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<ol class="ltx_toclist">
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#S0" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">0 </span>FOREWORD</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#Sx1" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">DEDICATION</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S1" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1 </span>INTRODUCTION</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS1" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.1 </span>Is taking estrogen safe?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS2" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.2 </span>What route of administration should I choose for estrogen?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS3" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.3 </span>Why do you not recommend pills, patches, or gel?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS4" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.4 </span>Is dosage of estrogen equivalent across administration routes or forms?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS5" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.5 </span>What is a “half-life”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS6" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.6 </span>What’s wrong with pills?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS7" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.7 </span>What’s wrong with patches?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS8" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.8 </span>What’s wrong with gel?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS9" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.9 </span>What about pellets?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS10" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.10 </span>What about sprays?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S1.SS11" title="In 1 INTRODUCTION ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">1.11 </span>Is the difference that significant?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S2" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2 </span>WHY INJECTIONS</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS1" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.1 </span>What makes injections so good?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS2" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.2 </span>Are antiandrogens necessary with injections?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS3" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.3 </span>How does monotherapy work?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS4" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.4 </span>How are injections safer?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS5" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.5 </span>But aren’t there risks with the physical act of injecting?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS6" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.6 </span>How are injections easier?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS7" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.7 </span>How are injections cheap?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS8" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.8 </span>But I don’t have insurance / my insurance won’t cover it / pills are cheaper than injections with my insurance / injections are not available in my country / my doctor won’t prescribe injections?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS9" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.9 </span>Is swapping to injections good even after years on HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS10" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.10 </span>But injections are scary?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS11" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.11 </span>Are injections like a blood draw or a vaccine?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS12" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.12 </span>Are there any accessibility tools for injections?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S2.SS13" title="In 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">2.13 </span>But I <span class="ltx_text ltx_font_italic">am</span> special and can’t inject because I have glass bones and paper skin and—?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S3" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3 </span>TYPES AND DOSAGES</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SSx1" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Key Vocabulary</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS1" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.1 </span>What are the different types of injectable estrogen?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS2" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.2 </span>What are the differences between each type of injectable estrogen?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS3" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.3 </span>Does one type of injectable estrogen feminize better than another?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS4" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.4 </span>What type of injectable estrogen should I choose if I have the choice?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS5" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.5 </span>What is “concentration”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS6" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.6 </span>What is meant by “dosage and frequency”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS7" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.7 </span>How do I know what my dosage is?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS8" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.8 </span>What are some example dosage calculations?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS9" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.9 </span>How do I convert dosages between esters?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS10" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.10 </span>How can I compare different curves and dosages between esters?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SSx2" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Meet Your Esters</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS11" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.11 </span>How do I dose <span class="ltx_text ltx_font_italic">estradiol valerate</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS12" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.12 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol valerate</span> characterized?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS13" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.13 </span>How do I dose <span class="ltx_text ltx_font_italic">estradiol cypionate</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS14" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.14 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol cypionate</span> characterized?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS15" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.15 </span>How do I dose <span class="ltx_text ltx_font_italic">estradiol enanthate</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS16" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.16 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol enanthate</span> characterized?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS17" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.17 </span>How do I dose<span class="ltx_text ltx_font_italic"> estradiol undecylate</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S3.SS18" title="In 3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">3.18 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol undecylate</span> characterized?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S4" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4 </span>BLOOD TESTS AND LEVELS</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SSx1" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Acquiring Results</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS1" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.1 </span>How often should I test my levels?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS2" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.2 </span>Do I have to test my levels before starting HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS3" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.3 </span>Do I have to test my levels if I haven’t changed my dosage in a long time?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS4" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.4 </span>I don’t have insurance or a doctor. Where can I get a blood test?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS5" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.5 </span>I can’t get / afford a blood test. Can I still do HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS6" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.6 </span>What should I test for?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS7" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.7 </span>When should I take a blood test during my hormone cycle?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS8" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.8 </span>My doctor said to take mid-point / peak level blood tests, should I?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SSx2" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Interpreting Results</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS9" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.9 </span>What estrogen levels do I want?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS10" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.10 </span>Do higher estrogen levels feminize better or faster?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS11" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.11 </span>Okay, but what number do I want to see from my estrogen lab result?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS12" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.12 </span>What testosterone levels do I want?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS13" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.13 </span>I naturally have high/low T. Do I need to adjust my dosage?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS14" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.14 </span>I have had bottom surgery. Do my estrogen levels need to be different?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS15" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.15 </span>Is there anything that can cause a blood test to be inaccurate?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S4.SS16" title="In 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">4.16 </span>Do different estrogen esters or administration routes show up differently on blood tests?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S5" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5 </span>TECHNIQUE AND SUPPLIES</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SSx1" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Sites &amp; Safety</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS1" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.1 </span>How do I safely perform an injection?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS2" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.2 </span>Do I have to inject exactly like this?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS3" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.3 </span>How do I get past injection anxiety?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS4" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.4 </span>Does it matter where I inject in my body?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS5" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.5 </span>What injection sites are safe?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS6" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.6 </span>What do “intramuscular” (IM) and “subcutaneous” (SubQ/SC) mean?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS7" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.7 </span>What is the difference between intramuscular injections (IM) and subcutaneous injections (SubQ/SC)?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS8" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.8 </span>Should I perform intramuscular injections (IM) or subcutaneous injections (SubQ/SC)?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS9" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.9 </span>Does my injection angle and/or preferred injection method matter?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS10" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.10 </span>Do I have to aspirate?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS11" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.11 </span>How do I minimize pain during injection?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SSx2" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Knowing Your Needles</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS12" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.12 </span>What is “needle gauge”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS13" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.13 </span>What are “Luer lock” and “insulin” syringe/needles?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS14" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.14 </span>What needle gauge should I draw with?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS15" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.15 </span>What needle length should I draw with?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS16" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.16 </span>What needle gauge should I inject with?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS17" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.17 </span>What needle length should I inject with?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS18" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.18 </span>Does syringe size matter?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS19" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.19 </span>Where do I buy syringes and needles?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS20" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.20 </span>Is it okay if I reuse needles or syringes?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS21" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.21 </span>What if I want to do injections but have difficulty performing it on myself?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SSx3" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Basics of a Vial</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS22" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.22 </span>What should I look for when inspecting vials?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS23" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.23 </span>What is “coring”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS24" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.24 </span>How long until a vial expires?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS25" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.25 </span>How should I store a vial?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS26" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.26 </span>What is “dead space”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S5.SS27" title="In 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">5.27 </span>What do I do with my used syringes and needles?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S6" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6 </span>SOURCING VIALS</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS1" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.1 </span>Where do I get estrogen vials to inject?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS2" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.2 </span>Should I use pharmaceutical sources or DIY sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SSx1" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Pharmaceutical Sourcing</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS3" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.3 </span>What are the pros of pharmaceutical sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS4" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.4 </span>What are the cons of pharmaceutical sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SSx2" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—DIY Sourcing</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS5" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.5 </span>What are the pros of DIY sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS6" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.6 </span>What are the cons of DIY sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS7" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.7 </span>What types of injectable estrogen are DIY only?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS8" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.8 </span>What actually <span class="ltx_text ltx_font_italic">are</span> DIY sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS9" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.9 </span>Where can I get DIY vials?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS10" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.10 </span>How can DIY sources be cheaper than pharmaceutical sources?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS11" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.11 </span>Is DIY legal?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS12" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.12 </span>Is DIY safe?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS13" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.13 </span>What things should I look for to know if a DIY source is trustworthy?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS14" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.14 </span>Should I hold different DIY sources to different standards?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SSx3" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Anatomy of a Vial</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS15" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.15 </span>What should I look for in a vial?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS16" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.16 </span>What carrier oil should I look for in a vial?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS17" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.17 </span>What preservatives should I look for in a vial?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S6.SS18" title="In 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">6.18 </span>What cosolvents should I look for in a vial?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S7" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7 </span>TROUBLESHOOTING</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SSx1" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Dosage Uncertainty</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS1" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.1 </span>My levels aren’t what I expected them to be. Why not?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS2" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.2 </span>Can I compare levels across different tests if I didn’t test at trough?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS3" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.3 </span>I feel really bad on my trough days. What should I do?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SSx2" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Injection Woes</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS4" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.4 </span>The injection is harder to do when it’s cold. What should I do?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS5" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.5 </span>The injection hurts more when it’s cold. What should I do?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS6" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.6 </span>I bled after my injection. Will I die?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS7" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.7 </span>There was some air in my syringe. Will I die?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS8" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.8 </span>Some of the fluid leaked out. Was my injection wasted and/or will I die?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS9" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.9 </span>Sometimes I am really sore after an injection. Will I die?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS10" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.10 </span>I am experiencing a lot of itchiness and irritation after injecting. Will I die?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S7.SS11" title="In 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">7.11 </span>My vial has crystals in it. Can I still use it?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S8" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8 </span>PROGESTERONE</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS1" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.1 </span>Do I want to take progesterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS2" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.2 </span>What is the difference between “progesterone” vs “progestin” / ”progestogen”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS3" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.3 </span>Do I want progesterone or a progestin?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS4" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.4 </span>What’s wrong with progestins?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS5" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.5 </span>What does progesterone do for feminization?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS6" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.6 </span>Does it matter when I start progesterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS7" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.7 </span>How is progesterone normally taken?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS8" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.8 </span>Are you serious that progesterone should be taken as a suppository?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS9" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.9 </span>How do I take progesterone as a suppository?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS10" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.10 </span>How much progesterone should I take?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS11" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.11 </span>Is there any benefit to “cycling” progesterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS12" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.12 </span>How long should I take progesterone for?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS13" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.13 </span>Can progesterone convert into <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> (DHT)?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS14" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.14 </span>Is there any benefit to topical progesterone applications in addition to pills?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS15" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.15 </span>Can I snort progesterone powder?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS16" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.16 </span>Where can I get progesterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS17" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.17 </span>I would like to read more about progesterone in an HRT context. What resources should I read?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S8.SS18" title="In 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">8.18 </span>Does progesterone interact with any other drugs related to HRT?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S9" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9 </span>TESTOSTERONE</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS1" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.1 </span>Why don’t we want zero testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS2" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.2 </span>Are there ever cases where I would want to supplement testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS3" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.3 </span>If I wanted to supplement testosterone, how would I do it?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS4" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.4 </span>What are the topical forms of testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS5" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.5 </span>Does it matter where I apply the testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS6" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.6 </span>How much and how often should I apply testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS7" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.7 </span>Where would I get testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS8" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.8 </span>Are other steroids equivalent to testosterone in an HRT context?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S9.SS9" title="In 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">9.9 </span>What is the relationship between testosterone and <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> (DHT)?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S10" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10 </span>ANTIANDROGENS</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS1" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.1 </span>What are “antiandrogens”?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS2" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.2 </span>Why wouldn’t I want antiandrogens?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS3" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.3 </span>When might I want antiandrogens?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS4" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.4 </span>What kinds of antiandrogens are there?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS5" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.5 </span>When might I want to take <span class="ltx_text ltx_font_italic">spironolactone</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS6" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.6 </span>When might I want to take <span class="ltx_text ltx_font_italic">bicalutamide</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS7" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.7 </span>When might I want to take <span class="ltx_text ltx_font_italic">cyproterone acetate</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS8" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.8 </span>When might I want to take <span class="ltx_text ltx_font_italic">dutasteride</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS9" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.9 </span>When might I want to take <span class="ltx_text ltx_font_italic">finasteride</span>?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S10.SS10" title="In 10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">10.10 </span>Where can I get antiandrogens?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S11" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11 </span>MYTHS AND MISCS</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SSx1" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Common Questions</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS1" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.1 </span>Should I be worried about blood clots?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS2" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.2 </span>Is it okay to use nicotine while on HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS3" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.3 </span>Is there benefit to starting at a low dosage vs a high dosage?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS4" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.4 </span>Does body weight affect dosage?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS5" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.5 </span>Is there such a thing as starting estrogen too late?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS6" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.6 </span>Does feminization / breast development stop after X years?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS7" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.7 </span>I haven’t seen any changes in years on injections. Would swapping back to pills make a difference?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS8" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.8 </span>Is low energy and low libido normal on HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS9" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.9 </span>I hear about [random drug / strategy] that my friend said helps feminization. Does it actually?