies. You need antiandrogens or GNRH antagonists if you haven't had an orchiectomy. Trisequens, while being available in Greece, is odd to take with 12 pills being 2mg EH, 10 norgestrel, and 6 1mg EH, for a much higher price than Cyclacur.
Dermestril	Estradiol Hemihydrate	Patch	Trans-dermally	44€ for 24 patches of 100mcg ~15€ for 8 patches of 50mcg	-	50mcg/3.5 days (when starting off) 100mcg/3.5 days (whenever your e2 levels are stable)	A	If you have no idea how to apply patches watch this: Demonstrational Video You need antiandrogens or GNRH antagonists if you haven't had an orchiectomy. 100mcg patches can be cut into 2 if needed.
Neofollin (can be ordered from pharmacies near Czechia, not tested in Greece), Delestrogen (Vial, unavailable), Progynon Depot (Ampules, unavailable)	Estradiol Valerate (EV)	Injectable	Subcutaneous or Intramuscular	80€/year (including shipping costs, syringes and alcohol swabs)	-	5-7mg/5 days (monotherapy) 4-5mg/7 days (only in combination with an antiandrogen or GNRH agonist)	A+	It can be used without antiandrogens or GNRH agonists in (Monotherapy) by increasing the dosage.
Depo-Estradiol (US only, unavailable)	Estradiol Cypionate (EC)	Injectable	Subcutaneous or Intramuscular	~70-80€/year (not including shipping costs, syringes and alcohol swabs)	-	5-7mg/7 days (mono dose) ? (TBD/dose with AA)	?	It can be used without antiandrogens or GNRH agonists in (Monotherapy)
-	Estradiol Enanthate (EEn)	Injectable	Subcutaneous or Intramuscular	80€/year (including shipping costs, syringes and alcohol swabs)	-	2.5mg-7mg/7 days (usual dosage: 4mg/7days)	A+	It can be used without antiandrogens or GNRH agonists in (Monotherapy) by increasing the dosage.
-	Estradiol Undecylate (EU, EUn)	Injectable	Subcutaneous or Intramuscular	130€/year (including shipping costs, syringes and alcohol swabs)	-	15-20mg/2 weeks 20-40mg+/4 weeks	A+	There's not much info on dosages, usually seen in monotherapy.

Anti-Androgens and GNRH Agonists

These should not be taken sublingually.

Brand Name(s)	Substance	Cost	Cost with Healthcare Coverage	Dosage	Safety	Form	Type	Notes
Androcur	Cyproterone Acetate (CPA) is also referred to as cypro	21.58€/50mg * 50 pills 19.7-31.5€/year (Pricemap)	?	12.5mg/2 days- 10mg/day Larger doses shouldn't be administered	C	Pill tablet	Progestin (Steroidal antiandrogen) Stops testosterone production.	The max recommended dosage is 10mg/day . Monitoring of prolactin levels is recommended through blood testing. Many doctors give overdoses of 50 mg/day. Cyproterone is a strong anti-androgen and testosterone suppression is possible with lower doses. A change of doctor is recommended. Side Effects: Benign brain tumor. In rare cases, liver damage. Vitamin B12 deficiency. Breast cancer. Testosterone suppression can be achieved with even lower doses, however a 50 mg pill is difficult to cut into pieces of less than 12.5 mg even with a pill cutter.
Bicalut	Bicalutamide (aka: bica)	29.10 euro/30 pills 29.10 euro/month ~350 euro/year (Pricemap)	6.77 euro/month (28 tabs) ~95 euro/year	50mg/day	A-	Pill/Tablet	Androgen receptor antagonist (Nonsteroidal antiandrogen) Blocks absorption of all androgens (including testosterone)	Serious negative interactions can be noted if combined with other anti-androgens and GNRH agonists (except progesterone) Very rare chance for recoverable and non-fatal liver damage for people with a certain rare mutation. Most of the effects listen in the instruction manual are scaremongering. (it lists a very high chance of liver issues when they are actually very rare, and also lists photosensitivity, which if it even occurs at all, it should be quite rare. We are aware of nobody who had a negative interction between alexandrite laser hair removal and bicalutamide). Note that bicalutamide, unlike most other anti-androgens, does not lower testosterone levels, in fact they usually rise as the body responds to testosterone receptors being inhibited. Do not be alarmed if you notice an increase of testosterone in your blood tests.
Arvekap	Triptorelin	-	~200/year?		A?	Injection	GNRH Agonist (indirectly) Stops testosterone AND estrogen production	Also a puberty blocker
Aldactone	Spironolactone	5.19 euro/20 tabs (100mg) (Pricemap)	?	50mg-200mg/day	B-C	Tablet	Antimineralocorticoid/MCRA	Very inefficient, makes you pee, it's a medication for blood pressure
	Flutamide				F---			Only in this table as an example to avoid

Miscellaneous/Progesterone

Progesterone falls under this category, as it is not quite the same as other Anti-Androgens, the mention of Progesterone in this title is necessary in order to reduce confusion and questions such as "Where is progesterone?" and "Did you remove prog from the page?".

