I'll be starting on Nov 18. My prescription:
Estradiol valerate, 20 mg/mL, 1mL intramuscular injection every other week
Spironolactone, 50 mg, oral tablet twice a day
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20mg every 14 days is a bad idea with estradiol valerate. You will most likely experience major mood swings and physical symptoms. Valerate has a half life of 3.5 days. Ideally you’d take it at that point, but don’t wait longer than 5 days. And obviously decrease your dosage accordingly. So for example 5mg every 5 days or 3mg every 3.5 days. Love ✨✌️
@Zoe I thought the half-life is larger for injections than for tablets, but idk, i'm new to this stuff 😅
@Yev It is, but it’s not that large and it depends on the ester (the “type” of estrogen you take). Tablets have a quite short half life and you’d take them multiple times a day. Valerate injections have a half life of around 3.5 days, cypionate of around 7 and enanthate of around 10. Ideally you’d want take your estrogen at its half life to get the most stable levels. You can also see this in this simulator: https://transfemscience.org/misc/injectable-e2-simulator/ . If you choose “valerate in oil”, 20mg and every 14 days, you will see that with that regime you will have huge swings, going all the way up to early pregnancy levels and down to the bare minimum. I’d talk with your doctor about this and not wait longer than 5 days at most. The website with the simulator also has a couple of articles that I’d highly recommend checking out. They can be a bit dry to read but they will safe you from some bad decisions that doctors like to make with us 🙈 Hope that helps ☺️
@Zoe I sent our conversation to my doctor, and got a this uninformative answer:
Hi Yev, Thanks for the updates, and it is good to hear from you.
There absolutely has been conversation around this and things that we follow.
We have at times split into weekly dosing, are you experiencing mood symptoms in the middle of your dose cycle?
We can talk through for sure and trial you on the more frequent injections or of course trial oral.
We have an appointment in January at which point we can talk through or sooner if you would like.
[full name], MSN, FNP-BC (She/Her/Hers)
@Yev I’d really encourage you to do your own research on this with the resources I provided above and not trust some random person on the internet like me 🙈 But I also want to help you, so my opinion is as follows:
I think taking EV (estradiol valerate) every two weeks is a really bad idea. I’d almost bet on it that you will experience really unpleasant psychological and physiological side effects. On the psychological side we are talking about major mood swings, being easily irritated, and even depression. On the physiological side it can be anything from headaches, hot/cold flashes, and other flu like symptoms. I’m myself for example really sensitive to those hormone level swings and often had short depressive episodes or PMS like symptoms induced by those changing levels before I went on a more stable method. And then there is also the issue that less stable E2 levels will lead to a higher SHBG level. We are not exactly sure what this will lead to. There are some people claiming high SHBG values lead to a worse feminization but I don’t believe this personally. There is also the idea that SHBG can be used as a proxy for liver activity which in turn means that higher SHBG means higher chance of cardiovascular risks. Whatever it is, it is probably best to stay in a cis women range and with your planned injection cycle I doubt that you will. I mean, your E2 levels will go all the way up to early pregnancy and all the way down to the minimum you should have. Every 2 weeks. Yes, most cis women also have a cycle with changing E2 levels, but they first up don’t change by that much at all and second up lead to really unpleasant symptoms that most women would be happy not to have.
Even going to a weekly injection cycle with EV will only be a partial fix. You are still twice over the half life of EV. Like I said, I’d personally not go above 5 days and try to get it done every 3.5 days.
But just to be clear: This is still far better than no HRT. If you need to decide between this or nothing then choose this. Having your androgens, LH and FSH sufficiently suppressed is the most important thing to feminization.
@Zoe Thanks for bringing this up. I talked to some of my trans friends about it, who all agree 14 days is too infrequent. I talked to a different doctor. We decided to still do the next dose after 14 days, but I will closely monitor my mood during this time. Then we will probably switch to 7 days.
So far I haven't noticed major swings (except the one time I had to reschedule my injection by a few days, and I felt like crap by the end). So it looks like I'm less sensitive than you, and 7 days is proooobably okay? (or not -- we might reduce it further)
@Yev That is great 😊 HRT is just really personal, and you have to test things out for yourself. Every 7 days means by the last day you will still only have a quarter of estradiol of what you originally had, but whether that is bad for you is something that only you can say. Try it, experiment, and don't trust everything your doc says. I'm sure you will be happy in the end 🌺
