I am not a doctor. I do not work in medicine. I am not a medical professional in any capacity. I am a layperson offering lay opinions based on the extent of my own education and experiences. All information and assertions below should be treated accordingly as mere opinion rather than statement of fact or medical advice. This guide prioritizes community moral truth where scientific research falters. Basically, don’t get mad at me.
@@ -329,7 +329,7 @@The purpose of this living document is to catalogue my thoughts and opinions regarding feminizing HRT because I believe that the various community wikis are impractical. They are valuable resources, but in my view these wikis lack utility for people who are more interested in clear actionable guidance than they are in learning every semi-relevant biological progress and graph. I aim to provide an exhaustive quick reference guide of simplified direct answers to the most common questions on how to safely and effectively perform HRT that I have received over the years with the goal of demystifying this life saving medicine both for people considering HRT and for established transsexuals. As such, I assume a baseline familiarity with the effects of HRT. In case you are not familiar: HRT does a lot and probably more than you think. It’s great. Changing your sex is really cool and fun. I recommend it. You deserve quality transition healthcare and are capable of making the best decisions for yourself. I hope that this document can be a useful tool in your decision-making process and a starting point for further learning if that is your interest.
If you would like to donate to support this project, CashApp, Ko-Fi, and Venmo all work. I appreciate it!
This document is structured linearly as a series of questions and answers such that broadly-speaking each question and section flows into the next. I encourage reading it top-to-bottom as that should hopefully answer any questions (including ones you didn’t know that you had) in a conversational narrative, but obviously this is lengthy. Take your time and read it in pieces if you wish.
This document is dedicated to all of our sisters who did not make it. May we carry the light of their torch into another day.
With modern bioidentical hormones, HRT could not be much safer. You’re just flipping the primary juice that your body runs on and shifting the balance of hormones that are already in your body. Even where the details of optimization get complex, the core principle of changing your biology is highly forgiving. The body is malleable and you will be able to adjust to what feels right for you.
Injections. They are on the whole the most effective, easy, consistent, safe, and inexpensive form of HRT. For some, injections become a ritual to look forward to, and others they can become quite fun.
Chiefly, all three have major downsides that injections do not. It is not that they do not work, it is that you deserve better than being forced to tolerate major downsides. Let me reiterate: all forms of HRT can produce satisfactory results, but that does not mean all forms of HRT are equal or good.
No. This is important enough that I did not relegate it to Section 11 “MYTHS AND MISCS”. Estrogen dosages cannot be directly compared across type or form. 1mg of one is not 1mg of another. Different types and forms have different properties that affect how much estrogen is absorbed into the body (“bioavailability”), at what rate, and the resulting half-life.
In simple terms, the half-life of a substance is the time it takes until half of that substance is eliminated. In the context of HRT, this is what determines how long a dosage stays active in your system, and thus your dosing frequency. This is referred to as your hormone cycle, and it forms a curve. Levels go up, they peak, and then they fall. The properties of this curve (how estrogen levels change over time) are important.
The largest issue with pills is that they carry increased long term blood clotting and liver coagulation risks. The severity of these risks can be mitigated in part by taking them sublingually or buccally (dissolving the pill either underneath your tongue or between your gum and cheek, respectively) as opposed to orally (swallowing the pill normally) to avoid first-pass metabolism in the liver. Even with sublingual and buccal methods, however, it’s common to ingest some amount of the pill, so it’s fair to assume that at least some risk remains. Please understand that the absolute risk is still low (e.g., acetaminophen has an order of magnitude more liver concerns than estrogen), however this risk compounds even further with nicotine-related estrogen risk. See Question 11.2 as well.
These are still fairly experimental so there is little to say about them, but they share pros and cons with gel. I mostly note this here so that you are aware that they exist.
Yes. To the point that I wrote all of this so that I could repeat myself less by instead linking this. A properly dosed injection regimen is the best form of estrogen that we have for achieving monotherapy target levels.
Consistency. Consistency is the name of the game when it comes to HRT. Consistent hormones means stability, and stability is good. Even the “worst” injection type (keep reading) can provide a more consistent hormonal cycle than other routes of administration which provides many benefits.
Generally, no. A properly dosed and spaced injection cycle that provides consistently high enough estrogen levels can naturally stop testosterone production which forgoes the need for an antiandrogen which is preferable in most cases. This is referred to as “monotherapy”.
In simple terms, the brain does not care which hormone it has, just as long as it has enough. If there are consistently enough hormones in your body, it stops producing more. The “consistent” part is what injections are capable of that other administration routes struggle with. Trying to do sufficient monotherapy on pills, for instance, is very likely impossible in most situations. In more specific terms regarding the HPG axis, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are suppressed by increased serum estradiol levels, thus inhibiting GnRH production and by extension testosterone production in the testes.
