So I started DIY a few months ago using estradiol gel for monotherapy (2.5g 0.06% gel applied scrotally twice a day for a total of 3 mg estradiol / day). I saw plenty of expected effects, including nipple sensitivity and no more spontaneous erections (after a month or so even direct stimulation was starting to get less effective). No blood tests, but I conclude estrogen levels are probably OK-ish and testosterone must be somewhat suppressed.
This month, I get on prescription injections instead at last. The standard course here is monotherapy, 10 or 20 mg estradiol valerate (Progynon) as an IM depot injection every two weeks. Different schedules, progestogens, anti-androgens etc are available but I’m probably going to have to advocate for that myself if necessary. First injection, 10mg; I stopped using gel that day. All seems OK, but a few days in, I start getting erections at night again. Weird, but I assume it could be an occasional thing. By day six, they’re happening every night, sometimes getting semi-hard during the day too. Nipple sensitivity has pretty much gone so I conclude the injection has worn off and go back on gel. Everything reverts to “gel normal” as above.
Injection two, two weeks after the first, I get 20mg this time. Stop gel again. After a few hours, boom lots of breast sensitivity / swelling. I’m guessing this is a pretty good indicator of E levels. That’s slowly dropped down to gel-like levels over the subsequent few days and what do you know, the erections are back again. I conclude peak levels were a bit higher than gel, but dropping off rapidly again and probably not going to last the full two weeks. (This is consistent with the simulator on transfem science).
I’ll be asking for blood tests next time and checking with the doctor, but I’d like to get a straw poll: does anybody see random erections even with T suppressed? Am I overthinking things? I’m not seeing a massive return of BO or anything, so I assume T isn’t getting that high, but god damn I hate waking up to that thing.
Estradiol valerate IM injections have an elimination half-life of 3.5 days (look at the Pharmacokinetic data section of the little box on the right).
10 mg is also a large dose, so you are probably spiking your blood estrogen levels much higher than necessary, and then living with very low estrogen levels (not enough to suppress T) starting around day 4 - 7 and onward to day 14. You could try injecting every 5 or every 7 days and reduce the dose significantly (maybe try 5 mg every 5 days?). Personally I inject every 3.5 days (twice a week), but I am extremely sensitive to testosterone and can’t tolerate it.
Mess with this tool, use the Advanced option: https://transfemscience.org/misc/injectable-e2-simulator/
For monotherapy keeping your trough at or above 300 pg/mL is probably sufficient for maximum T suppression.
Erections come back for me when I have other symptoms of testosterone (body odor much stronger, acne / skin breakouts, depression, increased anxiety, anhedonia) and go away when my estrogen is sufficiently high, but it’s also somewhat variable.
Thanks for the detailed response!
I kinda suspected two weeks was way too long after checking the medicine datasheet. The half-life, as you say, is far too short. My doctor doesn’t offer self-injections, so I guess a weekly visit to the clinic is the next thing to try :/
Why do they start everyone on such a bizarre dose?
My endo started me with 5 mg EV injected once every 10 days. I think by day 5 I felt like I “needed” another injection and by day 7 I started to feel it wasn’t humane to wait out the full 10 days. I just couldn’t do it, so I reached out to the doctor and he approved me controlling my own dose. I spent way too long trying to take as little as possible and it resulted in a lot of harm. Now I inject 4.6 mg twice a week (every 3.5 days) and it’s pretty stable.
All I can say is that doctors truly don’t know anything about trans healthcare and you have to educate yourself. I highly recommend reading this entire article (it’s long, like 70+ pages if you made it into a PDF, and technical - but it should help): https://transfemscience.org/articles/transfem-intro/
E valerate isn’t really the best for 2 week cycles(even 10 days would be pushing it). I’m fairly happy rn on 5 mg weekly, but that’s also with androgen suppression. For monotherapy, 5 every 5 days or 10 mg weekly would probably be enough. The only problem you’ll have in switching to 10 mg weekly is just that you’ll run out of needles/syringes faster, so I’d do that asap.
Petition your doctor to officially do 10 mg weekly since they were fine with 20 biweekly, or 7.5 if they have concerns. Try looking at the possibility of finding a safe supply of needles and syringes diy, or if you can get that prescription refilled early. Also, don’t forget to cycle injection spots!
With 5 every 5 I had >500pmol/ml E2 levels and have gone down to 3.5-5mg.
Was the blood drawn at trough (i.e. right before you injected)?
Blood levels are highly variable between individuals, e.g. 5 mg every 4 days at trough had my levels at 300 pg/mL.
You just have to get blood work and go based on that.
Yeah it was. I was surprised as well. I kinda oriented myself with the simulator at https://transfemscience.org/misc/injectable-e2-simulator/
Those are averages, I oriented on that as well but my blood levels are consistently lower than the simulator projects. Either way, it’s important to listen to the body and the symptoms you are having as well, the blood tests only show a single snapshot.
Thanks, that sounds like a good plan to me.
The doctor should be fine with 10mg weekly, and there are places here that offer self-injections, so worst case I just switch to a different clinic.