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS10" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.10 </span>Do we want to mimic the estrogen cycle of cis women?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS11" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.11 </span>Do trans women experience periods?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS12" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.12 </span>Can too much estrogen convert to testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS13" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.13 </span>Does bottom surgery cause an increase in testosterone?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS14" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.14 </span>How do I prevent/revert hair loss?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS15" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.15 </span>Does exercise affect feminization?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS16" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.16 </span>What should I exercise then?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS17" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.17 </span>Can estrogen really cause height shrinkage?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS18" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.18 </span>Can estrogen really cause foot shrinkage?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS19" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.19 </span>Can estrogen really cause any other kinds of shrinkage?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SSx2" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Sexual Health</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS20" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.20 </span>How do I improve erectile function on HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS21" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.21 </span>How do I increase cum/pre-cum volume on HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS22" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.22 </span>Can I lactate on HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS23" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.23 </span>Can HRT change your senses and your perceptions, i.e. smell?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS24" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.24 </span>Can HRT change your sexuality?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS25" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.25 </span>Should I be on PrEP?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SSx3" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Medical Malpractice</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS26" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.26 </span>I heard that injections are actually less stable because you do them less frequently. Is that true?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS27" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.27 </span>But my doctor said-?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS28" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.28 </span>My doctor won’t prescribe me injections. What do I do?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS29" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.29 </span>How does HRT for menopausal cis women relate to HRT for trans women?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SSx4" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Intersexuality and Comorbidities</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS30" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.30 </span>What’s up with Ehlers-Danlos Syndrome?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS31" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.31 </span>What kind of intersex things should I keep in mind?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS32" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.32 </span>What’s up with Klinefelter Syndrome?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS33" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.33 </span>What’s up with Persistent Müllerian Duct Syndrome (PMDS)?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS34" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.34 </span>What’s up with ovotesticular syndrome?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS35" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.35 </span>What’s the difference between intestinal cramps and uterine cramps?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS36" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.36 </span>What about other intersex conditions?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SSx5" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">—Oddball Questions</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS37" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.37 </span>Many DIY sources only take crypto. Is that required? How does that work?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS38" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.38 </span>What about Selective Estrogen Receptor Modulator (SERM) drugs for nonbinary regimens?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS39" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.39 </span>Are things like “herbal HRT” or “phytoestrogens” legitimate?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS40" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.40 </span>Is the Reddit Doctor that people constantly talk about Good?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS41" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.41 </span>I hear DIY estrogen is made in a bathtub. Is that true?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS42" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.42 </span>How does HRT affect fertility?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S11.SS43" title="In 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">11.43 </span>Is infertility from HRT reversible?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section">
<a class="ltx_ref" href="#S12" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12 </span>CREATINE</span></a>
<ol class="ltx_toclist ltx_toclist_section">
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS1" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.1 </span>What is creatine?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS2" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.2 </span>Isn’t it like a steroid or something that bodybuilders use?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS3" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.3 </span>How is creatine related to HRT?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS4" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.4 </span>Okay well why should I take creatine then?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS5" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.5 </span>What are the forms?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS6" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.6 </span>How do I take it then?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS7" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.7 </span>Does it matter when I take it?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS8" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.8 </span>How does it work then?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS9" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.9 </span>Do I have to do a “loading” phase of taking more at first?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS10" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.10 </span>What are the side effects?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS11" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.11 </span>Who shouldn’t take it?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS12" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.12 </span>Do you have any brand recommendations?</span></a></li>
<li class="ltx_tocentry ltx_tocentry_subsection"><a class="ltx_ref" href="#S12.SS13" title="In 12 CREATINE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">12.13 </span>You seriously put creatine into this document, huh?</span></a></li>
</ol>
</li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#S13" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title"><span class="ltx_tag ltx_tag_ref">13 </span>CLOSING REMARKS</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#Sx2" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">FRIENDS OF PGHRT</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#Sx3" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">ABOUT THE AUTHOR</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#Sx4" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">DISCLOSURES</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#Sx5" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">ACKNOWLEDGEMENTS</span></a></li>
<li class="ltx_tocentry ltx_tocentry_section"><a class="ltx_ref" href="#Sx6" title="In A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_title">CHANGELOG</span></a></li>
</ol></nav>
<div class="ltx_page_main">
<div class="ltx_page_content">
<article class="ltx_document ltx_authors_1line">
<h1 class="ltx_title ltx_title_document">A PRACTICAL GUIDE TO FEMINIZING HRT</h1>
<div class="ltx_authors">
<span class="ltx_creator ltx_role_author">
<span class="ltx_personname"><a class="ltx_ref ltx_href" href="https://katea.gay/" title="">Katie Tightpussy</a>
</span></span>
</div>
<div class="ltx_dates">(October 21, 2025)</div>
<div class="ltx_abstract">
<h6 class="ltx_title ltx_title_abstract">DISCLAIMER</h6>
<p class="ltx_p">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.</p>
</div>
<section class="ltx_section" id="S0">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">0 </span>FOREWORD<a class="ltx_ref chain" href="#S0" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="S0.p1">
<p class="ltx_p">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. <span class="ltx_text ltx_font_bold">Changing your sex is really cool and fun. I recommend it.</span> 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.</p>
</div>
<div class="ltx_para" id="S0.p2">
<p class="ltx_p">And stay off the trans subreddits, too. Just trust me on that one, okay? Or at the very least /r/mtf since that one is particularly bad. Neither healthy places nor sources of good wisdom. You’ll be pulling rotten brain worms out for years. Best advice I can give.</p>
</div>
<div class="ltx_para" id="S0.p3">
<p class="ltx_p">As for the fellas, sections of this are still highly relevant, but obviously there are key differences in goals and outcomes. <a class="ltx_ref ltx_href" href="https://docs.google.com/document/d/1DXFxzN0XTudPZez_SO61fpqncRLPH_Be_QG_8Pcz9LU/edit?tab=t.0" title="">This guide for masculinizing HRT</a> <span class="ltx_text" style="color:#FF0000;">(Warning: Google Docs link)</span> looks pretty solid, but I haven’t examined it in full depth, so use your brain and your judgement. Anyway they should make a tboy Katie Tightpussy. Oliver Longdick or something. Maybe Xavier.</p>
</div>
<div class="ltx_para" id="S0.p4">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">If you would like to donate to support this project,</span> <a class="ltx_ref ltx_href" href="https://cash.app/Katitties" title="">CashApp</a>, <a class="ltx_ref ltx_href" href="https://ko-fi.com/katitties" title="">Ko-Fi</a>, and <a class="ltx_ref ltx_href" href="https://account.venmo.com/u/katitties" title="">Venmo</a> all work. I appreciate it!</p>
</div>
<section class="ltx_subsection" id="S0.SSx1">
<h3 class="ltx_title ltx_title_subsection">How to Use This Document<a class="ltx_ref chain" href="#S0.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S0.SSx1.p1">
<p class="ltx_p">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.</p>
</div>
<div class="ltx_para" id="S0.SSx1.p2">
<p class="ltx_p">You can use the table of contents to navigate to a particular section or question as needed, especially when re-visiting. I recommend saving this page / document so that you can refer back to it any time you have questions about your HRT. It is a lot to absorb up front, so it’s okay if it doesn’t! No rush on any of this.</p>
</div>
<div class="ltx_para ltx_noindent" id="S0.SSx1.p3">
<p class="ltx_p"><a class="ltx_ref ltx_href ltx_font_bold" href="pghrt.pdf" title="">This document can also be downloaded as a PDF. Please do so.</a></p>
</div>
<div class="ltx_para ltx_noindent" id="S0.SSx1.p4">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="pghrtgretchensversion.txt" title="">Alternatively, you can read a 90s-00s style .txt version if you are inclined.</a> It won’t stay up to date though.</p>
</div>
<div class="ltx_para ltx_noindent" id="S0.SSx1.p5">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">If you are interested in doing a translation or any other alternate version, please get in touch!</span></p>
</div>
</section>
</section>
<section class="ltx_section" id="Sx1">
<h2 class="ltx_title ltx_title_section">DEDICATION<a class="ltx_ref chain" href="#Sx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="Sx1.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_section" id="S1">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">1 </span>INTRODUCTION<a class="ltx_ref chain" href="#S1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S1.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.1 </span>Is taking estrogen safe?<a class="ltx_ref chain" href="#S1.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS1.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.2 </span>What route of administration should I choose for estrogen?<a class="ltx_ref chain" href="#S1.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS2.p1">
<p class="ltx_p">Injections. They are on the whole the most foolproof, 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.</p>
</div>
<div class="ltx_para ltx_noindent" id="S1.SS2.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold ltx_framed ltx_framed_underline">But remember: any estrogen is better than no estrogen.</span></p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.3 </span>Why do you not recommend pills, patches, or gel?<a class="ltx_ref chain" href="#S1.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS3.p1">
<p class="ltx_p">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: <span class="ltx_text ltx_font_bold">all forms of HRT can produce satisfactory results</span>, but that does not mean all forms of HRT are equal or good.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.4 </span>Is dosage of estrogen equivalent across administration routes or forms?<a class="ltx_ref chain" href="#S1.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS4.p1">
<p class="ltx_p">No. This is important enough that I did not relegate it to Section <a class="ltx_ref" href="#S11" title="11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11</span></a> “MYTHS AND MISCS”. <span class="ltx_text ltx_font_bold">Estrogen dosages cannot be directly compared across type or form.</span> 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 (<span class="ltx_text ltx_font_italic">“bioavailability”</span>), at what rate, and the resulting half-life.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.5 </span>What is a “half-life”?<a class="ltx_ref chain" href="#S1.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS5.p1">
<p class="ltx_p">In simple terms, the <span class="ltx_text ltx_font_italic">half-life</span> 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.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.6 </span>What’s wrong with pills?<a class="ltx_ref chain" href="#S1.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS6.p1">
<p class="ltx_p">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., <span class="ltx_text ltx_font_italic">acetaminophen</span> has an order of magnitude more liver concerns than estrogen), however <span class="ltx_text ltx_font_bold">this risk compounds even further with nicotine-related estrogen risk.</span> See Question <a class="ltx_ref" href="#S11.SS2" title="11.2 Is it okay to use nicotine while on HRT? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.2</span></a> as well.</p>
</div>
<div class="ltx_para" id="S1.SS6.p2">
<p class="ltx_p">Beyond this, numerous other issues with pills stem from two main characteristics: 1) their short half-life and poor bioavailability, and 2) their common necessitation of antiandrogens. The former characteristic makes pills largely unsuitable for monotherapy (discussed below) when compared to injections. The latter often comes with an assortment of negative side effects depending on the antiandrogens involved (see Section <a class="ltx_ref" href="#S10" title="10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">10</span></a> “ANTIANDROGENS”). Together, these characteristics add additional degrees of variability that make poor regimens and their side effects (such as poor energy/libido and slower results) more common than with other administration routes. Pills are also more difficult to stockpile, and in some marketplaces are more expensive than vials. Please also note that importing pills from foreign distributors in large volumes may run afoul of customs which may lead to seizure, financial loss, and/or possible legal trouble depending on your country’s laws. <span class="ltx_text ltx_font_bold">If anyone asks, you don’t know who ordered those pills.</span></p>
</div>
<div class="ltx_para" id="S1.SS6.p3">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">If you are on pills for whatever reason, please take 4-8mg sublingually spaced throughout the day.</span> Under 4mg is almost never a sufficient dosage.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.7 </span>What’s wrong with patches?<a class="ltx_ref chain" href="#S1.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS7.p1">
<ul class="ltx_itemize" id="S1.I1">
<li class="ltx_item" id="S1.I1.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i1.p1">
<p class="ltx_p">Relatively expensive (typically even more than pills);</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i2.p1">
<p class="ltx_p">More difficult to procure DIY (only via grey market means);</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i3.p1">
<p class="ltx_p">Generally necessitate an antiandrogen (see Section <a class="ltx_ref" href="#S10" title="10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">10</span></a> “ANTIANDROGENS”);</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i4.p1">
<p class="ltx_p">Can result in skin irritation;</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i5.p1">
<p class="ltx_p">Require being applied 24/7;</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i6.p1">
<p class="ltx_p">Are prone to falling off;</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i7.p1">
<p class="ltx_p">Aren’t always consistent in their absorption (such as with heat);</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i8" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i8.p1">
<p class="ltx_p">Are harder to stockpile (difficult to acquire in bulk);</p>
</div>
</li>
<li class="ltx_item" id="S1.I1.i9" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I1.i9.p1">
<p class="ltx_p">Often fail to exceed menopause levels even with multiple on at once.</p>
</div>
</li>
</ul>
</div>
</section>
<section class="ltx_subsection" id="S1.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.8 </span>What’s wrong with gel?<a class="ltx_ref chain" href="#S1.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS8.p1">
<ul class="ltx_itemize" id="S1.I2">
<li class="ltx_item" id="S1.I2.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I2.i1.p1">
<p class="ltx_p">Difficult to dose accurately which leads to inconsistent levels;</p>
</div>
</li>
<li class="ltx_item" id="S1.I2.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I2.i2.p1">
<p class="ltx_p">Requires regular application of goop due to a relatively short half-life;</p>
</div>
</li>
<li class="ltx_item" id="S1.I2.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I2.i3.p1">
<p class="ltx_p">Can be messy (goopy);</p>
</div>
</li>
<li class="ltx_item" id="S1.I2.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I2.i4.p1">
<p class="ltx_p">Risk second-hand exposure via contact with others</p>
</div>
</li>
<li class="ltx_item" id="S1.I2.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I2.i5.p1">
<p class="ltx_p">Generally necessitates an antiandrogen (see Section <a class="ltx_ref" href="#S10" title="10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">10</span></a> “ANTIANDROGENS”).</p>
</div>
</li>
</ul>
</div>
<div class="ltx_para" id="S1.SS8.p2">
<p class="ltx_p">It should be noted however that gel requires minimal supplies for self-production which is a boon in some circumstances.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.9 </span>What about pellets?<a class="ltx_ref chain" href="#S1.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS9.p1">
<ul class="ltx_itemize" id="S1.I3">
<li class="ltx_item" id="S1.I3.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I3.i1.p1">
<p class="ltx_p">Generally far more expensive than any other option;</p>
</div>
</li>
<li class="ltx_item" id="S1.I3.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I3.i2.p1">
<p class="ltx_p">Few providers who offer them;</p>
</div>
</li>
<li class="ltx_item" id="S1.I3.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I3.i3.p1">
<p class="ltx_p">Dosing adjustment periods are highly spread out;</p>
</div>
</li>
<li class="ltx_item" id="S1.I3.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I3.i4.p1">
<p class="ltx_p">Defective pellets can cause insufficient levels;</p>
</div>
</li>
<li class="ltx_item" id="S1.I3.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I3.i5.p1">
<p class="ltx_p">Crushed/broken pellets can cause unexpectedly high levels;</p>
</div>
</li>
<li class="ltx_item" id="S1.I3.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S1.I3.i6.p1">
<p class="ltx_p">Generally not possible to DIY them.</p>
</div>
</li>
</ul>
</div>
<div class="ltx_para" id="S1.SS9.p2">
<p class="ltx_p">The last point in particular means that you can only go to those few likely-expensive providers. It’s possible that this is the first time you have even heard of pellets. See the issue?</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.10 </span>What about sprays?<a class="ltx_ref chain" href="#S1.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS10.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S1.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">1.11 </span>Is the difference that significant?<a class="ltx_ref chain" href="#S1.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S1.SS11.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Yes.</span> 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.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S2">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">2 </span>WHY INJECTIONS<a class="ltx_ref chain" href="#S2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S2.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.1 </span>What makes injections so good?<a class="ltx_ref chain" href="#S2.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS1.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.2 </span>Are antiandrogens necessary with injections?<a class="ltx_ref chain" href="#S2.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS2.p1">
<p class="ltx_p">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 <span class="ltx_text ltx_font_italic">“monotherapy”</span>.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.3 </span>How does monotherapy work?<a class="ltx_ref chain" href="#S2.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS3.p1">
<p class="ltx_p">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 <a class="ltx_ref ltx_href" href="https://en.wikipedia.org/wiki/Hypothalamic-pituitary-gonadal_axis" title="">the HPG axis</a>, <span class="ltx_text ltx_font_italic">luteinizing hormone</span> (LH) and <span class="ltx_text ltx_font_italic">follicle-stimulating hormone</span> (FSH) are suppressed by increased serum <span class="ltx_text ltx_font_italic">estradiol</span> levels, thus inhibiting GnRH production and by extension testosterone production in the testes.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.4 </span>How are injections safer?<a class="ltx_ref chain" href="#S2.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS4.p1">
<p class="ltx_p">By generally not necessitating antiandrogens (see Section <a class="ltx_ref" href="#S10" title="10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">10</span></a> “ANTIANDROGENS”), the long term risks associated with antiandrogens are obviated. Bioidentical estrogen that bypasses the liver (see Question <a class="ltx_ref" href="#S11.SS1" title="11.1 Should I be worried about blood clots? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.1</span></a>) is as close as we can possibly get to natural estrogen production which removes additional risk.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.5 </span>But aren’t there risks with the physical act of injecting?<a class="ltx_ref chain" href="#S2.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS5.p1">
<p class="ltx_p">Yes, but with minimal training required (see Section <a class="ltx_ref" href="#S5" title="5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5</span></a> “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.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.6 </span>How are injections easier?<a class="ltx_ref chain" href="#S2.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS6.p1">
<p class="ltx_p">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 (compared to gels), cannot fall off mid cycle (compared to patches), and don’t require potentially significant travel to a provider (compared to pellets).</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.7 </span>How are injections cheap?<a class="ltx_ref chain" href="#S2.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS7.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.8 </span>But I don’t have insurance / my insurance won’t cover it / pills are cheaper than injections with my insurance / injections are not available in my country / my doctor won’t prescribe injections?<a class="ltx_ref chain" href="#S2.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS8.p1">
<p class="ltx_p">Please see Section <a class="ltx_ref" href="#S6" title="6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">6</span></a> “SOURCING VIALS”. You will be amazed, and quite likely, radicalized.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.9 </span>Is swapping to injections good even after years on HRT?<a class="ltx_ref chain" href="#S2.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS9.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Yes.</span> 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.</p>
</div>
<div class="ltx_para" id="S2.SS9.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">It should be noted that time on HRT before injections is not ”wasted”, nor is there a limited window that estrogen is most effective for feminization.</span> It is the consistency of injections that makes them as good as they are, but the destination will be largely the same either way. See Questions <a class="ltx_ref" href="#S11.SS5" title="11.5 Is there such a thing as starting estrogen too late? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.5</span></a> and <a class="ltx_ref" href="#S11.SS6" title="11.6 Does feminization / breast development stop after X years? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.6</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.10 </span>But injections are scary?<a class="ltx_ref chain" href="#S2.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS10.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.11 </span>Are injections like a blood draw or a vaccine?<a class="ltx_ref chain" href="#S2.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS11.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.12 </span>Are there any accessibility tools for injections?<a class="ltx_ref chain" href="#S2.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS12.p1">
<p class="ltx_p">Yes. Auto-injectors exist and can be quite useful if you have fine motor control issues for instance. Please see Question <a class="ltx_ref" href="#S5.SS21" title="5.21 What if I want to do injections but have difficulty performing it on myself? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.21</span></a>, or just keep reading.</p>
</div>
</section>
<section class="ltx_subsection" id="S2.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">2.13 </span>But I <span class="ltx_text ltx_font_italic">am</span> special and can’t inject because I have glass bones and paper skin and—?<a class="ltx_ref chain" href="#S2.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S2.SS13.p1">
<p class="ltx_p">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.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S3">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">3 </span>TYPES AND DOSAGES<a class="ltx_ref chain" href="#S3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S3.SSx1">
<h3 class="ltx_title ltx_title_subsection">Key Vocabulary<a class="ltx_ref chain" href="#S3.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S3.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.1 </span>What are the different types of injectable estrogen?<a class="ltx_ref chain" href="#S3.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS1.p1">
<p class="ltx_p">The four main types used for HRT are <span class="ltx_text ltx_font_italic">estradiol valerate</span> (EV), <span class="ltx_text ltx_font_italic">estradiol cypionate</span> (EC), <span class="ltx_text ltx_font_italic">estradiol enanthate</span> (EEn), and <span class="ltx_text ltx_font_italic">estradiol undecylate</span> (EUn). Each of these is an “ester” of <span class="ltx_text ltx_font_italic">estradiol</span> and will be converted to <span class="ltx_text ltx_font_italic">estradiol</span> in your body.</p>
