That was a lot... So, what should I take?
Our goal is to have you be able to decide by yourself what you think is best, in relation to your expectations, your general physical and mental health, your relationships to medication…
However, if we were asked to propose an ideal treatment, this is our suggestion:
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Always consider starting with monotherapy, and see if you manage to sufficiently bring down your testosterone levels to 0.5 ng/ml (50 ng/dl). For routes of administration, we recommend transdermal gel or injections. With the gel, consider using the scrotal method to efficiently bring down your T - it can otherwise be difficult to have an efficient monotherapy. First, avoid it, and see with blood works if this works. The negative feedback (the mechanism of blocking T with E) starts at around 200 pg/ml. Consider staying between 200 and 600pg/ml of estradiol. If using injections, refer to the Injectable Estradiol Simulator as the dosage will differ depending on which ester you are using. Note however that this simulator is based on avarages, and your levels can greatly vary from the estimation. A blood test is always necessary to monitor your levels.
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If your testosterone is not sufficiently brought down by E2 (i.e. it remains over 0.5ng/ml), consider using a blocker. We recommend bicalutamide or GnRHa (leuprorelin/triptorelin). Keep in mind that it is not necessary and not recommended to bring down your T to absolute 0. Cis-women with typical hormonal balance have T (between 0,08 and 0,50 ng/ml), and it is necessary to maintain cognitive functions (memory…), among other functions. Staying anywhere under 0.5 ng/ml will not bring any masculinizing effects. Also keep in mind that bicalutamide will not lower your levels of T, only its effects. Your blood values will be the same.
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If you still notice masculinzing features - especially on the skin - Bicalutamide can make a difference by preventing the androgenic effects the adrenal activity (conversion of DHEA into androgens in the target cells of the skin - see the page on “Intracrinology”)
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Add 100mg to 200mg progesterone after around 2 years of HRT (or reaching Tanner 3 in breast development), ideally taken in the rectum.
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Use topical weak testosterone gel/cream if you want to maintain erectile function, or prevent penile pain and atrophy, and 6 months before SRS.