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MTF Dosages

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Getting the correct dosage is important to get the results you want! Getting regular blood tests is important but this is not always viable for everyone, this page’s dosages are some general dosage recommendations on getting an appropriate E level.

Pill dosage

Generally doctors will prescribe lower than ideal dosages for HRT, especially pills. Make sure you advocate for what you want to get the levels you require. See Underdosing for more information on under dosing.

Commonly for pills a 6mg daily dose is a good target, I’ve done 2mg pill 3 times a day (morning, lunch and dinner), others do 3mg twice a day.

Some sources recommend a lower dose if you start taking the pills via sublingual administration at 3mg a day, 1mg pills 3 times a day.

I personally took 6mg a day sublingual, if you have access to blood tests then please keep aiming for your preferred target range (See MTF Target Ranges) and adjust as needed.

Notes:

Underdosing

In many standards of care that doctors follow it states to start at a much lower dose of estrogen to “ease into” the process such as:

  • WPATH SoC8 has the recommendation of 2.0-6.0 mg/day for oral estrogen
  • AutsPATH has the recommendation of 2-8mg daily
  • New Zealand’s PATHA recommends starting at 1-2mg daily and only changing up the dosage incrementally every 3 months to 4-6mg maintenance

The big issue with the recommended low end of the dosages is when prescribed with T blockers you are likely to have neither sex hormone at a healthy level. When both hormones are low you can be risking accelerated bone loss, fatigue, low mood, hot flushes, low libido, joint aches, brain fog, and poor sleep. Not even mentioning the lower than desired feminising effects.

PATHA is exceptionally egregious here with the 1mg recommendation which is lower than WPATH, AusPATH and the Endocrine Society’s recommendations for a minimal dose. 1mg single oral dose provides a peak at only ~35 pg/mL of serum estradiol1 which compared to MTF Target Ranges is far bellow a desired level.

Footnotes

  1. According to “Pharmacokinetics of Sublingual Versus Oral Estradiol in Transgender Women” - https://doi.org/10.1016/j.eprac.2021.11.081 ↩

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