</div>
<div class="ltx_para" id="S3.SS1.p2">
<p class="ltx_p">Please note that in some regions pills are confusingly sold with the name <span class="ltx_text ltx_font_italic">estradiol valerate</span>, but this section only refers to the injectable form.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.2 </span>What are the differences between each type of injectable estrogen?<a class="ltx_ref chain" href="#S3.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS2.p1">
<p class="ltx_p">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.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.3 </span>Does one type of injectable estrogen feminize better than another?<a class="ltx_ref chain" href="#S3.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS3.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> 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.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.4 </span>What type of injectable estrogen should I choose if I have the choice?<a class="ltx_ref chain" href="#S3.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS4.p1">
<p class="ltx_p">If you have the choice, <span class="ltx_text ltx_font_italic">estradiol enanthate</span> 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 <a class="ltx_ref" href="#S6" title="6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">6</span></a> “SOURCING VIALS”). If you are going through a doctor, you may have the option of <span class="ltx_text ltx_font_italic">estradiol cypionate</span>, 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), <span class="ltx_text ltx_font_italic">estradiol valerate</span>, 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.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.5 </span>What is “concentration”?<a class="ltx_ref chain" href="#S3.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS5.p1">
<p class="ltx_p">Estrogen vials are made from estrogen held in an oil solution. The <span class="ltx_text ltx_font_italic">concentration</span> 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). <span class="ltx_text ltx_font_bold">Please understand that concentration alone is not a dosage.</span> 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). <span class="ltx_text ltx_font_bold">Typical concentrations are 5 mg/ml, 10 mg/ml, 20 mg/ml, 40 mg/ml, and occasionally 50 mg/ml.</span></p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.6 </span>What is meant by “dosage and frequency”?<a class="ltx_ref chain" href="#S3.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS6.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Dosage</span> and <span class="ltx_text ltx_font_italic">frequency</span> are the two factors that determine your hormone cycle. <span class="ltx_text ltx_font_italic">Dosage</span> refers to how much estrogen you put in you (measured in mg), and <span class="ltx_text ltx_font_italic">frequency</span> 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.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.7 </span>How do I know what my dosage is?<a class="ltx_ref chain" href="#S3.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS7.p1">
<p class="ltx_p">Your dosage is the concentration of your vial multiplied by the volume that you are injecting.</p>
<table class="ltx_equation ltx_eqn_table" id="S3.Ex1">
<tbody><tr class="ltx_equation ltx_eqn_row ltx_align_baseline">
<td class="ltx_eqn_cell ltx_eqn_center_padleft"></td>
<td class="ltx_eqn_cell ltx_align_center"><math alttext="Concentration(mg/ml)*volume(ml)=dosage(mg)" class="ltx_Math" display="block" id="S3.Ex1.m1"><mrow><mrow><mrow><mrow><mi>C</mi><mo>⁢</mo><mi>o</mi><mo>⁢</mo><mi>n</mi><mo>⁢</mo><mi>c</mi><mo>⁢</mo><mi>e</mi><mo>⁢</mo><mi>n</mi><mo>⁢</mo><mi>t</mi><mo>⁢</mo><mi>r</mi><mo>⁢</mo><mi>a</mi><mo>⁢</mo><mi>t</mi><mo>⁢</mo><mi>i</mi><mo>⁢</mo><mi>o</mi><mo>⁢</mo><mi>n</mi><mo>⁢</mo><mrow><mo stretchy="false">(</mo><mrow><mrow><mrow><mi>m</mi><mo>⁢</mo><mi>g</mi></mrow><mo>/</mo><mi>m</mi></mrow><mo>⁢</mo><mi>l</mi></mrow><mo rspace="0.055em" stretchy="false">)</mo></mrow></mrow><mo rspace="0.222em">∗</mo><mi>v</mi></mrow><mo>⁢</mo><mi>o</mi><mo>⁢</mo><mi>l</mi><mo>⁢</mo><mi>u</mi><mo>⁢</mo><mi>m</mi><mo>⁢</mo><mi>e</mi><mo>⁢</mo><mrow><mo stretchy="false">(</mo><mrow><mi>m</mi><mo>⁢</mo><mi>l</mi></mrow><mo stretchy="false">)</mo></mrow></mrow><mo>=</mo><mrow><mi>d</mi><mo>⁢</mo><mi>o</mi><mo>⁢</mo><mi>s</mi><mo>⁢</mo><mi>a</mi><mo>⁢</mo><mi>g</mi><mo>⁢</mo><mi>e</mi><mo>⁢</mo><mrow><mo stretchy="false">(</mo><mrow><mi>m</mi><mo>⁢</mo><mi>g</mi></mrow><mo stretchy="false">)</mo></mrow></mrow></mrow></math></td>
<td class="ltx_eqn_cell ltx_eqn_center_padright"></td>
</tr></tbody>
</table>
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Please understand that volume alone is not a dosage.</span> An analogy would be with baking: you cannot just say “bake for 45 minutes” because you have to know what temperature to set the oven.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.8 </span>What are some example dosage calculations?<a class="ltx_ref chain" href="#S3.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS8.p1">
<p class="ltx_p">The math is simple, I promise! Below is a small reference table comparing concentrations and volume for a range of common dosages. Stick to only two decimal places. You won’t be using syringes that have the accuracy for a number like 0.153ml for instance. That’s within rounding error and isn’t a relevant difference at our scale.</p>
</div>
<figure class="ltx_table" id="S3.T1">
<figcaption class="ltx_caption ltx_centering"><span class="ltx_tag ltx_tag_table">Table 1: </span>Example Dosages for Common Concentrations by Volume</figcaption>
<table class="ltx_tabular ltx_centering ltx_guessed_headers ltx_align_middle">
<tbody class="ltx_tbody">
<tr class="ltx_tr">
<th class="ltx_td ltx_th ltx_th_row ltx_border_tt"></th>
<td class="ltx_td ltx_align_center ltx_border_tt" colspan="4">Concentrations (mg/ml)</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_th ltx_th_row"></th>
<td class="ltx_td ltx_align_left ltx_border_t">5</td>
<td class="ltx_td ltx_align_left ltx_border_t">10</td>
<td class="ltx_td ltx_align_left ltx_border_t">20</td>
<td class="ltx_td ltx_nopad_r ltx_align_left ltx_border_t">40</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row">Dosage (mg)</th>
<td class="ltx_td ltx_align_center ltx_border_t" colspan="4">Volume (mL)</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row ltx_border_t">4</th>
<td class="ltx_td ltx_align_left ltx_border_t">0.8</td>
<td class="ltx_td ltx_align_left ltx_border_t">0.4</td>
<td class="ltx_td ltx_align_left ltx_border_t">0.2</td>
<td class="ltx_td ltx_nopad_r ltx_align_left ltx_border_t">0.1</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row">5</th>
<td class="ltx_td ltx_align_left">1</td>
<td class="ltx_td ltx_align_left">0.5</td>
<td class="ltx_td ltx_align_left">0.25</td>
<td class="ltx_td ltx_nopad_r ltx_align_left">0.13</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row">6</th>
<td class="ltx_td ltx_align_left">1.2</td>
<td class="ltx_td ltx_align_left">0.6</td>
<td class="ltx_td ltx_align_left">0.3</td>
<td class="ltx_td ltx_nopad_r ltx_align_left">0.15</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row">7</th>
<td class="ltx_td ltx_align_left">1.4</td>
<td class="ltx_td ltx_align_left">0.7</td>
<td class="ltx_td ltx_align_left">0.35</td>
<td class="ltx_td ltx_nopad_r ltx_align_left">0.18</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row">8</th>
<td class="ltx_td ltx_align_left">1.6</td>
<td class="ltx_td ltx_align_left">0.8</td>
<td class="ltx_td ltx_align_left">0.4</td>
<td class="ltx_td ltx_nopad_r ltx_align_left">0.2</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row">9</th>
<td class="ltx_td ltx_align_left">1.8</td>
<td class="ltx_td ltx_align_left">0.9</td>
<td class="ltx_td ltx_align_left">0.45</td>
<td class="ltx_td ltx_nopad_r ltx_align_left">0.23</td>
</tr>
<tr class="ltx_tr">
<th class="ltx_td ltx_align_left ltx_th ltx_th_row ltx_border_bb">10</th>
<td class="ltx_td ltx_align_left ltx_border_bb">2</td>
<td class="ltx_td ltx_align_left ltx_border_bb">1</td>
<td class="ltx_td ltx_align_left ltx_border_bb">0.5</td>
<td class="ltx_td ltx_nopad_r ltx_align_left ltx_border_bb">0.25</td>
</tr>
</tbody>
</table>
</figure>
<div class="ltx_para" id="S3.SS8.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">How to read this chart:</span> Take your desired dosage on the left and find the corresponding volume on the right for your given concentration in the column at the top. You will notice that the volume requirements for 5 mg/ml vials to have reasonable dosages is not good. That is because 5 mg/ml vials are not good.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.9 </span>How do I convert dosages between esters?<a class="ltx_ref chain" href="#S3.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS9.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">You don’t. </span>Because they behave differently, there isn’t a “conversion” between dosages in that sense. If you swap from one ester to another, you should just do a typical dosage for the new ester and work from there. You can make comparisons between them, but there is no method to convert one to another.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.10 </span>How can I compare different curves and dosages between esters?<a class="ltx_ref chain" href="#S3.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS10.p1">
<p class="ltx_p">If you would like to get nerdy, I rate <a class="ltx_ref ltx_href" href="http://estrannai.se" title="">estrannai.se</a> quite highly. Keep in mind that this isn’t required but it is a good tool for performing rough comparisons. <a class="ltx_ref ltx_href" href="https://estrannai.se/#i0__cu,7,7,1-cu,5,7,3-cu,5,7,2" title="">Here is an example comparison between typical weekly dosages</a> which we will now see individually.</p>
</div>
<div class="ltx_para" id="S3.SS10.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">It should be noted that the dosages I list below should be sufficient on the lower end of the range in most cases.</span> Start with the lower number and move up if you need. More is not inherently better, but we will discuss that in depth later. These dosage ranges are unlikely to change regardless of where you acquired your vial.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SSx2">
<h3 class="ltx_title ltx_title_subsection">Meet Your Esters<a class="ltx_ref chain" href="#S3.SSx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S3.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.11 </span>How do I dose <span class="ltx_text ltx_font_italic">estradiol valerate</span>?<a class="ltx_ref chain" href="#S3.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS11.p1">
<p class="ltx_p">Either twice a week at a lower dosage or once a week at a higher dosage is necessary for good levels with <span class="ltx_text ltx_font_italic">estradiol valerate</span>. It is a matter of comfort and tolerance. The typical rule of thumb is about 1mg for every day in a cycle with frequencies generally between 3-7 days. <span class="ltx_text ltx_font_bold">A weekly dosage between 6-8mg is my typical recommendation</span>, but 4-5mg per 5 days is also very common. <span class="ltx_text ltx_font_bold">The frequency should never be less often than weekly (i.e., No more than seven days between injections).</span> Weekly is already pushing how long the ester can last. Anything further is highly discouraged to avoid side effects related to variance (See Question <a class="ltx_ref" href="#S7.SS3" title="7.3 I feel really bad on my trough days. What should I do? ‣ 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">7.3</span></a>).</p>
</div>
<div class="ltx_para" id="S3.SS11.p2">
<p class="ltx_p">Please note that in some regions pills are confusingly sold with the name <span class="ltx_text ltx_font_italic">estradiol valerate</span>, but this section only refers to the injectable form.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.12 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol valerate</span> characterized?<a class="ltx_ref chain" href="#S3.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS12.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol valerate</span> is the most finicky of esters. It rapidly spikes to a very high peak a few days after injection and just as quickly crashes back down. This relative instability can be unpleasant depending on your personal sensitivities, but with adjustments to frequency and dosage this can be mitigated to a degree.</p>
</div>
<figure class="ltx_figure" id="S3.F1"><img alt="Refer to caption" class="ltx_graphics ltx_centering ltx_img_landscape" height="317" id="S3.F1.g1" src="img/ev.png" width="598"/>
<figcaption class="ltx_caption ltx_centering"><span class="ltx_tag ltx_tag_figure">Figure 1: </span>Serum Estradiol (pg / ml) of Estradiol Valerate vs Time (days) </figcaption>
</figure>
</section>
<section class="ltx_subsection" id="S3.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.13 </span>How do I dose <span class="ltx_text ltx_font_italic">estradiol cypionate</span>?<a class="ltx_ref chain" href="#S3.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS13.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol cypionate</span> can accommodate a weekly dosage without issue. <span class="ltx_text ltx_font_bold">A weekly dosage between 5-7mg is typical.</span> Extending the duration past weekly (e.g., every 10 days) is not recommended because it is a less efficient use of estrogen compared to weekly as it requires increasingly higher dosages to reach acceptable levels. Any extension past weekly is much more prone to side effects due to variance (See Question <a class="ltx_ref" href="#S7.SS3" title="7.3 I feel really bad on my trough days. What should I do? ‣ 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">7.3</span></a>).</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS14">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.14 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol cypionate</span> characterized?<a class="ltx_ref chain" href="#S3.SS14" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS14.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol cypionate</span> is more forgiving than <span class="ltx_text ltx_font_italic">estradiol valerate</span>. The curve does not progress as quickly with a much lower variation between high and low, but there is still a noticeable rise and fall over a typical weekly duration.</p>
</div>
<figure class="ltx_figure" id="S3.F2"><img alt="Refer to caption" class="ltx_graphics ltx_centering ltx_img_landscape" height="317" id="S3.F2.g1" src="img/ec.png" width="598"/>
<figcaption class="ltx_caption ltx_centering"><span class="ltx_tag ltx_tag_figure">Figure 2: </span>Serum Estradiol (pg / ml) of Estradiol Cypionate vs Time (days) </figcaption>
</figure>
</section>
<section class="ltx_subsection" id="S3.SS15">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.15 </span>How do I dose <span class="ltx_text ltx_font_italic">estradiol enanthate</span>?<a class="ltx_ref chain" href="#S3.SS15" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS15.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol enanthate</span> can easily accommodate a weekly dosage without issue and can possibly be extended up to 10 days if one is inclined. Beyond that is technically possible but not recommended as levels will become increasingly unstable. <span class="ltx_text ltx_font_bold">A weekly dosage of 4-6mg is typical</span>, with 5-7mg recommended for up to 10 days. Weekly is still recommended regardless for consistency and ease of scheduling as any extension up to 10 days does not offer much benefit in my opinion.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS16">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.16 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol enanthate</span> characterized?<a class="ltx_ref chain" href="#S3.SS16" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS16.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol enanthate</span> is the gold standard for injectable estrogen. It has a curve that is extremely flat (i.e., has little variance) over the duration of a typical weekly duration. This allows for very consistent levels without any negative side effects related to variance (See Question <a class="ltx_ref" href="#S7.SS3" title="7.3 I feel really bad on my trough days. What should I do? ‣ 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">7.3</span></a>).</p>
</div>
<figure class="ltx_figure" id="S3.F3"><img alt="Refer to caption" class="ltx_graphics ltx_centering ltx_img_landscape" height="317" id="S3.F3.g1" src="img/een.png" width="598"/>
<figcaption class="ltx_caption ltx_centering"><span class="ltx_tag ltx_tag_figure">Figure 3: </span>Serum Estradiol (pg / ml) of Estradiol Enanthate vs Time (days) </figcaption>
</figure>
</section>
<section class="ltx_subsection" id="S3.SS17">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.17 </span>How do I dose<span class="ltx_text ltx_font_italic"> estradiol undecylate</span>?<a class="ltx_ref chain" href="#S3.SS17" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS17.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol undecylate</span> is capable of extending far beyond weekly into the range of monthly or quarterly. The recommended dosing for this, however, is not standardized or known. The factors that affect how the estrogen from an injection is absorbed (<span class="ltx_text ltx_font_italic">“pharmacokinetics”</span>) that are negligible for other esters are significant for <span class="ltx_text ltx_font_italic">estradiol undecylate</span>. As a result, this is still highly experimental territory that is beyond the scope of this guide. Consider consulting a witch’s almanac for the lunar calendar to inject once every full moon.</p>
</div>
</section>
<section class="ltx_subsection" id="S3.SS18">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">3.18 </span>How is the hormone curve for <span class="ltx_text ltx_font_italic">estradiol undecylate</span> characterized?<a class="ltx_ref chain" href="#S3.SS18" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S3.SS18.p1">
<p class="ltx_p">We don’t really know. The data is too sparse to paint an accurate picture of it in full, and the variables are plentiful. It is something that you can research and experiment with if you are interested, but it is new ground and you need to understand the risks involved with being a human guinea pig, so I don’t recommend it unless you know what you are doing.</p>
</div>
<figure class="ltx_figure" id="S3.F4"><img alt="Refer to caption" class="ltx_graphics ltx_centering ltx_img_square" height="569" id="S3.F4.g1" src="img/moon.png" width="598"/>
<figcaption class="ltx_caption ltx_centering"><span class="ltx_tag ltx_tag_figure">Figure 4: </span>The Moon</figcaption>
</figure>
</section>
</section>
<section class="ltx_section" id="S4">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">4 </span>BLOOD TESTS AND LEVELS<a class="ltx_ref chain" href="#S4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S4.SSx1">
<h3 class="ltx_title ltx_title_subsection">Acquiring Results<a class="ltx_ref chain" href="#S4.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S4.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.1 </span>How often should I test my levels?<a class="ltx_ref chain" href="#S4.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS1.p1">
<p class="ltx_p">While you are first dialing in your dosage, you will want to test relatively frequently. Following any adjustment to your regimen, you should give your levels 1-2 months to stabilize, and then test once they’ve reached their new normal.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.2 </span>Do I have to test my levels before starting HRT?<a class="ltx_ref chain" href="#S4.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS2.p1">
<p class="ltx_p">Arguably no, because testosterone will be too high and estrogen will be too low so it’s not particularly useful data, but routine general blood tests (i.e., a lipid panel and such) are recommended for your health nonetheless. The exception is if you believe that you may have an intersex condition which may affect your HRT regimen as sometimes this can be visible in the preliminary blood test.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.3 </span>Do I have to test my levels if I haven’t changed my dosage in a long time?<a class="ltx_ref chain" href="#S4.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS3.p1">
<p class="ltx_p">Arguably no, because if you have not changed anything then nothing should have changed. It can be good for peace of mind if you have changed aspects of your routine / supplier, and doctors/insurance often require it, but major deviation shouldn’t be expected. A caveat is that if you are experimenting with <span class="ltx_text ltx_font_italic">estradiol undecylate</span>, you almost certainly should test quarterly at minimum regardless.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.4 </span>I don’t have insurance or a doctor. Where can I get a blood test?<a class="ltx_ref chain" href="#S4.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS4.p1">
<p class="ltx_p">Look into private blood testing options in your region depending on the legality of it. In many locations, you are legally able to get private blood tests, but they might not be cheap. There may be online options that allow you to get those tests at a discount but it depends heavily on your region.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.5 </span>I can’t get / afford a blood test. Can I still do HRT?<a class="ltx_ref chain" href="#S4.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS5.p1">
<p class="ltx_p">While having the information is obviously preferable to not, HRT is extremely safe and at typical dosages should pose no issue. You will just have to rely more on how you are feeling and what you observe.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.6 </span>What should I test for?<a class="ltx_ref chain" href="#S4.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS6.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Estradiol</span> (E2) and <span class="ltx_text ltx_font_italic">total testosterone</span> (T) at the least because these are the main things to be concerned about. <span class="ltx_text ltx_font_italic">Sex hormone binding globulin</span> (SHBG), <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> (DHT), <span class="ltx_text ltx_font_italic">estrone</span> (E1), and <span class="ltx_text ltx_font_italic">prolactin </span>(PRL) can also be useful to test if you are experiencing issues because these can be useful for troubleshooting. <span class="ltx_text ltx_font_italic">Follicle-stimulating hormone</span> (FSH) and <span class="ltx_text ltx_font_italic">luteinizing hormone</span> (LH) can tell you if your HPG axis is inactive which is the basis of monotherapy (See Question <a class="ltx_ref" href="#S2.SS3" title="2.3 How does monotherapy work? ‣ 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">2.3</span></a>). But again: <span class="ltx_text ltx_font_bold ltx_font_italic">Estradiol<span class="ltx_text ltx_font_upright"> and </span>Total Testosterone<span class="ltx_text ltx_font_upright"> are the primary concerns. </span></span></p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.7 </span>When should I take a blood test during my hormone cycle?<a class="ltx_ref chain" href="#S4.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS7.p1">
<p class="ltx_p">At the end of your cycle (<span class="ltx_text ltx_font_italic">“trough”</span>). You want as close to the bottom as possible because this is the most useful piece of information. Arguably, it is the only useful piece of information as consistent minimum levels are the primary concern. Example: If you normally inject Thursday afternoon, get your labs in the morning or early afternoon on the following Thursday before your next injection.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.8 </span>My doctor said to take mid-point / peak level blood tests, should I?<a class="ltx_ref chain" href="#S4.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS8.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> Measuring the peak estrogen level does not provide useful information and is only a measure of what ester you are using. Charitably, it is incompetence because of dated conservative standards of care. Uncharitably, it is malice to ensure insufficient estrogen levels that will result in poor health, slow results, or otherwise negative outcomes. <span class="ltx_text ltx_font_bold">I recommend measuring at trough regardless.</span></p>
</div>
</section>
<section class="ltx_subsection" id="S4.SSx2">
<h3 class="ltx_title ltx_title_subsection">Interpreting Results<a class="ltx_ref chain" href="#S4.SSx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S4.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.9 </span>What estrogen levels do I want?<a class="ltx_ref chain" href="#S4.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS9.p1">
<p class="ltx_p">This is probably the most controversial question with transition. The short answer is that you want enough that you feel good and that you are suppressing testosterone if you need to, but beyond that, higher levels are unnecessarily wasteful at best and may be counterproductive at worst. This is a wide range however, and with so many variables there is always personal deviation. In other words: You want enough estrogen such that you feel good, and that’s it.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.10 </span>Do higher estrogen levels feminize better or faster?<a class="ltx_ref chain" href="#S4.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS10.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> Higher estrogen levels than necessary might be preferred by someone for their subjective experience, but they do not confer feminization benefits. In fact, levels that are too high can feel bad by causing mood instability or other undesirable side effects. <span class="ltx_text ltx_font_bold">Minimizing testosterone levels to a baseline is far more important for feminization than maximizing estrogen levels.</span></p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.11 </span>Okay, but what number do I want to see from my estrogen lab result?<a class="ltx_ref chain" href="#S4.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS11.p1">
<p class="ltx_p">With the understanding that the exact number does not matter, that the number will always be slightly higher than whatever is in your body even on a trough day because of latency, and that the number will be in a cloud of possibilities based on any number of factors, <span class="ltx_text ltx_font_bold">I recommend a trough of about 200 pg/ml (730 pmol/L) minimum.</span> This is a slightly conservative recommendation to provide ample wiggle room as suppression of the HPG axis occurs below this. Around here tends to work well for most, although some prefer higher or lower. I don’t believe this is a number that should be overly fixated upon because it is inherently variable and if you feel good that is what matters most, <span class="ltx_text ltx_font_bold">but</span> <span class="ltx_text ltx_font_bold">beyond 300pg/ml (1100 pmol/L) at trough is almost certainly higher than it needs to be or should be.</span> There are exceptions to this, but you probably aren’t the exception. Still, do what feels right. Additionally see Question <a class="ltx_ref" href="#S11.SS1" title="11.1 Should I be worried about blood clots? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.1</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.12 </span>What testosterone levels do I want?<a class="ltx_ref chain" href="#S4.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS12.p1">
<p class="ltx_p">Testosterone suppression is the key requirement for adequate feminization, so under 50 ng/dL (1.7 nmol/L) is generally sufficient. <span class="ltx_text ltx_font_bold">Notably, near-zero testosterone is not desired.</span> See Section <a class="ltx_ref" href="#S9" title="9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">9</span></a> “TESTOSTERONE”.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.13 </span>I naturally have high/low T. Do I need to adjust my dosage?<a class="ltx_ref chain" href="#S4.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS13.p1">
<p class="ltx_p">Probably not. The testosterone range that is typically found prior to HRT is almost always higher than what is desired for feminization and will still be suppressed regardless (See Question <a class="ltx_ref" href="#S2.SS3" title="2.3 How does monotherapy work? ‣ 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">2.3</span></a>). The exception would be if you have any variety of intersex conditions that may cause need for finer adjustment than the recommendations listed in this guide which is beyond the scope of what this guide can provide to you. You might not need to tweak, but maybe you feel better if you do. Ultimately, do what feels right. See Question <a class="ltx_ref" href="#S9.SS2" title="9.2 Are there ever cases where I would want to supplement testosterone? ‣ 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">9.2</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS14">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.14 </span>I have had bottom surgery. Do my estrogen levels need to be different?<a class="ltx_ref chain" href="#S4.SS14" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS14.p1">
<p class="ltx_p">Since testosterone suppression is no longer a concern for you, you likely can still feel great with lower estrogen levels than you currently have, <span class="ltx_text ltx_font_bold">but you do still need estrogen.</span> Because you no longer produce your own hormones, it is crucial that you still maintain sufficient hormone levels for your health. Having little to no hormones will lead to menopause symptoms which is the same reason that older cis women might take HRT once they hit menopause. Adjust as you see fit.</p>
</div>
<div class="ltx_para" id="S4.SS14.p2">
