Trying hard to trust the process, and while I have seen other expected changes in skin, hair, and mood, I am getting anxious that nothing is happening under my shirt. I had some minor sensitivity within the first two weeks, but never anything painful.
This Friday will be 6 weeks on HRT. 2mg Est, 4mg Prog, 200mg Spiro daily.
Edit: thanks for talking me off the cliff everyone, I’m much less anxious now 😅
Mine came at around 3 months in.
6 weeks isn’t very long, and if you’re just starting your likely on a lower dose as your doc ramps you up to whatever level works.
I’d talk to your doc or whoever prescribed you the meds about dosages and what your levels are, they usually monitor with bloodwork to try to get you in the normal ranges, and if you have concerns they will usually work with you to try to get the results you want.
But yeah. i didn’t really notice breast development for a good few months(partially due to my weight too at the time), and they didn’t really stop growing for a few years. It was just a lot of very slow growth over time.
This stuff comes in waves. I have been on hrt for close to five years at this point and I remember the first year, almost no breast growth. Year two, bit of a boom. Then very little growth but year 4 has been like 2-3 cups. Everyone’s body is different. I would definitely make sure your doc is checking on your blood work cause I know for me, my T didn’t get to an appropriate level till I hit the year and a half mark. And that T level can really slow down your progress.
oof, your T suppression should not have taken a year and a half to occur. With sufficient estrogen levels it should happen rather rapidly. My testosterone and estrogen were both in cis-female levels by the time I did my next blood work two months later.
I wonder what your E levels were as your T failed to reduce (I’m going to guess they were too low) 🤔 Were you on spiro?
My T levels started really high (my T levels were higher than that of a teenager while I was 26), by the time I got my T levels to a proper level I was up to 300mg of Spiro (and on estrogen patches) and went into a sodium deficiency. After that I actually got to switch to Lupron which was great. Now I’m back on Spiro but only 50mg and my T levels are still at an appropriate level. I am also on injectable estrogen which I have found to be much better than patches. My doctors didn’t want to put me on pill form estrogen due to concerns for liver health.
Just so you know, spiro does not meaningfully change blood T levels, it is a weak androgen receptor antagonist, so it (rather poorly / partially) blocks androgen receptors in your body from using the T in your blood.
The main thing that would be stopping your body from producing T is having enough estrogen in your body, which tells your brain you have enough sex hormones and it can stop producing T.
Lupron basically does this more directly: it tells the brain to stop sex hormone production.
Lupron is really great, it should be covered for all pre-op trans people, even adults. It’s a safer and more direct medicine, and the only reason it isn’t used for adults is because insurance companies don’t want to pay for it.
So Lupron would definitely tank your T levels, but I suspect the injectable estrogen was much better at keeping your blood E levels elevated, which is probably why your T levels haven’t come back.
Patches are better than oral in terms of increasing blood E levels, but you still don’t absorb a lot of it, and it can be uneven especially compared to injections.
So thank goodness you got Lupron and switched to injections!
Haven’t read all of the other comments or seen your hormone levels but your doc starting you on 200mg spiro is diabolical, i started on 50 and most start between 50-100. everyone is different so maybe you need that much but i’d talk to your doc about that.
As for the actual question, it took me like 8-10 weeks and ymmv. I also started on 4mg estradiol/day rather than 2. Also make sure you’re eating enough for fat redistribution. You’ll get there girl, don’t worry.
does sound like a bad (or malicious) doctor, they shouldn’t be starting someone at the max dose … especially since spiro can cause serious side effects.
I had breast soreness pretty quickly. Increased sensitivity could be right (that’s how it was for me at first), but at some point it did become painful enough that I had to change how I slept, etc.
My advice: switch to injections (I recommend subcutaneous as you can use very small needles that can be painless).
As others have said, oral is a poor way to get estrogen - 80+% is eliminated by the liver, and the rest spikes blood levels and eliminates relatively quickly, creating vicious ups and downs without providing sufficient and consistent estrogen blood levels to estrogenize the body by. Anecdotally the people I know IRL who do pills have slower and less feminization than those who inject.
