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this post was submitted on 05 May 2025
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Transfem
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I had breast soreness pretty quickly. Increased sensitivity could be right (that's how it was for me at first), but at some point it did become painful enough that I had to change how I slept, etc.
My advice: switch to injections (I recommend subcutaneous as you can use very small needles that can be painless).
As others have said, oral is a poor way to get estrogen - 80+% is eliminated by the liver, and the rest spikes blood levels and eliminates relatively quickly, creating vicious ups and downs without providing sufficient and consistent estrogen blood levels to estrogenize the body by. Anecdotally the people I know IRL who do pills have slower and less feminization than those who inject.
(I actually started hormones at the same time as an IRL friend, and a year later my friend still passes as a boy and boymodes full-time, and I ... wouldn't be able to pass as a boy anymore. The main difference is that they take oral and I inject.)
Highly recommend reading: https://transfemscience.org/articles/transfem-intro/
Is there a reason not to do injections (unless you have bad enough fear of needles so that you can't do it)? To me it seems to be by far the best option in every way (at least price, effectiveness, frequency of administration, convenience) and I see no reason to pick anything else. Not that I personally have much of an alternative anyway because I'm doing DIY right now.
Not really. Injections and implants really are the most convenient options (and injections are of course super cheap). That said, gel/spray isn't too bad, especially when first starting out or for those afraid of needles.
gel and patches aren't so bad when starting out if you are taking an effective anti-androgen, but I doubt it's that feasible for monotherapy, tbh.
I use patches alongside spiro and progesterone. I can't recommend patches enough! Injections give me crazy dysphoria, so I turned that option down immediately.
Oh, no not usually. It's at least not recommended, but I've heard of people doing it with many patches. But with an AA or after orchiectomy it's rather easy.
I tried doing mono with gel, but wasn't doing blood tests at the time. Not knowing my levels was stressful as I was never quite sure if T was suppressed, but changes were happening at least. I feel way better on injections.
my alternative to taking bica was spiro, and I had read and heard enough to know I wasn't interested (it's a pretty mild anti-androgen anyway), so I felt like monotherapy was my only option.
Trans healthcare is not the best :-/
And yeah, that does sound stressful, not knowing your levels and trying to wing it. Even knowing my levels, I had pretty uneven suppression of T with monotherapy, even with very high levels of estrogen (>500 pg/mL trough). Post-orchi I felt much, much better.
Yeah winging it isn't the best. I seem to be rather lucky actually. 4mg een weekly is more than enough to suppress my T to lower cis fem levels. I'm actually taking 3.8mg right now and still seeing good levels.
My E usually hovers around 200pg/mL and my T hovers around 17ng/dL.
I couldn't get T levels that low even post-orchi 🫠 ...
Though, my blood work showed my T levels were suppressed to cis fem levels the whole time, I swear I still had biochemical dysphoria where my body seemed to produce a little T once a week in the trough, which then would have me feeling off.
It could have been something else, maybe it's just side effects of really high estrogen, but even when I tried lower doses I would have worse mental health symptoms ...
Either way, that stopped post-orchi, I just no longer felt biochemical dysphoria a couple days after trough and it didn't seem to matter what my estrogen levels were anymore (I mean, the high E levels made me very sensitive and more moody / emotional, so I lowered my dose, first by half and then later by half again).
That said, I was injecting EV, which is so spiky - I suspect my E levels were dropping so suddenly on trough day that my brain triggered the testes to produce T, and it didn't show up in blood work because I always tested right before injecting again and not the day after injection when it seemed like my T levels had risen.
Either way, it's not an issue for me anymore, I just think it was cruel and unnecessary to force me to go through that entire year without an orchi, I was very firm about wanting it when I socially transitioned, then I had to wait three months to get HRT, then an entire year after that to get the orchi. They wouldn't force me to wait that long if I wanted the testes removed as a cis person, like the post-vasectomy pain I experienced. It's just transphobic, tbh - and it works, I suffered that whole year as a result.
Well, I'm glad you're feeling alright now at least!
Personally I feel like I would like to have slightly higher T. If it hovered around 30-40 that would be nice. I just want my downstairs stuff working fine with minimal maintenance until I can get surgery and rid myself off it :P
But yeah, I've heard plenty of people notice some kind of dysphoria at trough. I remember feeling very clearly off if I was late by an hour or two when I was taking gel. Got worse when I was on higher dosages actually, so I suspect it's the spikiness that does it.