<p class="ltx_p">For additional clarity: <span class="ltx_text ltx_font_bold">maintaining a minimum of about 100 pg/ml (350 pmol/L) is essential to avoid bone mineral density concerns.</span> If the bulk of your feminization is already complete, then in many respects your hormonal profile is comparable to a menopausal cis woman so lessons can be learned from them (See Question <a class="ltx_ref" href="#S11.SS29" title="11.29 How does HRT for menopausal cis women relate to HRT for trans women? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.29</span></a>). In some cases of fatigue or low energy, supplementing low dosages of testosterone may be beneficial (See Question <a class="ltx_ref" href="#S9.SS2" title="9.2 Are there ever cases where I would want to supplement testosterone? ‣ 9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">9.2</span></a>).</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS15">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.15 </span>Is there anything that can cause a blood test to be inaccurate?<a class="ltx_ref chain" href="#S4.SS15" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS15.p1">
<p class="ltx_p">Depending on how the blood is measured (<span class="ltx_text ltx_font_italic">“assay”</span>), biotin supplements can cause <span class="ltx_text ltx_font_italic">estradiol</span> (E2) levels (among others, but <span class="ltx_text ltx_font_italic">estradiol </span>is our concern) to be unexpectedly high. It is not always possible to know the type of assay that will be used, so pausing any biotin supplements a few days before testing is recommended. It is also possible that there was an error with the equipment or the sample, although this is not likely.</p>
</div>
</section>
<section class="ltx_subsection" id="S4.SS16">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">4.16 </span>Do different estrogen esters or administration routes show up differently on blood tests?<a class="ltx_ref chain" href="#S4.SS16" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S4.SS16.p1">
<p class="ltx_p">No. There is no way to tell what type of estrogen someone is taking based solely on a blood test result. The various injectable esters all convert to <span class="ltx_text ltx_font_italic">estradiol </span>like we want, and the same is true for pills, patches, gels, sprays, or whatever else. It’s all estrogen at the end of the day.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S5">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">5 </span>TECHNIQUE AND SUPPLIES<a class="ltx_ref chain" href="#S5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S5.SSx1">
<h3 class="ltx_title ltx_title_subsection">Sites &amp; Safety<a class="ltx_ref chain" href="#S5.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S5.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.1 </span>How do I safely perform an injection?<a class="ltx_ref chain" href="#S5.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS1.p1">
<p class="ltx_p">I recommend the following two videos:</p>
</div>
<div class="ltx_para" id="S5.SS1.p2">
<ol class="ltx_enumerate" id="S5.I1">
<li class="ltx_item" id="S5.I1.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">1.</span>
<div class="ltx_para" id="S5.I1.i1.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href ltx_font_italic" href="https://www.youtube.com/watch?v=cBabaGC2Dok" title="">“How to perform an intramuscular (IM) self-injection”</a></p>
</div>
</li>
<li class="ltx_item" id="S5.I1.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">2.</span>
<div class="ltx_para" id="S5.I1.i2.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href ltx_font_italic" href="https://www.youtube.com/watch?v=YfNlAZLxLyw" title="">“Painless (for me so far) IM Injection Technique”</a></p>
</div>
</li>
</ol>
</div>
<div class="ltx_para" id="S5.SS1.p3">
<p class="ltx_p">Between these two videos, you should be fully equipped to properly inject with minimal pain. I suggest studying them and revisiting as needed. <span class="ltx_text ltx_font_bold">One key thing to emphasize is to inject with the bevel facing up to reduce pain.</span> In other words: the needle has a clearly defined point, and you want that to be what touches your skin first. You want a nice straight line of travel. You can think about how your hand/wrist rotates if that helps you visualize the motion, but realistically it’ll be intuitive muscle memory that you’ll learn naturally.</p>
</div>
<div class="ltx_para" id="S5.SS1.p4">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Remember: injecting is a skill!</span> You will get better with time, and it won’t take long. You got this.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.2 </span>Do I have to inject exactly like this?<a class="ltx_ref chain" href="#S5.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS2.p1">
<p class="ltx_p">No, variation is fine. Ultimately when the task is just poking yourself, there’s a lot of ways to do that. Find the way that works best for you. Doing a quick dart motion usually works best, but if you have to go slow that works fine too if it’s something that is consistent that you can get better at doing.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.3 </span>How do I get past injection anxiety?<a class="ltx_ref chain" href="#S5.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS3.p1">
<p class="ltx_p">I suggest making a ritual out of the process. By forming a routine, the process becomes second nature. If you can distract your mind by listening to music, having a conversation, watching a show, or doing something else that works for you to let your muscle memory take over, that’s great! Find what works for you. Having a friend or loved one do your first few injections can help too. For most people, the first injection is the scariest. Usually people say, “Oh, that was it?” because it’s never as bad as they expect.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.4 </span>Does it matter where I inject in my body?<a class="ltx_ref chain" href="#S5.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS4.p1">
<p class="ltx_p">Yes and no. Staying within safe areas matters, but otherwise, where you inject primarily depends on your mobility, the volume of fluid that you are injecting, the needle/syringe combo that you are using, and your own comfort. Either way, <span class="ltx_text ltx_font_bold">make sure to rotate injection sites.</span> Alternate sides of your body with every injection–for example, if you inject into your right leg one week, use your left leg the next. This is to minimize any long term scarring risks.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.5 </span>What injection sites are safe?<a class="ltx_ref chain" href="#S5.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS5.p1">
<p class="ltx_p">Opinions vary between medical authorities, but your body composition can also play a role. I recommend injecting on the side of the leg as shown in the video(s) because it is doable for most people and is capable of being very consistent which means consistently painless injections once your technique is practiced, but other people prefer their glute or their stomach. <a class="ltx_ref ltx_href" href="https://vertisis.com/articles/how-to-self-administer-a-subcutaneous-injection" title="">This video and website</a> shows other injections sites that can be acceptable depending on the supplies you use. Figure out what works best for you.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.6 </span>What do “intramuscular” (IM) and “subcutaneous” (SubQ/SC) mean?<a class="ltx_ref chain" href="#S5.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS6.p1">
<p class="ltx_p">You will often hear these terms in the context of injections. <span class="ltx_text ltx_font_italic">Intramuscular</span> means injected into the muscle and <span class="ltx_text ltx_font_italic">subcutaneous</span> means injected into the fatty layer beneath your skin.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.7 </span>What is the difference between intramuscular injections (IM) and subcutaneous injections (SubQ/SC)?<a class="ltx_ref chain" href="#S5.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS7.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">In the context of HRT, there is little to no difference between intramuscular and subcutaneous injections.</span> Subcutaneous injections are absorbed more slowly than intramuscular injections, however this is generally not significant enough of a difference to impact dosing. It should also be noted that an injection is rarely deposited fully in muscle or fully in the subcutaneous layer which blurs any difference together even further on an injection-by-injection basis.</p>
</div>
<div class="ltx_para" id="S5.SS7.p2">
<p class="ltx_p">As a side note, pharmaceutical sources for estradiol vials typically say they are for intramuscular injections only because that is what they are technically approved for. It does not matter though.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.8 </span>Should I perform intramuscular injections (IM) or subcutaneous injections (SubQ/SC)?<a class="ltx_ref chain" href="#S5.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS8.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">This is the wrong question.</span> <span class="ltx_text ltx_font_bold">An injection is an injection.</span> Subcutaneous injections are often recommended because people believe that they allow for less painful injections by virtue of being subcutaneous, but there is not a fundamental difference in how an injection is performed. <span class="ltx_text ltx_font_bold">The advantages that people refer to are not inherent to the injection depot location; they are inherent to the factors that affect injection pain.</span> The better question would be “How do I minimize pain during injection?”, but two other questions first.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.9 </span>Does my injection angle and/or preferred injection method matter?<a class="ltx_ref chain" href="#S5.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS9.p1">
<p class="ltx_p">No. To reiterate, the most important part of performing an injection is that you pierce a needle through your skin and deposit fluid into your body. If the fluid doesn’t leak out (or at least, not much) and it doesn’t hurt (or at least, not much), then you have done a fantastic job. <span class="ltx_text ltx_font_bold">I cannot stress enough that the intramuscular vs subcutaneous “divide” is nonexistent and that the question does not meaningfully impact the effectiveness of injectable estrogen.</span> <span class="ltx_text ltx_font_italic">Estradiol undecylate</span> is the only case where depot location seems to meaningfully affect absorption, but even then, we don’t fully understand the details. Point being: please be concerned about the things that matter and not the things that don’t matter.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.10 </span>Do I have to aspirate?<a class="ltx_ref chain" href="#S5.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS10.p1">
<p class="ltx_p">No. “Aspiration” refers to pulling the plunger back after puncturing the skin before injecting the fluid with the intent of ensuring a blood vessel is not being injected into. Its necessity is controversial, but for hormone injections following standard procedures, there are few benefits that outweigh the negatives. The standard injection sites have low risk of striking a blood vessel in the first place, lessened even further by shorter needle lengths, so this practice is not recommended anymore by most medical organizations.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.11 </span>How do I minimize pain during injection?<a class="ltx_ref chain" href="#S5.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS11.p1">
<p class="ltx_p">Aside from practicing your technique and improving your skill, the main factor for injection discomfort is the needle and syringe combination that you are using. <span class="ltx_text ltx_font_bold">To minimize discomfort, the highest needle gauge that your vial’s carrier oil is capable of tolerating should be used along with an appropriately sized syringe and needle length. </span>You should ask “What needle gauge and length should I inject with?” To answer that, let’s talk about how needles work.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SSx2">
<h3 class="ltx_title ltx_title_subsection">Knowing Your Needles<a class="ltx_ref chain" href="#S5.SSx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S5.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.12 </span>What is “needle gauge”?<a class="ltx_ref chain" href="#S5.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS12.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Needle gauge </span>is a measure of needle thickness. The bigger the number, the thinner the needle. A 25G needle is thinner than a 20G needle, for instance. Higher gauge needles also tend to be shorter because longer needles become more prone to bending, so their length has a lower maximum. Unsurprisingly, thinner needles generally hurt less. It should be noted that the gauge of needle(s) used will not affect HRT in any way; it will only affect the ease and comfort of the injection itself.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.13 </span>What are “Luer lock” and “insulin” syringe/needles?<a class="ltx_ref chain" href="#S5.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS13.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Luer lock syringes</span> have separate syringes and needles so a separate needle can be used for drawing and injecting. <span class="ltx_text ltx_font_italic">Insulin syringes</span> have a needle fixed in place which means that the same needle will be used for drawing and injecting. Note: You do not want “Luer slip” needles as they are prone to error. Where possible, insulin syringes are preferred for comfort and for minimizing dead space (See Question <a class="ltx_ref" href="#S5.SS26" title="5.26 What is “dead space”? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.26</span></a>).</p>
</div>
<div class="ltx_para" id="S5.SS13.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Safety Warning: Recapping needles is generally not recommended out of concern for sticking yourself, but if you do (such as when swapping out a drawing needle), NEVER apply force with your hand towards the needle.</span></p>
</div>
<div class="ltx_para" id="S5.SS13.p3">
<p class="ltx_p">It is possible that the cap may break and you may injure yourself if you place the cap incorrectly. Gently “scooping” the cap onto the needle off of a horizontal surface and pressing the loosely capped needle against a wall or pulling the cap on the sides to fully seat the cap is preferred. There isn’t a disease transfer risk when performing a self injection, so heed this warning at your own discretion, but resticking is a VERY serious concern when performing injections on others. For disposal, see Question <a class="ltx_ref" href="#S5.SS27" title="5.27 What do I do with my used syringes and needles? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.27</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS14">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.14 </span>What needle gauge should I draw with?<a class="ltx_ref chain" href="#S5.SS14" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS14.p1">
<p class="ltx_p">If you are using Luer lock syringes, it is recommended to use a lower gauge than what you inject with so that it takes less time to draw from the vial. Too low can lead to coring (See Question <a class="ltx_ref" href="#S5.SS23" title="5.23 What is “coring”? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.23</span></a>), so <span class="ltx_text ltx_font_bold">drawing with at least 21-23G is recommended.</span> If you have patience and lower volumes to inject, then higher gauges are recommended for the aforementioned coring risk reduction. Please note that the needle does not meaningfully blunt on the stopper. This question is irrelevant with insulin syringes because the needle is not removable.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS15">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.15 </span>What needle length should I draw with?<a class="ltx_ref chain" href="#S5.SS15" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS15.p1">
<p class="ltx_p">If you are using Luer lock syringes, the length of the drawing needle does not matter too much outside of the inconvenience of having too long of a needle being unwieldy. In other words, no need to be picky. This question is irrelevant with insulin syringes because the needle is not removable.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS16">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.16 </span>What needle gauge should I inject with?<a class="ltx_ref chain" href="#S5.SS16" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS16.p1">
<p class="ltx_p">This is a tricky and highly subjective question, and your answer will depend on 4 main factors: 1) the carrier oil for what you are injecting; 2) if the vial contains a cosolvent; 3) your patience to have a needle in your leg for longer; and 4) your willingness/ability to push harder on the syringe plunger. It’s a question of comfort. Thicker oils mean more time and more effort when using a higher gauge, but also higher gauges can be significantly less painful going in. <span class="ltx_text ltx_font_bold">As a baseline, 25G is the minimum needle gauge that you should use to manage discomfort. </span>Most common carrier oils can generally do up to 27G comfortably, whereas MCT oil in particular is notable for being able to easily do 30G (See Question <a class="ltx_ref" href="#S6.SS16" title="6.16 What carrier oil should I look for in a vial? ‣ 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">6.16</span></a>).</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS17">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.17 </span>What needle length should I inject with?<a class="ltx_ref chain" href="#S5.SS17" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS17.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">I recommend between 0.5” to 1” (12.5mm to 25mm) depending on your gauge.</span> Below 0.5” (12.5mm) increases the likelihood of leakage. 0.25” (6.5mm) length needles can be fine depending on your technique and the fluid you’re injecting, but 0.5” (12.5mm) is a safe bet. Beyond 1” (25mm) is unnecessarily daunting and painful without any added benefits.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS18">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.18 </span>Does syringe size matter?<a class="ltx_ref chain" href="#S5.SS18" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS18.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Yes, size matters.</span> There are two reasons for this. 1) Higher volume syringes tend to be less precise which leads to incorrect dosing, and 2) physics makes higher volume syringes more difficult to inject. For dosing accuracy, you do not want to use a syringe far larger than the volume that you are injecting (i.e., for injections less than 0.1ml, get smaller than 1ml syringes). <span class="ltx_text ltx_font_bold">Avoid 3mL syringes entirely if you can.</span> Obviously use them if it’s all you have, but they’re really not meant for a task like this. Do not ask me why pharmacists seem to near-exclusively hand them out. A cruel joke, maybe.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS19">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.19 </span>Where do I buy syringes and needles?<a class="ltx_ref chain" href="#S5.SS19" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS19.p1">
<p class="ltx_p">It depends on your local jurisdiction as some localities ban the sale of needles and syringes to individuals as a punitive measure against drug users. Otherwise, medical and veterinary supply businesses or authorized manufacturer retailers should be good places to look. <span class="ltx_text ltx_font_bold">Amazon is not recommended</span> because the quality is uncertain.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS20">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.20 </span>Is it okay if I reuse needles or syringes?<a class="ltx_ref chain" href="#S5.SS20" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS20.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No. Never reuse needles or syringes. </span>Or share either. You probably already know this but I’m just reminding you because it’s really not good or safe to do!</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS21">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.21 </span>What if I want to do injections but have difficulty performing it on myself?<a class="ltx_ref chain" href="#S5.SS21" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS21.p1">
<p class="ltx_p">You might like an auto-injector. As the name suggests, auto-injectors perform the injection for you. Auto-injectors like the <a class="ltx_ref ltx_href ltx_font_italic" href="https://unionmedico.com/90-super-grip/" title="">UnionMedico 45/90 Super Grip</a> can take 1ml syringes which can take the difficulty out of injecting (but you still manually press the plunger), whereas auto-injectors like the <a class="ltx_ref ltx_href ltx_font_italic" href="https://www.owenmumford.com/us/medical-devices/autoject-2" title="">Owen Mumford Autoject 2</a> entirely hide the needle of an insulin syringe and automatically push down the plunger. There are also a variety of 3D printable designs available online. I have used none of these products and these are not endorsements.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SSx3">
<h3 class="ltx_title ltx_title_subsection">Basics of a Vial<a class="ltx_ref chain" href="#S5.SSx3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S5.SS22">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.22 </span>What should I look for when inspecting vials?<a class="ltx_ref chain" href="#S5.SS22" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS22.p1">
<p class="ltx_p">Aside from looking for signs of coring (see below), you should look for any signs of discoloration, separation, contamination, crystallization, cracks in the glass, fibers, hairs, etc. A properly made vial should not deviate too much from usual. <span class="ltx_text ltx_font_bold">Always inspect your vials before use. Do not use a vial that does not seem right.</span></p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS23">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.23 </span>What is “coring”?<a class="ltx_ref chain" href="#S5.SS23" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS23.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Coring</span> is when a piece of the rubber stopper breaks away and falls into the vial. This can occur with too large of drawing gauges, repeated punctures on the exactly same spot, or too many punctures (i.e., a very small volume injection with a very large volume vial). <span class="ltx_text ltx_font_bold">A cored vial should be immediately discarded. </span>The <a class="ltx_ref ltx_href ltx_font_italic" href="https://www.youtube.com/watch?v=w5F0SLoMjC8" title="">45-90° technique</a> can also be used to help minimize coring.</p>
</div>
<div class="ltx_para" id="S5.SS23.p2">
<p class="ltx_p">The concern with coring is that you do not want to inject bits of rubber into you. If there are large bits of rubber, there might be smaller ones that you can’t see. The purpose of the stopper is to protect the contents from the elements, so a vial with a hole in the top is more prone to oxidation and/or bacterial growth. <span class="ltx_text ltx_font_bold">As a side note: Please ensure that you remove the metal or plastic cap off the top of a new vial. </span>This may seem obvious, but some vial designs can be confusing.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS24">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.24 </span>How long until a vial expires?<a class="ltx_ref chain" href="#S5.SS24" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS24.p1">
<p class="ltx_p">A sealed vial could last for years without issue if it is stored at stable temperatures away from the light. Concerns with age are primarily carrier oil oxidation assuming that the vial was sterilized as it should be. A punctured vial that has a preservative in it (See Question <a class="ltx_ref" href="#S6.SS17" title="6.17 What preservatives should I look for in a vial? ‣ 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">6.17</span></a>) should last at least a year or whatever the life time of the vial is (i.e., how long until you use it all). The “discard after 28 days” listing on vials is simply the minimum requirement for how long manufacturers must guarantee sterility, not the maximum shelf life.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS25">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.25 </span>How should I store a vial?<a class="ltx_ref chain" href="#S5.SS25" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS25.p1">
<p class="ltx_p">Stable room temperature and away from light. High heat and UV can cause degradation of the carrier oil, whereas low temperatures can cause crystallization. Crystals can be dissolved and reincorporated, but it’s a potential cause for irritation if they aren’t fully dissolved. This goes for both sealed and unsealed vials.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS26">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.26 </span>What is “dead space”?<a class="ltx_ref chain" href="#S5.SS26" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS26.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Dead space</span> refers to the amount of fluid that is wasted when performing an injection. This is fluid that is trapped in the syringe or in the needle. With a standard Luer lock needle/syringe this can be up to 0.1mL, whereas in an insulin needle can be as low as 0.003mL. Reducing dead space is recommended for economic reasons because it adds up to a lot of wasted estrogen. <a class="ltx_ref ltx_href" href="https://hrtcafe.net/Calc/" title="">This calculator</a> can be useful for estimating how much estrogen is wasted depending on the supplies used.</p>
</div>
<div class="ltx_para" id="S5.SS26.p2">
<p class="ltx_p">One thing to note if you are swapping needles for drawing and injecting, then you should pull the plunger back slightly prior to taking off the drawing needle so that the fluid inside the drawing needle is not wasted. It is very minor, but it can make a difference. See Question <a class="ltx_ref" href="#S7.SS7" title="7.7 There was some air in my syringe. Will I die? ‣ 7 TROUBLESHOOTING ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">7.7</span></a> for another possible strategy if concerned about high dead space.</p>
</div>
</section>
<section class="ltx_subsection" id="S5.SS27">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">5.27 </span>What do I do with my used syringes and needles?<a class="ltx_ref chain" href="#S5.SS27" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S5.SS27.p1">
<p class="ltx_p">Place all used injection supplies pointed down in a sharps container (either a dedicated biohazard container or reusing hard plastic tubs such as from protein powder or laundry detergent). When the container becomes three-quarters full, seal it closed so that it cannot be accidentally opened. Clearly label it “USED SHARPS” and then dispose of it according to your local jurisdiction’s requirements. <span class="ltx_text ltx_font_bold">Note that sharps should NOT be placed into trash or recycling containers.</span> Your city/state/region likely has a website somewhere describing how and where to dispose of household hazardous waste. For the US, <a class="ltx_ref ltx_href" href="https://safeneedledisposal.org/" title="">you can go here.</a></p>
</div>
</section>
</section>
<section class="ltx_section" id="S6">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">6 </span>SOURCING VIALS<a class="ltx_ref chain" href="#S6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S6.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.1 </span>Where do I get estrogen vials to inject?<a class="ltx_ref chain" href="#S6.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS1.p1">
<p class="ltx_p">Broadly speaking, you have two options: <span class="ltx_text ltx_font_italic">pharmaceutical sources</span> and <span class="ltx_text ltx_font_italic">DIY sources</span>. <span class="ltx_text ltx_font_italic">Pharmaceutical sources</span> typically require a doctor’s prescription because HRT is not available over-the-counter (or if it is, vials are not included) in most countries. <span class="ltx_text ltx_font_italic">DIY sources</span> encompass everything else.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.2 </span>Should I use pharmaceutical sources or DIY sources?<a class="ltx_ref chain" href="#S6.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS2.p1">
<p class="ltx_p">The choice is yours, but sometimes there is no choice at all. There are pros and cons to each. Of course, there is nothing stopping you from procuring estrogen from multiple sources to get the benefits of both. In many situations, it may be recommended.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SSx1">
<h3 class="ltx_title ltx_title_subsection">Pharmaceutical Sourcing<a class="ltx_ref chain" href="#S6.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S6.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.3 </span>What are the pros of pharmaceutical sources?<a class="ltx_ref chain" href="#S6.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS3.p1">
<ul class="ltx_itemize" id="S6.I1">
<li class="ltx_item" id="S6.I1.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I1.i1.p1">
<p class="ltx_p">Can generally trust quality control processes and certifications;</p>
</div>
</li>
<li class="ltx_item" id="S6.I1.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I1.i2.p1">
<p class="ltx_p">Insurance may cover it in part or in full;</p>
</div>
</li>
<li class="ltx_item" id="S6.I1.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I1.i3.p1">
<p class="ltx_p">Can be more convenient depending on your luck with doctors;</p>
</div>
</li>
<li class="ltx_item" id="S6.I1.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I1.i4.p1">
<p class="ltx_p">The product most likely will be consistent;</p>
</div>
</li>
<li class="ltx_item" id="S6.I1.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I1.i5.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">At least appearing to be using pharmaceutical sources may be required if you are seeking insurance approval for surgeries.</span></p>
