Revisiting Injectable Estradiol Valerate Dosing for Gender-Affirming Hormone Therapy: A Retrospective Cohort Review
Authors' conclusion
Despite using injectable estradiol doses on the lower end of the current guidelines, most estradiol concentrations outside the range suggested by the Endocrine Society (100-200 pg/mL) were above the suggested range. The majority of patients obtained physiologic estradiol concentrations, as approximated by lab reference ranges. Guidelines for physiologic estradiol concentrations should recommend lower doses for injectable estradiol valerate.
Study context
- Population
- Adults prescribed 3 or 4 mg of injectable estradiol valerate weekly for gender-affirming hormone therapy through a statewide clinic network459 per protocol
- Participants
- 526 adults
- Exposure
- Injectable estradiol valerate 3 mg vs 4 mg weekly
- Outcome
- Serum estradiol concentrations 100-357 pg/mL mid-way between injections (physiologic range per protocol)
Methodological detailsretrospective chart review, statewide clinic network
- Retrospective chart review
- Statewide clinic network
Main finding
As reported in the abstract
Serum estradiol 100-357 pg/mL
Observational data: associations, not effects.
Further findings
Serum estradiol 100-200 pg/mL · per protocol analysis
Total testosterone <50 ng/dL
Total testosterone <50 ng/dL
- Lower testosterone levels among those taking spironolactone
Original publication
Revisiting Injectable Estradiol Valerate Dosing for Gender-Affirming Hormone Therapy: A Retrospective Cohort Review. Endocr Pract. Published 10 June 2026. doi:10.
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