travelcupcake

Hi Dr Webberly! I wanted to say I’m so thankful for you and really for any doctor that goes out of their way to provide care to us trans people. Being discriminated against and even denied basic care is sadly our norm, as you’re aware. Given how few doctors work in this area I’m always terrified that if only on or two per major city were to leave, half or even most of the trans population there would have to move. Our lives feel precarious.

My question is concerning estrogen levels/dose for trans women. My doctor recently increased my dose to 2-3 times what other doctors had put me on for years, and I’m finding that this higher dose has fixed many problems that I was having. I’m 30, in good health, and I started HRT when I was 19. My current levels of estrodiol are ~500 pmol/L, which seems normal for my age. But I’m realizing that my previous doctors had me at levels under 200 (around the lowest levels of the cycle for cis women) for most of my twenties, while I suffered from mood problems and lack of energy.

Is under dosing a common trend with trans care providers? I’m aware there are worries about side effects, including blood clots, and that doctors try to aim for the lowest possible dose that is effective. But given that having my estrogen levels around cis normal for my age has massively benefitted me, I feel like many doctors are minimizing the benefits that come from a higher dose. It’s almost like my previous doctors felt that as long as I could ‘pass’ then my dose was high enough, neglecting to pay attention to the other aspects of HRT. How do you approach this issue?

Thanks. I wasn’t asking for specific medical advice, I’m very satisfied with my doctor currently.