Oral E2 + Spironolactone
Oral estradiol with spironolactone anti-androgen — the most commonly prescribed transfeminine HRT regimen in North America. Simple, accessible via GP or Planned Parenthood informed consent. Higher VTE risk than transdermal routes due to first-pass hepatic metabolism.
Duration
—
Steps
4
Total Weeks
4
Route
Oral
Protocols
3
Source
clinical practice
Protocol Timeline
| Step | Weeks | Dose | Compound | Note |
|---|---|---|---|---|
| 1 | 0 | 2 mg | Estradiol Oral | Starting dose: 2 mg 1-2x/day oral. Low bioavailability (~5%), high E1:E2 ratio. |
| 1 | 4 | 50 mg | Spironolactone | 50 mg 2x/day (100 mg/day total). Monitor potassium at 4 weeks. |
| 2 | 0 | 100 mg | Spironolactone | 100 mg 2x/day (200 mg/day total). Standard therapeutic dose. Take with food. |
| 1 | 0 | 100 mg | Progesterone (Oral) | 100-200 mg at bedtime. Sedating — allopregnanolone metabolite. Added at Tanner stage 3-4 for breast maturation. |
Rationale
Oral estradiol has higher VTE risk than patches or injections due to first-pass liver metabolism. Consider transitioning to transdermal or injectable if history of blood clots or smoking. Spiro requires potassium monitoring and blood pressure checks.
Compounds Used
Related Tools
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