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<strong>📄 Archived:</strong> 2025-08-31 14:01:45 UTC
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<strong>🔗 Source:</strong> <a href="https://papers.lgbt/papers/dosing">https://papers.lgbt/papers/dosing</a>
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url: 'https://papers.lgbt/papers/dosing',
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archivedAt: "2025-08-31T14:01:45.270376+00:00Z",
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<main class="paper-main flex-1 max-w-4xl mx-auto px-10 sm:px-12 md:px-16 lg:px-20 xl:px-28 2xl:px-36 py-8 lg:py-12" style="max-width: 76rem;"><div class="lg:hidden mb-8"><h3 class="text-xs font-medium uppercase tracking-wider text-muted-foreground mb-2">/dosing</h3><h1 class="text-2xl font-medium text-foreground mb-2">a general guide to estradiol dosing</h1><p class="text-sm text-muted-foreground">by emily/endocrinemoder/adenine</p></div><div class="bg-background p-6 mb-8 border"><h2 class="text-lg font-medium text-foreground mb-3">abstract</h2><p class="text-foreground leading-relaxed">my recommended dosing for monotherapy, very very short. </p></div><div class="lg:hidden mb-8"><div class="flex flex-wrap gap-2"><span class="px-3 py-1 bg-secondary text-secondary-foreground text-sm">dosing</span><span class="px-3 py-1 bg-secondary text-secondary-foreground text-sm">estradiol</span><span class="px-3 py-1 bg-secondary text-secondary-foreground text-sm">injections</span></div></div><div class="paper-container bg-background border mx-auto max-w-3xl px-6 md:px-10 lg:px-14 py-10" style="max-width: 70rem;"><article class="prose prose-neutral prose-lg max-w-none [&_*]:break-words [&_table]:prose-table [&_thead_th]:uppercase [&_thead_th]:tracking-wide [&_thead_th]:text-xs [&_h1]:scroll-mt-24 [&_h2]:scroll-mt-24 [&_h3]:scroll-mt-24 [&_h4]:scroll-mt-24 [&_h5]:scroll-mt-24 [&_h6]:scroll-mt-24 [&_a]:text-blue-600 hover:[&_a]:text-blue-700 dark:[&_a]:text-blue-400 dark:hover:[&_a]:text-blue-500 underline-offset-4" style="--para-space: 0.5em;"><h1 class="c26"><span class="c0 c39">DOSING MASTER DOC</span></h1><h2 class="c35"><span class="c0 c31">Estradiol-Only Monotherapy (Estrogen-Only HRT)</span></h2><p class="c8"><span>Estradiol-only monotherapy relies on estrogen’s ability to </span><span class="c5">directly suppress testosterone production</span><span class="c1"> 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).</span></p><p class="c8"><span>However, estradiol monotherapy is generally effective only at the </span><span class="c5">upper end</span><span class="c1"> 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.</span></p><p class="c8"><span class="c1">A SMALL NOTE:</span></p><p class="c8"><span class="c1">This document originally covered pellets as well but since nobody can really uses pellets it’s been removed. </span></p><p class="c8"><span>ORAL/PATCH IS INCLUDED BUT INJECTIONS IS </span><span class="c0">ALWAYS </span><span>BEST FOR MONOTHERAPY</span></p><h3 class="c19"><span class="c0 c23">Injectable Estradiol (IM or Subcutaneous)</span></h3><ul class="c16 lst-kix_qst3zhki39s4-0 start"><li class="c25 li-bullet-0"><span class="c0">Form and Dosing:</span><span> Intramuscular or subcutaneous injections of estradiol esters are highly effective for monotherapy. Common esters used include </span><span class="c0">estradiol valerate (EV)</span><span>, </span><span class="c0">estradiol cypionate (EC)</span><span>, </span><span class="c0">estradiol enanthate (EEn)</span><span>, and </span><span class="c0">estradiol undecylate (EUn)</span><span class="c1">. These are typically compounded in oil for injection. Typical monotherapy injection doses are:</span></li></ul><div><br></div><div><br></div><ul class="c16 lst-kix_qst3zhki39s4-1 start"><li class="c17 li-bullet-0"><span class="c0"><b>Estradiol Valerate</b>:</span><span> ~4–6 mg </span><span class="c0">per week</span><span class="c1"> (for example, 4 mg every 5 days is a common schedule).</span></li><li class="c17 li-bullet-0"><span class="c0"><b>Estradiol Cypionate or Enanthate</b>:</span><span> ~6 mg </span><span class="c0">per week</span><span class="c1"> (often given as 6 mg weekly, or slightly higher dose if stretching to 10-day intervals).</span></li><li class="c17 li-bullet-0"><span class="c0"><b>Estradiol Undecylate</b>:</span><span> a </span><span class="c5">very</span><span> long-acting ester, dosed at ~12–20 mg </span><span class="c0">every 3–4 weeks</span><span class="c1"> (e.g. 12 mg every 20 days, or up to 20 mg monthly).</span></li></ul><ul class="c16 lst-kix_qst3zhki39s4-0"><li class="c25 li-bullet-0"><br></li><li class="c25 li-bullet-0"><span><br></span></li><li class="c25 li-bullet-0"><span>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 </span><span class="c5">“the vast majority of people [on these doses] have high enough estradiol levels to suppress testosterone on its own.”