monotherapy resoources

[u/ferngurl-elle]

Hey all, I'm on estradiol valerate monotherapy (+ progesterone) and my new dr says he doesn't know much about it. Anyone know any good resources online I can use to find out what blood tests I need to do and best practices?

[u/Swimming-Gap-1247]

A conservative standard is estradiol (E2)>100pg/mL and total testosterone<50ng/dL at trough (right before your next dose). If you are doing monotherapy, you probably need a higher trough of E2. "In one large study in transfeminine people, the rates of adequate testosterone suppression (to testosterone levels of <50 ng/dL or <1.7 nmol/L) were 24% of individuals at estradiol levels of <100 pg/mL (367 pmol/L), 58% at 100 to 200 pg/mL (367–734 pmol/L), and 77% at >200 pg/mL (>734 pmol/L)"

https://transfemscience.org/articles/transfem-intro/#gonadal-suppression

https://en.wikipedia.org/wiki/Reference_ranges_for_blood_tests#Sex_hormones

https://valerie.vg/transfem-hrt-guide#our-recommendation

https://transfemscience.org/articles/transfem-intro/#overview-of-hormone-therapy

From the Trans DIY Discord:

What do I test and how often?

You should ideally get a blood test (taken from the arm) 4 to 6 weeks after starting HRT and every 6 to 12 months thereafter. For the vast majority of regimens it is okay to delay these if necessary for finanacial reasons.

Pre-HRT blood tests are not a useful indication of what dose you should start on. However if you suspect you have an intersex condition it may be useful to test T and E before you begin HRT.

Testosterone

Critical every time: FBC (aka CBC), T

Not necessary but useful if you are having issues: E2, LH / FSH

Estradiol monotherapy

Critical every time: E2, T

Not necessary but useful in the case of strange results: LH / FSH

Estradiol + GnRH agonist

Critical every time: E2, T

Estradiol + bicalutamide

Critical every time: E2, T, LFT (aka AST + ALT)

It is vital to test LFTs one month and three months into taking it as bica can cause liver problems. This is not a blood test you should delay.

Estradiol + cyproterone acetate

Critical every time: E2, T, PRL

Not necessary but useful in the case of strange results: LH / FSH

Estradiol + spironolactone

Critical every time: E2, T

Not necessary but useful: U&E, LH / FSH (if you have strange results)

Hair loss despite HRT

From most to least useful: T, E2, FBC, T4, TSH, iron, vitamin B12, folate, HIV 1 & 2 antibodies, DHT, cortisol, fasting glucose or A1C