Brand Name(s)	Substance	Cost	Cost with Healthcare Coverage	Dosage	Safety	Form	Type	Notes
Utrogestan	Progesterone (P4) it is also referred to as prog	5.83 euro/30 caps (100mg) 8.08 euro/15 caps (200mg) (Pricemap)	?	100mg or 200mg daily (rectal administration, blood tests are recommended)	A	Capsule	Stops testosterone production.	There is not much confirmed information about progesterone. It can also be taken orally but the absorption rate is very low. Anecdotal claims: Helps with breast development and with feminization in general. Can be given after one year of estradiol. Suggested to be given after the individual reaches Tanner stage 3. It can have androgenic or other (non-serious, recoverable) effects for some individuals - in particular it can be converted to DHT by the body even in combination with dutasteride or bicalutamide.

Other anti-androgens (optional)

These are used to block conversion of other androgens to DHT (which causes hair loss (hair) and body hair growth). They aren't general use Anti-Androgens.

Brand Name(s)	Substance	Cost	Cost with Healthcare Coverage	Dosage	Safety	Form	Type	Notes
Dastidem, Rafuster, Duaride, Dustezor	Dutasteride	7.90€/30 caps	~6€/30 caps	0.5mg/day (?/TBD)	A-	Capsule	-	High effectiveness.
-	Finasteride	-	-	-	F	-	-	Effectiveness is none to medium (Just take Dutasteride - will not stop conversion of Progesterone to DHT)

Transmasc

Medications

Testosterone

Galinos.gr's testosterone availability page

Brand Name(s)	Substance	Form	Method of Administration	Cost	Cost with Healthcare Coverage	Dosage	Safety	Notes
Norma	Testosterone Enanthate	Injection/Ampule	Intramuscular	17.67€/ampule (Pricemap)	?	?	?	-
Nebido	Testosterone Undecanoate	Injection/Vial	Intramuscular	100.37€/vial (Pricemap)	~32.52€/vial (you pay 25%)	1 vial (1000mg/4mL)/10-20 weeks	A	As a starting dose after a year of HRT, you could also consider: Instead of injecting one vial per 20 weeks, you do half every 10-12 weeks, however nothing could be sourced to support this. Though logically it could make sense as a practice. Do a test at 6 weeks after starting, if T is too high don't take the 2nd dose, if it's not you can take the 2nd and then test 2 weeks before every other dose.
Tostran	Testogel	Gel	Trans-dermally	Starting dose 35.54€/2 months 213.24€/year 30 mg dose 35.54€/40 days ~324.30€/year 40 mg dose 35.54€/30 days 426.48€/year (Pricemap)	35.54€ -> 8.89€	20mg/day (starting dose) 30-40mg/day	A	1 pump of Tostran (0.5g) delivers 10 mg of T. 2 pumps of Tostran are 1 pump of Testogel (20.25mg of T) Can cause skin reactions.

GNRH Agonists

Brand Name(s)	Substance	Cost	Cost with Healthcare Coverage	Dosage	Safety	Form	Type	Notes
Arvekap	Triptorelin	-	~200/year?		A?	Injection	GNRH Agonist (indirectly) Stops testosterone AND estrogen production	Also a puberty blocker

Other anti-androgens (optional)

These are used to block conversion of other androgens to DHT (which causes hair loss (hair) and body hair growth). They aren't general use Anti-Androgens.

Brand Name(s)	Substance	Cost	Cost with Healthcare Coverage	Dosage	Safety	Form	Type	Notes
Dastidem, Rafuster, Duaride, Dustezor	Dutasteride	7.90€/30 caps	~6€/30 caps	0.5mg/day (?/TBD)	A-	Capsule	-	High effectiveness. Not to be confused with proper Anti-Androgens.

