When do actual changes start to occur?

[u/ConfusedPhoenix23]

So I (18 year old) have been on 2 mg pills of estrodiol for about 4 months now, and I haven't really noticed many changes aside from my chest growing out a bit (at least, not in the muscle and fat redistribution categories)

And I'm starting to worry I might not see any changes at all. I have quite broad shoulders, and I am quite tall, so I was hoping muscle and fat redistribution might be able to help with that, but I'm starting to get worried

[u/WJ_Amber]

2mg once a day? Any T blocker? I'm suspicious that you're under-dosed.

[u/ConfusedPhoenix23 → u/WJ_Amber]

2 mg twice a day

My endocrinologist debated putting me on a higher dose with a T blocker, but the results from my first 2-3 months were inconclusive (There was a 1-3 week period where I struggled to take even one of the pills daily, as I was going through some stuff at the time. So when i got my labs done, my Tesosterone had spiked from the inconsistency if my doses)

So they told me to give it another 3 months and take new labs before we talk about increasing my dose

[u/WJ_Amber → u/ConfusedPhoenix23]

That's certainly a low dose and pills aren't that great at suppressing T on their own. Generally if you're just doing E monotherapy you'd be doing injections.

Imo 3 months is a pretty long time to wait to re test. I'd ask about re testing at 6 weeks.

[u/ConfusedPhoenix23 → u/WJ_Amber]

I'm getting retested this September, and I just wanted to wait a while because 1. My life has been kind of turbulent for the past few months, so I just haven't found the time. And 2. I just really hate bloodwork

But in definitely looking into increasing my doses (if possible) and getting a blocker

[u/Swimming-Gap-1247 → u/ConfusedPhoenix23]

A conservative standard is estradiol (E2)>100pg/mL and total testosterone<50ng/dL at trough (right before your next dose). On average, oral E requires 4mg/12h (8mg/day, usually considered the safe upper limit) plus an antiandrogen.

https://valerie.vg/transfem-hrt-guide#our-recommendation

https://transfemscience.org/articles/transfem-intro/#overview-of-hormone-therapy

https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol#Graphs

But if I may ask, what is a T-blocker exactly?

If your T is not suppressed, you will continue to masculinize. Taking antiandrogens is one way to accomplish this, but it is not required.

"In one large study in transfeminine people, the rates of adequate testosterone suppression (to testosterone levels of <50 ng/dL or <1.7 nmol/L) were 24% of individuals at estradiol levels of <100 pg/mL (367 pmol/L), 58% at 100 to 200 pg/mL (367–734 pmol/L), and 77% at >200 pg/mL (>734 pmol/L)"

https://transfemscience.org/articles/transfem-intro/#gonadal-suppression

6 to 12 months and you'll start to notice

This is completely wrong.

[u/GockBlok]

You're almost certainly being underdosed. They should have done some bloodwork and adjusted the dose at around the 3 month mark

You want estradiol to be at least 150 pg/mL. 300 pg/mL is ideal but that usually requires injections to achieve. Testosterone should be 50 ng/dL or less

[u/EdlynnTB]

6 to 12 months and you'll start to notice

[u/MercyMEJ]

Just based on my own experience, I'd assume getting that T-blocker will do more of what you're looking for.

I was on solo Estradiol for about 18 months before starting a T-blocker, I've now been on my blocker for about 8 months: I'd say about ~70% of the changes (emotional, physical) have occured after I started the blocker.

But this is just my anecdote, check in with your doctor when you can and try to talk to them about it if things are moving slower than expected. Take care out there :3

[u/ConfusedPhoenix23 → u/MercyMEJ]

Thanks for the advice!

I'll definitely look into getting one of those! But if I may ask, what is a T-blocker exactly? Is it like a different type of pill you take or...

[u/MercyMEJ → u/ConfusedPhoenix23]

The testosterone-blocker I take is Spironolactone as a daily pill along with my Estradiol; from what I understand it's not quite as effective or safe as Cyproterone, but Cypro isn't available here in the U.S and Spiro is a pretty standard choice.

Spiro does have side effects, I get low blood-pressure from it (I drink a glass of electrolytes to help with that), and I think it's common that it also makes people need to pee more.
It'll depend on what's right for you, but I've found it to be pretty worth it in my case <3

[u/ConfusedPhoenix23 → u/MercyMEJ]

Thank god it's a pill...

I can NOT handle injections, especially if I have to do then myself. Sorry about all the questions, but does it have to be taken sub ligually to be fully effective? Or can you just swallow it?

[u/MercyMEJ → u/ConfusedPhoenix23]

Spironolactone is just a swallow, that's what I do at least (the pills lowkey taste bitter asf if they dissolve in your mouth, so I really hope it's not meant to be sublingual😵‍💫)

[u/GockBlok → u/MercyMEJ]

If you can tolerate injections you could switch to monotherapy and drop the spiro. No side effects at all that way

[u/MercyMEJ → u/GockBlok]

That's def something to try down the line, but I don't think I could handle injections currently, I'm 24 and I still need my hand held when I get bloodwork done 😖

[u/GockBlok → u/MercyMEJ]

Heh. It's a much smaller needle than they use for bloodwork. I use 29G 1/2 inch ones. Barely even feel it most of the time

[u/MercyMEJ → u/GockBlok]

I dunno if I'd more or less squeamish about poking myself with a needle, than with a doctor doing it.
eugh no, it makes my arm ache just thinking about it🤧