#hormones

Research supports a shift toward estradiol monotherapy for trans women, using estradiol alone without additional testosterone blockers.

A groundbreaking study published in the Journal of the Endocrine Society reveals that injectable estradiol may significantly improve hormone therapy outcomes for trans women, Pink News reports.

Researchers analyzed data from 29 patients who switched from traditional estradiol forms (gels or tablets) to weekly injections over a 15-month period. Despite receiving a lower average dose (3.7 mg vs. 4.3 mg), all participants experienced a dramatic reduction in testosterone levels, while maintaining stable estrogen levels.

The study also challenges the efficacy of Spironolactone, a commonly prescribed anti-androgen.

From the research paper Injectable Estradiol Dosing Regimens in Transgender and Nonbinary Adults Listed as Male at Birth: Results The average estradiol dose decreased from 4.3 to 3.7 mg weekly (P < .001) during the study period with a final on-treatment estradiol level of 248 pg/mL. All individuals achieved a testosterone level of less than 50 ng/dL during the study period. The average initial on-treatment testosterone level was not significantly different from average final on-treatment measurement of 24.0 mg/dL (P = .95). Spironolactone use at study initiation was not associated with a lower initial on-treatment testosterone level, though it was associated with a lower estradiol level of 285 pg/dL compared to 427 pg/dL for those on estradiol monotherapy (P = .017). Conclusion Lower doses of injectable estradiol can achieve therapeutic estradiol levels with excellent testosterone suppression. Spironolactone was not associated with additional testosterone suppression and may result in lower estradiol levels.

I am nearly 29, knew I was trans since 17 and I have been on HRT (estrogen) on and off for the past 18 months with testosterone for the last 6. Currently: 8mg Estradiol Enanthate weekly, plus 25mg testosterone weekly.

The hypothesis: The body auto-converts excess T→E and excess E→T, so it can handle high levels of both without much trouble. Women regularly take testosterone during menopause — this should be doable.

My theory: Take high E to block natural T production, then supplement a tiny bit of T to compensate. Should keep everything contextually balanced.

Six months in, and I just got my labs back. My doctor (not amused by this experiment) is shocked: I'm healthier than I've ever been across every metabolic marker. Dead center on every single metric. Blood pressure normal (first time ever). Weight stable. I have some breast growth starting, but no solidified nodules — so with raloxifene I could revert 90%+ if I wanted (TBD). They are very sensitive, for better or worse.

I have noticed my body becoming more feminine (appreciated), which is saying something since I am naturally broad and muscular. Think of a very masc blacksmith-NPC-character-model kind of build. I have curves now. Skin is overall softer. Body hair is much thinner (previously was bold, black, and gnarly). Face is smoother, jawline more defined, but the face itself is a bit rounder, especially in the cheeks.

Mental state is solid. Making real progress on projects, feeling hopeful, taking more risks and actually being comfortable with it. More open, more outgoing. Before this was quite depressed, anxious, paranoid, unable to make decisions, and just felt worthless, now its the exact opposite - I have tried every anti-depressant around, and had great luck with LSD, but this has been by far the most 'calm', happy, and level-headed I have ever been. That said, on pure estrogen, my mental clarity is certainly sharper. The combo is still clear enough though.