</span><span class="c1">. 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.</span></li></ul><div><br></div><div><br></div><ul class="c16 lst-kix_qst3zhki39s4-0"><li class="c25 li-bullet-0"><span class="c0"><b>Effectiveness</b>:</span><span> </span><span class="c0">Injectable estradiol is widel</span><span class="c0" style="font-size: var(--reader-font-size,16px);">y regarded as the most consistently effective monotherapy method </span><span style="font-size: var(--reader-font-size,16px);">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 </span><span class="c5" style="font-size: var(--reader-font-size,16px);">injectable</span><span style="font-size: var(--reader-font-size,16px);"> 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 </span><span class="c5" style="font-size: var(--reader-font-size,16px);">“almost anyone”</span><span class="c1" style="font-size: var(--reader-font-size,16px);"> 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.</span></li><li class="c25 li-bullet-0"><br></li></ul><h3></h3><h2><ul class="c16 lst-kix_qst3zhki39s4-0"><li class="c25 li-bullet-0"><span class="c1">Some considerations:</span></li></ul></h2><ul class="c16 lst-kix_qst3zhki39s4-1 start"><li class="c17 li-bullet-0"><span class="c5"><b>Injection Technique</b>:</span><span> 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 syringe</span><span class="c33"><a class="c24" href="https://www.google.com/url?q=https://pastebin.com/eFZitc0M&sa=D&source=editors&ust=1756330861978512&usg=AOvVaw1gOojhshz5ZN9brLj06xjk">read this!!!</a></span><span class="c1">) 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).</span></li><li class="c17 li-bullet-0"><span class="c5"><b>Dosing Frequency</b>:</span><span class="c1"> 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.</span></li><li class="c17 li-bullet-0"><span class="c5">Monitoring:</span><span> Because injection monotherapy often achieves higher estradiol levels, regular blood tests are advised to ensure estradiol isn’t </span><span class="c5">excessively</span><span> 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 </span><span class="c5">lowest dose that keeps T at goal</span><span class="c1"> (<50 ng/dL at trough).</span></li></ul><p class="c8"><span><br></span></p><p class="c8"><span><br></span></p><p class="c8"><span>In summary, injectable estradiol is the </span><span class="c0">preferred method for DIY estrogen monotherapy</span><span class="c1"> 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.</span></p><p class="c8"><span class="c1"><br></span></p><h3 class="c19"><span class="c23 c0">Summary of Estradiol Monotherapy Dosing by Route</span></h3><p class="c8"><span>The following table summarizes typical </span><span class="c0">estradiol dosing ranges</span><span class="c1"> for monotherapy, along with notes on effectiveness and considerations:</span></p><table class="c36"><tbody><tr class="c10"><td class="c9" colspan="1" rowspan="1"><p class="c12"><span class="c13 c0">Estradiol Delivery Method</span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c12"><span class="c0">Typical Monotherapy Dose</span><span class="c5 c0 c40">(DIY/self-med & clinical ranges)</span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c12"><span class="c13 c0">Schedule</span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c12"><span class="c13 c0">Effectiveness & Notes</span></p></td></tr><tr class="c20"><td class="c9" colspan="1" rowspan="1"><p class="c2"><span class="c0">Oral Estradiol</span><span class="c1">(pills, swallowed)</span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c2"><span>4–8 mg/day (in 2–3 divided doses)</span><span class="c5 c21">Up to ~10 mg/day max in some cases</span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c2"><span class="c1">Daily (split doses morning and evening or TID)</span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c2"><span class="c1">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.</span></p></td></tr><tr class="c18"><td class="c9" colspan="1" rowspan="1"><p class="c2"><span class="c0">Sublingual Estradiol</span><span class="c1">(dissolve under tongue)</span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c2"><span>4–6 mg/day (often as 2 mg pills 2–3× daily)</span><span class="c21 c5">Range ~1–8 mg/day</span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c2"><span class="c1">Daily (2–3 doses held sublingually for absorption)</span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c2"><span class="c1">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.