I’m going to deviate from the empirical now, because I realize that some of my opinions may or may not be helpful in your context. First,and funnily enough this one is empirical, plenty of trans women have perfectly normal transitions on just oral estradiol, which we know results in far lower serum estradiol levels, so I’d be cautious of trusting the 300-500pg/mL that was thrown out there by someone else as being “the most effective.” As we agreed earlier, more E =/= better development. With this in mind, I’m going to walk you through how I landed on my dose.
I have severe bipolar disorder and borderline personality disorder, and I’ve found that extremely high dose estradiol made my symptoms significantly worse. Given that a common symptom of estradiol is mood swings, that didn’t come at a surprise for me. I’d met and talked with many trans women who did oral, and they were overall very happy with their transition development. So what I decided to do, for the sake of my own sanity, was lower my estradiol dose as much as I could while maintaining testosterone suppression. If you read around, you may find sources citing ~300pg/mL as the ideal for monotherapy. Well, at trough, I sit at 135pg/mL and don’t need an anti-androgen. And now that I covered it from the some ~300pg/mL I had before, I’m doing much better mentally. That’s been my personal experience, and I don’t mean to imply it will work well for you, just putting it out there.
Now if you wanna get into empirical evidence, this meta analysis is an excellent source to draw from. It goes over recommended ranges, including WPATH’s recommended range of 100-200pg/mL (which honestly I think is too narrow, but at 200pg/mL, average testosterone suppression is about 90%, which is high enough to be below 50ng/dL of testosterone). I’ve linked specifically to the section on injectable estradiol, but you can scroll up for lots more info. It covers what all our best research points to.
Additionally, I don’t buy into the “progesterone too early stunts growth” stuff, as the only study on that was done on rabbits, and they used extreme, supraphysiological levels. I believe that confirmation bias has fed the rest of the rumor. Out of an abundance of caution though, I did start my progesterone 16 months into HRT. I don’t expect that to matter, though.
I’d focus on getting your estradiol levels down fast, however. That high of a dosage can (and evidenced by my bipolar/borderline ass *will) cause significant psychological effects. Everything is your choice, of course, it just worries me seeing a reading that high.
You mention BPD/bipolar…well, I’m starting to think I might be similar. Not as bad, but…well, not great. And my E levels definitely have at least some effect on that.
I think 300-500pg/ml is high as well, but I just wanna say something…
This is not to criticize or make fun of anyone, but I’ve had a certain experience. I’m part of a Discord server of trans people, mostly women. They’re a bit…conservative with the recommended E levels. To each their own, but they say stuff like “200pg/ml is already too high” and “100pg/ml is enough for monotherapy” and they’re really adamant about it, lashing out at people who speak against that quite harshly. They also keep insisting prog does absolutely nothing. To be honest, I’m not a fan of that place, but to each their own. And this is a complete side-tangent, so probably ignore this.
I’m glad I’m not the only one who doesn’t buy “prog too early”. I know the study was done on rabbits with extremely high levels and also, if I’m not mistaken, they used progestins instead of actual progesterone? Not completely certain tho.
I’m getting my levels down ASAP. It might just be why I’ve been feeling the way I have lately. I actually had no idea my levels were that high…jeez. This really is way too much…
Thanks for your concern! Thanks so much for the pointers, this is great info. Transfem Science is honestly great.
I’ll do the best I can and good luck to you too! 💜
Of course! Always looking to help!
I’m going to deviate from the empirical now, because I realize that some of my opinions may or may not be helpful in your context. First,and funnily enough this one is empirical, plenty of trans women have perfectly normal transitions on just oral estradiol, which we know results in far lower serum estradiol levels, so I’d be cautious of trusting the 300-500pg/mL that was thrown out there by someone else as being “the most effective.” As we agreed earlier, more E =/= better development. With this in mind, I’m going to walk you through how I landed on my dose.
I have severe bipolar disorder and borderline personality disorder, and I’ve found that extremely high dose estradiol made my symptoms significantly worse. Given that a common symptom of estradiol is mood swings, that didn’t come at a surprise for me. I’d met and talked with many trans women who did oral, and they were overall very happy with their transition development. So what I decided to do, for the sake of my own sanity, was lower my estradiol dose as much as I could while maintaining testosterone suppression. If you read around, you may find sources citing ~300pg/mL as the ideal for monotherapy. Well, at trough, I sit at 135pg/mL and don’t need an anti-androgen. And now that I covered it from the some ~300pg/mL I had before, I’m doing much better mentally. That’s been my personal experience, and I don’t mean to imply it will work well for you, just putting it out there.
Now if you wanna get into empirical evidence, this meta analysis is an excellent source to draw from. It goes over recommended ranges, including WPATH’s recommended range of 100-200pg/mL (which honestly I think is too narrow, but at 200pg/mL, average testosterone suppression is about 90%, which is high enough to be below 50ng/dL of testosterone). I’ve linked specifically to the section on injectable estradiol, but you can scroll up for lots more info. It covers what all our best research points to.
Additionally, I don’t buy into the “progesterone too early stunts growth” stuff, as the only study on that was done on rabbits, and they used extreme, supraphysiological levels. I believe that confirmation bias has fed the rest of the rumor. Out of an abundance of caution though, I did start my progesterone 16 months into HRT. I don’t expect that to matter, though.
I’d focus on getting your estradiol levels down fast, however. That high of a dosage can (and evidenced by my bipolar/borderline ass *will) cause significant psychological effects. Everything is your choice, of course, it just worries me seeing a reading that high.
Best of luck however you move forward <3
You’re so nice, omfg 😭
Tysm! 🩷
You mention BPD/bipolar…well, I’m starting to think I might be similar. Not as bad, but…well, not great. And my E levels definitely have at least some effect on that.
I think 300-500pg/ml is high as well, but I just wanna say something…
This is not to criticize or make fun of anyone, but I’ve had a certain experience. I’m part of a Discord server of trans people, mostly women. They’re a bit…conservative with the recommended E levels. To each their own, but they say stuff like “200pg/ml is already too high” and “100pg/ml is enough for monotherapy” and they’re really adamant about it, lashing out at people who speak against that quite harshly. They also keep insisting prog does absolutely nothing. To be honest, I’m not a fan of that place, but to each their own. And this is a complete side-tangent, so probably ignore this.
I’m glad I’m not the only one who doesn’t buy “prog too early”. I know the study was done on rabbits with extremely high levels and also, if I’m not mistaken, they used progestins instead of actual progesterone? Not completely certain tho.
I’m getting my levels down ASAP. It might just be why I’ve been feeling the way I have lately. I actually had no idea my levels were that high…jeez. This really is way too much…
Thanks for your concern! Thanks so much for the pointers, this is great info. Transfem Science is honestly great.
I’ll do the best I can and good luck to you too! 💜