Chart: Properties of HRT Estrogens

This is our most recent Estrogens Properties Table by Beverly Cosgrove and Juno Krahn — [Version 14, Nov 28, 2017]. The chart is intended to present estrogens as used as either suppressing testosterone (without using antiandrogens) or for the purpose of post-op maintenance. Some data is from “Cardiovascular Disease in transsexual persons…” Gooren LJ, Eur J Endo, 2014 Jun:170(6):809-19 and “Pharmacology of Estrogens and Progestogens — Influence of Different Methods of Administration” by Kuhl, from Climacteric, 2005;8 Suppl 1:3-63. The table may also represent unpublished research and non-medical opinions of the authors. Some risk data is extrapolated or inferred. This is for educational purposes only, not for medical use. DOSAGE INFORMATION is only representative of a typical dose. Doses can vary by a factor of 2-3, depending on the individual. Dose information here is to be regarded as unreliable unless verified by each patient with blood tests. Some terms: DVT: Deep Vein Thrombosis, a blood clot originating in the veins mostly due to fibrinolysis and can cause pulmonary embolism; “Clot”: platelet-based clotting which can lead to heart attack and other dangers; “Lipids”: undesirable blood lipoprotein effects; “CRP”: C-Reactive Protein, one of many inflammatory markers associated with cardiovascular problems; “SHBG”: Sex Hormone Binding Globulin, an indicator of the effort being made by the liver to detoxify sex hormones in the blood stream or the portal vein system.

estradiol-summary-chart14

20 thoughts on “Chart: Properties of HRT Estrogens”

  4. While this is helpful, it would be more helpful if you defined some of the abbreviations. “E2 Recp Cov.” “EV” “EC” “E2” “uG” and others. If you are supplying this information to lay people, this is needed. I am a therapist working with trans folks and if I give this to them, they will have those kinds of questions.

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      1. Hi Ms. Cosgrove, could you please explain the term “E2 Recp Cov”? Also, does the term “spikes” mean the raise of price?
        And may I translate your chart in Chinese as a lot of Chinese MtF are not allowed to get prescribed for HRT due to the conservative society? Thank you!

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  5. […] [6] Because of the reduced risk of Deep Vein Thrombosis (DVT) and Coronary Heart Disease (CHD) discussed above, we believe there is no longer a general rationale for reducing the estrogen levels of post-GRS MTF patient in good health to postmenopausal female ones if the patient has never experienced an extended period (>10 years) of youthful levels, assuming that parenteral estradiol is used instead of oral methods. However, at the time of surgical removal of testicles, the need for Estradiol-based suppression of Testosterone ends, and suggested doses may be cut back. A chart showing some typical pre- and post-castration Estrogen doses is here. […]

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  6. Hi Beverly!! Can you explain the difference between “typical transition” and “typical maintenance”? Is one considered a starting point and the other standard regime once you have suppressed your T?

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  7. Just want to add that a pellet dosage stability can be easily achvieved, some doctors start on patches to get a base for a few months and then move to pellets. If the pellet dose is to low, they have another implanted. 90 days is not a horrible time frame.with doctor consult. The scar can be an issue but mostly clears. Patches are more like $100/month vs pellet of $130/ for 3months.

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    1. There’s a shortage of doctors who do pellets for those that want them. Unfortunately in the past, a few doctors giving pellets have overcharged or used ethically questionable patient management techniques. We do need more doctors who can do implants, especially for those who cannot do injections.

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  8. Has there been any new information on the rectal suppository method? It’s something I’ve thought about before but have never seen anyone else mention it actually being done until now. I’m planning to hopefully start injections soon, but it still seems interesting. I guess the bio-availability must be pretty high if the listed dose is half of sublingual/oral. Have you heard anything more about what kind of levels it gives and if/how much it spikes?

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    1. The rectal method for progesterone capsules is well established. We have very limited experience with using the method for estradiol tablets. As soon as we can get better data, we’ll publish it. It seems likely that some patients attempting estradiol by suppository are using Estradiol Valerate pills instead of Estradiol. That is why they may be getting poor results, because they aren’t aware of the difference. We know this is an important issue for UK patients who are being denied access to injection, sadly.

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  10. Beverly, i used rectal for a period of time, my levels slightly reduced compared to buccal despite increasing my dosage, but could be normal fluctuation from last dosage. i used elleste solo back then.

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  11. *
    Thank you for posting your chart here. I have seen this at a few social media sites, but had not been able to find an ‘Original’ version clear enough to reproduce til reference to your web-site came to my feed today.

    My next Endocrinologist appointment will be next week. I can send this to her to review and discuss. She has me on estradiol tablet and progesterone.

    One question. I also do vaginal cream to accompany weekly dilation. Could a suppository work vaginally?

    *

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    1. So far, it seems that the neovagina is a poor absorber of estradiol. Estradiol creme may help the skin elasticity but you won’t get the kind of systemic absorption you get from patches, but this may also depend on type of GRS. Sigmoid colon GRS probably would give good results with absorption, for instance, but full thickness graft neovaginas would give the poorest. It depends a lot on blood supply and skin thinness.

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  12. Thank you for sharing. I have been doing rectal dosing with estradiol tablets meant for sublinqual or buccal. Will start doing more buccal then spitting out and not swallowing salivia. I am not comftorable with increased blood clot risks. Hopefully can switch to injections soon to have a higher natal E level. Can’t wait till the orchie to lower doses.

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