Estradiol is preferred, as it most closely resembles the hormone produced by the ovaries. It is prescribed in a similar way to hormone replacement therapy for postmenopausal women, but with slightly higher doses. The dose of estradiol valerate tablets starts at 2–4 mg daily, increasing up to 8 mg.
The optimal oestrogen in HRT is a type of oestrogen called '17 beta oestradiol'. This is a body identical estrogen and has the same molecular structure as the estrogen which decreases in your body during the menopause.
Target estradiol levels 90–200 pg/mL (330–734 pmol/L).
Estrogen may be given as a pill, by injection, or by a number of skin preparations such as a gel, spray or a patch. Pills are convenient, cheap and effective, but are less safe if you smoke or are older than 35. Patches can be very effective and safe, but they need to be worn at all times.
Overdosage of estrogen may cause nausea, vomiting, breast tenderness, abdominal pain, drowsiness and fatigue, and withdrawal bleeding may occur in women. Treatment of overdose consists of discontinuation of ESTRING together with institution of appropriate symptomatic care.
Adults—2.5 to 7.5 mg a day. This dose may be divided up and taken in smaller doses. Your doctor may want you to take the medicine each day or only on certain days of the month.
Typical dosing for estradiol
Low estrogen levels: The typical starting dose is 1 mg to 2 mg by mouth daily. Breast cancer: The typical dose is 10 mg by mouth three times daily for at least 3 months.
It will begin 1 to 3 months after you start treatment. You'll see the full effect within 1 to 2 years.
People who start estrogen hormone replacement therapy will notice many changes in their body and breast growth is one of the earliest and most noticeable developments.
Oestrogen causes feminising effects such as breast growth, more curvy body shape and softer skin. Oestrogen medication is generally safe when prescribed under medical supervision. It's important to have regular check ups and blood tests when taking hormones.
Estradiol is the most potent. Estrone and estradiol are synthesised by the aromatisation of androstenedione and testosterone, respectively (Fig. 1). They can also be interconverted by the action of 17β-hydroxysteroid dehydrogenases (17β-HSDs).
For people taking estrogen as part of their gender transition, breast growth typically begins within three months of starting GAHT. Breast growth or changes in sensation tends to increase dramatically within the first six to twelve months.
A practical target for hormone therapy for transgender women (MTF) is to decrease testosterone levels to the normal female range (30–100 ng/dl) without supra- physiological levels of estradiol (<200 pg/ml) by administering an antiandrogen and estrogen.
In transgender women or trans feminine people (MTF), the most commonly used medications are estrogens and anti-androgens.
The facial changes can take up to 2 years or more to see the final result. It is usually a good idea to wait at least 2 years after beginning HRT before considering facial feminization procedures.
Once a person starts taking estrogen hormone therapy, they may begin to experience erectile dysfunction and fewer erections. However, a person will still be able to reach orgasm.
Hormone therapy lowers the amount of testosterone in the body and this affects your ability to have and maintain an erection. This may get better within 3 to 12 months after the treatment ends. For some men, erection problems are permanent.
Two pumps (2.5 g) of Oestrogel once daily (1.5 mg Estradiol) is the usual starting dose, which in the majority of women will provide effective relief of symptoms.
Most pills prescribed today have around 30-35 micrograms of hormones. Any pill that has less than 30 micrograms (i.e. 10-20 micrograms) is considered low dose.
A pill is considered low dose if it contains less than 30 micrograms (mcg) of estrogen, and those that contain 10 mcg of estrogen are considered ultra-low-dose.
Your body needs estrogen for your reproductive, cardiovascular and bone health. Too much estrogen, though, can cause irregular periods and may worsen conditions that affect your reproductive health. Your provider can help diagnose what's causing your high estrogen levels and recommend treatments that can help.
High-dose versus low-dose therapy
Low-dose estrogen is often considered to be 0.3mg or less of conjugated estrogen, 0.5mg or less of oral micronized estradiol, 2.5μg or less of ethinyl estradiol, or 25μg or less of transdermal estradiol.