Microdosing Estrogen
It’s very important to see an experienced physician who specializes in HRT before taking hormones. The Gender Confirmation Center performs gender affirming surgery and does not prescribe hormones to patients. Starting hormones or adjusting your hormone dose or regimen without a discussion with a hormone specialist has the potential to be dangerous or life threatening. You should seek out a medical provider experienced in hormone treatment if are considering going on hormones or adjusting your dosage.
When someone takes small amounts of hormones for hormone replacement therapy (HRT), it is called “microdosing.” Estrogen (used synonymously with “estradiol,” which is one of three forms of estrogen found in the human body) is a feminizing hormone that many trans women, transfeminine, non-binary, and gender expansive people take to reduce gender dysphoria or discomfort. There are a few reasons why someone might want to microdose estradiol, and a couple ways to go about it. Estradiol is usually accompanied by anti-androgens (often referred to as hormone blockers or testosterone blockers), but a regimen and dose should be guided by your specific transitioning goals.
While microdosing usually refers to testosterone and masculine folks, the Gender Confirmation Center works with feminine-spectrum non-binary patients who seek feminizing HRT. Learn more about how to access estrogen here.
Why Microdose?
Microdosing estradiol can be an effective way to achieve more subtle feminization for feminine-spectrum non-binary people, or for any trans person with similar hormone replacement therapy goals. Taking low doses of hormones can also be important for many other groups of people (see “Why Microdose” on the Microdosing Testosterone page). It is always a best practice to choose the correct hormone dose for you with a doctor.
Similar to testosterone, estradiol and/or anti-androgens impact secondary sex characteristics, which are the changes to the body that happen during puberty in adolescence. UCSF’s guide to feminizing hormone therapy has an in-depth list of the changes that one can expect during feminizing HRT and information relating to the health concerns of estradiol and hormone blockers.
What is microdosing Estrogen/T blockers?
It is important to point out that the use of anti-androgens can be an important part of hormonal feminization for feminine-spectrum trans people. Testosterone blockers are used to lower testosterone levels, enhancing the impact that estrogen can have on the body. Blockers are sometimes used just when someone is starting estrogen, and in other cases are used throughout the entirety of someones HRT journey.
For some non-binary people, the use of a testosterone blocker alone can achieve the right amount of feminization. For others, the use of estrogen along with a testosterone blocker is essential. Again, it is recommended to discuss your HRT goals with a doctor to help decide which method is best for you.
Below are some dosing recommendations for the different forms of estrogen used in HRT and two common anti-androgens. Recommendations are taken from UCSF Transgender Care:
Estrogen
Oral Estradiol: A “typical” dose of oral estradiol is in the 2 to 8mg range per day. A microdose would be around 1mg daily. Oral estradiol is usually taken sublingually.
Transdermal Patch: Estradiol patches come in different concentration levels, and there are different recommendations for how often a patch can be changed based on the brand. A “normal” patch dose is 100 to 400mcg per day, and a low dose estrogen patch would be around 50mcg per day.
Estradiol Valerate: Usually injected intramuscularly, a “normal” dose of estradiol valerate would be between 20 and 40mg every two weeks. A microdose would be injecting less than 20mg every two weeks. For weekly injections, doses can be divided in half.
Estradiol Cypionate: Also injected intramuscularly, a “typical” dose of estradiol cypionate is between 2 and 5mg every two weeks. A low dose would be injecting less than 2mg every two weeks. Similarly to estradiol valerate, doses can be divided in half for weekly injections.
Anti-Androgens (Testosterone Blockers)
Spironolactone: Commonly referred to as “Spiro,” this testosterone blocker is the most commonly used anti-androgen in the United States. A “normal” dose of Spiro usually falls in the 50 to 200mg twice per day range. A microdose would be around 25mg per day. Spiro is taken orally and is recommended to be taken at mealtimes.
Finasteride: A maximum dose of Finasteride is around 5mg per day, and a low dose is around 1mg per day.
Personal accounts of non-binary transitioning
Below are some stories that highlight the process of medically transitioning as a non-binary person. People discuss taking low doses of estrogen, talking with doctors about non-binary identity, and what others can expect when starting their own transitioning journey.
- In this NBC news story, non-binary folks discuss their reasons for choosing to microdose. While most of these stories are about people taking low doses of testosterone, there are a couple of accounts about estrogen.
- In this piece, Them.us asks non-binary people to discuss their medical transition, cost barriers to hormone therapy, doctors appointments, and non-binary visibility in the trans community.
- Teen Vogue gives a platform to non-binary folks who have chosen to medically transition in this piece. Folks talk about transitioning, intermittent use of hormones, and the difference between gender identity and gender expression.
In summary
- The information on this page is not meant to be medical advice. This page is intended for informational purposes only.
- Taking low doses of estrogen and/or testosterone blockers is an option that can work for many groups of people, regardless of gender identity. Visit UCSF’s guide to feminizing hormone therapy and talk to your doctor and mental health providers to find a dose and system that works for you.
- There are many different ways to microdose estrogen and/or anti-androgens. It is normal to try out some options before landing on a regimen that feels best for you.
- The standards of care put out by the World Provider Association for Transgender Health suggests that doctors start by prescribing lower doses of estrogen to all trans patients seeking feminizing HRT. Look through this guide to learn more about how to talk to your doctor about microdosing.
