This article was updated 8/8/23 by the FOLX editorial team.
Each method of estrogen HRT has different dosage levels that can result in slower or quicker physical changes. Whatever method and dosage you decide is right for you depends on your health history and personal goals. Remember, the dose and routes for estrogen gender-affirming hormone therapy you choose are always in your control. FOLX offers hormones for transgender people, trans women, trans feminine, non-binary and other gender variant people looking to start or continue estrogen hormone replacement therapy.
Don't worry if you're unsure which route or dosage is the perfect combination for you. Fortunately, the way you take estrogen can always be adjusted! Our clinicians will work with you to figure out what method is best for you at any point during your gender journey. Read on to learn more information about FOLX's offerings for estrogen hormone replacement therapy.
Oral estradiol pill
The estradiol pill is a dose of estrogen taken daily, once or multiple times a day. These pills are usually dissolved under the tongue and can take up to 30 minutes to dissolve. Though they are in the oral form, many folks take them sublingually (dissolved under the tongue).
Common pros and cons of oral estrogen
While a pill can be more appealing than a needle for those who struggle with self-injection, there are both pros and cons to the oral method. Whether this method is right for you is entirely dependent on your preferences.
Oral estrogen dosage levels
Transgender women may prefer to jumpstart their estrogen HRT journey with an average dose. Other transfeminine and/or non-binary people may prefer to microdose or receive a lower dose of estrogen. There are no fixed dosages for specific gender identities, so we encourage you to choose the dosage that fits your goals.
Self-administered estrogen injection shots occur weekly or biweekly (every other week). There are two injection types: intramuscular (IM), which is injected into the muscle, and subcutaneous (Sub-Q, SQ, or SC), which is injected into the fatty tissue under the skin.
There are two different types of injectable estrogen: estradiol valerate and estradiol cypionate. The most common injectable estrogen used in the United States is estradiol valerate, which FOLX usually initiates for those pursuing the injectable estrogen HRT route. Both valerate and cypionate are prodrugs of estradiol and have a similar affinity for estrogen receptors in the body, meaning they're equally effective.
What are the major differences? Valerate is suspended in castor oil. Cypionate is suspended in cottonseed oil. Valerate has a more predictable pattern of movement throughout the body (aka pharmacokinetics).
Meanwhile, cypionate has a longer active life, which means it can be dosed every two weeks. However, cypionate is often only prescribed if valerate is unavailable. It's important to know that dosing varies for each. If switching from one to the other, the dosage would also shift substantially.
If you experience needle phobia and injection anxiety, check out our tips for overcoming self-injection fear!
Common pros and cons of injectable estrogen
While self-injecting may be scary for some, the advantages might outweigh the disadvantages, depending on what you want for your journey.
Injectable estrogen dosage levels
How do you know which injectable estrogen dosage is right for you? Check out the chart below for variations of dosage between estradiol valerate and estradiol cypionate.
Estrogen transdermal patch
The transdermal estrogen patch enables estrogen to be absorbed through the skin and into the bloodstream. A patch is applied to skin every three to four days. While the patch is prone to falling off with exposure to moisture, it can also be covered up with plastic to avoid falling off.
Common pros and cons of estrogen transdermal patch
If you think the estrogen patch is the most attractive estrogen replacement therapy option for you, take a moment to read about the pros and cons.
Transdermal patch estrogen dosage levels
While all estrogen transdermal patches are to be replaced every three to four days, dosages vary depending on your desired transition goals.
Anti-androgens and progesterone
Estrogen HRT can also include taking supplemental medications known as anti-androgens and/or progesterone in addition to one of the above methods. While not everyone on estrogen HRT pursues either, you may consider either or both.
Androgens are described as hormones that regulate the development of sex characteristics, such as testosterone. Moreover, anti-androgens work to block the effects of androgens, including testosterone. FOLX offers spironolactone as well as finasteride and dutasteride.
Progesterone is another type of hormone that can help improve breast or areolar development in those who don’t achieve full breast development with estrogen alone. However, medical research on progesterone is limited and, unfortunately, has been inconclusive.
For more information about supplemental medications for estrogen HRT and what FOLX offers, check out this guide.
With the multiple routes and dosages of estrogen replacement therapy, there are several ways to find the one that fits best for you. For those ready to get started with FOLX for estrogen HRT, the process begins here. For existing FOLX members with questions about dosage, don't hesitate to schedule time with a clinician. Have more questions or concerns? Read up on estrogen here and feel free to reach out to the FOLX Help Center.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, and preventive care. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!