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Hormone Therapy Dose Adjustments

Hormone Therapy Dose Review: Striking the Right Balance

When it comes to hormone therapy, achieving the right balance is crucial for a successful and safe transition. Whether you are on estrogen or testosterone, and whether you are taking antiandrogens/blockers, maintaining appropriate hormone levels is essential. Here are some key considerations for reviewing your current hormone therapy dose:

The Importance of Hormone Balance

Achieving Balance: Hormone therapy aims to help you achieve a hormone balance that aligns with your gender identity and desired physical changes. Striking the right balance is key to a successful transition.

Starting Doses

These dose are the recommended starting doses for the common gender-affirming care treatments.

Estradiol patches – 100mcg
Estradiol tablets – 2mg a day
Estradiol gel – 2.25mg a day
Estradiol Spray – 1 spray a day
Oestrogen valerate injections – 20mg i-m every 2 weeks
Oestrogen cypionate injections – 2mg i-m once a month
Utrogestan – 200mg at bedtime
Cyclogest – 200mg once a day
Testosterone gel – 40-60mg a day
Testosterone 50mg unit gels – 50mg a day
Tostran 2% gel – 50mg a day
Testogel 16.2mg pump – 40.5mg a day
Testavan gel 20mg/g – 46mg a day
Testosterone cream – 50mg a day
Sustanon – 250mg every 3 weeks
Testosterone Undecanoate (Nebido) – 1g every 13 weeks
Testosterone Enanthate – 100mg every 2 weeks
Testosterone Cypionate – 50mg every week
Finasteride – 5mg a day
Dutasteride – 0.5mg a day
Leuprorelin – 11.25mg i-m every 3 months
Triptorelin – 11.25mg i-m every 3 months
Spironolactone – 50 mg a day
Cyproterone – 12.5mg a day

When to Review Your Dose

Insufficient Changes: If you are not experiencing the desired physical changes or are not progressing as expected, it may be time to review your hormone therapy dose.

Hormone Level Testing: Regularly monitoring your hormone levels through blood tests is essential to determine whether adjustments are necessary.

Adjusting Estrogen or Testosterone

Too High Hormone Levels: If your hormone levels are too high (either estrogen or testosterone), it may not be safe to increase them further. Instead, consider reviewing and potentially reducing your dose.

Too Low Hormone Levels: If your hormone levels are too low, you have two options:

  • Increase Hormone Dose: You can consider increasing your hormone dose
  • Reduce Blocker: If you are taking antiandrogens/blockers, reducing the blocker may help your natural hormone levels increase

Managing Antiandrogens/Blockers

Too Much of the Wrong Hormone: If you have too much of the hormone that you are trying to suppress (e.g., too much testosterone for individuals on estrogen therapy), it may be necessary to increase your blocker dosage.

Balancing Blockers: Ensure that you are not overusing blockers, as it’s important to have a balance between hormone suppression and maintaining appropriate hormone levels.

Regular Consultation with a Healthcare Provider

Safety First: It’s crucial to consult with a knowledgeable team who specialise in transgender care when considering any adjustments to your hormone therapy regimen.

Blood Tests: Regular blood tests are essential to monitor hormone levels and guide dose adjustments.

Holistic Approach: Hormone therapy is not just about hormone levels; it’s also about overall wellbeing. Discuss your goals, mental health, and any concerns with your healthcare provider.


Balancing hormone therapy to achieve the right levels of estrogen or testosterone and managing antiandrogens/blockers is a nuanced process. Your safety, wellbeing, and satisfaction with your transition are the primary goals. Regular review is essential to ensure that you maintain the right balance and make informed decisions about your hormone therapy. Remember, your journey is unique, and adjustments can be made to suit your individual needs and goals.

Hormone Therapy Dose Adjustment Guide

Situation Recommended Options Details
Too High Hormone Levels Review and potentially reduce hormone dose Increasing hormone levels may not be safe.
Too Low Hormone Levels 1. Increase hormone dose
2. Reduce blocker
Adjusting your hormone dose may be necessary for better balance.
Too Much of the Wrong Hormone Increase blocker dosage If you have too much of the hormone you’re trying to suppress, increasing the blocker may be necessary.
Balancing Blockers Avoid overusing blockers Maintaining a balance between hormone suppression and appropriate levels is essential.

Remember to consult with a knowledgeable team for personalised guidance and safety in hormone therapy adjustments.

Updated on January 27, 2024

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