DOSING MASTER DOC
Estradiol-Only Monotherapy (Estrogen-Only HRT)
Estradiol-only monotherapy relies on estrogen’s ability to directly suppress testosterone production at high levels, eliminating the need for a separate T-blocker. In high doses, estradiol triggers negative feedback in the hypothalamic-pituitary-gonadal (HPG) axis, reducing gonadotropins and thereby lowering testicular testosterone output. The goal is to achieve blood estradiol concentrations high enough to shut down endogenous testosterone (often aiming for estradiol levels above 200 pg/mL at trough, which typically keeps total testosterone <50 ng/dL).
However, estradiol monotherapy is generally effective only at the upper end of dosing ranges, so careful attention to dose and delivery method is critical. Below I talk about common delivery routes for estradiol in monotherapy, with typical dosing and considerations for each.
A SMALL NOTE:
This document originally covered pellets as well but since nobody can really uses pellets it’s been removed.
ORAL/PATCH IS INCLUDED BUT INJECTIONS IS ALWAYS BEST FOR MONOTHERAPY
Injectable Estradiol (IM or Subcutaneous)
- Form and Dosing: Intramuscular or subcutaneous injections of estradiol esters are highly effective for monotherapy. Common esters used include estradiol valerate (EV), estradiol cypionate (EC), estradiol enanthate (EEn), and estradiol undecylate (EUn). These are typically compounded in oil for injection. Typical monotherapy injection doses are:
- Estradiol Valerate: ~4–6 mg per week (for example, 4 mg every 5 days is a common schedule).
- Estradiol Cypionate or Enanthate: ~6 mg per week (often given as 6 mg weekly, or slightly higher dose if stretching to 10-day intervals).
- Estradiol Undecylate: a very long-acting ester, dosed at ~12–20 mg every 3–4 weeks (e.g. 12 mg every 20 days, or up to 20 mg monthly).
- These doses are on the higher side of standard, intended to produce estradiol levels well above normal female range initially, ensuring that even at trough (right before the next shot) levels stay high enough to suppress testosterone. For instance, the Endocrine Society notes that 10 mg EV weekly IM can yield peak E ~1250 pg/mL and trough ~200 pg/mL at 7 days – sufficient to drive T down. DIY guidelines similarly list injection regimens (e.g. 4 mg EV every 5 days, 5 mg EC weekly, etc.) designed so that “the vast majority of people [on these doses] have high enough estradiol levels to suppress testosterone on its own.”. In practice, many individuals start around 4–5 mg per week and adjust if needed based on bloodwork, targeting trough estradiol typically >200 pg/mL for full T suppression.
- Effectiveness: Injectable estradiol is widely regarded as the most consistently effective monotherapy method for testosterone suppression. Because injections can deliver very high levels and maintain relatively stable blood concentrations (especially with appropriate dosing intervals for each ester’s half-life), they reliably shut down gonadal testosterone production for the majority of people. Community experience and medical studies concur – for example, an endocrine clinic review found that all transfeminine patients who achieved T <50 ng/dL on monotherapy were on either injectable or high-dose patch; 5 of 7 were using injectable estradiol valerate 4–6 mg weekly. The DIY HRT community often recommends estradiol injection monotherapy as an optimal regimen: it “ticks a lot of boxes” by providing stable levels, predictable results, infrequent dosing, and cost-effectiveness. In fact, a weekly subcutaneous injection of ~4 mg estradiol enanthate is said to bring “almost anyone” into a high estrogen range sufficient to turn off testosterone without any blocker. With proper technique and scheduling, injection monotherapy can maintain female-range or castrate-range T levels continuously.
- Some considerations:
- Injection Technique: Monotherapy injections can be given subcutaneously (into fat) or intramuscularly; both routes achieve similar estradiol levels. Subcutaneous injections with a small needle (e.g. insulin syringeread this!!!) are generally well-tolerated; intramuscular injections might be chosen if larger volumes are used or if subcutaneously the solution causes irritation (some homebrew preparations use solvents like benzyl benzoate that can sting subq).
- Dosing Frequency: To maintain stable levels, one time the injections according to the ester’s half-life (see Table below). For example, valerate (half-life ~3–4 days) is dosed every 5–7 days; cypionate or enanthate (half-life ~5–7 days) every 7–10 days; undecylate (half-life ~20–30 days) every few weeks. Adjusting the schedule can fine-tune peak/trough – some monotherapy users prefer slightly more frequent, lower-dose shots (e.g. split weekly dose into twice weekly) to keep levels very steady.
