NHS Pathway — Patches + GnRH Analogue
NHS Gender Dysphoria Clinic standard pathway: oestradiol patches with goserelin (Zoladex) GnRH analogue for testosterone suppression. Safest VTE risk profile. Goserelin implant every 1 or 3 months administered by GP or GIC nurse.
Duration
—
Steps
4
Total Weeks
6
Route
transdermal
Protocols
3
Source
clinical practice
Protocol Timeline
| Step | Weeks | Dose | Compound | Note |
|---|---|---|---|---|
| 1 | 6 | 100 mcg/day | Estradiol Transdermal Patch (Twice-Weekly) | 1 x 100 mcg/day patch. Vivelle-Dot: change 2x/week. Climara: change weekly. Check labs at 6 weeks. |
| 2 | 0 | 200 mcg/day | Estradiol Transdermal Patch (Twice-Weekly) | 2-4 patches (200-400 mcg/day) needed for feminizing levels. Lower VTE risk than oral. |
| 1 | 0 | 3.6 mg | Goserelin | 3.6 mg SC implant every 28 days. Castrate T levels in ~21 days. Initial hormone flare. |
| 1 | 0 | 100 mg | Progesterone (Oral) | 100-200 mg at bedtime. Sedating — allopregnanolone metabolite. Added at Tanner stage 3-4 for breast maturation. |
Rationale
UK NHS pathway. Patches changed twice weekly (every 3.5 days). Goserelin implant injected subcutaneously into abdomen by healthcare professional. Initial testosterone flare possible in first 2 weeks of GnRH — monitor.
Compounds Used
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