(I actually started hormones at the same time as an IRL friend, and a year later my friend still passes as a boy and boymodes full-time, and I … wouldn’t be able to pass as a boy anymore. The main difference is that they take oral and I inject.)
Highly recommend reading: https://transfemscience.org/articles/transfem-intro/
Is there a reason not to do injections (unless you have bad enough fear of needles so that you can’t do it)? To me it seems to be by far the best option in every way (at least price, effectiveness, frequency of administration, convenience) and I see no reason to pick anything else. Not that I personally have much of an alternative anyway because I’m doing DIY right now.
Not really. Injections and implants really are the most convenient options (and injections are of course super cheap). That said, gel/spray isn’t too bad, especially when first starting out or for those afraid of needles.
gel and patches aren’t so bad when starting out if you are taking an effective anti-androgen, but I doubt it’s that feasible for monotherapy, tbh.
I use patches alongside spiro and progesterone. I can’t recommend patches enough! Injections give me crazy dysphoria, so I turned that option down immediately.
Oh, no not usually. It’s at least not recommended, but I’ve heard of people doing it with many patches. But with an AA or after orchiectomy it’s rather easy.
I tried doing mono with gel, but wasn’t doing blood tests at the time. Not knowing my levels was stressful as I was never quite sure if T was suppressed, but changes were happening at least. I feel way better on injections.
my alternative to taking bica was spiro, and I had read and heard enough to know I wasn’t interested (it’s a pretty mild anti-androgen anyway), so I felt like monotherapy was my only option.
Trans healthcare is not the best :-/
And yeah, that does sound stressful, not knowing your levels and trying to wing it. Even knowing my levels, I had pretty uneven suppression of T with monotherapy, even with very high levels of estrogen (>500 pg/mL trough). Post-orchi I felt much, much better.
Yeah winging it isn’t the best. I seem to be rather lucky actually. 4mg een weekly is more than enough to suppress my T to lower cis fem levels. I’m actually taking 3.8mg right now and still seeing good levels.
My E usually hovers around 200pg/mL and my T hovers around 17ng/dL.
I couldn’t get T levels that low even post-orchi 🫠 …
Though, my blood work showed my T levels were suppressed to cis fem levels the whole time, I swear I still had biochemical dysphoria where my body seemed to produce a little T once a week in the trough, which then would have me feeling off.
It could have been something else, maybe it’s just side effects of really high estrogen, but even when I tried lower doses I would have worse mental health symptoms …
Either way, that stopped post-orchi, I just no longer felt biochemical dysphoria a couple days after trough and it didn’t seem to matter what my estrogen levels were anymore (I mean, the high E levels made me very sensitive and more moody / emotional, so I lowered my dose, first by half and then later by half again).
That said, I was injecting EV, which is so spiky - I suspect my E levels were dropping so suddenly on trough day that my brain triggered the testes to produce T, and it didn’t show up in blood work because I always tested right before injecting again and not the day after injection when it seemed like my T levels had risen.
Either way, it’s not an issue for me anymore, I just think it was cruel and unnecessary to force me to go through that entire year without an orchi, I was very firm about wanting it when I socially transitioned, then I had to wait three months to get HRT, then an entire year after that to get the orchi. They wouldn’t force me to wait that long if I wanted the testes removed as a cis person, like the post-vasectomy pain I experienced. It’s just transphobic, tbh - and it works, I suffered that whole year as a result.
Can confirm: I was able to get T down into cisfem ranges with monotherapy using 3 x 0.72mg patches every two days. That gave me about 400pg/mL E2 though, which was a bit high, so I’m on spiro as well now.
This might be of interest to you: https://transfemscience.org/articles/estrogens-blood-clots/
Basically taking E has a reputation of giving you a higher chance of blood clots, but what we see is that this mostly a thing to worry about when taking non bio-identical E and when you take E orally. This is not to say that I recommend going back to 400pg/mL, but it is something to keep in mind since AAs have side effects of their own.
