The Use of Injectable Estradiol in Transgender and Gender Diverse Adults: A Scoping Review of Dose and Serum Estradiol Levels
Authors' conclusion
The optimal starting dose for injectable estradiol remains unclear and whether it should differ for cypionate and valerate. Based on the data available, we suggest that clinicians start injectable estradiol cypionate or valerate via subcutaneous or intramuscular injections at a dose ≤5 mg weekly and then titrate accordingly to keep levels within guideline-recommended range. Future studies should assess timing of injections and subsequent levels more precisely across the injection cycle and between esters.
Study context
- Population
- Transgender and gender diverse adults on feminizing gender-affirming hormone therapy using estradiol injections
- Outcome
- Serum estradiol levels achieved with various doses of estradiol injections
Methodological detailsAlso reported testosterone suppression, route (subcutaneous vs intramuscular), estradiol ester type and timing of blood draw relative to last dose, where available
- Also reported testosterone suppression, route (subcutaneous vs intramuscular), estradiol ester type and timing of blood draw relative to last dose, where available
Main finding
As reported in the abstract
Serum estradiol levels vs guideline starting doses
- Current guideline starting doses (2 to 10 mg weekly or 5 to 30 mg every 2 weeks of estradiol cypionate or valerate) appear too high and likely lead to supraphysiologic levels across much of the injection cycle
Original publication
The Use of Injectable Estradiol in Transgender and Gender Diverse Adults: A Scoping Review of Dose and Serum Estradiol Levels. Endocr Pract. Published 21 May 2024. doi:10.
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