</div>
</li>
</ul>
</div>
</section>
<section class="ltx_subsection" id="S6.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.4 </span>What are the cons of pharmaceutical sources?<a class="ltx_ref chain" href="#S6.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS4.p1">
<ul class="ltx_itemize" id="S6.I2">
<li class="ltx_item" id="S6.I2.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i1.p1">
<p class="ltx_p">Reduced (or no) selection of esters;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i2.p1">
<p class="ltx_p">Possible lengthy wait time (months or years);</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i3.p1">
<p class="ltx_p">May be required to have a prescription (depending on country);</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i4.p1">
<p class="ltx_p">Insurance may not cover costs in part or in full;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i5.p1">
<p class="ltx_p">May not be prescribed at all in your country;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i6.p1">
<p class="ltx_p">Your doctor may arbitrarily refuse to prescribe it to you;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i7.p1">
<p class="ltx_p">Your doctor may arbitrarily withhold refilling a prescription;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i8" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i8.p1">
<p class="ltx_p">Shortages may prevent filling a prescription at all;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i9" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i9.p1">
<p class="ltx_p">Likely held to stringent WPATH requirements or worse;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i10" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i10.p1">
<p class="ltx_p">Harder to stockpile;</p>
</div>
</li>
<li class="ltx_item" id="S6.I2.i11" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I2.i11.p1">
<p class="ltx_p">Access is subject to the whims of your country’s political situation which also means that your transness will likely be included on your medical record.</p>
</div>
</li>
</ul>
</div>
</section>
<section class="ltx_subsection" id="S6.SSx2">
<h3 class="ltx_title ltx_title_subsection">DIY Sourcing<a class="ltx_ref chain" href="#S6.SSx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S6.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.5 </span>What are the pros of DIY sources?<a class="ltx_ref chain" href="#S6.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS5.p1">
<ul class="ltx_itemize" id="S6.I3">
<li class="ltx_item" id="S6.I3.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i1.p1">
<p class="ltx_p">Generally much cheaper in most places;</p>
</div>
</li>
<li class="ltx_item" id="S6.I3.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i2.p1">
<p class="ltx_p">Available anywhere in the world;</p>
</div>
</li>
<li class="ltx_item" id="S6.I3.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i3.p1">
<p class="ltx_p">Obtaining it can take months or even years less time than waitlists (the only wait is shipping and production);</p>
</div>
</li>
<li class="ltx_item" id="S6.I3.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i4.p1">
<p class="ltx_p">Easy to stockpile;</p>
</div>
</li>
<li class="ltx_item" id="S6.I3.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i5.p1">
<p class="ltx_p">Full selection of esters;</p>
</div>
</li>
<li class="ltx_item" id="S6.I3.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i6.p1">
<p class="ltx_p">No requirement of dealing with the medical system;</p>
</div>
</li>
<li class="ltx_item" id="S6.I3.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I3.i7.p1">
<p class="ltx_p">It’s probably made with love.</p>
</div>
</li>
</ul>
</div>
</section>
<section class="ltx_subsection" id="S6.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.6 </span>What are the cons of DIY sources?<a class="ltx_ref chain" href="#S6.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS6.p1">
<ul class="ltx_itemize" id="S6.I4">
<li class="ltx_item" id="S6.I4.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i1.p1">
<p class="ltx_p">Almost certainly not made in a certified clean room;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i2.p1">
<p class="ltx_p">Quality can vary depending on the source;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i3.p1">
<p class="ltx_p">Can be inconvenient depending on the source;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i4.p1">
<p class="ltx_p">Requires trusting the source;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i5.p1">
<p class="ltx_p">Requires finding a source;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i6.p1">
<p class="ltx_p">Sources are more likely to close than your local pharmacy;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i7.p1">
<p class="ltx_p">Product delivery times can vary;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i8" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i8.p1">
<p class="ltx_p">Most likely have to use cryptocurrency which is annoying;</p>
</div>
</li>
<li class="ltx_item" id="S6.I4.i9" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I4.i9.p1">
<p class="ltx_p">Cannot use insurance if that was an option for you.</p>
</div>
</li>
</ul>
<p class="ltx_p">Additionally as already stated, if you are seeking insurance approval for surgeries, they likely require a minimum amount of time with an HRT prescription. This may or may not be a concern for you.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.7 </span>What types of injectable estrogen are DIY only?<a class="ltx_ref chain" href="#S6.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS7.p1">
<p class="ltx_p">Chiefly, <span class="ltx_text ltx_font_italic">estradiol enanthate</span>. Pharmaceutical sources will almost always prescribe you <span class="ltx_text ltx_font_italic">estradiol valerate</span>, but not always at a 40 mg/ml concentration. <span class="ltx_text ltx_font_italic">Estradiol cypionate</span> may occasionally be prescribed, but rarely above 5 mg/ml or 10 mg/ml concentrations, which are annoying to dose. The benefits provided by <span class="ltx_text ltx_font_italic">estradiol enanthate</span> alone are very good reasons to consider DIY, but you can get any ester at 40 mg/ml from DIY sources.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.8 </span>What actually <span class="ltx_text ltx_font_italic">are</span> DIY sources?<a class="ltx_ref chain" href="#S6.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS8.p1">
<p class="ltx_p">DIY sources include commercial brewers, mutual aid projects, your friend, and yourself if you have an entrepreneurial spirit!</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.9 </span>Where can I get DIY vials?<a class="ltx_ref chain" href="#S6.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS9.p1">
<p class="ltx_p">What are you, a cop? I’m not telling you that. That’s not the point of this guide anyways. There are other resources that have that information. Stay focused.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.10 </span>How can DIY sources be cheaper than pharmaceutical sources?<a class="ltx_ref chain" href="#S6.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS10.p1">
<p class="ltx_p">The cost to produce a vial is roughly around $10, including labor and amortized capex cost. This is likely a high estimate. The bulk of the cost for commercial DIY sources are the layers of overhead and shipping involved in anonymity. Non-commercial DIY sources likely have no such overhead. Pharmaceutical sources generally do not have any incentive to be cheaper than what they are.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.11 </span>Is DIY legal?<a class="ltx_ref chain" href="#S6.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS11.p1">
<p class="ltx_p">In most locations including America, estrogen is not a scheduled substance, whereas testosterone may or may not be criminalized. The US is an anomaly for testosterone in this regard, as other countries don’t criminalize possession of testosterone, but prosecution is rare anyway given the wide availability of steroids. <span class="ltx_text ltx_font_bold">This guide is not legal advice.</span></p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.12 </span>Is DIY safe?<a class="ltx_ref chain" href="#S6.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS12.p1">
<p class="ltx_p">“DIY” as a broad category of sources is neither safe nor unsafe, but not all DIY sources are equal. When we are discussing the topic of safely injecting something into your body, the real question is: do you trust that the person who produced that vial properly followed aseptic techniques and procedures such that the vial contains what you want and nothing else? For pharmaceutical sources, that trust is innate on the assumption that laws and regulations exist. For DIY sources, that trust must be earned through demonstration/explanation of process, independent third-party testing for concentration/purity, and community reputation.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.13 </span>What things should I look for to know if a DIY source is trustworthy?<a class="ltx_ref chain" href="#S6.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS13.p1">
<p class="ltx_p">Use your gut and your brain.</p>
</div>
<div class="ltx_para" id="S6.SS13.p2">
<ul class="ltx_itemize" id="S6.I5">
<li class="ltx_item" id="S6.I5.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i1.p1">
<p class="ltx_p">Are they open to talking to you about their process / have it listed somewhere? (e.g., do they filter for dust? The answer should be yes!!!)</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i2.p1">
<p class="ltx_p">Do they seem competent in their ability?</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i3.p1">
<p class="ltx_p">Have they had their product tested?</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i4.p1">
<p class="ltx_p">Are they a trusted member of the community?</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i5.p1">
<p class="ltx_p">Have they been vetted or vouched for by other members of the community who you trust? (i.e., inspections, reviews, testimonials, etc)</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i6.p1">
<p class="ltx_p">Mistakes happen, but do they take accountability or do they try to silence negativity?</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i7.p1">
<p class="ltx_p">For commercials, do they resolve any issues with customer orders?</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i8" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i8.p1">
<p class="ltx_p">For commercials, are they taking payment on product not yet produced without indicating that it is a backorder? (You should never backorder!)</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i9" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i9.p1">
<p class="ltx_p">Do their vials contain preservatives?</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i10" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i10.p1">
<p class="ltx_p">How long have they been producing? (For good reason, they may not tell you!)</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i11" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i11.p1">
<p class="ltx_p">How much do they produce? (For good reason, they may not tell you!)</p>
</div>
</li>
<li class="ltx_item" id="S6.I5.i12" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S6.I5.i12.p1">
<p class="ltx_p">Are the vibes just <span class="ltx_text ltx_font_italic">off</span>?</p>
</div>
</li>
</ul>
</div>
<div class="ltx_para" id="S6.SS13.p3">
<p class="ltx_p">These are just some of the many questions that can be asked to know if you trust that they care as much as you do about the quality of their product.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS14">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.14 </span>Should I hold different DIY sources to different standards?<a class="ltx_ref chain" href="#S6.SS14" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS14.p1">
<p class="ltx_p">Likely, yes. Commercial brewers should also be held to a high standard if you are giving them money in exchange for product because they can afford to do it right. A mutual aid product on the other hand that is distributing vials for free might not be something that you can afford to be picky about, although that is not to say that the product is likely to be better or worse. As for a friend or yourself, only you can decide that!</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SSx3">
<h3 class="ltx_title ltx_title_subsection">Anatomy of a Vial<a class="ltx_ref chain" href="#S6.SSx3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S6.SS15">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.15 </span>What should I look for in a vial?<a class="ltx_ref chain" href="#S6.SS15" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS15.p1">
<p class="ltx_p">The ingredients inside of a vial can be categorized as <span class="ltx_text ltx_font_italic">“active”</span> and <span class="ltx_text ltx_font_italic">“excipient”</span>. The<span class="ltx_text ltx_font_italic"> active</span> is the estrogen ester in our case, and the <span class="ltx_text ltx_font_italic">excipients</span> are everything else. There are generally three or four ingredients: 1) the estrogen ester; 2) the carrier oil; 3) the preservative; and optionally, 4) any cosolvent(s). We have already covered the estrogen esters in Section <a class="ltx_ref" href="#S3" title="3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">3</span></a> “TYPES AND DOSAGES”. Pharmaceutical vials almost always have all four ingredients.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS16">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.16 </span>What carrier oil should I look for in a vial?<a class="ltx_ref chain" href="#S6.SS16" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS16.p1">
<p class="ltx_p">This is a question of preference, personal tolerance, and possibly allergies. <span class="ltx_text ltx_font_bold">The main variable relevant to you is viscosity because that affects injection comfort and convenience.</span> As discussed (See Question <a class="ltx_ref" href="#S5.SS16" title="5.16 What needle gauge should I inject with? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.16</span></a>), thinner oils are able to more conveniently use higher gauge needles without difficulty when drawing and injecting. <span class="ltx_text ltx_font_bold">The most commonly used carrier oils for HRT are castor oil and MCT oil. </span>Castor oil is the thickest oils commonly used, but it also tends to result in the least amount of irritation so pharmaceutical vials typically use it. MCT oil is the thinnest oil commonly used, but some people find it more irritating than other oils and it’s DIY only. Cottonseed oil and grapeseed oil occasionally find use, but usually not by HRT manufacturers. Other oils like sunflower or sesame or whatever else occasionally find use but aren’t generally recommended. Depending on your circumstances, this question might not matter to you, you might not have a choice, or it may be a strict requirement.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS17">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.17 </span>What preservatives should I look for in a vial?<a class="ltx_ref chain" href="#S6.SS17" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS17.p1">
<p class="ltx_p">The most common preservative used in injectable vials is <span class="ltx_text ltx_font_italic">benzyl alcohol</span> (BA) in low concentration. This is mandatory and not up to debate. <span class="ltx_text ltx_font_bold">You should never use a vial without a preservative. </span>For people with the rare allergy, <span class="ltx_text ltx_font_italic">chlorobutanol </span>is an alternate commonly used preservative, but almost never by DIY sources which would necessitate hunting specific pharmaceutical formulas.</p>
</div>
</section>
<section class="ltx_subsection" id="S6.SS18">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">6.18 </span>What cosolvents should I look for in a vial?<a class="ltx_ref chain" href="#S6.SS18" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S6.SS18.p1">
<p class="ltx_p">The main cosolvent used is <span class="ltx_text ltx_font_italic">benzyl benzoate</span> (BB) which reduces the viscosity of the resulting solution. This is technically optional, but it is generally recommended for batch consistency and in many cases is necessary depending on the carrier oil and the desired concentration. Some people find it irritating, but others don’t.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S7">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">7 </span>TROUBLESHOOTING<a class="ltx_ref chain" href="#S7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S7.SSx1">
<h3 class="ltx_title ltx_title_subsection">Dosage Uncertainty<a class="ltx_ref chain" href="#S7.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S7.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.1 </span>My levels aren’t what I expected them to be. Why not?<a class="ltx_ref chain" href="#S7.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS1.p1">
<p class="ltx_p">There are a number of possibilities. Recall first that model estimations cannot take into account any plethora of factors which may cause some deviation. Recall as well that it takes multiple injections until you reach stability, so if you just changed your dosage that may be why. Quadruple check with a friend that you are injecting as much as you think you are. That is more commonly an issue than you might think, but for DIY sources it is also possible that the concentration is lower than advertised due to inexperience or less precise equipment. In that case, injecting you may just need to inject a little more for that vial. <span class="ltx_text ltx_font_bold">But remember, the most important thing is how you feel, not your levels. </span>Please note that even professional compounding pharmacies can produce dud vials not caught by quality control, as hopefully rare as that may be!</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.2 </span>Can I compare levels across different tests if I didn’t test at trough?<a class="ltx_ref chain" href="#S7.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS2.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> Not accurately, anyway. This is part of why you should always test at trough. Hours before your normal time for your next injection; that’s what you want. Eliminating as many variables as possible makes the data far more useful to you. If there is nothing else that you take from this guide, please just test at trough.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.3 </span>I feel really bad on my trough days. What should I do?<a class="ltx_ref chain" href="#S7.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS3.p1">
<p class="ltx_p">In most cases, either the dosage is too low or the frequency is too low. This is most pressing for <span class="ltx_text ltx_font_italic">estradiol valerate</span> and <span class="ltx_text ltx_font_italic">estradiol cypionate</span>. Adjust your dosage within the range listed or adjust the frequency. Find what works for you. It is also possible with <span class="ltx_text ltx_font_italic">estradiol valerate</span> in particular that your dosage might actually be too *high* instead of too low as the high level variability across your cycle may be the culprit for this crashing sensation. In short: swap to <span class="ltx_text ltx_font_italic">estradiol enanthate</span> if you can.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SSx2">
<h3 class="ltx_title ltx_title_subsection">Injection Woes<a class="ltx_ref chain" href="#S7.SSx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S7.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.4 </span>The injection is harder to do when it’s cold. What should I do?<a class="ltx_ref chain" href="#S7.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS4.p1">
<p class="ltx_p">Warm up the vial before drawing, then warm the syringe before injecting. Rolling the barrel of the syringe between your hands should be plenty to warm up the fluid. Forming this as a habit all the time should improve your injection consistency.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.5 </span>The injection hurts more when it’s cold. What should I do?<a class="ltx_ref chain" href="#S7.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS5.p1">
<p class="ltx_p">Warm up your leg before injecting. Relaxing the muscles with a massage or a hot shower (specifically: increasing the temperature with the water aimed at your leg before you get out) before injecting can help.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.6 </span>I bled after my injection. Will I die?<a class="ltx_ref chain" href="#S7.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS6.p1">
<p class="ltx_p">No. This means that you likely just hit a vein or a capillary which can happen sometimes. You might experience some light bruising or increased soreness. Using a cute bandage will make it heal faster.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.7 </span>There was some air in my syringe. Will I die?<a class="ltx_ref chain" href="#S7.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS7.p1">
<p class="ltx_p">No. While you obviously do not want to inject just air and it can affect dosage if there is too much in the syringe, a small amount of air under 0.1ml is almost certainly not going to cause issue for you. It might actually be recommended in some cases. For instance, the <span class="ltx_text ltx_font_italic">air lock technique</span> (a standard technique for injecting fluids that are irritating or can stain, not crucial knowledge for HRT) generally involves injecting 0.1-0.3ml of air, so you have nothing to be worried about. You aren’t doing intravenous injections.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.8 </span>Some of the fluid leaked out. Was my injection wasted and/or will I die?<a class="ltx_ref chain" href="#S7.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS8.p1">
<p class="ltx_p">No. Leakage can happen for any number of reasons and is rarely enough to make a difference, so you do not need to do another injection. For the future, make sure to leave the needle in for 5-10 seconds before retracting and then apply pressure afterwards. You might consider using the air lock technique mentioned above or <a class="ltx_ref ltx_href" href="https://www.nurse.com/nursing-resources/definitions/what-is-z-track-method/" title="">the Z-track method</a> if you are particularly concerned about leakage.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.9 </span>Sometimes I am really sore after an injection. Will I die?<a class="ltx_ref chain" href="#S7.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS9.p1">
<p class="ltx_p">No. Assuming you have otherwise followed all of the suggestions within this guide, sometimes the deposit of fluid hits an uncomfortable place for one reason or another. Better luck next time. <span class="ltx_text ltx_font_bold">Make sure you alternate injection spots!</span> You do not want scar tissue to build up over the long term, and if a spot is already sore, you do not want to make it more sore.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.10 </span>I am experiencing a lot of itchiness and irritation after injecting. Will I die?<a class="ltx_ref chain" href="#S7.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS10.p1">
<p class="ltx_p">Probably not. There are a number of possible causes. Infection is the most concerning cause, but is unlikely in most cases. <span class="ltx_text ltx_font_bold">Immediately go to a doctor if you are experiencing a fever, severe pain, muscle aches, pus, red streaks, or other signs of infection. </span>In most cases however, irritation like itchiness, redness, light swelling, warmth, etc are the result of using a vial whose estrogen and oil have separated (“crashed out of solution”). See below. It’s possible that you may be having a reaction to the carrier oil, but if you are suddenly experiencing issues after some injections without any issue, it is most likely that the vial contents are out of solution.</p>
</div>
</section>
<section class="ltx_subsection" id="S7.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">7.11 </span>My vial has crystals in it. Can I still use it?<a class="ltx_ref chain" href="#S7.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S7.SS11.p1">
<p class="ltx_p">It most likely means your vial got too cold. Warm it up and gently shake to reincorporate. If the crystals are not going away, then it’s possible the vial contents have separated entirely. With a lot more heat and stirring the crystals might reincorporate, but it is simplest and safest to replace the vial if you can.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S8">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">8 </span>PROGESTERONE<a class="ltx_ref chain" href="#S8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S8.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.1 </span>Do I want to take progesterone?<a class="ltx_ref chain" href="#S8.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS1.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Probably.</span> This is a controversial question for some reason. Detractors (namely, doctors) will argue that there’s no studies to show that it plays a role in feminization therefore it should not be taken. Aside from transfeminine subjects being woefully understudied, heuristically speaking, progesterone is a key female sex hormone that plays an important role in the brain and in many functions throughout the body. Regardless of physical feminization, it is an important hormone for good health that should not be lightly overlooked.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.2 </span>What is the difference between “progesterone” vs “progestin” / ”progestogen”?<a class="ltx_ref chain" href="#S8.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS2.p1">
<p class="ltx_p">The class of hormones, both natural and synthetic, that activate the progesterone receptor are “proges<span class="ltx_text ltx_font_bold">togens</span>”. The natural, bioidentical, and most important progestogen is “proges<span class="ltx_text ltx_font_bold">terone</span>”. Synthetic progestogens are “proges<span class="ltx_text ltx_font_bold">tins</span>”. These three terms are mistakenly used interchangeably in scientific literature and in clinical settings, likely causing much of the broader confusion regarding the role of progesterone in HRT, despite the fact that they are <span class="ltx_text ltx_font_bold">not </span>equivalent.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.3 </span>Do I want progesterone or a progestin?<a class="ltx_ref chain" href="#S8.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS3.p1">
<p class="ltx_p">Progesterone. You want bioidentical progesterone.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.4 </span>What’s wrong with progestins?<a class="ltx_ref chain" href="#S8.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS4.p1">
<p class="ltx_p">Progestins, most typically <span class="ltx_text ltx_font_italic">medroxyprogesterone</span>, <span class="ltx_text ltx_font_italic">medroxyprogesterone acetate</span>, or <span class="ltx_text ltx_font_italic">levonorgestrel</span>, are generally associated with the negative side effects and long term risks (breast cancer, blood clots, depression, etc) that are falsely attributed to progesterone. They are not bioidentical which means they do not behave the same as progesterone and thus cannot be directly compared.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.5 </span>What does progesterone do for feminization?<a class="ltx_ref chain" href="#S8.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS5.p1">
<p class="ltx_p">Progesterone is believed to play a role in breast development and libido in particular, but as mentioned it’s a key hormone aside from its outward appearance effects. It does also have some antigonadotropic (i.e., it contributes to testosterone suppression) properties which can be sometimes relevant.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.6 </span>Does it matter when I start progesterone?<a class="ltx_ref chain" href="#S8.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS6.p1">
<p class="ltx_p">It is unknown. There is some belief that starting too early may harm breast development long term, but this is purely theoretical and contrary anecdotal evidence makes the answer unclear. The conservative estimate is waiting roughly a year into HRT (until Tanner Stage 3 or 4) in the possible chance that it does matter.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.7 </span>How is progesterone normally taken?<a class="ltx_ref chain" href="#S8.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS7.p1">
<p class="ltx_p">Aside from topical applications, the main form is via a pill. It is prescribed as an oral pill but is most effective when taken as a suppository. Topical sprays and creams can also work very well.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.8 </span>Are you serious that progesterone should be taken as a suppository?<a class="ltx_ref chain" href="#S8.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS8.p1">
<p class="ltx_p">Progesterone metabolizes entirely differently when taken orally vs rectally due to passing through the liver when taken orally. Oral progesterone primarily converts to <span class="ltx_text ltx_font_italic">allopregnanolone</span> which can cause heavy drowsiness, whereas rectal progesterone primarily converts to progesterone itself which is what we want (although some still converts). Some people take additional oral progesterone as a sleep aid, but please note that too much <span class="ltx_text ltx_font_italic">allopregnanolone </span>can sometimes lead to negative mental health side effects.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.9 </span>How do I take progesterone as a suppository?<a class="ltx_ref chain" href="#S8.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS9.p1">