Also, I have had rather varied blood tests from taking the same dosage of E for a long time. I’ve had between 170 and 320 pg/mL. How many blood tests did you take when on patches? I suppose it’s also possible patches are a bit more stable in what levels you get, and going back to that regime might be too much of a hassle anyways.
Thanks! Yeah, I saw that article (and I know my doctor reads that site too!), so I’ve been pushing back a bit.
That’s a good point about blood tests. I don’t think I’ve yet had more than one test for any particular dose, so I can’t say for sure how stable my levels are. I can tell when things start to get out of whack (especially when T goes up) from my experience with injections, and I’m pretty sure that my T is consistently suppressed on patches, at least.
I’m currently on 2 x 0.72mg / 2 days and 50mg spiro / day, which last test had me at 268 pg/mL E2 and 58 ng/dL T. I’m pretty happy with that, at least until I can get a few things chopped off.
I have a horrible needle phobia, and even so I did a lot to overcome it so I could do injections. Ultimately I agree, injections are the best method. Transdermal (patches or gel) isn’t that bad of a route for lower doses, but pre-op I wanted to do monotherapy when bica didn’t seem to help my biochemical dysphoria enough.
Even post-op I still do injections, as my skin is very sensitive, so I was worried about getting rashes from the patches, and I also exercise a lot and worried about the patches coming off (they can be expensive to replace, this is just a major downside to patches).
Yeah, the patch coming off is what I would be worried about as well, especially also when showering. Patches would be my top alternative because they also last a while but it’s just an extra thing to have to be careful about.
Congratulations on overcoming your needle phobia! :)
I’ve not yet had one come off in the shower, and I’m not particularly careful. The adhesive gets a little loose, but it goes back to normal pretty quickly once you dry off. Having tried gel, injections and patches I have to say patches easily beat everything else for me! That’s assuming you don’t get irritation from them, of course.
Denmark doesn’t use injections for trans care, so it’s simply not legally available
You can actually probably still get injections in some cases. Apparently you can request to have them ordered from the one EU country that prescribes them (can’t remember which) if your GP agrees (or something like that). Still yeah, not super likely or widespread.
Patches aren’t too bad for most people. I know lots of people who seem rather happy on them. Only issue is sometimes there are supply issues.
Ah, that sucks :(
How about spray/gel?
still better than oral, and if you’re on an anti-androgen or post-op it could work really well.
Not as effective as injections at getting your estrogen blood levels up consistently though, so it’s not practical for monotherapy, for example.
If you take estrogen as pills, don’t swallow them. Out then under your upper lip or undr tounge and let them dissolve. The stomach destroys 80+% of estrogen
I wouldn’t recommend doing this if you have been prescribed oral estradiol (that is, taking the pill you are prescribed daily in a single sublingual dose). The significantly higher bioavailability of sublingual administration can cause incredibly high spikes, and the significantly shorter half life over oral necessitates taking the estradiol 3-4x daily to maintain (only semi) stable levels. This requires a dosage and schedule adjustment; it is not sufficient to simply take the same dose of oral prescription and start taking it sublingually once daily.
Additionally, the stomach does not destroy estradiol. The reason behind the low bioavailability of oral estradiol (and by extension, also oral progesterone) is that it passes through the liver before entering the bloodstream. The liver processes the estradiol before it enters the bloodstream, resulting in significantly less E2 available in the blood. This also presents an additional long term problem that has been well documented at this point: liver flooding. The high concentration of estradiol entering the liver in a short amount of time puts an incredible amount of strain on the liver, and can cause long term liver damage. This is alleviated through sublingual administration.
The sublingual route has its own pros and cons (mainly the incredibly spiky and unstable hormone levels and requirement of frequent 3-4x doses per day), and it is not advisable to recommend someone take the medication their doctor prescribed them in a manner that is not consistent with their prescription. OP’s prescription was written with the intention of it being taken orally, thus the dosage has been planned for that, not for sublingual.