Mine is usually around 25 now, I don't really have thoughts about it - I actually wish I had more atrophy than I do, erections are not as firm but otherwise it is about the same as before. I would prefer significant atrophy, tbh.
Though you're right, that isn't good for surgery, so that's a thing.
oh, interesting - that does sound similar to what I experienced ... and it has gone away now post-orchi, so ... I just assume I was right about it being the T.
It's so freeing to be able to be late on a dose and not be impacted meaningfully. It was surreal cutting my dose and frequency in half, and watching the window pass for when I would have normally injected again. I had so much suspense built-up around it, and I felt completely fine for the first time. There was no building desperation for my next injection, no onset of crippling depression and worsening mood, as if the world is flat and nothing is enjoyable, no more 24/7 obsessive anxious rumination, and so on.
Now I just feel "normal" - it's bizarre. Estrogen actually feels sorta optional now, where before I clung to it for my life - I was very sensitive to its absence before, but now I feel fine when my E is lower even if I still enjoy when my levels are higher, too.
I highly recommend for anyone like me to get an orchi ASAP. It's more affordable, it's an easier and less painful recovery, it's a faster surgery, and it means you can get of anti-androgens and feel confident knowing your HRT supply isn't the only thing preventing you from sliding into hell again.
Yeah :3 I'm not post orchi but een has a decent half life so I can put off my injection by a day and feel fine, but I feel very minorly off after two, but not comparable to when I was on gel. Really did feel kinda desperate back then.
ugh, I wish EEn was available through Rx, it's so much better than EV - I suspect I wouldn't have had such severe trough dysphoria that year if I had been on EEn.
Can confirm: I was able to get T down into cisfem ranges with monotherapy using 3 x 0.72mg patches every two days. That gave me about 400pg/mL E2 though, which was a bit high, so I'm on spiro as well now.
This might be of interest to you: https://transfemscience.org/articles/estrogens-blood-clots/
Basically taking E has a reputation of giving you a higher chance of blood clots, but what we see is that this mostly a thing to worry about when taking non bio-identical E and when you take E orally. This is not to say that I recommend going back to 400pg/mL, but it is something to keep in mind since AAs have side effects of their own.
Also, I have had rather varied blood tests from taking the same dosage of E for a long time. I've had between 170 and 320 pg/mL. How many blood tests did you take when on patches? I suppose it's also possible patches are a bit more stable in what levels you get, and going back to that regime might be too much of a hassle anyways.
Thanks! Yeah, I saw that article (and I know my doctor reads that site too!), so I've been pushing back a bit.
That's a good point about blood tests. I don't think I've yet had more than one test for any particular dose, so I can't say for sure how stable my levels are. I can tell when things start to get out of whack (especially when T goes up) from my experience with injections, and I'm pretty sure that my T is consistently suppressed on patches, at least.
I'm currently on 2 x 0.72mg / 2 days and 50mg spiro / day, which last test had me at 268 pg/mL E2 and 58 ng/dL T. I'm pretty happy with that, at least until I can get a few things chopped off.
I have a horrible needle phobia, and even so I did a lot to overcome it so I could do injections. Ultimately I agree, injections are the best method. Transdermal (patches or gel) isn't that bad of a route for lower doses, but pre-op I wanted to do monotherapy when bica didn't seem to help my biochemical dysphoria enough.
Even post-op I still do injections, as my skin is very sensitive, so I was worried about getting rashes from the patches, and I also exercise a lot and worried about the patches coming off (they can be expensive to replace, this is just a major downside to patches).
Yeah, the patch coming off is what I would be worried about as well, especially also when showering. Patches would be my top alternative because they also last a while but it's just an extra thing to have to be careful about.
Congratulations on overcoming your needle phobia! :)
I've not yet had one come off in the shower, and I'm not particularly careful. The adhesive gets a little loose, but it goes back to normal pretty quickly once you dry off. Having tried gel, injections and patches I have to say patches easily beat everything else for me! That's assuming you don't get irritation from them, of course.
Denmark doesn't use injections for trans care, so it's simply not legally available
You can actually probably still get injections in some cases. Apparently you can request to have them ordered from the one EU country that prescribes them (can't remember which) if your GP agrees (or something like that). Still yeah, not super likely or widespread.
Patches aren't too bad for most people. I know lots of people who seem rather happy on them. Only issue is sometimes there are supply issues.
Ah, that sucks :(
How about spray/gel?
still better than oral, and if you're on an anti-androgen or post-op it could work really well.
Not as effective as injections at getting your estrogen blood levels up consistently though, so it's not practical for monotherapy, for example.