HRT

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Note: after around a month on HRT some of your ranges in your blood test should be in the ranges of the sex you are transitioning into.

If you are a transfem: no, its not anemia

Transfem

THERE IS NO GOOD REASON TO TAKE ONLY PUBERTY BLOCKERS (GNRH agonists, e.g: Arvekap) OR ANY ANTIANDROGEN WITHOUT ESTROGEN (I say this about youth transitioners, not nb ppl)

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, 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 Enanthate (EEn)
my honest reaction
 4-7mg/Week

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 [idk if honscience the study is from 2005 on cis women]

Vial info

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

~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.
-
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.

Antiandrogens 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 23.10€/50mg * 50 pills

21.1-33.7€/year

? 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/month

~350/year

6.77 euro/month (28 tabs)

~95/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.

Utrogestan
 Progesterone (P4) it is also referred to as prog 6.56 euro/15 caps (200mg) ? 200mg daily (rectal administration) 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.

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) ? 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

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.

Name Effectiveness
Dutasteride
 High
Finasteride
 None to Medium (Please just take duta - will not stop conversion of progesterone to DHT)

Blood Levels

Additionally, refer to the Blood Testing page.

PLEASE make sure that you are using the right measures

Careful: biotin can mess with blood tests and make everything seem much higher

Grapefruit fucks everything

Do the test JUST BEFORE your next dosage


E2: - pg/ml

Some doctors claim that it should be 100-200 pg/ml, this is not scientifically supported.

T: <1.5nmol/L (ng/??)

DHT: <10? (High values signify an issue but low values don't signify lack of an issue, DHT is often created inside of tissues and doesn't leak to blood)


If taking Androcur (Cyproterone acetate), also check: Prolactin

If taking either Androcur (Cyproterone acetate) or Bicalutamide, also check: ALT, AST. As an extra if you feel like wasting money: Bilirubin, ???

Transmasc

Brand Name(s) Substance Form Method of Administration Cost Cost with Healthcare Coverage Dosage Safety Notes
Norma Testosterone Enanthate Injection/Ampule Subcutaneous or Intramuscular 17.67€/ampule ? ? A+ -
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
 35.54€ -> 8.89€ 20mg/day (starting dose)

30-40mg/day

B-
  • 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.

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 Tostran (Testogel) or TEn (Testosterone Enanthate/Norma, injections).

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

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