Injectable Estradiol Monotherapy Effectively Suppresses Testosterone in Gender-Affirming Hormone Therapy
Authors' conclusion
Injectable estradiol, even as monotherapy, was effective at TT suppression in 82.6% of patients and comparable with combination therapy with an antiandrogen(s) or progestogen. Progestogen use was independently associated with a lower TT concentration, whereas spironolactone had no significant effect.
Study context
- Population
- Adult transgender and gender-diverse patients without gonadectomy or concurrent GnRH agonist use, on weekly injectable estradiol at stable dose for >75 days, 2019–2023
- Participants
- 357 participants
- Exposure
- Estradiol monotherapy vs estradiol with antiandrogen and/or progestogen
- Outcome
- Serum total testosterone (TT) concentration; TT suppression (<50 ng/dL)
Methodological detailsretrospective, multisite
- Retrospective
- Multisite
Main finding
As reported in the abstract
Median total testosterone (TT) concentration (all patients)
17 ng/dL
IQR, 10–33 ng/dL
Observational data: associations, not effects.
Further findings
Estradiol dose and concentration
- Median estradiol dose
- 4 mg (IQR, 3-6 mg)
- Median estradiol concentration
- 232 pg/mL (IQR, 134-371 pg/mL)
Covariates of TT concentration (weighted linear mixed model)
- Higher estradiol concentration, fewer days since injection and progestogen use were associated with lower TT concentration
Original publication
Injectable Estradiol Monotherapy Effectively Suppresses Testosterone in Gender-Affirming Hormone Therapy. Endocr Pract. Published 8 July 2025. doi:10.
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