Injectable Estradiol Use in Transgender and Gender-Diverse Individuals throughout the United States
Authors' conclusion
Injectable estradiol esters effectively reach guideline-recommended estradiol concentrations but at lower doses than previously recommended. Estradiol concentrations are best interpreted relative to timing of last injection. Route of administration and type of ester do not significantly affect estradiol concentrations.
Study context
- Population
- Transgender and gender-diverse (TGD) adults designated male at birth on same-dose injectable estradiol (EV or EC, SC or IM) for >75 days, with confirmed timing of estradiol concentration relative to last injection, 2019–2023
- Participants
- 562 adults
- Exposure
- IM vs SC route; EV vs EC ester
- Outcome
- Dose of injectable estradiol needed to reach guideline-recommended estradiol concentrations
Methodological detailsmulticentre, 6 US medical centers, weighted linear mixed models
- Multicentre
- 6 US medical centers
- Weighted linear mixed models
Main finding
As reported in the abstract
Estradiol dose among patients injecting every 7 days who reached guideline-recommended estradiol concentration
Patients injecting every 7 days who reached guideline-recommended concentration
n = 131, 27.5%
Median estradiol dose (IQR 3.0-5.0 mg)
4.0 mg
Observational data: associations, not effects.
Further findings
Estradiol concentration among all patients
- Majority reached supraphysiologic estradiol concentrations (>200 pg/mL [>734 pmol/L])
- Dose and timing in the injection cycle were significant covariates for estradiol concentration
Dosing differences between IM/SC EV/EC
- No significant dosing differences between IM/SC EV/EC
Original publication
Injectable Estradiol Use in Transgender and Gender-Diverse Individuals throughout the United States. J Clin Endocrinol Metab. Published 11 January 2025. doi:10.
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