<p class="ltx_p">Just a bit of water on the pill should work, then dry off and wash your hands. Obviously, don’t go to the bathroom for the next hour or so, so doing it before bed is best. If you are having issues with it not dissolving then you can try piercing the capsule but usually should be no issue. Be aware that if you use large homebrew suppositories made using coconut oil, the large volume of coconut oil will not want to stay in you.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.10 </span>How much progesterone should I take?<a class="ltx_ref chain" href="#S8.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS10.p1">
<p class="ltx_p">For pills, Standard dosage is 100-200mg daily at night. It is a rather arbitrary dosage; 200mg is the max that most doctors will prescribe. Some people take more than 200mg on occasion, but be aware that spiking your levels may lead to an unpleasant crash. See question below.</p>
</div>
<div class="ltx_para" id="S8.SS10.p2">
<p class="ltx_p">For topical applications, nobody can tell you with certainty due to the high variability of the delivery medium, nor is there any clear guidance on desired levels, or even frequency (likely daily), as progesterone is simply understudied. Because of this, I would advise titrating your dosage so that you understand how progesterone affects you.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.11 </span>Is there any benefit to “cycling” progesterone?<a class="ltx_ref chain" href="#S8.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS11.p1">
<p class="ltx_p">No. Some people do this to mimic a cis woman’s menstrual cycle, but there is no reason to believe there is any benefit to this and it may cause negative PMS symptoms. The only exception is if you have good reason to suspect that you have an intersex condition involving a uterus that you are managing. I discourage it otherwise. See Question <a class="ltx_ref" href="#S11.SS10" title="11.10 Do we want to mimic the estrogen cycle of cis women? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.10</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.12 </span>How long should I take progesterone for?<a class="ltx_ref chain" href="#S8.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS12.p1">
<p class="ltx_p">For as long as you plan to take estrogen and for as long as you want to. So, probably forever.</p>
</div>
<div class="ltx_para" id="S8.SS12.p2">
<p class="ltx_p">Sometimes people (or doctors) arbitrarily say to only take progesterone for X years. There is zero theoretical or empirical reason to suggest that this is sound advice. It’s about as coherent as if someone (or a doctor) asked how long a trans person planned to take HRT for—oh wait never mind they do ask that.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.13 </span>Can progesterone convert into <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> (DHT)?<a class="ltx_ref chain" href="#S8.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS13.p1">
<p class="ltx_p">No. Well, strictly speaking yes, but also no. It is largely a myth, although <a class="ltx_ref ltx_href" href="https://whsah.co/posts/rethinking-progesterone-and-androgens/" title="">as outlined in detail by alix in this article</a>, for cases of people with <span class="ltx_text ltx_font_italic">nonclassical congenital adrenal hyperplasia</span> (ncCAH) progesterone can cause some negative side effects of increased androgenic activity. In those cases, discontinuing progesterone is recommended along with seeking out a formal diagnosis/treatment for potential adrenal disorders.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS14">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.14 </span>Is there any benefit to topical progesterone applications in addition to pills?<a class="ltx_ref chain" href="#S8.SS14" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS14.p1">
<p class="ltx_p">Maybe. It’s a possible alternative to pills, especially in the case of someone with a peanut allergy since the most common pill manufacturer uses peanut oil, but again dosage is unclear. Some people find more progesterone fun, if nothing else. Be safe and have fun.</p>
</div>
<div class="ltx_para" id="S8.SS14.p2">
<p class="ltx_p">For clarity: Apply creams to your inner thigh region (elsewhere if directed), or optionally on scrotal skin (it’s thin and highly vascular) in the case of sprays. And no, applying progesterone to your breasts directly is unlikely to make them grow bigger or faster compared to otherwise.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS15">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.15 </span>Can I snort progesterone powder?<a class="ltx_ref chain" href="#S8.SS15" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS15.p1">
<p class="ltx_p">Please don’t. It’s hell on your sinuses. It isn’t hard to make your own topical progesterone spray and there are guides out there. Do that instead. It’s significantly more effective, consistent, and safer.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS16">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.16 </span>Where can I get progesterone?<a class="ltx_ref chain" href="#S8.SS16" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS16.p1">
<p class="ltx_p">Progesterone tends to be more expensive through DIY sources due to the higher mass of hormones required, so ideally get it through pharmaceutical sources covered by insurance. There is also the option of grey market foreign pharmacies, which are simply pharmacies in another country, although these often require some hurdles to purchase from. Topical progesterone creams are available OTC in some locations, although it is not always the most economical depending on the concentration.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS17">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.17 </span>I would like to read more about progesterone in an HRT context. What resources should I read?<a class="ltx_ref chain" href="#S8.SS17" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS17.p1">
<p class="ltx_p">Originally I linked a document here but I opted to remove it due to a number of faults that can be misleading. The problem with progesterone is that literally nobody agrees about a single aspect of it. I don’t know a single source or study that people agree is good. Hell, people don’t even agree if the word starts with the letter “P”. <span class="ltx_text ltx_font_bold">The crucial thing to know is that progesterone is not strictly required for full feminization or good breast development, but assuming that it’s not contraindicated for you, it’s probably worth taking.</span></p>
</div>
<div class="ltx_para" id="S8.SS17.p2">
<p class="ltx_p">It should be noted that for the entire category of progestogens there are countless myths and falsehoods invented whole cloth by both proponents and detractors alike which does not make discerning truth from the already-sloppy scholarship any easier. Fantastical claims of magical benefits and fearmongering of alleged risks based on nothing are both equally unhelpful, although the later is worse in my opinion when comes from a medical authority, whether neglectful or malicious.</p>
</div>
</section>
<section class="ltx_subsection" id="S8.SS18">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">8.18 </span>Does progesterone interact with any other drugs related to HRT?<a class="ltx_ref chain" href="#S8.SS18" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S8.SS18.p1">
<p class="ltx_p">If you are taking 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S8.SS18.p1.m1"><mi>α</mi></math>-Reductase Inhibitors like <span class="ltx_text ltx_font_italic">finasteride</span> and <span class="ltx_text ltx_font_italic">dutasteride</span> (See Section <a class="ltx_ref" href="#S10" title="10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">10</span></a> “ANTIANDROGENS”, or keep reading), these can affect how progesterone naturally breaks down into <span class="ltx_text ltx_font_italic">allopregnanolone</span> which can cause adverse mood effects in some people, irrespective of how you are taking progesterone. It is not fully clear how much the administration route for the 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S8.SS18.p1.m2"><mi>α</mi></math>-Reductase Inhibitors (i.e., topical vs oral) makes a difference, but lower systemic absorption via topical application may mitigate these side effects. It is recommended to not take either of those if you are someone affected by this interaction, but it is not in all cases anyway. Note that these depressive effects may be felt for up to a month after stopping.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S9">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">9 </span>TESTOSTERONE<a class="ltx_ref chain" href="#S9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S9.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.1 </span>Why don’t we want zero testosterone?<a class="ltx_ref chain" href="#S9.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS1.p1">
<p class="ltx_p">Testosterone is an essential sex hormone which plays a key role in your health and well-being. We want to suppress it for feminization, but near-zero testosterone (less than 10 ng/dl, or 0.35 nmol/L) can cause issues such as poor libido, low energy, low strength (fatigue beyond just the strength loss of HRT), poor concentration, trouble sleeping, etc. Notably, issues very similar to having too little estrogen. Cis women also have more than zero testosterone, so that need not be the fear. <span class="ltx_text ltx_font_bold">Adequate hormone levels are important!</span></p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.2 </span>Are there ever cases where I would want to supplement testosterone?<a class="ltx_ref chain" href="#S9.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS2.p1">
<p class="ltx_p">Yes. If you are experiencing the issues of the above and your estrogen levels are otherwise good, it’s possible that you might want to supplement with a microdose of testosterone. If you wanted to improve your erectile function, minimize any atrophy before bottom surgery, or otherwise wanted to experiment with your hormones to see what feels best for you, then that might be a reason to explore testosterone in a different context that you can hopefully appreciate more compared to pre-HRT.</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.3 </span>If I wanted to supplement testosterone, how would I do it?<a class="ltx_ref chain" href="#S9.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS3.p1">
<p class="ltx_p">There’s a few possibilities. Testosterone comes in either injections or topical gels/creams, similar to estrogen as already discussed. Topical is more likely what you are going to be prescribed. Topical applications have the downsides that we have discussed for estrogen, but those are less of a concern here when precise levels are less important.</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.4 </span>What are the topical forms of testosterone?<a class="ltx_ref chain" href="#S9.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS4.p1">
<p class="ltx_p">There is gel and cream. Gel is typically what will be prescribed, but some compounding pharmacies are able to make low-penetrating cream if someone wanted just topical application on the genitals. The latter is harder to get and generally more expensive, however.</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.5 </span>Does it matter where I apply the testosterone?<a class="ltx_ref chain" href="#S9.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS5.p1">
<p class="ltx_p">It depends on if you have gel or cream. If you have the kind of localized cream as mentioned above, you would apply it as directly as mentioned. Otherwise, shoulders and upper arms are where gel should go. Make sure not to touch things until long after it dries!</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.6 </span>How much and how often should I apply testosterone?<a class="ltx_ref chain" href="#S9.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS6.p1">
<p class="ltx_p">Season to taste. This largely depends on how you are feeling. If you have too much, you might start to experience side effects of testosterone (e.g., oily skin and body hair), but only you can say what is preferred for you. A weekly injection of 5-10mg of <span class="ltx_text ltx_font_italic">testosterone cypionate</span> might work for you, but in the case of 1% topical gels which are often disbursed in 25/50mg packets, there is more variability. You almost never want even half a packet, and definitely not daily. I would suggest starting with much less than you think to see how you feel.</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.7 </span>Where would I get testosterone?<a class="ltx_ref chain" href="#S9.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS7.p1">
<p class="ltx_p">If you are an American, you would have to get a prescription or ask any juicer at your closest Planet Fitness. Elsewhere, it depends on what gym chain is closest to you. Disclaimer: This is a joke. See Question <a class="ltx_ref" href="#S6.SS11" title="6.11 Is DIY legal? ‣ 6 SOURCING VIALS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">6.11</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.8 </span>Are other steroids equivalent to testosterone in an HRT context?<a class="ltx_ref chain" href="#S9.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS8.p1">
<p class="ltx_p">Anabolic-androgenic steroids, i.e., drugs that are structurally similar to testosterone, are not all equivalent. Commonly used black market steroids like <span class="ltx_text ltx_font_italic">trenbolone acetate</span> have a laundry list of undesirable side effects, but steroids like <span class="ltx_text ltx_font_italic">nandrolone decanoate </span>are occasionally used for postmenopausal cis women due to their relatively low androgenic properties which make them very favorable for transfeminine individuals. Regardless, in America it is unlikely you will be prescribed anything other than testosterone itself, if you are able to get a prescription at all.</p>
</div>
</section>
<section class="ltx_subsection" id="S9.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">9.9 </span>What is the relationship between testosterone and <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> (DHT)?<a class="ltx_ref chain" href="#S9.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S9.SS9.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Dihydrotestosterone</span> is primarily synthesized from testosterone via the 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S9.SS9.p1.m1"><mi>α</mi></math>-Reductase enzyme with around 5% of testosterone in your body being converted. Generally speaking, if testosterone levels are suppressed (or if you have had bottom surgery) then there should not be much left to convert, but systemic levels won’t be zero because it is still locally produced. Depending on your body, this would be the main reason that you might want to consider supplementing with a 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S9.SS9.p1.m2"><mi>α</mi></math>-Reductase Inhibitor antiandrogen as discussed in the following section. As a reminder, <span class="ltx_text ltx_font_italic">dihydrotestosterone </span>is the hormone that is responsible for body hair and hair loss.</p>
</div>
<div class="ltx_para" id="S9.SS9.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">For any trans mascs reading this,</span> I will make a brief detour to note that at time of writing it is not clear what role the hormone plays with bottom growth regarding speed or total size as it relates to 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S9.SS9.p2.m1"><mi>α</mi></math>-Reductase inhibition. That is to say: it is known that <span class="ltx_text ltx_font_italic">dihydrotestosterone </span>plays a primary role in penile development, but it’s not clear how directly the lack thereof affects a trans masc person. Applying knowledge of micropenis treatment, we know that a topical cream is more effective than exogenous injections particularly with how <span class="ltx_text ltx_font_italic">dihydrotestosterone </span>cream is useful when a patient doesn’t respond to testosterone (particularly in the case of 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S9.SS9.p2.m2"><mi>α</mi></math>-Reductase deficiencies). So, food for thought. Someone get Oliver Longdick to handle the rest of this.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S10">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">10 </span>ANTIANDROGENS<a class="ltx_ref chain" href="#S10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S10.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.1 </span>What are “antiandrogens”?<a class="ltx_ref chain" href="#S10.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS1.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_italic">Antiandrogens, </span>commonly also referred to as “T blockers” or just “blockers”, as the name(s) may suggest prevent androgens (that’s what testosterone is) from acting on your body. There are many types of antiandrogens and they are commonly prescribed as part of an HRT regimen. They are needed if someone still produces testosterone and is not doing a form of HRT conducive to monotherapy, such as injections, but they are usually not desirable. It also should be noted that (most) antiandrogens do not reduce testosterone levels in any way that matters but instead simply reduce/negate effects on the body. This is relevant when interpreting lab results and such.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.2 </span>Why wouldn’t I want antiandrogens?<a class="ltx_ref chain" href="#S10.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS2.p1">
<p class="ltx_p">The main issue with most antiandrogens is that they generally have very undesirable side effects that are superfluous if testosterone is suppressed in the first place by having enough estrogen, so those side effects are being experienced despite—in most cases, at least—being rendered unnecessary by a reasonably-dosed monotherapy regimen. Bottom surgery of any kind also makes antiandrogens unnecessary in most cases.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.3 </span>When might I want antiandrogens?<a class="ltx_ref chain" href="#S10.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS3.p1">
<p class="ltx_p">If you are not most cases, if you desire peace of mind, or if your insurance requires a prescription on file before they will cover a procedure, then you may want antiandrogens. The medications used as antiandrogens might have other effects that may be desirable outside of their antiandrogen properties depending on your health situation. Additionally, if you are supplementing androgens, you may want a <span class="ltx_text ltx_font_italic">dihydrotestosterone </span>(DHT) blocker to minimize side effects related to body hair and hair loss, but be aware that this may not be the case if you are not using bioidentical testosterone (e.g. <span class="ltx_text ltx_font_italic">nandrolone decanoate</span>) because not all androgens behave the same.</p>
</div>
<div class="ltx_para" id="S10.SS3.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">It should be noted that temporarily using antiandrogens at the start of HRT when planning to perform monotherapy is unlikely to be necesssary nor is it recommended.</span> There is an adjustment period that you will experience regardless while your body adapts to the change in your primary hormones, so there is no need to overcomplicate what you are doing. Don’t worry about it.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.4 </span>What kinds of antiandrogens are there?<a class="ltx_ref chain" href="#S10.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS4.p1">
<p class="ltx_p">The main medications taken as general testosterone blockers in an HRT context are <span class="ltx_text ltx_font_italic">spironolactone</span>, <span class="ltx_text ltx_font_italic">bicalutamide</span>, and <span class="ltx_text ltx_font_italic">cyproterone acetate</span>. The main medications taken to block the conversion of testosterone into <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> (DHT) called “5<math alttext="\alpha" class="ltx_Math" display="inline" id="S10.SS4.p1.m1"><mi>α</mi></math>-Reductase Inhibitors” (5-ARI) are <span class="ltx_text ltx_font_italic">finasteride</span> and <span class="ltx_text ltx_font_italic">dutasteride</span>. There are also GnRH agonists like <span class="ltx_text ltx_font_italic">leuprolide</span> and <span class="ltx_text ltx_font_italic">triptorelin</span>, but both of those are more often used as puberty blockers in minors, although in parts of Europe they are used for adults as well.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.5 </span>When might I want to take <span class="ltx_text ltx_font_italic">spironolactone</span>?<a class="ltx_ref chain" href="#S10.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS5.p1">
<p class="ltx_p">Due to the heroic dosages and significant negative side effects required for it to function as an antiandrogen in most cases, the only time I would ever recommend taking <span class="ltx_text ltx_font_italic">spironolactone</span> would be if you would benefit from its other effects such as its antimineralocorticoid (i.e., blocking <span class="ltx_text ltx_font_italic">aldosterone</span>) properties as it relates to blood pressure management or edema. <span class="ltx_text ltx_font_bold">If you insist on taking <span class="ltx_text ltx_font_italic">spironolactone</span>, please do not take more than 100mg daily.</span> It has a bad reputation for a reason. “The Devil”, as it were.</p>
</div>
<div class="ltx_para" id="S10.SS5.p2">
<p class="ltx_p">In case you are unfamiliar, some of the many side effects include: brain fog, lethargy, poor memory, increased urination frequency, low blood pressure, low sodium / electrolyte imbalance, etc. In other words, <span class="ltx_text ltx_font_italic">spironolactone</span> is a blood pressure lowering dieurtic that is a mediocre antiandrogen which is typically prescribed at high dosages in an otherwise-healthy population for questionably-effective off-label use. In any other healthcare context this would (or SHOULD!) be highly unadvisable given the undesirable side effect profile and the widely-available preferable alternatives that already exist, but that’s the state of trans healthcare for you.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.6 </span>When might I want to take <span class="ltx_text ltx_font_italic">bicalutamide</span>?<a class="ltx_ref chain" href="#S10.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS6.p1">
<p class="ltx_p">If you are going to take an antiandrogen, <span class="ltx_text ltx_font_italic">bicalutamide</span> is likely the one to take. It is generally well tolerated, barring 1% cases of abnormal liver function test results and symptoms of liver dysfunction, but otherwise performs the job with relatively minimal side effects. <span class="ltx_text ltx_font_bold">If you take <span class="ltx_text ltx_font_italic">bicalutamide</span>, ensure regular liver function tests to make sure that your results are in range. </span>The liver risks are dependent on your body rather than cumulative so any problem would likely present itself within the first year. Otherwise, there should be no issues.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.7 </span>When might I want to take <span class="ltx_text ltx_font_italic">cyproterone acetate</span>?<a class="ltx_ref chain" href="#S10.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS7.p1">
<p class="ltx_p">Likely never. Take <span class="ltx_text ltx_font_italic">bicalutamide</span> instead.</p>
</div>
<div class="ltx_para" id="S10.SS7.p2">
<p class="ltx_p">The long term risk profile is poor and there is no situation that I can think of in which I would recommend this over an alternative solution. You can do everything <span class="ltx_text ltx_font_italic">cyproterone acetate</span> can by just taking more estrogen and adding progesterone to your regimen.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.8 </span>When might I want to take <span class="ltx_text ltx_font_italic">dutasteride</span>?<a class="ltx_ref chain" href="#S10.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS8.p1">
<p class="ltx_p">If you are extremely concerned about possible hair loss and/or want to maximize your chances for hair regrowth, you may want to take <span class="ltx_text ltx_font_italic">dutasteride</span>. If your testosterone is otherwise suppressed then it theoretically shouldn’t have much benefit as your <span class="ltx_text ltx_font_italic">dihydrotestosterone</span> levels should be relatively low, but bodies can be complicated, so it may be something of interest to you. Also, see Question <a class="ltx_ref" href="#S11.SS14" title="11.14 How do I prevent/revert hair loss? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.14</span></a>.</p>
</div>
<div class="ltx_para" id="S10.SS8.p2">
<p class="ltx_p">It should be noted that <span class="ltx_text ltx_font_italic">dutasteride</span> can cause adverse mood effects in some people, in which case stopping is strongly recommended. Note as well that these depressive effects may be felt for up to a month after stopping.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.9 </span>When might I want to take <span class="ltx_text ltx_font_italic">finasteride</span>?<a class="ltx_ref chain" href="#S10.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS9.p1">
<p class="ltx_p">If <span class="ltx_text ltx_font_italic">dutasteride </span>is not something prescribed to you or if your insurance mandates <span class="ltx_text ltx_font_italic">finasteride</span> specifically to cover a hair treatment. Otherwise, <span class="ltx_text ltx_font_italic">dutasteride</span> is preferred as it is more effective and better tolerated.</p>
</div>
<div class="ltx_para" id="S10.SS9.p2">
<p class="ltx_p">It should be noted that <span class="ltx_text ltx_font_italic">finasteride</span> can cause adverse mood effects in some people, in which case stopping is strongly recommended. Note as well that these depressive effects may be felt for up to a month after stopping.</p>
</div>
</section>
<section class="ltx_subsection" id="S10.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">10.10 </span>Where can I get antiandrogens?<a class="ltx_ref chain" href="#S10.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S10.SS10.p1">
<p class="ltx_p">Aside from being prescribed them by your doctor or perhaps available over-the-counter, there is also the option of grey market foreign pharmacies. These are simply pharmacies in another country, although these often take some hurdles to purchase from. <span class="ltx_text ltx_font_italic">Dutasteride</span> and <span class="ltx_text ltx_font_italic">finasteride </span>are generally the easiest to get over-the-counter because of their commonality as hair loss medication.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S11">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">11 </span>MYTHS AND MISCS<a class="ltx_ref chain" href="#S11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S11.SSx1">
<h3 class="ltx_title ltx_title_subsection">Common Questions<a class="ltx_ref chain" href="#S11.SSx1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S11.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.1 </span>Should I be worried about blood clots?<a class="ltx_ref chain" href="#S11.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS1.p1">
<p class="ltx_p">Yes and no. It is true that there is a correlation between estrogen dosages/levels and blood clot risk, but this is primarily related to the route of administration and the type of estrogen. Synthetic estrogens are the rightful cause of scorn and do lead to significantly increased blood clot risk, but bioidentical estrogens are not as concerning. In particular, the route of administration makes a major difference. Oral bioidentical estrogen passes through the liver which is what causes the increased blood clot risk. Injections bypass the liver, and there’s no evidence to suggest nor reason to believe that injections of bioidentical estrogen provide any significant risk increase beyond the innate differences between testosterone and estrogen. The pervasive fearmongering towards all estrogen has persisted for decades despite these differences.</p>
</div>
<div class="ltx_para" id="S11.SS1.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">If you are undergoing surgery, please know that pausing hormones out of concern for blood clots is no longer recommended by WPATH.</span> Many surgeons still include it in their pre-surgery guidelines out of concern for blood clots, but this is torture that has been disproven and even WPATH doesn’t recommend it anymore. Remarkable, I know. Per <a class="ltx_ref ltx_href" href="https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644" title="">WPATH SOC 8 Statement 12.19</a>:</p>
<blockquote class="ltx_quote ltx_blockquote">
<p class="ltx_p"><span class="ltx_text ltx_inline-quote">After careful examination, investigators have found no perioperative increase in the rate of VTE [KT: <span class="ltx_text ltx_font_italic">venous thromboembolism</span>, i.e. a blood clot] among transgender individuals undergoing surgery, while being maintained on sex steroid treatment throughout when compared with that among patients whose sex steroid treatment was discontinued preoperatively (Gaither et al., 2018; Hembree et al., 2009; Kozato et al., 2021; Prince &amp; Safer, 2020).</span></p>
</blockquote>
<p class="ltx_p">I should put this in another question entirely, but to not break links, it would have to be at the bottom of a section and I think this is too important for that, so I note it here. A very important clarification that I should have had sooner.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.2 </span>Is it okay to use nicotine while on HRT?<a class="ltx_ref chain" href="#S11.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS2.p1">
<p class="ltx_p">This is related to the above question. <span class="ltx_text ltx_font_bold">Nicotine usage on HRT, especially if you’re on pills, compounds your risk of a blood clot on top of all the other reasons that nicotine is not good.</span> This extends to all forms of nicotine usage, but obviously smoking is by far the worst. You really do not want a blood clot. Even if you are not on pills, nicotine disrupts the way estrogen is metabolized and can lead to significantly reduced feminization effects. This aspect is understudied but community anecdotal reports are common. It’s not easy to quit, but I believe in you. There are good resources out there and strategies like tapering down by using patches really do work. You got this.</p>