- Monitoring: Because injection monotherapy often achieves higher estradiol levels, regular blood tests are advised to ensure estradiol isn’t excessively high and testosterone is indeed suppressed. Typically, trough estradiol >200–250 pg/mL is needed to fully suppress T, but extremely high peaks are not necessary and could increase side effects. The aim is the lowest dose that keeps T at goal (<50 ng/dL at trough).
In summary, injectable estradiol is the preferred method for DIY estrogen monotherapy and is increasingly recognized medically as a viable single-medication regimen for transfeminine therapy. It provides robust feminization and T suppression, often obviating the need for any anti-androgen.
Summary of Estradiol Monotherapy Dosing by Route
The following table summarizes typical estradiol dosing ranges for monotherapy, along with notes on effectiveness and considerations:
Estradiol Delivery Method | Typical Monotherapy Dose(DIY/self-med & clinical ranges) | Schedule | Effectiveness & Notes |
Oral Estradiol(pills, swallowed) | 4–8 mg/day (in 2–3 divided doses)Up to ~10 mg/day max in some cases | Daily (split doses morning and evening or TID) | Can feminize and partially suppress T; full T suppression may require higher end doses. First-pass metabolism -> higher clot risk and more estrone. Not ideal for monotherapy due to VTE risk at high doses. |
Sublingual Estradiol(dissolve under tongue) | 4–6 mg/day (often as 2 mg pills 2–3× daily)Range ~1–8 mg/day | Daily (2–3 doses held sublingually for absorption) | Bypasses liver initially -> higher peaks, but very rapid clearance. Can achieve high estradiol briefly; must dose frequently. T suppression possible but levels fluctuate; generally not recommended as sole monotherapy method due to instability. |
Transdermal Patch(estradiol patches) | 100–200 μg/day is common target; up to 300–400 μg/day for monotherapy if needed. | Patch changed 1–2× per week (e.g. twice weekly 100 μg = ~200 μg/day) | Safest route (no liver pass). Steady absorption. High-dose patches can suppress T in many – documented cases with 200–300 μg/day achieving T <50 ng/dL. However, may need multiple patches; some find this route insufficient alone. |
Transdermal Gel (or solution) | ~2–6 mg/day applied to skin (e.g. 2–4 pumps of 0.75 mg each). Some DIY sources start ~3–4 mg. | Applied daily (usually morning) | Avoids first-pass; can reach moderate-high E levels. Effective if dosed correctly, but missing even one application or applying too little can quickly allow T rebound. Often combined with a blocker; monotherapy use requires consistent, high dosing and monitoring. |
Injectable Estradiol(IM or SubQ; valerate, cypionate, etc.) | Valerate: ~4–6 mg weekly (e.g. 4 mg q5 days).Cyp/Enanthate: ~5 mg weekly (or 7–10 mg every 2 weeks).Undecylate: 12–20 mg every 3–4 weeks.Typical range ~2–10 mg weekly across esters | Injection every 5–10 days (shorter interval for shorter ester; longer for longer ester) | Most reliable T suppression. Quickly lowers gonadal T by high estradiol feedback. Consistently achieves female/castrate T levels in most patients. Peaks can be high but troughs should stay >200 pg/mL on these doses. DIY-preferred method for monotherapy due to effectiveness and cost. Requires injections (technique and needle access needed). |
CITATIONS:
Micol S. Rothman, Danit Ariel, Carly Kelley, Ole-Petter R. Hamnvik, Jessica Abramowitz, Michael S. Irwig, Kyaw Soe, Caroline Davidge-Pitts, Aaron L. Misakian, Joshua D. Safer, Sean J. Iwamoto, The Use of Injectable Estradiol in Transgender and Gender Diverse Adults: A Scoping Review of Dose and Serum Estradiol Levels, Endocrine Practice, Volume 30, Issue 9, 2024, Pages 870-878, ISSN 1530-891X, https://doi.org/10.1016/j.eprac.2024.05.008.
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Samuel Cortez, Dominic Moog, Christopher Lewis, Kelley Williams, Cynthia J Herrick, Melanie E Fields, Teddi Gray, Zhaohua Guo, Ginger Nicol, Thomas Baranski, Effectiveness and Safety of Different Estradiol Regimens in Transgender Females: A Randomized Controlled Trial, Journal of the Endocrine Society, Volume 8, Issue 8, August 2024, bvae108, https://doi.org/10.1210/jendso/bvae108
Marieke Tebbens, Annemieke C Heijboer, Guy T’Sjoen, Peter H Bisschop, Martin den Heijer, The Role of Estrone in Feminizing Hormone Treatment, The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 2, February 2022, Pages e458–e466, https://doi.org/10.1210/clinem/dgab741
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