Transfeminine Guide: FAQ

Frequently Asked Questions:

There’s no clinical evidence that higher estradiol levels results in better breast development/feminization or a quicker transition. The main factor that determines how quickly breast growth or feminization occurs is adequate suppression of testosterone.

No mention of progesterone (AKA prog)?

There is some tentative clinical evidence that progesterone may be able to increase breast size (by around 10-30% of baseline), though it’s likely the increase is fully reversible after progesterone use is stopped. Due to this, it’s not strong enough of an effect for its addition to the main guide. Claims about progesterone’s influence on libido and mood is mostly anecdotal and there exists little clinical evidence in support of such claims.

Despite this, there’s very little harm in trying progesterone if you wish.

Some people advocate for rectal administration of progesterone due to increased bioavailability, though there is a lack of research as to whether this would result in more desired effects compared to standard oral administration.

Do I have to worry about DHT?

DHT (dihydrotestosterone) is an androgen (masculinizing hormone) that causes facial/body hair growth and contributes to male-pattern baldness. DHT occurs in the body as a natural result of some testosterone converting itself into DHT.

All HRT regimens that will block/suppress/prevent the effects of testosterone generally also do the same for DHT.

Rarely, some trans feminine people will experience unexpectedly high DHT levels, even though their testosterone levels are adequately suppressed.

If you are particularly concerned (perhaps due to body or facial hair growth, or progressive hair loss, despite testosterone levels being low), you can get your DHT tested with a blood test to see if it’s too high (anything >20 ng/dL would be considered high).

Finasteride and dutasteride are medications that prevents the conversion of testosterone into DHT. You can add in 5mg daily finasteride or 0.5mg daily dutasteride to block DHT. Finasteride is slightly weaker than dutasteride in preventing DHT, though it is likely still very effective for transfem purposes. It is also usually cheaper.

(https://diyhrt.market/meds/groups/finasteride) and (https://hrtcafe.net/Other_Meds/finasteride.html)

(https://diyhrt.market/meds/groups/dutasteride) and (https://hrtcafe.net/Other_Meds/dutasteride.html)

Bicalutamide can also block the effects of DHT in the same way that it does for testosterone. Caution the potential risks described earlier in this guide though.

Powers method/Estrone (E1) levels?

Dr. Will Powers is a trans healthcare provider very well known in the trans community. He has made many claims about HRT and has a number of unique practices regarding the HRT regimens he prescribes.

There’s very little evidence to suggest that Powers’ methods are any better at attaining quicker/better/faster feminization or breast development versus a typical HRT regimen. There is no clinical evidence that suggests his estrone theory (higher E1 levels during the start of transition with oral estradiol causing better breast growth) works any better than other HRT regimens.

The reason Powers’ patients tend to get better results is because he prescribes regimens and adjusts levels based on blood testing so that the patient’s hormone levels are actually within reasonable ranges, which is already quite rare for any trans healthcare provider to do.

Much of what Powers claims/says are mostly unfounded, and there is much evidence in the contrary for many of his claims. This includes his claims about boron, progesterone, the ‘Powers’ method’, etc.

Despite this, there are some things that Powers has done that are worthy of praise, namely the use of bicalutamide as an antiandrogen for transfems, using high dose estradiol monotherapy, using rectal progesterone instead of oral, etc.

What’s the best way of knowing my T levels if I can’t get a blood test done?

Content Warning: NSFW mentions of genitals

There are really no good ways to find out if your T levels are suppressed if you can’t access blood tests.

If you ejaculate very little or no semen, it’s a likely sign that your T is adequately suppressed. However, being able to ejaculate semen doesn’t necessarily mean your T isn’t being suppressed.

If you notice your libido being significantly higher than normal, an increase in acne/oil production, more random erections, and increased semen volume, it can be a sign that your testosterone is too high.

Try and avoid relying on very subjective factors like changes in mood to gauge hormone levels.

Is this illegal?

Ordering these medications almost always carries zero risk of legal consequence. This is because in most countries, estrogens and antiandrogens are not controlled substances that are illegal to order or possess.

However, because ordering medication online without a prescription is unregulated, packages may still be seized by customs (essentially the border police that look through mail) and destroyed. Customs seizure is rare though, and most sellers will resend a package for free or refund an order if it is seized.

This is how the law works in most countries (including the USA, Canada, UK, EU, most South American countries, Australia, etc).

However, ordering from a domestic source (usually homebrew sources) will carry essentially zero risk of seizure, because domestic mail does not pass through customs.

What do I do if my package is seized?

In the unlikely event your package is held by customs and you are contacted by phone or email, do not tell customs what is inside the package. If they contact you (usually you are only contacted if you provide your contact information to an overseas pharmacy source), know that you cannot get in legal trouble for ordering HRT. Contact the seller if possible to resolve the issue. It is bad for people who want to order from a specific seller, and bad for that seller’s business if you tell customs that you’re ordering HRT without a prescription. Don’t do that.

Traveling with HRT.

Yes it’s fine to travel with most HRT. Even with weeks worth of needles and injection supplies. You’ll almost certainly be fine.

For air travel, be sure your HRT is clearly labeled as what it actually is (write the full name of the medication on the bottle/vial/etc if you need to). Don’t try to take wrongly labeled HRT onto a plane, for example, putting HRT pills into a vitamin bottle. If you use injections, store it in your checked baggage.

If you want to be extra safe, throw a bottle of Aspirin and some allergy medication into a large, clear Ziploc bag along with your HRT.

Is weight cycling real/worth it?

Content Warning: Food, Weight, Eating Disorders.

Weight cycling is an idea popular in some transfeminine communities. It is the idea that losing weight if you are a heavier person pre-HRT, or gaining some weight if you were a skinnier person pre-HRT can help in obtaining a more feminine figure/feminine fat distribution and will enhance breast development.

There’s no strong evidence to suggest that weight cycling works, and many people can develop eating disorders from it. I personally wouldn’t recommend it.

More extreme forms of weight cycling involve repeatedly gaining and losing significant amounts of weight. I would definitely not recommend this, as it can have serious health consequences.

Do I have to change my HRT regimen if I get an orchiectomy or bottom surgery/SRS?

If you no longer have testes, you can take a lower dose of estrogen without an antiandrogen, because your body no longer produces significant amounts of testosterone or other androgens, thus negating the need for an antiandrogen. Below are some more tailored HRT regimens for those who have had an orchi or bottom surgery/SRS. Make sure your estradiol levels are still above 100pg/mL on average:

Estradiol Form	Dosage	Frequency	Total Daily/Weekly Dose
Oral	2mg	Twice per day	4mg/day
Sublingual/Buccal	0.5mg	Three times per day	1.5mg/day
Patches	100μg	Changed weekly	100μg/day (approx.)
Gel	2.5mg	Once daily	2.5mg/day
Valerate (injection)	2mg	Every 5 days	~2.8mg/week
Cypionate (injection)	2mg	Every 7 days	2mg/week
Enanthate (injection)	3mg	Every 10 days	~2.1mg/week