</div>
<div class="ltx_para" id="S11.SS2.p2">
<p class="ltx_p">However, to be abundantly clear, <span class="ltx_text ltx_font_bold">this does not mean that you cannot or should not take estrogen. The downsides of not taking estrogen at all far exceed the downsides of using nicotine.</span> This section is simply seeking to make you aware of any increased risks and potentially slower transition as a very strong recommendation and encouragement to quit. One step at a time.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.3 </span>Is there benefit to starting at a low dosage vs a high dosage?<a class="ltx_ref chain" href="#S11.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS3.p1">
<p class="ltx_p">To the best of knowledge, no. Sex hormones are not like other drugs that need to be titrated to manage side effects as we know the dosages that work for the majority of people, so personally I view “starter dosages” and “antiandrogen first” regimens as medical abuse. Some people believe that mimicking the slow timeline of puberty might be best (even though there are far more things happening than just estrogen levels), but there’s no evidence to support this. An orchiectomy day one might be best for all we know, but who is going to do that the moment they decide they are trans and/or want to start HRT?</p>
</div>
<div class="ltx_para" id="S11.SS3.p2">
<p class="ltx_p">Reframing this in another way: <span class="ltx_text ltx_font_bold">there is no reason to believe that “starting slowly” on a dosage below the typical range is advantageous or preferable for feminization outcomes.</span> There isn’t a concern of going “too fast” or anything like that. Both doctors and other trans women seemingly invent new myths by the day.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.4 </span>Does body weight affect dosage?<a class="ltx_ref chain" href="#S11.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS4.p1">
<p class="ltx_p">No. Because there is no “optimal” blood level for estrogen and because the therapeutic range of acceptable levels is so wide, <span class="ltx_text ltx_font_bold">body weight does not meaningfully affect dosage for HRT.</span> It is for the same reason that slight deviations in dosage are unlikely to affect how you feel. There is no such thing as being “too light” or “too heavy” for HRT in any capacity.</p>
</div>
<div class="ltx_para" id="S11.SS4.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Adjusting your dosage in increments of 0.1mg is a difference that should not be expected to be perceived simply because our bodies are not sensitive enough to such exact measurements,</span> let alone the high possibility of imprecision when performing an injection that makes that certainty of this measurement unlikely. In other words, the accuracy of your dosage is more important than the precision.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.5 </span>Is there such a thing as starting estrogen too late?<a class="ltx_ref chain" href="#S11.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS5.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> No matter when you start, estrogen is able to do a LOT and a proper regimen will be able to have powerful results. Sex hormones are some of the strongest hormones in our body in terms of our appearance. Everybody always wishes that they could’ve started sooner, but that’s no reason not to start now. Even if you’ve been on estrogen for years, there is still a benefit to be had in improving the quality of your regimen.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.6 </span>Does feminization / breast development stop after X years?<a class="ltx_ref chain" href="#S11.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS6.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> There is not an arbitrary time where estrogen suddenly stops working. Various numbers are given and usually it’s either 1) entirely made up or 2) pointing to a study that only went for X years. Doctors in particular love to tell trans women not to expect more than B cup breasts (which isn’t even how breast sizing <span class="ltx_text ltx_font_italic">works</span>, but I digress) or for any growth after 2 years, but this is simply not true. There are cases of people who restarted estrogen after stopping for many years and still experiencing new growth.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.7 </span>I haven’t seen any changes in years on injections. Would swapping back to pills make a difference?<a class="ltx_ref chain" href="#S11.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS7.p1">
<p class="ltx_p">Maybe, but maybe not. There are some anecdotes of people swapping back from injections to pills (or adding pills on top of injections) and experiencing more breast growth after “stalling out”, but the mechanism is not clear. There is speculation that the E1:E2 ratio (<span class="ltx_text ltx_font_italic">estrone</span> : <span class="ltx_text ltx_font_italic">estradiol</span>) heavily weighted towards E1 with oral pills compared to E2 for injections might make a difference for some people, although <span class="ltx_text ltx_font_italic">estrone</span> is not typically associated with feminization. There likely are other factors at play, but you are free to experiment if you wish. Data is limited.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.8 </span>Is low energy and low libido normal on HRT?<a class="ltx_ref chain" href="#S11.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS8.p1">
<p class="ltx_p">Generally, no. How libido is expressed changes in the beginning, but the vast majority of the time that someone experiences abnormally low libido it’s because they haven’t gotten their hormones sorted. The same goes for low energy. Get your hormones squared away, and barring that, check your diet/vitamins next. Make sure you don’t randomly have critically low vitamin D levels or something like that. It happens more often than you think.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.9 </span>I hear about [random drug / strategy] that my friend said helps feminization. Does it actually?<a class="ltx_ref chain" href="#S11.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS9.p1">
<p class="ltx_p">Maybe, but probably not. There is a lot of wild speculation about ways to achieve feminization goals, but many of them are akin to snake oil or have potentially serious risks far beyond HRT itself. You have the right to bodily autonomy and I cannot stop you, but I can encourage you to be smart about what you are doing. The more you get into the weeds of biology as it relates to transition, the shakier the ground becomes as quality data becomes less and less available. Desperation can lead to a lot of unwise and dangerous decisions. So be smart, and be safe.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.10 </span>Do we want to mimic the estrogen cycle of cis women?<a class="ltx_ref chain" href="#S11.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS10.p1">
<p class="ltx_p">Arguably no. This is controversial, but I am of the belief that because we (well, most of us) do not have a uterus and corresponding menstrual cycle synced to our hormone levels, then there is no reason we should strive to copy that behavior. This is an <span class="ltx_text ltx_font_italic">is-ought</span> problem, in my view. The primary hormonal concern for most trans women is testosterone suppression which necessitates consistently high enough levels (barring post bottom surgery, where there is no testosterone to suppress), so high fluctuation and/or relatively low levels are likely to cause undue distress. You’re welcome to experiment, of course. Especially if testosterone suppression is no longer a concern for you. See Question <a class="ltx_ref" href="#S8.SS11" title="8.11 Is there any benefit to “cycling” progesterone? ‣ 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">8.11</span></a>, and see below.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.11 </span>Do trans women experience periods?<a class="ltx_ref chain" href="#S11.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS11.p1">
<p class="ltx_p">Similar to the last question, it’s important to understand what is happening. The unique hormone curve produced by your particular ester, your dosage, and your frequency can cause changes in your mood as your estrogen levels oscillate between injections. Some trans women liken this phenomenon to a period, but the underlying cause for these physiological changes is different and is usually a sign that your regimen needs tweaking so that you feel the best that you can as suffering is not virtuously feminine. Pain and discomfort are not requirements for womanhood nor should we assert ourselves based on bioessentialist arguments. The exception here are the intersex trans women who have a uterus and literally are having a period, in which case: yeah duh. See Question <a class="ltx_ref" href="#S11.SS35" title="11.35 What’s the difference between intestinal cramps and uterine cramps? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.35</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.12 </span>Can too much estrogen convert to testosterone?<a class="ltx_ref chain" href="#S11.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS12.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> Aromatase is the enzyme responsible for converting testosterone into estrogen, but there is no mechanism to convert estrogen into testosterone. This cannot happen. This is a completely false myth and you should be immediately wary of the knowledge level of anyone who says it to you. Unfortunately, it is doctors who repeat this myth the most.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.13 </span>Does bottom surgery cause an increase in testosterone?<a class="ltx_ref chain" href="#S11.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS13.p1">
<p class="ltx_p">No. This is not a thing. There is not a magic mechanism that suddenly causes testosterone to increase the moment that testicles are removed. Even if magic was stored in the balls, this simply isn’t how hormone production works. “Well, your adrenals…” They don’t work like that either. The only possible rare exception would be undiagnosed adrenal hyperandrogenism conditions that were suppressed by an antiandrogen like <span class="ltx_text ltx_font_italic">spironolactone </span>prior to surgery which might show itself after antiandrogens are ceased. Please stop repeating this myth.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS14">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.14 </span>How do I prevent/revert hair loss?<a class="ltx_ref chain" href="#S11.SS14" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS14.p1">
<p class="ltx_p">Mechanically, it is pretty simple. A standard HRT regimen alone is borderline magic (don’t ask where the magic is stored) in this regard already, but the inclusion of 5<math alttext="\alpha" class="ltx_Math" display="inline" id="S11.SS14.p1.m1"><mi>α</mi></math>-Reductase Inhibitors (5-ARI) as discussed in Section <a class="ltx_ref" href="#S10" title="10 ANTIANDROGENS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">10</span></a> “ANTIANDROGENS” is recommended in more extreme cases to completely halt any loss. Topical minoxodil 5% is the only thing that works to firm up your hairline beyond hormones alone, but keep in mind that aside from miracle cases, you’re only saving dying/dormant follicles. Dead follicles don’t come back.</p>
</div>
<div class="ltx_para" id="S11.SS14.p2">
<p class="ltx_p">If this alone is insufficient for you, hair transplant technology has improved significantly. The Follicular Unit Extraction (FUE) procedure is what you want to look into. Here is where in the future I will link a guide written by an expert on getting insurance to cover that, once she writes it. This is peer pressure. Watch this space.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS15">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.15 </span>Does exercise affect feminization?<a class="ltx_ref chain" href="#S11.SS15" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS15.p1">
<p class="ltx_p">Probably. HRT causes gradual body recomposition, so you can help encourage your body to shift through exercise. Keep in mind that this process is VERY SLOW, so it is crucial that you eat enough to fuel how patient you have to be. The growth hormones from muscle stimulation via strength training also play a role in breast development, so it’s probably a good thing even aside from the rest of the obvious health benefits of exercise.</p>
</div>
<div class="ltx_para" id="S11.SS15.p2">
<p class="ltx_p">This is NOT just the writer’s barely-disguised fetish; strength training is important for your health! I mention this because a lot of trans women believe that touching a dumbbell will make them look like the hulk. I get it, but if you have no testosterone in you and you aren’t on steroids, then you aren’t going to look like that. Let alone the constant time, effort, and diligence required to even get close.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS16">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.16 </span>What should I exercise then?<a class="ltx_ref chain" href="#S11.SS16" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS16.p1">
<p class="ltx_p">Cardio is useful for living which is important. Lower body exercises will fill out your hips and glutes to accentuate your figure. Upper body exercises will improve your posture and support your breasts which will make them look bigger. In other words, everything. You’re on estrogen. Have you seen cis women athletes? Exercise will feminize you.</p>
</div>
<div class="ltx_para" id="S11.SS16.p2">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://docs.google.com/document/d/1-NyE5EY5TTaRRMhk7HlTbKJ7HifjEsA4jlDO1qKQVl0/edit?tab=t.0" title="">This guide was shared with me</a> <span class="ltx_text" style="color:#FF0000;">(Warning: Google Docs link)</span> and looks to be a good starting place. I will note that there aren’t particular exercises that feminize vs masculinize as bodies don’t work like that, but you may wish to focus more on lower body exerices and flexibility more than the typical lifter.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS17">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.17 </span>Can estrogen really cause height shrinkage?<a class="ltx_ref chain" href="#S11.SS17" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS17.p1">
<p class="ltx_p">Yes. It is possible that it’s related to water content changes within tendons and ligaments, but it is not something that has been studied so the cause is fully speculation. Scientists: free study idea!</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS18">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.18 </span>Can estrogen really cause foot shrinkage?<a class="ltx_ref chain" href="#S11.SS18" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS18.p1">
<p class="ltx_p">Yes. See above.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS19">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.19 </span>Can estrogen really cause any other kinds of shrinkage?<a class="ltx_ref chain" href="#S11.SS19" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS19.p1">
<p class="ltx_p">Well, “use it or lose it” like they always say.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SSx2">
<h3 class="ltx_title ltx_title_subsection">Sexual Health<a class="ltx_ref chain" href="#S11.SSx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S11.SS20">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.20 </span>How do I improve erectile function on HRT?<a class="ltx_ref chain" href="#S11.SS20" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS20.p1">
<p class="ltx_p">Aside from using it regularly, ways to improve erectile function include: 1) Improving your fitness and physical health, particularly your cardiovascular ability; 2) consider medication like <span class="ltx_text ltx_font_italic">tadalafil</span> or <span class="ltx_text ltx_font_italic">sildenafil</span>; and 3) consider testosterone supplementation (see Section <a class="ltx_ref" href="#S9" title="9 TESTOSTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">9</span></a> “TESTOSTERONE”).</p>
</div>
<div class="ltx_para" id="S11.SS20.p2">
<p class="ltx_p">If you would like to read a longer explanation for how erectile function works, <a class="ltx_ref ltx_href" href="https://stainedglasswoman.substack.com/p/how-to-maintain-your-penis-function" title="">this Substack article</a> provides a good overview of the topic.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS21">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.21 </span>How do I increase cum/pre-cum volume on HRT?<a class="ltx_ref chain" href="#S11.SS21" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS21.p1">
<p class="ltx_p">Don’t be embarrassed, it’s a common question. Sunflower lecithin and pygeum increase both of those. It seems to also make a difference for vaginal wetness and arousal for those who have had bottom surgery, but data and anecdotes are limited so it’s hard to say. Otherwise just be sure you drink enough water and have your nutrition in check.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS22">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.22 </span>Can I lactate on HRT?<a class="ltx_ref chain" href="#S11.SS22" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS22.p1">
<p class="ltx_p">Yes. Domperidone, fenugreek, sunflower lecithin, ample estrogen, and ample progesterone. Get a pump. Knock yourself out.</p>
</div>
<div class="ltx_para" id="S11.SS22.p2">
<p class="ltx_p">It should be noted that domperidone has side effects and risks associated with it, and that ability to lactate does not affect breast development. Newman-Goldfarb protocols would be what you want to look into.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS23">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.23 </span>Can HRT change your senses and your perceptions, i.e. smell?<a class="ltx_ref chain" href="#S11.SS23" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS23.p1">
<p class="ltx_p">You very likely were dissociated and depressed for years prior to starting HRT. The world is more vibrant now because you are no longer dissociating 24/7. The wonders of modern medicine!</p>
</div>
<div class="ltx_para" id="S11.SS23.p2">
<p class="ltx_p">It can, however, directly change your eye prescription. That can definitely happen.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS24">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.24 </span>Can HRT change your sexuality?<a class="ltx_ref chain" href="#S11.SS24" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS24.p1">
<p class="ltx_p">Similar to being dissociated as with above, HRT often incurs a lot more openness and acceptance with yourself which can cause a shift in how your sexuality presents itself. It is largely a semantics argument as to whether that is chemical or behavioral. A matter of perspective.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS25">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.25 </span>Should I be on PrEP?<a class="ltx_ref chain" href="#S11.SS25" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS25.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">Yes.</span> <a class="ltx_ref ltx_href" href="https://en.wikipedia.org/wiki/Pre-exposure_prophylaxis_for_HIV_prevention" title=""><span class="ltx_text ltx_font_italic">Pre-exposure prophylaxis for HIV prevention</span> (PrEP)</a> is a category of antiviral drugs for the purpose of preventing HIV/AIDS. This is not directly related to HRT, but it is common for trans women to be at elevated risk of HIV/AIDs. Given the history of the AIDS pandemic, PrEP is a miracle of modern medicine that should interest you. <span class="ltx_text ltx_font_bold">Note: There is no effect of any PrEP drug on HRT so you are encouraged to be on PrEP.</span></p>
</div>
<div class="ltx_para" id="S11.SS25.p2">
<p class="ltx_p">If you are sexually active, you should strongly consider being on PrEP. Even if you are not sexually active, trans women are at a significantly higher risk of sexual violence, so you should still strongly consider being on PrEP. In most places you are likely to be prescribed <span class="ltx_text ltx_font_italic">Truvada</span> as a once-daily pill, although if you experience nausea as a side effect you can likely swap to <span class="ltx_text ltx_font_italic">Descovy</span> with no change in effectiveness. In the US, insurance commonly does not cover <span class="ltx_text ltx_font_italic">Descovy</span> unless you have tried or say you have tried <span class="ltx_text ltx_font_italic">Truvada</span>. The novel drug <span class="ltx_text ltx_font_italic">lenacapavir</span> as a twice-yearly injection is expected to make PrEP significantly easier as access becomes more widely available, if current options are prohibitive for you.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SSx3">
<h3 class="ltx_title ltx_title_subsection">Medical Malpractice<a class="ltx_ref chain" href="#S11.SSx3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S11.SS26">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.26 </span>I heard that injections are actually less stable because you do them less frequently. Is that true?<a class="ltx_ref chain" href="#S11.SS26" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS26.p1">
<p class="ltx_p">Only if you follow the dipshit WPATH SOC 8 guidelines that list a recommended regimen of <span class="ltx_text ltx_font_italic">estradiol valerate</span> or <span class="ltx_text ltx_font_italic">estradiol cypionate</span> in the range of 5-30mg every two weeks which, to be abundantly clear, you absolutely should never do in a million years. “Do no harm”, my ass.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS27">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.27 </span>But my doctor said-?<a class="ltx_ref chain" href="#S11.SS27" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS27.p1">
<p class="ltx_p">The average doctor has essentially no training in anything related to trans healthcare, and <a class="ltx_ref ltx_href" href="https://www.endocrine.org/news-and-advocacy/news-room/2017/endocrinologists-want-training-in-transgender-care" title="">4/5 endocrinologists have never had any formal training in trans healthcare</a>. It is most likely that you are their first trans patient and that they are inexperienced in the practical elements of managing a trans patient. Even among doctors who care a lot, they are often limited by conservative standards of care that they are forced to follow which do not always align with the care best for you. See above.</p>
</div>
<div class="ltx_para" id="S11.SS27.p2">
<p class="ltx_p">Please also be aware of “trans broken arm syndrome”, aka the tendency of doctors to blame everything on HRT. If your arm is broken, it’s probably not “because of those hormones”!</p>
</div>
<div class="ltx_para" id="S11.SS27.p3">
<p class="ltx_p">And I should put this as a separate question but I don’t want to break the formatting: in line with medical malpractice, there is no situation in which it is reasonable for a doctor to request to see or feel your breasts to “monitor growth” or for any other reason. It is far less common these days, thankfully, but it is sexual assault and completely unacceptable.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS28">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.28 </span>My doctor won’t prescribe me injections. What do I do?<a class="ltx_ref chain" href="#S11.SS28" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS28.p1">
<p class="ltx_p">Attempt to convince them, replace them, or seek DIY sources. Do not let a gatekeeping medical establishment prevent you from receiving the appropriate care that you deserve. <span class="ltx_text ltx_font_bold">The most crucial aspect of interfacing with the medical system while trans is that you have to advocate for yourself. </span>This is compounded with disability, ethnicity, and other afflictions that scare doctors like womanhood.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS29">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.29 </span>How does HRT for menopausal cis women relate to HRT for trans women?<a class="ltx_ref chain" href="#S11.SS29" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS29.p1">
<p class="ltx_p">While we generally have different goals and crucially have very different dosage requirements, there is an immense amount of overlap in experience for trans women and menopausal cis women. Medical misogyny in the form of incompetence, dismissiveness, antagonism, and/or misinformation is something that we unfortunately both experience. It is for this reason that it is paramount to build solidarity on this front. To give an example of what I mean, <a class="ltx_ref ltx_href" href="https://www.youtube.com/watch?v=W0XW6av2wLQ" title="">the first 30-40 minutes of this interview</a> will likely sound extremely familiar to you if you would like to raise your blood pressure. The interviewee herself notes the connection too! The WHI ruined the lives of countless women.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SSx4">
<h3 class="ltx_title ltx_title_subsection">Intersexuality and Comorbidities<a class="ltx_ref chain" href="#S11.SSx4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S11.SS30">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.30 </span>What’s up with Ehlers-Danlos Syndrome?<a class="ltx_ref chain" href="#S11.SS30" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS30.p1">
<p class="ltx_p">This connective tissue disorder doesn’t actually relate to HRT but a lot of trans people have it so congrats in case this is how you learned that you do too. Aside from general cardiovascular long term concerns to maybe look into, keep up with strength training so that your joints work. Look into that elsewhere though. See Question <a class="ltx_ref" href="#S11.SS16" title="11.16 What should I exercise then? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.16</span></a>.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS31">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.31 </span>What kind of intersex things should I keep in mind?<a class="ltx_ref chain" href="#S11.SS31" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS31.p1">
<p class="ltx_p">Throughout this guide, I have mentioned intersex conditions vaguely. Below is a short list of things that might be useful for you to know in your travels for yourself or for a friend.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS32">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.32 </span>What’s up with Klinefelter Syndrome?<a class="ltx_ref chain" href="#S11.SS32" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS32.p1">
<p class="ltx_p">This is a relatively (considering chromosomal mutations) common intersex-related condition that some trans women might not realize that they have as the two can overlap. It generally presents as low testosterone at the start of puberty. Good for you to know the name, just in case.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS33">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.33 </span>What’s up with Persistent Müllerian Duct Syndrome (PMDS)?<a class="ltx_ref chain" href="#S11.SS33" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS33.p1">
<p class="ltx_p">Another “I’m putting this here because this might be the first time you’ve even heard of the term” intersex-related condition that can affect some trans women, however few that may be since we don’t have numbers. The possible presence of an underdeveloped uterus leads to some possible complications and oddities. You probably extra want to have progesterone to avoid uterine cancer risks.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS34">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.34 </span>What’s up with ovotesticular syndrome?<a class="ltx_ref chain" href="#S11.SS34" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS34.p1">
<p class="ltx_p">This intersex condition in particular can cause early level fluctuations which made lead to confusing test results due to the presence of both ovarian and testicular tissues, either separate or combined in an <span class="ltx_text ltx_font_italic">ovotestis</span>. This presents in many different ways which HRT can interact with as you begin suppressing <span class="ltx_text ltx_font_italic">luteinizing hormone</span> (LH). A uterus may or may not be present, multiple sets of gonads could be present, and/or it could look outwardly typical.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS35">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.35 </span>What’s the difference between intestinal cramps and uterine cramps?<a class="ltx_ref chain" href="#S11.SS35" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS35.p1">
<p class="ltx_p">These are commonly misattributed in early transition as a symptom of intersex conditions. Intestinal cramps are widespread and diffuse across your abdomen, whereas uterine cramps are highly concentrated in a location somewhere below your belly button and tend to be sharp stabs/contractions in rapid succession. Like the inside of your body is used as a stress ball. Very different!</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS36">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.36 </span>What about other intersex conditions?<a class="ltx_ref chain" href="#S11.SS36" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS36.p1">
<p class="ltx_p">I have listed a few notable ones, but there are far more expressions and ways of testing them that go far beyond the scope of this guide. Anecdotally, prevalence is higher than average among trans people so basic familiarity with this is useful.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SSx5">
<h3 class="ltx_title ltx_title_subsection">Oddball Questions<a class="ltx_ref chain" href="#S11.SSx5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
</section>
<section class="ltx_subsection" id="S11.SS37">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.37 </span>Many DIY sources only take crypto. Is that required? How does that work?<a class="ltx_ref chain" href="#S11.SS37" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS37.p1">
