Microdosing (Low Dose) Estrogen HRT

Low-dose, or microdosing estrogen, is a way for folx to experience slower, subtle changes on HRT.

A purple gradient background with illustrations of estrogen HRT as a patch, syringe, and pills.

Illustration by Leo Mateus.

With all of the different gender identities and expressions out there, many folx live somewhere on the great spectrum beyond the binary male and female. Nonbinary, gender nonconforming (GNC), genderqueer, X-gender, and transgender experiences within or beyond the binary can entail exploring bodily changes in all different ways.

Many along the gender spectrum may be considering taking or are currently taking estrogen HRT as a tool for their body to reflect their truest self. With estrogen HRT, folx can expect changes such as a softening of the skin and breast growth, along with other shifts, depending on the person. More and more now, we’re seeing folx who are interested in subtle changes, or those who want to ease into changes to slowly see how they feel, opting for microdosing estrogen.

Microdosing is a tool for more subtle or slower changes.

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Microdosing or low-dose HRT has become a tool for many trans, nonbinary, and GNC people. In fact, The World Professional Association for Transgender Health (WPATH) now includes nonbinary identities and the need for personalized approaches in their Standards of Care.

Some folx consider microdosing when they want certain effects of HRT but not others. While it is hard to know for sure in advance exactly how changes will happen with HRT, we can work with folx to try to achieve the best outcome with the tools we have.

Compared to standard doses of estrogen, these lower doses are often half that amount. This allows the physical changes to develop slowly and over a longer period of time. Other folx will use HRT to achieve certain effects, such as breast development, then discontinue before further effects take place. 

Some people will take anti-androgens alone, as another alternative to low-dose estrogen.

People seeking more “feminine” features may choose to go on low-dose estrogen and/or anti-androgens. Some folx will trial a testosterone blocker like spironolactone (spiro) or finasteride alone first to see what reduction of testosterone feels like without added estrogen (this can cause hot flashes, low mood or energy, and bone loss long-term). While there is still some controversy whether spironolactone stops breast growth early, some folx prefer to start with low dose estrogen without taking spiro.

There are multiple options to microdose estrogen with FOLX:

There are just as many ways to microdose as there are to typical dose, and the main difference is in the concentration of hormones taken. Typical low dose regimens are listed below, but lower doses can be tried if desired. For estrogen, there are pill, patch, and injectable routes, along with oral routes of taking anti-androgens.

Estrogen Pills Estrogen Patches Injectable Estrogen Valerate Spironolactone Pills (Anti-Androgen) Finasteride Pills (Anti-Androgen)
Low Dose (Microdose) 2mg daily 100mcg every 3-4 days 0.2mL (4mg of 20mg/mL vial) weekly OR 0.10mL (4mg of 40mg/mL vial) weekly 25mg daily 1mg daily
Average Dose 2mg twice a day (4mg/day) 200mcg every 3-4 days 0.3mL (6mg of 20mg/mL vial) weekly OR 0.15mL (6mg of 40mg/mL vial) weekly 25mg twice a day (50mg per day) 2.5mg daily
Maximum Dose 4mg twice a day (8mg/day) 400mcg every 3-4 days 1mL (20mg of 20mg/mL vial) weekly OR 0.5mL (20mg of 40mg/mL vial) weekly 200mg twice a day (400mg per day) 5mg daily

If you’re curious about how other nonbinary and GNC folx have approached microdosing and low-dose HRT, there are a few great anecdotes in recent years. In this piece by them, NB/GNC folx talk about 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 get started with FOLX for microdosing estrogen, the process begins here. For existing FOLX members with questions about their dosage, don't hesitate to message or schedule time with a clinician. And for those who’ve just got some more questions, read up on estrogen here, and feel free to reach out to us at thelibrary@folxhealth.com.