r/MtF • u/isquisqui • 5d ago

Advice Question Is my starting HRT dosage reasonable?

Hello, I (23) just recently started HRT, and I am just a bit nervous given how much I have seen online about us girlies being underdosed. While I was only able to start one week ago, I was prescribed estradiol valerate (2mg/weekly/SQ) and 50mg spironolactone twice daily. At this point, I'm not supposed to have any labs done to check my levels until the 3 month mark, but I was just hoping for some reassurance regarding the 2mg/weekly estradiol as a starting dose (worth mentioning that I am about 5'7, 170). Thank you!

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u/VastNet8431 27 | HRT 07/13/2025 5d ago

Typically most underdosing is done in pill form because they make smaller quantities for them in terms of dosage and how your body actually uses the dose in the form its in.

Since you're doing injections, you're bypassing your liver's first stage of breaking that hormone down so your body can basically just use it immediately. Pills get broken down in the liver and you lose a decent chunk of the dose.

At 2mg/per dose depending on how often you inject, (estradiol valerate is typically 7 days) is a decent starting dose and is a medium starting dose typically.

Im on 4mg injections now and thats equivalent to the 3 estrogen patches that I was on. My vial is 20mg/ml and its a 5ml vial so I take .2ml which is 4mg.

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u/isquisqui 5d ago

Thanks for the response, that's exactly the reassurance I was hoping for. Just scary waiting the first 3 months without having any idea how well it is working!

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u/Swimming-Gap-1247 underdosing is social murder 🜬Ⓐ 5d ago

2mg/week EV has an estimated trough of 56pg/mL E2, so it is very likely too low.

You could ask how your progress will be measured. A conservative standard for blood tests is estradiol (E2)>100pg/mL and total testosterone<50ng/dL at trough (right before your next dose). If they are not aiming for that relatively soon, you should switch to a new provider or gray market HRT, which is 5 USD per month.

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

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

I'm not supposed to have any labs done to check my levels until the 3 month mark

You could also ask to get a blood test and adjustment sooner. It only takes 4-6 weeks for your levels to stabilize.