I took mine sublingually for awhile, but I am now switching to injections, as I am not happy with the dosage frequency. I’ve missed doses because I also struggle with ADHD, and it’s resulted in me feeling really off when my levels get too low. I would never do oral, as it isn’t an effective way of taking estradiol. It’s incredibly inefficient and presents its own health issues. Injections are the most convenient and most stable option (although I haven’t looked too deeply into the implants, those may potentially be more stable, but estradiol cypionate allows me weekly injections that peak at ~175ng/dL and trough at ~135ng/dL, which is very stable inside my target range), as well as being quite cheap and well studied.
TL;DR: Either talk to your doctor about adjusting dosage and scheduling for sublingual administration, or do the due diligence of reading about it. I recommend the meta-analyses from Transfeminine Science. The dosage and scheduling need to be adjusted if switching to sublingual.
Check out these two links:
Cyv_ has already said everything that needs to be said about doctors and bloodwork, but I figure having a look at what are considered standard dosages might put your mind somewhat at ease.
Also, do consider what Kamills says about taking your pills sublingually (under the tongue). Taking estrogen orally is associated not just with absorbing less E, but also with a higher risk of blood clots and is generally considered the least safe and effective way of taking E within the DIY community. Sublingual lowers the risk, even if you still swallow some. There are studies on this, but most doctors aren’t exactly up to date on this stuff.
Do be aware however that while most pills can be taken sublingually some can’t. You can try looking them up online, sharing the name of the E you take here, or looking for the words “sub-lingual” or “micronized” on the packaging. Not all packages are marked with this even if they are.
Lots of great responses! My E is from Estradiol, if that helps.
We all mean estradiol when we say E here! I meant more the brandname and such.
Ope, I couldn’t say for sure. The brand isn’t on my prescription bottle as far as I can tell :/
Unfortunate. No label with any info? Just a bottle with pills in it? Never heard of things being prescribed in this manner before
Oh no there’s a label with plenty of info, just no brands that I recognize. Here’s what it looks like, with anything specific to me or my area obscured.
I just hit week 7. I’m not on the same dosing as you (4mg estradiol tablets, no prog, 50mg spiro) but have had no physical changes. Emotional for sure, and my spouse claims I no longer smell like a man, but that’s all. I begged my doctor to put me on bica and injections, but they are all too cautious about adverse effects. I already had an episode of incredibly high heart rates this weekend that impacted activities, but that’s apparently not enough to go to injections until month 3 for them. I started taking the tablets sublingual (dissolve them under the tongue) but that has had very little effect. I have had no soreness or sensitivity at all, and everything still looks like it did before. I’m not sure if this is normal or not, but I’m considering finding a new doctor. I don’t want to switch to DIY and have them decline to provide referrals. It was enough of a chore to find this clinic in the first place!
I begged my doctor to put me on bica and injections, but they are all too cautious about adverse effects
Aaaand that’s when you get a different doctor - the adverse effects would be from taking oral, which at least plausibly taxes the liver, while injections are practically risk-free by comparison. My current endo actually tries to get her patients off oral and suggests injections instead.
I already had an episode of incredibly high heart rates this weekend that impacted activities, but that’s apparently not enough to go to injections until month 3 for them
What’s the reasoning here? There is no evidence injected bioidentical estrogen carries any heart risks, the closest thing would be that synthetic estrogen pills might increase risk because of those studies on Premarin, but that’s a reason to do injections rather than oral (though the pills you take should be bioidentical now).
but I’m considering finding a new doctor.
please, please do!
Even somewhere like Planned Parenthood that offers informed consent would be better. Your current doctor sounds transphobic and misinformed, they should let you be in control of your care especially with a decision like oral vs injections.
I recommend meeting and talking to the local trans community and finding out who other people see and which doctors the community recommends, that can be a good way to find a doctor who actually knows something about trans care or at least will allow you to have more autonomy in your care (though … don’t expect even the good ones to know enough, unfortunately we’re still at a place where trans people really have to educate themselves and take their care into their own hands).
