I am currently on 0.12ml (12 units) injected weekly, I don’t really know if it’s enough?
https://transfemscience.org/misc/injectable-e2-simulator/
I tried this but had no idea how to convert 12 units into mg, also the pharmacy does not seem to list to concentration.
https://www.empowerpharmacy.com/drugs/estradiol-valerate-injection
Maybe it looks different on your end, but I see the concentration as the first thing in that link. It seems like it comes in 10, 20, 30, or 40mg/ml, and it should say that on the bottle, so see what you have and just multiply the number by the ml you’re dosing (so if you have the 20mg/ml, do 20mg/ml X 0.12ml to get 2.4mg)
I concur. Furthermore I will note that 2.4 mg estradiol valerate IM is below the dose range for the indication of MtF transitioning, and the frequency should be every two weeks instead of weekly (though admittedly 4.8 mg per 2 weeks is almost there, and weekly vs biweekly dosing probably doesn’t matter all that much, but I trust the source). I’ve posted the dosing recommendations for you in the image below. It is from a source called Lexicomp, which is unfortunately paywalled (I have access via my uni). Lexicomp cites this article which is also unfortunately paywalled. I suppose you’ll just have to trust me, though I will add the necessary disclaimer that this is not medical advice and I accept no responsibility for your use of this medication, and the information provided is solely for the purpose of harm-reduction.
I really don’t know why some of the more conservative dosing recommendations still give two week dosing schedules for EV. It has a lower half life than cypionate and should be injected more often, assuming you’re aiming for stable levels (most people are). A lot of our original recommendations for transfem people were based around studies for populations with prostate cancer and menopause, and it seems like dosing strategies for them have stuck around.
I personally wouldnt ever go over a week long dosing of ev, and would likely switch to twice weekly injections if were I on it. The people over at transfemscience.org put together a neat way to visualize the difference in esters for achieving a steady state dose based on the pharmacokinetics of them all. Basically, at this point if I get a recommendation from a doctor for 14 day dosing of EV, I’m going to assume they’re not up to date on current feminizing hrt research and are likely going to also be giving old information about things like IM vs SubQ injections.
Finally, nobody should ever be paywalled from medical information (and it’s pretty abhorrent that this research even has to have hoops to jump around to get through). Just as an fyi for anybody else reading this, most articles that aren’t brand newwill have a copy of it you can access by its doi number on sci-hub.ru (or another mirrored domain, searching scihub normally gives a list of current working addresses). In the case where it isn’t available yet, the journal should provide a way to email them asking for specific articles for patient access.
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Why more often injections?
Go fiddle with the calculator on the website I linked to see how injecgion time changes peak-trough gap in the hormone curves. But generally I want stable levels because research shows we need a minimum amount of estrogen in order to have feminizing effects. We don’t want to overshoot it because your body will create SHBG at too high of levels. I’ve never seen any research that hints at varying levels be more effective.
It really depends on the concentration. I’ve seen anywhere between 10mg/mL and 40mg/mL. So if your vial is 10mg/mL, you’d only be getting 1.2mg/week which does seem pretty low to me. If your vial is 40mg/mL then your weekly dose would be 4.8mg which seems more reasonable. Really though it all depends on how your levels are, when was your last blood test?
It’s also important to note when in your injection cycle you tested. I’m mostly interested in what my trough values will be (so immediately prior to the next injection), since that’s the best approximation of steady state tissue levels. Especially on a two week injection cycle of EV, I’d be worried about my levels dipping quite low by the end of the cycle.
What concerns come with levels dropping?
For me personally, I got mood swings right before my next dose until I changed the frequency because my levels would drop. But in general, the goal with feminizing hrt is to change your hormone profile to something approximating that of a cis woman in order to get the changes you want. With a long enough gap between doses, the short half life of EV means that you’ll have very low levels of estrogen right before your next injection, below your goal range.
If you’re still looking for a more concrete answer, post a picture of the info on your actual estradiol packaging with your personal info blocked out or blurred. I worked in direct care handling medications for many years. If I have the official packaging, I can tell you how much you’re taking how often. Only then can we assess the effects of the dosage.
Usually injectable E comes in 100mg/5 mL or 200mg/ 5 mL (100 is usually red and 200 is usually purple).
It really depends on what your prescribed dose is, and what your levels are, but it could be. I do .1 mL of 200mg/ 5ml, which is about 4mg of E/week, and my levels are right where they should be. Different people metabolize it differently, so the actual amount administered can vary quite a bit from person to person.
