So, without context, this question sounds really strange. I've been on DIY HRT since the 15th of January, 2025 (started on estradiol valerate pills with cyproterone acetate). I switched to estradiol cypionate injections on the 6th of May, 2025, and have been using it since then. I've dialed in a stable EC dose for monotherapy that has given me adequate testosterone suppression (this month's labs show 15ng/dL). I've been getting regular bloodwork, and have an exact timeline of my dosage adjustments since I started HRT. I'm also in the US, since that's likely relevant.

I now want to start progesterone, and I want to just get a prescription for 2 reasons: price, and a letter of support for surgery showing I've been on HRT 2+ years by the time I get surgery (for insurance coverage). But if I'm to get a progesterone prescription, I'd also be getting an estradiol prescription. The problem is that I'm stable on EC, but even if my insurance were to cover it (under the brand name Depo-Estradiol, it's a Tier 3 drug since it doesn't have a generic), it would be $100 for a 90 day supply (3 vials). Uninsured, it's $250/vial, and I find it likely it won't be covered, as EV is a Tier 1 covered drug (they'd want me to take that instead because it costs the insurance less for a generic).

I have concerns with starting EV, because my dose would have to be dialed in again, and my estradiol levels would be far, far more erratic. EC has a much longer half-life than EV, so it keeps hormone levels much more stable. With EV at an "equivalent dose" (keeping the average over the week the same as the EC I'm currently on), I'd have much higher peaks, and much lower troughs, and I'm concerned that it will worsen my mood swings (I'm bipolar, but have been doing better with medication). There's also the downside that Depo-Estradiol is only available in 5mg/mL concentration, so I'd be injecting 8x more volume than my 40mg/mL DIY vial.

So, if I were to get a prescription, here are my options (in no particular order):

• Switch to EV and be forced to dial in the correct dosage to adequately suppress testosterone while minimizing supraphysiological serum levels of estradiol
• Get an EC prescription and risk no coverage (and pay as much for 3 months as I do for 2 years DIY if it is covered)
• Get an EV prescription and fill the drug, but keep taking my EC
• Get an EV prescription and don't fill it while continuing EC
• Get an EC prescription and don't fill it while continuing DIY (because I don't have that kind of money)

I believe the insurance will not be checking my prescription history, since I could choose not to use insurance at all for it; they just ask for a letter from my prescribing provider. I'm also aware that in the US, providers can check if you've filled a prescription (and sometimes even be notified when you fill/decline to fill a prescription). I'm apprehensive to discuss this with the provider I'll be seeing, as they may become suspicious that I'm not following my treatment regimine, and thus may deny me a letter when the time comes.

So I'm kind of at a loss for what to do here. The option I feel most comfortable with is filling EV, but continuing EC, as EV is really cheap (<$10/month). That also leaves a trail of prescription history. But my labs might show unexpected serum estradiol levels, so my dosage may be adjusted, and then I may get questions about why my serum estradiol levels didn't change when the prescribed dosage changed. I also feel like throwing out good vials of EV is a waste. So my next preferred option would be to get prescribed EC, and not fill it because it's so expensive. That way, my bloodwork lines up, but again, prescription history wouldn't match up.

I just feel a little overwhelmed.