This article was reviewed by Jess, DNP. Images are illustrated by Leo. This article was updated on 8/30/23 by the FOLX Editorial Team.
Many people live outside the gender binary of woman and man. Nonbinary folks and other gender-expansive people within or beyond the binary can explore bodily changes in different ways, including starting gender-affirming hormone therapy (GAHT). GAHT is sometimes referred to as hormone replacement therapy or HRT.
Some folks on the gender spectrum may consider—or currently are—taking estrogen gender-affirming hormone therapy as a tool for their body to reflect their most authentic self. With estrogen therapy, trans women and nonbinary folks can expect common physical changes. Common changes on estrogen HRT include softened skin, decreased muscle mass, enhanced breast growth, and thinning facial and body hair.
We see more and more people interested in subtle changes and slowly easing into hormone therapy to see how they feel at a gradual pace. GAHT can significantly reduce gender dysphoria and improve a trans person’s overall baseline of mental health, even when microdosing.
Microdosing is a tool for more subtle or slower changes.
What is the purpose of microdosing estrogen?
Microdosing is technically considered a "sub-therapeutic" dose of a medication, or a very low dose. However, low-dose GAHT has become a tool for many trans, nonbinary, and other gender-variant people to feel good in their bodies without committing to the faster secondary-sex changes that come with higher doses. Previously, many felt overwhelmed that GAHT was a kind of “no turning back” since healthcare providers were only familiar with prescribing higher doses of feminizing hormone therapy. In part, this was to combat testosterone levels to achieve a more “binary” type of appearance.
However, providers have more information on recommended guidance for slower hormone changes than the traditional GAHT route. For instance, the World Professional Association for Transgender Health (WPATH) now includes nonbinary identities and the need for personalized approaches in their Standards of Care.
Why do some people take lower doses of estrogen?
Some consider microdosing (taking lower doses) when they want certain effects of GAHT but not others. So while it is hard to know in advance exactly how changes will happen, we can work with folks to achieve the best outcome with the tools we have.
Compared to standard doses of estrogen, these lower doses are often half, or less, that amount. This allows the physical changes from estrogen to develop more gradually. Other people will use GAHT to achieve certain effects and then discontinue before further effects take place. However, some changes will recede once GAHT is discontinued.
How does microdosing estrogen work?
People seeking more “feminine” features may choose to go on low-dose estrogen or anti-androgens. Some will try a testosterone blocker like spironolactone (spiro) or finasteride alone first to see what a reduction of testosterone feels like without added estrogen. Symptoms can include hot flashes, low mood or energy, and even long-term bone loss. There is still some controversy about whether spironolactone stops breast growth early, though this data is inconclusive. While some prefer to start with low dose estrogen without taking spiro, most will follow the guidelines to start E and spiro together.
There are multiple options to microdose estrogen with FOLX.
There are many ways to adjust your estrogen levels by taking a very low dose of estrogen. The main difference is in the concentration of hormones taken. Typical low-dose regimens are listed below, but lower doses can be trialed if desired. For estrogen, there are oral, transdermal (via the skin), and injectable routes. For anti-androgens, there is the oral route.
If you’re curious about how others have approached microdosing and low-dose GAHT, there are a few great anecdotes in recent years. In this piece by them, some share their medical transition, costs, and hurdles they face in the current medical system. Transfeminine Science is another great resource aggregated from various Reddit threads and includes personal experiences from the founders Aly, Lain, Sam, and Kay as well as medical literature.
For those ready to join FOLX for low-dose estrogen, start by signing up for a membership. For existing FOLX members with questions about their dosage, don't hesitate to message or schedule time with your clinician. For those with more questions, read up on estrogen in the Library or reach out to us directly via the 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, preventive care, and fertility consultations. 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!