I like the patches personally but I wish insurance would cover the hrt implant pellets.
I haven’t done them personally, but my endo offered. I am too much of a control freak about my levels to rely on a pellet, at least pre-op. I should re-consider them now that I’m post-orchi 🤔
I know someone post op on pellets. She is very pleased to only have to think about hrt once every six months. I’m a bit jealous
I’m on implants too. Love them precisely for that reason. Not having to think about HRT is nice
you are person I was thinking of :P
Oh. Well, in that case, FYI, I get 100mg pellets and they last about 12 months
The risk aversion is deviation from their standard plan and from possible mortality as a side effect of bica. Yes, I 'm aware that it’s an exceedingly low chance. They are still stuck in the early 2000’s for treatment plans.
The risk of heart issues is actually the spiro, which appears to be happening but they still aren’t responding to the request. I was over 190bpm during a distance run this weekend, and that’s considered the red zone for ages 40 and up. I’m normally around 150 for a tempo run and 50 flat for resting. This is absolutely an anomaly for me.
Your current doctor sounds transphobic and misinformed, they should let you be in control of your care especially with a decision like oral vs injections.
My doctor happens to be a trans woman. Howewver, she transitioned more than a decade ago and is comparing everything to her experience. I’m not sure if she’s bothered keeping up with things. I’m not here to judge, just to get myself in order.
I recommend meeting and talking to the local trans community
Try as I have, this part has been exceedingly difficult. The only meetups are youth oriented or singles mingles at bars. I’m married, don’t drink, and too old for that. There’s pride, annually, but this area isn’t fantastic for just finding folx at local establishments being themselves. I also happen to work a later shift. It’s quite lonely out here.
The risk aversion is deviation from their standard plan and from possible mortality as a side effect of bica. Yes, I 'm aware that it’s an exceedingly low chance. They are still stuck in the early 2000’s for treatment plans.
Spiro also carries mortality risk, a greater but similar risk AFAIK as bica. My liver enzyme levels were elevated on bica, but my endo was not concerned about it, he said they often just stabilize and it’s not a reason to stop. I only stopped bica because it didn’t act on the CNS and help with my biochemical dysphoria - I was just as miserable from the T in my body with it vs without. (So I did monotherapy instead.)
The risk of heart issues is actually the spiro, which appears to be happening but they still aren’t responding to the request.
Your doctors are not sufficiently educated and are putting your life at risk as a result. That’s unfortunate, but at least it sounds like you know what to do.
My doctor happens to be a trans woman. Howewver, she transitioned more than a decade ago and is comparing everything to her experience. I’m not sure if she’s bothered keeping up with things. I’m not here to judge, just to get myself in order.
tbh, I don’t know that being trans makes a difference, Caitlyn Jenner is trans and that doesn’t stop her from being an anti-trans menace on Fox News. You would hope being trans would help, but it sounds like it’s actually hurting your care, since she is not educating herself.
Try as I have, this part has been exceedingly difficult. The only meetups are youth oriented or singles mingles at bars.
I’m in a conservative southern city, but even we have a local pride organization that runs the annual pride event - they had a trans support group that I went to and that’s how I got connected. Sometimes it’s just a matter of finding the right person to let you in the door, so to speak. Maybe reaching out to the local pride org and asking around to see if any other events you don’t know about are happening, or even suggesting hosting a trans event if you ever feel like it.
Either way, it’s probably just a matter of persistence and continuing to network - there are trans people where you are, and someone is probably organizing something. If not, you could always try to get a directory going, make a group chat, etc. and start to get people connected. That’s more effort, but it’s quite valuable to have your local trans community’s experiences available to you - it tells you a lot, what places to go to, what places to avoid. Which hair dresser is safe and good, which dentist is safe, etc. - there are so many reasons that network is so important.
If you do ever consider DIY we in the HRT chat in the matrix have lots of info and experience. We can help you with every step. It’s safe and cheap, and tmk people aren’t denied referrals or anything for being on diy in most countries.
