AA: HRT Advice

Here is a recent Ask Abbey question that I got, my hope is to give a broad understanding of the process and hopefully get others on the right track.

Q: Hiya abbey.

I wont take up to much of your time. I just want to ask  you, my doctor started me on 2mg of esteofem daily but wont give me anything else because they really don’t know what I have to take. She told me to ask around hence why I am here. The esteofem has yielded good results so far(boobs are growing fast and my waist is getting curvy) but want to be taking the right things. I have done some research and apparently I should also be on “spiro.”

Can you advise me on what else I should be taking so i can inform my doctor.

Ashley
X

A: Hi Ashley,

The estrofem is a good start, after being on it for a while you may raise that dose a little. The average estrogen dose can be anywhere from 2mg to 8mg per day.

You are correct about Spiro, it is an antiandrogen called Spironolactone (Aldactone): http://en.wikipedia.org/wiki/Spironolactone

What it does is block the effects of testosterone on your body and effectively lowers your blood testosterone levels. Estrogen has some antiandrogenic properties alone but it is far more effective to pair it with Spironolactone. My advice for your doctor would be to start you on 50 or 100mg/day of spironolactone for a few weeks to make sure you have no adverse reactions, then increase your dose until your testosterone is sufficiently suppressed. The average dose is around 200mg but some people take up to 300 or 400mg per day. There are some other antiandrogens out there, but Spironolactone is by far the most commonly used and tested and has the fewest side effects.

Now when seeing an endocrinologist They will usually run blood tests before adjusting your medications to determine if you need to increase your dosage or not.

The tests my doctor runs are:

Estradiol, Ultra Sensitive, LC/MS/MS
Testosterone
Prolactin
Potassium
Lipid Panel
TSH
Vitamin D, 25-Hydroxy

The first 4 are the most important, the lipid panel, TSH, and Vitamin D are more for general health. The prolactin level is important to watch at first because HRT can increase those levels, especially in someone who already has elevated levels. If you have high prolactin levels before hormones it could be explained by a Prolactinoma, which is a benign tumor on the pituitary gland. They can be treated with medication or surgery but are not an immediate cause for alarm. Spiro is a Potassium-sparing diuretic so it can cause elevated potassium levels in your blood. It is important to monitor your levels for the first year or so to watch out for Hyplerkalemia but

as long as you are not eating a bushel of bananas every day you probably won’t have any issues. I can still eat bananas and be fine.

Now for the your testosterone and estradiol levels.

For a MtF person on HRT the target blood Estradiol level is in the range of 50-150 pg/mL. The ideal testosterone level would be below 100 ng/dL.
Before starting hormones my Testosterone level was 184 ng/dL and my estradiol was 24.02 pg/mL
After starting hormones my Testosterone levels are 27 ng/dL and my estradiol is 68 pg/mL
As you can see, my numbers are quite different now.

That pretty much covers the basics, some people also take progesterone, but the results are very controversial as to whether they do anything or not. They are usually claimed to help in breast development and increase sex drive, as well as make you more moody. Not surprising because it is the hormone that spikes during a females menstrual cycle during and after ovulation. My doctor does not prescribe it so I do not know as much about it, but if you do decide to research it and try it, do so after you have your estrogen and testosterone levels where you want them.

Abbey
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About gingertrap

I am a mtf transgender girl. I want to document my experiences with hormone treatment and help educate other transgirls of their effects as well as the daily struggles of being a human being.

2 responses to “AA: HRT Advice”

  1. Elle says :

    That covered the basics pretty well Ginger, nicely done. You could also recommend these sites to her for further information on hormones and dosages.

    http://www.annelawrence.com/hormoneindex.html

    http://www.albertatrans.org/mtf.shtml

    http://www.hormone.org

    Hope she has a succesful transition!

    Elle

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