<p class="ltx_p">There are other guides that cover this in better depth than I can on how to use crypto safely, including some vendors who have their own guides. But yes, crypto is often required for a lot of reasons. “Crypto” means a lot of things, but using it as a currency was the original point after all. It’s mostly just a pain in the ass. Monero (XMR) is good.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS38">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.38 </span>What about Selective Estrogen Receptor Modulator (SERM) drugs for nonbinary regimens?<a class="ltx_ref chain" href="#S11.SS38" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS38.p1">
<p class="ltx_p">Some people use SERMs as a part of a transition that is not looking to feminize as much for a more androgynous look, but it’s pretty much entirely uncharted waters thus why their mention is otherwise absent from this guide. You’re on your own if that’s something you want to explore, so please be safe. I don’t personally rate them very highly as I have not seen much to suggest that they work well for how people usually think or want them to work, at least not without a lot more caveats, but obviously there are people who like them. It’s just not something I feel comfortable giving recommendations for.</p>
</div>
<div class="ltx_para" id="S11.SS38.p2">
<p class="ltx_p">The various proposed nonbinary regimens are often highly individualized because they are specific to what a persons’ particular goals are. All HRT should be individualized to a degree, but there is often more variation in desired outcomes when people ask about androgyny. Hormonally, it is nontrivial. Everything stated in this guide should be treated solely as a starting place if you are wanting to experiment with something more complicated, but do remember that there is much more to achieving transition goals than just hormones alone.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS39">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.39 </span>Are things like “herbal HRT” or “phytoestrogens” legitimate?<a class="ltx_ref chain" href="#S11.SS39" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS39.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">No.</span> If someone is telling you they have “herbal HRT”, they are telling you they have snake oil. The only thing that is going to feminize you is estrogen, not plant estrogens. No amount of “natural” products are a replacement for estrogen itself. This isn’t a common scam and you probably already know, but just in case you run into it, now you know for sure. If it smells like bullshit, it’s probably bullshit. Unless we’re talking about bug steroids in which case yeah those are actually cool. Won’t feminize you though.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS40">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.40 </span>Is the Reddit Doctor that people constantly talk about Good?<a class="ltx_ref chain" href="#S11.SS40" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS40.p1">
<p class="ltx_p">No.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS41">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.41 </span>I hear DIY estrogen is made in a bathtub. Is that true?<a class="ltx_ref chain" href="#S11.SS41" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS41.p1">
<p class="ltx_p">No. I honestly have no idea where or why this joke started that people now take seriously, but there’s no step in any process where a bathtub would even be considered. Don’t believe everything you read online. I don’t even know what you could even theoretically do with a bathtub, unless you think estrogen vials are full of the bathwater of trans women. I don’t know why you would think that though. It’s obviously cum.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS42">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.42 </span>How does HRT affect fertility?<a class="ltx_ref chain" href="#S11.SS42" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS42.p1">
<p class="ltx_p">It is important to understand that this is extremely understudied so exact figures cannot be stated, and given the seriousness of pregnancy, I urge you to practice safe sex and lean on the side of caution where possible. HRT itself can, and likely will, make you infertile eventually, but only through full suppression of <a class="ltx_ref ltx_href" href="https://en.wikipedia.org/wiki/Hypothalamic-pituitary-gonadal_axis" title="">the HPG axis</a> (See Question <a class="ltx_ref" href="#S2.SS3" title="2.3 How does monotherapy work? ‣ 2 WHY INJECTIONS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">2.3</span></a>) over a long time span. In other words, if you haven’t had bottom surgery of any kind and you are on an HRT regimen that is less capable of HPG axis suppression (such as pills), then this is more of a consideration.</p>
</div>
<div class="ltx_para" id="S11.SS42.p2">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">If the HPG axis is not suppressed then it is fully possible to impregnate someone</span>, and the timeline for sperm maturation is long enough that this is true even after the HPG axis has been initially suppressed for <span class="ltx_text ltx_font_bold">multiple months</span>. Please take this very seriously. Full HPG axis suppression for at minimum six months, perhaps closer to a year out of an abundance of caution, is recommended.</p>
</div>
</section>
<section class="ltx_subsection" id="S11.SS43">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">11.43 </span>Is infertility from HRT reversible?<a class="ltx_ref chain" href="#S11.SS43" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S11.SS43.p1">
<p class="ltx_p">It is theoretically possible to reverse HRT-induced infertility, assuming you weren’t already infertile prior to HRT (a large assumption!), but there are not many documented cases of this so the full efficacy of fertility restoration after long-term HRT is unknown. The process would involve restarting the HPG axis with a variety of medications along with entirely stopping HRT, which would in essence require a hormonal detransition for likely six months at minimum, and even then sperm quality is not certain or guaranteed. It is not something that should be planned for, to say the least, so planning around it would be wise. A sperm bank would be recommended before or early in HRT, financially permitting, if potential biological children are a priority and if a future relationship where that is possible/desired is likely.</p>
</div>
</section>
</section>
<section class="ltx_section" id="S12">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">12 </span>CREATINE<a class="ltx_ref chain" href="#S12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<section class="ltx_subsection" id="S12.SS1">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.1 </span>What is creatine?<a class="ltx_ref chain" href="#S12.SS1" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS1.p1">
<p class="ltx_p">Creatine is an organic compound in your muscles and in your brain. It recycles ADP into ATP which is important for energy production in your body, especially initial high burst applications before other energy systems take over.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS2">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.2 </span>Isn’t it like a steroid or something that bodybuilders use?<a class="ltx_ref chain" href="#S12.SS2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS2.p1">
<p class="ltx_p">No. Bodybuilders and athletes like it because having more energy means more activity before getting tired. They aren’t the only ones who use it since it is basically the #1 supplement in terms of things that are actually useful and are actually researched.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS3">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.3 </span>How is creatine related to HRT?<a class="ltx_ref chain" href="#S12.SS3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS3.p1">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">It isn’t!</span> But it’s something I yell about because I think it’s good and I am tired of repeating myself because people keep asking and you’re reading this anyway, aren’t you? I love a captive audience. My standup routine is at the bottom.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS4">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.4 </span>Okay well why should I take creatine then?<a class="ltx_ref chain" href="#S12.SS4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS4.p1">
<p class="ltx_p">What a great question! It’s good for your brain and your muscles. Creatine is often found in relatively low concentrations for many people depending on their diet, especially people who don’t eat meat. There is compelling research about various chronic fatigue and post-viral conditions (long COVID in particular) being related to depleted creatine reserves in the brain, so some people find cognitive benefits from supplementing it. It isn’t magic but it is dirt cheap so it is worth trying in my opinion.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS5">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.5 </span>What are the forms?<a class="ltx_ref chain" href="#S12.SS5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS5.p1">
<p class="ltx_p">Just <span class="ltx_text ltx_font_italic">creatine monohydrate</span> powder is what you want. The pills tend to be low dosage and are up charging you anyway, while gummies often destroy the creatine in the creation of the gummy. A lot of brands include creatine in some sort of mix but the pure stuff is usually cheaper.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS6">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.6 </span>How do I take it then?<a class="ltx_ref chain" href="#S12.SS6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS6.p1">
<p class="ltx_p">The general recommendation is 5-10g daily dissolved in some sort of liquid. It dissolves best in things that aren’t just water. It’s mostly flavorless, so just throw a scoop or two in your coffee or a smoothie and call it a day. It can be a little chalky or gritty depending on the quantity and the fluid.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS7">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.7 </span>Does it matter when I take it?<a class="ltx_ref chain" href="#S12.SS7" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS7.p1">
<p class="ltx_p">Not really. It doesn’t have an immediate effect like that which is why it’s silly that it’s microdosed in pre-workout mixes. Take it whenever it’s convenient for you.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS8">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.8 </span>How does it work then?<a class="ltx_ref chain" href="#S12.SS8" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS8.p1">
<p class="ltx_p">It builds up in your body to a maximum level of saturation over a week or two. Then you just maintain that and reap the rewards (of maybe feeling better).</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS9">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.9 </span>Do I have to do a “loading” phase of taking more at first?<a class="ltx_ref chain" href="#S12.SS9" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS9.p1">
<p class="ltx_p">Probably not. Unless you’re on some sort of intense training time crunch or something, this probably doesn’t matter at all. Just take whatever is convenient with some regularity.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS10">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.10 </span>What are the side effects?<a class="ltx_ref chain" href="#S12.SS10" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS10.p1">
<p class="ltx_p">Slight weight gain may be possible because of increased water weight in your muscles (which to be clear is Good, so don’t be alarmed). If you don’t take it with water, or if you take too much at once, you might get a tummy ache. Ouchie.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS11">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.11 </span>Who shouldn’t take it?<a class="ltx_ref chain" href="#S12.SS11" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS11.p1">
<p class="ltx_p">People with kidney issues. Not because it causes them, but because creatinine (Different spelling! Creatine becomes creatinine) is used as a marker in lab tests for a number of kidney issues and supplementing might give a false positive. Just keep it in mind.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS12">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.12 </span>Do you have any brand recommendations?<a class="ltx_ref chain" href="#S12.SS12" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS12.p1">
<p class="ltx_p">No. It shouldn’t really matter. Just get whatever seems reputable and is a reasonable price. I’d give a recommendation for the one I like but when I asked the brand for affiliate link they turned me down, so their loss! No free clout.</p>
</div>
</section>
<section class="ltx_subsection" id="S12.SS13">
<h3 class="ltx_title ltx_title_subsection">
<span class="ltx_tag ltx_tag_subsection">12.13 </span>You seriously put creatine into this document, huh?<a class="ltx_ref chain" href="#S12.SS13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h3>
<div class="ltx_para" id="S12.SS13.p1">
<p class="ltx_p">Yeah it’s pretty funny. It’s not my fault that I joked about it and people told me it legitimately helped them because now I feel obligated to keep talking about it!!!</p>
</div>
</section>
</section>
<section class="ltx_section" id="S13">
<h2 class="ltx_title ltx_title_section">
<span class="ltx_tag ltx_tag_section">13 </span>CLOSING REMARKS<a class="ltx_ref chain" href="#S13" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="S13.p1">
<p class="ltx_p">If any of the following are true:</p>
</div>
<div class="ltx_para" id="S13.p2">
<ul class="ltx_itemize" id="S13.I1">
<li class="ltx_item" id="S13.I1.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i1.p1">
<p class="ltx_p">you are still mad at me despite the disclaimer;</p>
</div>
</li>
<li class="ltx_item" id="S13.I1.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i2.p1">
<p class="ltx_p">you spotted an issue or typo;</p>
</div>
</li>
<li class="ltx_item" id="S13.I1.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i3.p1">
<p class="ltx_p">you have a clarifying question that should be put into the text;</p>
</div>
</li>
<li class="ltx_item" id="S13.I1.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i4.p1">
<p class="ltx_p">you have an objection that hopefully isn’t an Uhm Ackshually;</p>
</div>
</li>
<li class="ltx_item" id="S13.I1.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i5.p1">
<p class="ltx_p">you wish to sing my praises;</p>
</div>
</li>
<li class="ltx_item" id="S13.I1.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i6.p1">
<p class="ltx_p">you wish to pledge fealty;</p>
</div>
</li>
<li class="ltx_item" id="S13.I1.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">•</span>
<div class="ltx_para" id="S13.I1.i7.p1">
<p class="ltx_p">you wish to send tithes my way;</p>
</div>
</li>
</ul>
</div>
<div class="ltx_para" id="S13.p3">
<p class="ltx_p">Then please feel free to contact me and I’ll see what we can do. Bluesky is the easiest contact point, and you can DM me for my Signal. Otherwise, thank you for reading and I hope it helps.</p>
</div>
<div class="ltx_para" id="S13.p4">
<p class="ltx_p"><span class="ltx_text ltx_font_bold">If you would like to donate to support this project,</span> <a class="ltx_ref ltx_href" href="https://cash.app/Katitties" title="">CashApp</a>, <a class="ltx_ref ltx_href" href="https://ko-fi.com/katitties" title="">Ko-Fi</a>, and <a class="ltx_ref ltx_href" href="https://account.venmo.com/u/katitties" title="">Venmo</a> all work. I appreciate it!</p>
</div>
<div class="ltx_para" id="S13.p5">
<p class="ltx_p">And lastly: <span class="ltx_text ltx_font_bold">The most important thing that you can do as a trans person is to live.</span> For as much as this document is a manual, it is in equal measure a message to you as a trans person that your existence is a gift upon the world, your presence is a blessing on those around you, and that you deserve to be treated with respect. Even if you do nothing else, your life is a feat worth praising. Thank you.</p>
</div>
</section>
<section class="ltx_section" id="Sx2">
<h2 class="ltx_title ltx_title_section">FRIENDS OF PGHRT<a class="ltx_ref chain" href="#Sx2" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="Sx2.p1">
<p class="ltx_p">Across this document is a scattering of links to other guides and resources. Below is a consolidation of them which will also include more links to external resources as time goes on, ideally by other trans people. For the privacy minded or noided, note that some of these are Google Docs links.</p>
</div>
<div class="ltx_para" id="Sx2.p2">
<ol class="ltx_enumerate" id="Sx2.I2">
<li class="ltx_item" id="Sx2.I2.i1" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">1.</span>
<div class="ltx_para" id="Sx2.I2.i1.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://startwith4mgestradiolenanthateweeklyandtestatonetothreemonths.com/" title="">SW4EEWATAOTTM</a> - TL;DR for PGHRT</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i2" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">2.</span>
<div class="ltx_para" id="Sx2.I2.i2.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://hrtcafe.net/" title="">HRT Cafe</a> - HRT Resource Aggregator</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i3" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">3.</span>
<div class="ltx_para" id="Sx2.I2.i3.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://transfemscience.org/" title="">Transfeminine Science</a> - Informational resource for trans medical literature</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i4" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">4.</span>
<div class="ltx_para" id="Sx2.I2.i4.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="http://estrannai.se" title="">Estrannai.se</a> - Estradiol Pharmacokinetics Playground</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i5" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">5.</span>
<div class="ltx_para" id="Sx2.I2.i5.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://globoho.moe/" title="">Globoho.moe</a> - Thailand Orchiectomy Medical Tourism Travel Guide</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i6" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">6.</span>
<div class="ltx_para" id="Sx2.I2.i6.p1">
<p class="ltx_p">Julia’s FUE Guide - COMING SOON, I’M BULLYING HER TO WRITE FASTER</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i7" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">7.</span>
<div class="ltx_para" id="Sx2.I2.i7.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://docs.google.com/document/d/1-NyE5EY5TTaRRMhk7HlTbKJ7HifjEsA4jlDO1qKQVl0/edit?tab=t.0" title="">Sky’s Feminine Figure Beginner Program</a> - An exercise regimen geared towards trans fems</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i8" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">8.</span>
<div class="ltx_para" id="Sx2.I2.i8.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://docs.google.com/document/d/114sztSw1aVWM2pXLDl9NrHklyvewz3EmFiHiisjM71k/edit?tab=t.0" title="">Sky’s Diet 101</a> - A guide towards adjusting weight in a healthy way</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i9" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">9.</span>
<div class="ltx_para" id="Sx2.I2.i9.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://stainedglasswoman.substack.com/p/how-to-maintain-your-penis-function" title="">How to Maintain Erectile Function on HRT</a> - A longer form explanation on the ”use it or lose it” phenomenon</p>
</div>
</li>
<li class="ltx_item" id="Sx2.I2.i10" style="list-style-type:none;">
<span class="ltx_tag ltx_tag_item">10.</span>
<div class="ltx_para" id="Sx2.I2.i10.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://docs.google.com/document/d/1DXFxzN0XTudPZez_SO61fpqncRLPH_Be_QG_8Pcz9LU/edit?pli=1&amp;tab=t.0" title="">Biohax Guide Googleslop Edition</a> - Trans Masc DIY Guide</p>
</div>
</li>
</ol>
</div>
</section>
<section class="ltx_section" id="Sx3">
<h2 class="ltx_title ltx_title_section">ABOUT THE AUTHOR<a class="ltx_ref chain" href="#Sx3" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="Sx3.p1">
<p class="ltx_p">Katie Tightpussy is an award-winning author and professional trans woman with nearly a decade of experience in the field of transgender. Her accomplishments include transiferating her sex through the novel technique of cross-sex hormone injections, being physically unable to shut up, and utilizing a very fortunate set of hyperfixations as they relate to transbobulation of the humors. She spends her days in the idyllic rural countryside of Los Angeles scheming of new ways to achieve world domination and enjoys riding her bicycle. Media inquiries can reach her agent at <a class="ltx_ref ltx_href" href="http://katietightpussy.com" title="">katietightpussy.com</a>.</p>
</div>
</section>
<section class="ltx_section" id="Sx4">
<h2 class="ltx_title ltx_title_section">DISCLOSURES<a class="ltx_ref chain" href="#Sx4" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="Sx4.p1">
<p class="ltx_p">No robot girls were harmed in the making of this document, including any usage of generative large language models. The author does not endorse any reproduction without attribution nor scraping of this work. Leave those poor robot girls alone.</p>
</div>
<div class="ltx_para" id="Sx4.p2">
<p class="ltx_p">The author declares an attraction towards women and acknowledges a potential conflict of interest for the existence of more beautiful trans women in the world.</p>
</div>
</section>
<section class="ltx_section" id="Sx5">
<h2 class="ltx_title ltx_title_section">ACKNOWLEDGEMENTS<a class="ltx_ref chain" href="#Sx5" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para" id="Sx5.p1">
<p class="ltx_p">Though the text is primarily my voice, this document would not be even half as good without the contributions, feedback, and suggestions from others involved at every step along the way. A good reminder as ever that transition is not something best done alone.</p>
</div>
<div class="ltx_para" id="Sx5.p2">
<p class="ltx_p">Many thanks to Q, R, RM, and S in alphabetical order for close review and generally being fun nerds to talk to; love y’all. Special thanks to CB and J for close review that also inspired some very good bits. Thanks to KG for additional intersex information. Thanks to w [sic] for additional injection resources. Thanks to BIR collectively for a plethora of crucial nerd nitpicks. Appreciation for general review from C, JTP, K, S, and V. Thanks to E for web dev assistance. Thanks to everyone on Bluesky who encouraged me to write this up in the first place, and everyone over the years sharing knowledge. And of course: much appreciation to all HRT nerds, even when we disagree, since we’re all trying to do the best for our community where we’ve otherwise been let down. Keep up the good work everyone.</p>
</div>
<div class="ltx_para" id="Sx5.p3">
<p class="ltx_p">Shout out to my IB Chemistry HL teacher many years ago who quite reasonably doubted my studiousness even though I’m now putting much of that knowledge to use for the art of transsexuality; go figure.</p>
</div>
</section>
<section class="ltx_section" id="Sx6">
<h2 class="ltx_title ltx_title_section">CHANGELOG<a class="ltx_ref chain" href="#Sx6" onclick="copyURI(event)" title="Click to copy a link here"> 🔗</a></h2>
<div class="ltx_para ltx_noindent" id="Sx6.p1">
<p class="ltx_p"><a class="ltx_ref ltx_href" href="https://github.com/Juicysteak117/pghrt/" title="">Source code available here on GitHub.</a></p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p2">
<p class="ltx_p">Full Compilation Datetime: <span class="undefined">Tue Oct 21 13:10:20 2025</span></p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p3">
<p class="ltx_p">(There aren’t LaTeXML bindings for <span class="ltx_text ltx_font_typewriter">datetime2</span>, <span class="ltx_text ltx_font_typewriter">hanging</span>, or <span class="ltx_text ltx_font_typewriter">hyphenat</span>, so the formatting is slightly ugly. If you’d really like to help me out, please write those bindings!!!)</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p4">
<p class="ltx_p">2025-08-20: Initial release. 15.9k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p5">
<p class="ltx_p">2025-08-20: A lot of typos and minor verbiage tweaks. Added Question <a class="ltx_ref" href="#S8.SS18" title="8.18 Does progesterone interact with any other drugs related to HRT? ‣ 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">8.18</span></a>.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p6">
<p class="ltx_p">2025-08-21: Typos grow on trees. Added Question <a class="ltx_ref" href="#S5.SS27" title="5.27 What do I do with my used syringes and needles? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.27</span></a>.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p7">
<p class="ltx_p">2025-08-21: More tweaks. Opted to remove “WHY PROG” from Question <a class="ltx_ref" href="#S8.SS17" title="8.17 I would like to read more about progesterone in an HRT context. What resources should I read? ‣ 8 PROGESTERONE ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">8.17</span></a>. 17.0k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p8">
<p class="ltx_p">2025-08-22: Nitpicks, clarifications, and typos. 17.2k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p9">
<p class="ltx_p">2025-08-24: A few more twinks sorry tweaks. 17.3k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p10">
<p class="ltx_p">2025-08-27: How long until remaining typos are embarrasing? 17.3k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p11">
<p class="ltx_p">2025-08-28: Reduced ambiguity in a few areas. 17.4k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p12">
<p class="ltx_p">2025-08-29: Additional clarity for frequencies in Section <a class="ltx_ref" href="#S3" title="3 TYPES AND DOSAGES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">3</span></a>. 17.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p13">
<p class="ltx_p">2025-09-01: Sisyphus boulder meme captioned fixing typos dot png. 17.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p14">
<p class="ltx_p">2025-09-07: Added donation links per request. That’s very kind. 17.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p15">
<p class="ltx_p">2025-09-07: Few more tweaks. Clarified an additional common progestin. 17.6k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p16">
<p class="ltx_p">2025-09-19: Added Question <a class="ltx_ref" href="#S4.SS16" title="4.16 Do different estrogen esters or administration routes show up differently on blood tests? ‣ 4 BLOOD TESTS AND LEVELS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">4.16</span></a> plus tweaks. 17.7k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p17">
<p class="ltx_p">2025-09-23: A wide variety of clarifications up and down the line. 18.1k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p18">
<p class="ltx_p">2025-09-24: Added an important note about surgery to Question <a class="ltx_ref" href="#S11.SS1" title="11.1 Should I be worried about blood clots? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.1</span></a>. 18.3k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p19">
<p class="ltx_p">2025-09-24: “Katie my doctor told me-” It never ends. 18.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p20">
<p class="ltx_p">2025-09-26: Another pass of clarification edits. Yes I should have a git diff. Sorry that I don’t. I thought I’d be done by now anyway! 18.7k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p21">
<p class="ltx_p">2025-09-30: Added some cross references for clarity. 18.7k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p22">
<p class="ltx_p">2025-10-02: More cross references. Likely will do another pass. 18.8k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p23">
<p class="ltx_p">2025-10-02: Added a big bold warning about recapping to Question <a class="ltx_ref" href="#S5.SS13" title="5.13 What are “Luer lock” and “insulin” syringe/needles? ‣ 5 TECHNIQUE AND SUPPLIES ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">5.13</span></a> because SOMEONE didn’t watch the video smh. 18.9k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p24">
<p class="ltx_p">2025-10-10: Added Question <a class="ltx_ref" href="#S11.SS42" title="11.42 How does HRT affect fertility? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.42</span></a> and Question <a class="ltx_ref" href="#S11.SS43" title="11.43 Is infertility from HRT reversible? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.43</span></a> per request. Honestly I just forgot about fertility being a thing lol. Also added the Friends Of PGHRT postword section. 19.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p25">
<p class="ltx_p">2025-10-10: Added Gretchen’s Version (.txt) and fixed formatting. 19.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p26">
<p class="ltx_p">2025-10-11: Added permalinks to everything, yay! And finally made a git repo. Look at me being a big girl, wow. 19.5k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p27">
<p class="ltx_p">2025-10-11: Added an external link to Question <a class="ltx_ref" href="#S11.SS20" title="11.20 How do I improve erectile function on HRT? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.20</span></a>. 19.6k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p28">
<p class="ltx_p">2025-10-14: Reduced the pithiness and expanded the usefulness of Question <a class="ltx_ref" href="#S11.SS25" title="11.25 Should I be on PrEP? ‣ 11 MYTHS AND MISCS ‣ A PRACTICAL GUIDE TO FEMINIZING HRT"><span class="ltx_text ltx_ref_tag">11.25</span></a> per repeat request because I <span class="ltx_text ltx_font_italic">guess</span> there is public health utility to doing so. 19.8k words.</p>
</div>
<div class="ltx_para ltx_noindent" id="Sx6.p29">
<p class="ltx_p">2025-10-17: Dark mode! And a font toggle off. Plus a few links. 19.8k words.</p>
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