By generally not necessitating antiandrogens (see Section 10 “ANTIANDROGENS”), the long term risks associated with antiandrogens are obviated. Bioidentical estrogen that bypasses the liver (see Question 11.1) is as close as we can possibly get to natural estrogen production which removes additional risk.
Yes, but with minimal training required (see Section 5 “TECHNIQUE AND SUPPLIES”), at worst one may experience a minor bruise. It is akin to riding a bike in that once you know how to do it, you would have to try VERY hard to do it significantly wrong.
Once you are dialed in, you are good. Injections don’t require frequent administration (e.g., a weekly injection vs multiple daily pills), are not at major risk of inaccurate dosing, cannot fall off mid cycle, and don’t require potentially significant travel to a provider.
In simple terms, far less estrogen is needed. A 5ml vial that is capable of providing nearly a years’ worth of estrogen has only 200mg of estrogen in that vial, whereas a minimum equivalent supply of pills for example (4mg * 365 days = 1460 mg) is substantially more. This is not a rigorous comparison, but it’s a useful demonstration of scale. Another fun comparison is that you can fit 1-2 years of estrogen vials inside of a typical three-month supply bottle of pills.
Please see Section 6 “SOURCING VIALS”. You will be amazed, and quite likely, radicalized.
Yes. Nothing is guaranteed, but many people experience substantial noticeable differences after swapping to injections even after years on HRT. These range from increased breast development, improved mental health, alleviated side effects of antiandrogens or other forms of estrogen, generally feeling better, etc. Switching is worth it.
Yes, they are at first. Nobody likes needles because the body naturally does not want to poke itself, but with proper technique and supplies, it won’t hurt much at all. There are countless cases of people with debilitating needlephobias who now find the experience of injecting to be boring. The fear is normal and common, but it is wholly surmountable and worth overcoming. “Oh, that wasn’t as bad as I thought,” is a very common sentence. As the mantra goes: do it scared. You’ll be okay.
No. Blood draws typically use much larger needles and go into a more sensitive spot while also draining you of blood which is usually unpleasant. Vaccines contain vaccines which cause painful immune reactions because they are vaccines. HRT injections put a small amount of hormones in you which causes you to feel good because you have hormones in you. You see the difference, I trust. The act of injecting yourself can also be easier than someone else injecting you, depending on your inclination.
Yes. Auto-injectors exist and can be quite useful if you have fine motor control issues for instance. Please see Question 5.21, or just keep reading.
I understand the fear, but if you truly do not wish to do injections under any circumstances and don’t have some sort of legitimate contraindication like hemophilia, then don’t. You can just say that. It’s fine. When you change your mind, this guide will still be here. And if you don’t, so be it.
The four main types used for HRT are estradiol valerate (EV), estradiol cypionate (EC), estradiol enanthate (EEn), and estradiol undecylate (EUn). Each of these is an “ester” of estradiol and will be converted to estradiol in your body.
The only relevant difference between esters is that each has a different half-life and resultant hormone curve which in turn affects dosage and frequency.
No. The differences affect dosage and frequency which is a qualitative difference in experience that can make one ester preferable to another, but all four types work acceptably well and retain the benefits of injections.
If you have the choice, estradiol enanthate is preferred for most people due to the exceptionally stable levels it provides, with the caveat that in most countries this choice only exists if you are doing DIY (see Section 6 “SOURCING VIALS”). If you are going through a doctor, you may have the option of estradiol cypionate, but usually in low concentrations which can make the benefits moot depending on your tolerance for high volume injections. The most commonly prescribed injectable estrogen (particularly in the US), estradiol valerate, is still fully capable of producing good results, but it has some minor annoyances that make it not preferred when there is the choice for otherwise (i.e., when doing DIY). Keep reading.
Estrogen vials are made from estrogen held in an oil solution. The concentration of a vial is the amount of estrogen held in that solution. This is given as a ratio of mass to volume for the vial. In other words: for every one milliliter of oil (volume measurement), there is that many milligrams of estrogen (mass measurement). You will often see concentrations listed by the vial’s total volume (e.g., 200mg / 5ml) but it is always preferred to simplify this fraction (so 40 mg/ml in this case). Typical concentrations are 5 mg/ml, 10 mg/ml, 20 mg/ml, 40 mg/ml, and occasionally 50 mg/ml.
Dosage and frequency are the two factors that determine your hormone cycle. Dosage refers to how much estrogen you put in you (measured in mg), and frequency refers to how often you put estrogen in you (measured in days or weeks). You will often hear the word “regimen” as well, referring to everything HRT-related that you are taking and at what frequencies.
Your dosage is the concentration of your vial multiplied by the volume that you are injecting.