</span></p></td></tr><tr class="c27"><td class="c9" colspan="1" rowspan="1"><p class="c2"><span class="c0">Transdermal Patch</span><span class="c1">(estradiol patches)</span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c2"><span class="c1">100–200 μg/day is common target; up to 300–400 μg/day for monotherapy if needed.</span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c2"><span class="c1">Patch changed 1–2× per week (e.g. twice weekly 100 μg = ~200 μg/day)</span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c2"><span class="c1">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.</span></p></td></tr><tr class="c32"><td class="c9" colspan="1" rowspan="1"><p class="c2"><span class="c0">Transdermal Gel</span><span class="c1"> (or solution)</span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c2"><span class="c1">~2–6 mg/day applied to skin (e.g. 2–4 pumps of 0.75 mg each). Some DIY sources start ~3–4 mg.</span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c2"><span class="c1">Applied daily (usually morning)</span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c2"><span class="c1">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.</span></p></td></tr><tr class="c14"><td class="c9" colspan="1" rowspan="1"><p class="c2"><span class="c0">Injectable Estradiol</span><span class="c1">(IM or SubQ; valerate, cypionate, etc.)</span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c2"><span>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.</span><span class="c21 c5">Typical range ~2–10 mg weekly across esters</span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c2"><span class="c1">Injection every 5–10 days (shorter interval for shorter ester; longer for longer ester)</span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c2"><span class="c0">Most reliable T suppression.</span><span class="c1"> 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).</span></p></td></tr><tr class="c27"><td class="c9" colspan="1" rowspan="1"><p class="c2 c11"><span class="c0 c13"></span></p></td><td class="c4" colspan="1" rowspan="1"><p class="c2 c11"><span class="c1"></span></p></td><td class="c3" colspan="1" rowspan="1"><p class="c2 c11"><span class="c1"></span></p></td><td class="c15" colspan="1" rowspan="1"><p class="c2 c11"><span class="c1"></span></p></td></tr></tbody></table><p class="c8"><span class="c13 c0">CITATIONS:</span></p><p class="c8"><span class="c5 c38">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, </span><span class="c5 c30"><a class="c24" href="https://www.google.com/url?q=https://doi.org/10.1016/j.eprac.2024.05.008&sa=D&source=editors&ust=1756330861987509&usg=AOvVaw1IZyg0LtSjT2hXPYiSrmjt">https://doi.org/10.1016/j.eprac.2024.05.008</a></span><span class="c5 c37">.</span></p><p class="c8"><span class="c6 c5">Aaron L Misakian, Carly E Kelley, Erika A Sullivan, Julia J Chang, Gagandeep Singh, Sarah Kokosa, Jonathan Avila, Holly Cooper, Jane W Liang, Bren Botzheim, Meg Quint, Athavi Jeevananthan, Ellenor Chi, Madison Harmer, Laurel Hiatt, Michaela Kowalewski, Benjamin Steinberg, Telisha Tausinga, Hannah Tanner, Tiffany F Ho, Bayarmaa Mark, Brian Zenger, Sophia Hu, Amanuail Gebregzabheir, Justin M Penny, Danielle F Loeb, Tyler Strickland, Sean J Iwamoto, Micol S Rothman, Ole-Petter R Hamnvik, Danit Ariel, Injectable Estradiol Use in Transgender and Gender-Diverse Individuals throughout the United States, </span><span class="c5 c34">The Journal of Clinical Endocrinology & Metabolism</span><span class="c6 c5">, Volume 110, Issue 9, September 2025, Pages e2898–e2907, </span><span class="c5 c29"><a class="c24" href="https://www.google.com/url?q=https://doi.org/10.1210/clinem/dgaf015&sa=D&source=editors&ust=1756330861988553&usg=AOvVaw2N9J1pFNVinabU1Gcq3yJm">https://doi.org/10.1210/clinem/dgaf015</a></span></p><p class="c8"><span class="c6 c5">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, </span><span class="c5 c34">Journal of the Endocrine Society</span><span class="c6 c5">, Volume 8, Issue 8, August 2024, bvae108, </span><span class="c5 c29"><a class="c24" href="https://www.google.com/url?q=https://doi.org/10.1210/jendso/bvae108&sa=D&source=editors&ust=1756330861989153&usg=AOvVaw1DO6BdC56yh7v2cxRofARV">https://doi.org/10.1210/jendso/bvae108</a></span></p><p class="c8"><span class="c6 c5">Marieke Tebbens, Annemieke C Heijboer, Guy T’Sjoen, Peter H Bisschop, Martin den Heijer, The Role of Estrone in Feminizing Hormone Treatment, </span><span class="c5 c34">The Journal of Clinical Endocrinology & Metabolism</span><span class="c5 c6">, Volume 107, Issue 2, February 2022, Pages e458–e466, </span><span class="c5 c29"><a class="c24" href="https://www.google.com/url?q=https://doi.org/10.1210/clinem/dgab741&sa=D&source=editors&ust=1756330861989747&usg=AOvVaw1LLU_7IxUxrBNUfHhp_MkV">https://doi.org/10.1210/clinem/dgab741</a></span></p>
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