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On a personal note, I started HRT today. Happy dance! 

From a TGS perspective, I quite enjoyed the conversation I had with the prescribing doctor. She seemed surprised to have someone in the clinic who’d done all the reading on male-to-female hormones, and so she was willing to talk to me about some of the larger questions about HRT as it is prescribed in her program (the UMHS-CGSP).

As it turns out, they have a pretty standard regimen that they like to follow, depending on the age of the patient. For most, the beginning treatment is 200mg spironolactone [oral] and 4mg estradiol [buccal]. They also allow patients to choose, if they like, to begin 100mg progesterone [oral]. For patients over 50, the doctor said that she often will replace spirornolactone with finasteride, but she did not share the dosage. Her view was that finasteride was safer for older patients as it didn’t potentially step on the toes of other medicines the patient may be on (like meds for hypertension). 

After one month, the clinic likes to measure E and T levels. Typically, they will raise the estradiol to 6mg; and if the numbers dictate it they will lower the spironolactone to 100mg. She didn’t say if and how the progesterone might be adjusted (and I forgot to ask). 

As I was not an atypical case, the above is the course of hormones I was started on. Yes, I chose to take the progesterone (which, by the way, is REALLY expensive). For all three meds, I was given a generic equivalent of the brand name prescribed (Aldactone, Estrace, and Prometrium, respectively). 

While the preceding was anecdotal, I thought it was be worth sharing here. As the WPATH SOC notes that there’s no actual consensus on what the “right” dose of HRT is, any bit of data might be of interest to those who choose this path. Please note that I am not a doctor, and that the above is offered neither as medical advice nor as a recommended dosage (and I do NOT endorse self-medicating). I just felt it would be helpful for those who want to know what to expect in the future when they go to their own HRT appointments. 


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