Nonbinary hrt *under construction*

Medications

Selective Estrogen Receptor Modulators (SERMs)

• Tamoxifen is a selective estrogen receptor modulator (SERM). In some tissues such as the brain it activates estrogen receptors, which may help reduce dysphoria. In breast tissue it antagonizes estrogen receptors, preventing the formation of breast tissue if desired. There is some evidence that Tamoxifen inhibits memory, though the effects of taking it alongside regular estrogen are undocumented. Tamoxifen can cause cognitive dysfunction and increase your risk of stroke and pulmonary embolism. Tamoxifen may also be taken alongside 17β-estradiol, more research is needed. In this combination, estradiol should still have its effects (combating dysphoria in the brain, redistribution of body fat, smoother skin etc.) while tamoxifen prevents the growth of breast tissue.
• Raloxifene is another SERM. It is an estrogen receptor antagonist in breast tissue. It is an estrogen receptor agonist in bone and can be used to prevent osteoporosis. Raloxifene has been shown to reduce ERα expression in breast tissue in premenopausal women. As the synthesis of progesterone receptors (PR) is estrogen-regulated, raloxifene also decreases the expression of PR. Additionally, it was shown to decrease the presence of Ki-67, a biomarker for cell proliferation, in breast tissue of premenopausal women. As a result, it can be used to treat gynecomastia, and has been shown effective in reducing breast size in those with the condition. Raloxifene may promote feminine fat distribution: in a study on 56-66 year old postmenopausal women, there was an increase in fat in the legs and buttocks and a decrease in fat in the abdomen and trunk after 1 year on 60 mg/day raloxifene. It is not yet known how pronounced this effect is, as there have been no comparisons of body fat distribution between raloxifene and estradiol. Raloxifene may increase the risk of stroke and pulmonary embolism.
• Afimoxifene is a topical SERM and the primary metabolite of tamoxifen.

Bicalutamide

Bicalutamide is an anti-androgen which is used mainly in the treatment of prostate cancer but can also be used to treat hirsutism, or as a component of hormone therapy in feminizing HRT, among other uses. It is nonsteroidal anti-androgen and a selective/pure antagonist of the androgen receptor. It has no other hormonal activity and does not lower androgen levels. Bicalutamide crosses the blood-brain barrier and blocks the effects of testosterone and dihydrotestosterone (DHT) both in the body and in the brain. While it has been observed that bicalutamide does not cross the blood-brain barrier in rats and dogs, this was found not to be the case in humans

In general Ralox seems the best idea based on overall effectiveness and less severe side effects compared to other SERMs. Most people on this kind of MtNB hrt seem to be using a combination of ralox (in place of estradiol) and bica [expand this + powers e1s schizo stuff?]

Legal

It is legal to buy anything without a diagnosis or a prescription (off the counter - OTC), Testosterone can be hit or miss, look for any product names mentioned (that have links attached to them/are blue in colour) here.

You can also check the Trans-Friendly Pharmacies Map for any pharmacies near you (this goes for both Transfem and Transmasc HRT).

There is no minimum or maximum legal age for someone to start HRT.

It is not legally mandatory for someone to have a diagnosis by a psychiatrist in order to medically transition.

There is no legally mandatory time restriction for a psychiatrist to monitor you before diagnosing you.

You don't legally need to be on HRT in order to be exempt from the army, change your legal sex, or to have a surgery.

Other resources

• Simulator: https://www.estrannai.se/
• https://transfemscience.org/ (note, the authors of this site disagree with a lot of what they are saying, regardless, it is still interesting)
  • Introduction to Hormone Therapy for Transfeminine People: https://transfemscience.org/articles/transfem-intro/
  • Older simulator: https://transfemscience.org/misc/injectable-e2-simulator/
  • Dosage calculator: https://transfemscience.org/misc/injectable-dose-vol-conc-conv/
• https://diyhrt.wiki/ (alt link: https://anarch.cc/transfeminine-diy-hrt-the-ultimate-guide-2/)
• https://hrtcafe.net/
• ?? https://hrt.coffee/
• https://www.reddit.com/r/TransDIY/
• https://www.reddit.com/r/TransfemScience/
• https://groups.io/g/MTFHRT/wiki/29602 (alt link: https://anarch.cc/mtf-hrt-ultimate-diy/)
• https://hrt.cat/ - info for making your own (you will probably not need it - version 1.0: https://hrtcafe.net/hrtcat/)
• https://archive.ph/uQb8g (alt link: https://anarch.cc/making-your-own-injections/, as above)
• https://crimethinc.com/2022/12/15/producing-transdermal-estrogen-a-do-it-yourself-guide (alt link: https://anarch.cc/producing-transdermal-estrogen-a-do-it-yourself-guide/, as above)
• https://archive.ph/cpy7k (alt link: https://anarch.cc/homebrewing-hormones-mtf-guide/, as above)