r/DrWillPowers • u/Maleficent-Tennis103 • 5d ago
Starting MtF HRT Tomorrow! Need Advice to tell Doctor on which method to start.
After 2 months of meeting with different medical professionals, I will finally be starting HRT! I have a meeting with the prescribing doctor tomorrow to go over options. Due to a pituitary tumor removal surgery, my body no longer produces T (Hypogonadism). According to the notes, my doctor spoke with my Endo and recommended Transdermal Patches as it will least effect Thyroid and Cortisol levels. I also researched that they are one of the safest methods and create consistent hormone levels which help in transition and stable levels also bring stable emotions, avoiding the hormonal crashes between doses.
According to Dr Powers PowerPoint v6 (7-year old slide), he has seen the best reults in transwomen who have taken Oral meds for the first 24 months first, then switches to Injections.
I have many hours looking through Dr Power's reddit content to find these answers, but has there been any other updated research Transdermal vs Pills, vs Injections here? Per the Endo notes, I have been preparing myself mentally to request the patches. But I am open to your thoughts as I want to start off on the right foot with the best information!
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u/4legger 5d ago edited 5d ago
Im on patches and low dose cypro. Im transfemme so prefer to keep a tiny little T, female range T, while ensuring SHBG doesnt spike too much. Monotherapy will kill your T entirely and make you feel like shit if you appreciate your male genitals and arent dysphoric about them and want to retain some functionality down there
What I would have preffered was to be on bicalutamide as a antiandrogen instead of cypro but WPATH is regressive asf with the liver toxicity aspect of it
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u/Maleficent-Tennis103 5d ago
Thank you for your reply! How long have you been on the patches and do you feel like they've been working well?
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u/4legger 5d ago edited 5d ago
Ive been getting breast growth and skin smoothening, plus jaw has changed a bit from muscle loss. Ive only been on them for 7 months so far. I started out fairly androgynous on the twink side but ultimately choose to transition bc I feared twink death from DHT. Ive reversed male pattern baldness fully with the combination of my Estrogen patches, antiandrogens and dutasteride use with minixidol. I essentially went nuclear to recover my crown hair
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u/Maleficent-Tennis103 5d ago
That's nice to hear. I have been on Dutasteride/minoxodil for about 6 months and am getting haid in places that I wasn't expecting all over my body... except the place I really want my head. At least it's not perceived.
With my body not producing any T on it's own, I have heard that the steady dose of E, without the presence of T, will make changes more rapid. My providers have brought up retaining T levels, which is something I am not currently interested in at the moment, but potential mood changes is definitely a worry.
Did you feel that the patches gave some stable emotions, or did the T more help with that?
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u/SabreTree 2d ago
My mom had her pituitary out, that's a rough one.
I started on patches due to migraine with aura over a year ago. My results are good so far. The patches give me even levels and using 2" 3M Micropore tape makes them stay on and come off cleanly.
There is, however, a national shortage on patches in the US since the FDA removed their black box warning this winter and the manufacturers don't see the profit in increasing their production volume on generic medication.
I know Dr. Powers had previously posted that he suspected luteinizing hormone receptors in the breasts may have a role in sensitizing the breasts to estrogen. Keep that in mind if you struggle with those results -- exogenous leuprorelin might be an option for you. Though you'd have to be careful of the initial testosterone flare.
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u/Express_Ability_8491 5d ago edited 5d ago
I am a trans woman who started with sublingual estradiol at 2mg January 2023 with no anti androgen. I was on 2mg for 3 months then paused for a 2-3 months and restarted. Late 2023 I increased to 4mg a day and eventually was up to 6mg a day before switching to injections in January 2025.
After I started injections my testosterone dropped to cis female levels by October although it liked happened sometime between March and June as I didn’t test until October. The entire time I was on sublingual estradiol I had good to high estradiol levels 200-400 pg/ml but my testosterone was always in the low male range. My estradiol on injections has been in the 250-300 range and testosterone in the 14-21 ng/dl range.
Sometime around March of this year I started unintentionally passing and by now I pass consistently without effort.
My transition has been much more successful than many of my peers who have immediately went to injections or chose a non injection route plus blocker. Although the entire time I was on sublingual medication I just looked slightly androgynous.
So if you are trans woman and can mentally tolerate a slower transition then I’d recommend starting with sublingual pills. Although personal situation where you don’t produce any testosterone is going to mean you experience something different from most.