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<h1>Transfem HRT Guide</h1>
<div class="row">
<div class="col-md-4 col-lg-3 mb-3">
<div class="list-group">
<a class="list-group-item" href="transfem-hrt-guide.html#introduction">
<strong>Introduction</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#what-is-hrt">
&emsp; What is Hormone Replacement Therapy (HRT)?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#is-hrt-dangerous">
&emsp; Is HRT dangerous?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#what-does-hrt-do">
&emsp; What does HRT do?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#how-long-does-it-take">
&emsp; How long does it take?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#sex-hormones">
<strong>Sex Hormones</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estrogens">
&emsp; Estrogens
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estradiol-info">
&emsp;&emsp; <i>Estradiol</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estrone-info">
&emsp;&emsp; <i>Estrone</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#androgens-info">
&emsp; Androgens
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#testosterone-info">
&emsp;&emsp; <i>Testosterone</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#dht-info">
&emsp;&emsp; <i>Dihydrotestosterone (DHT)</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#progestogens">
&emsp; Progestogens
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#progesterone-info">
&emsp;&emsp; <i>Progesterone</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#hpg-axis">
<strong>Hypothalamic Pituitary Gonadal (HPG) Axis</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#recommended-regimens">
<strong>Recommended Regimens</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estradiol-injection-monotherapy">
&emsp; Estradiol Injection Monotherapy
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#transdermal-gel-plus-blockers">
&emsp; Transdermal Gel + Blockers
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estradiol-gels-plus-blockers">
&emsp; Estradiol Pills + Blockers
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#honorable-mentions">
&emsp; Honorable Mentions
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#blood-tests">
<strong>Blood Tests</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#baseline">
&emsp; Baseline
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#units">
&emsp; Units
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#target-levels">
&emsp; Target Levels
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#wpath-soc-v8">
&emsp;&emsp; <i>WPATH SoC v8</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#ucsf">
&emsp;&emsp; <i>UCSF</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#nhs-target-levels">
&emsp;&emsp; <i>NHS</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#will-powers-target-levels">
&emsp;&emsp; <i>Dr Will Powers</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#female-reference-ranges">
&emsp;&emsp; <i>Female Reference Ranges</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#our-recommendation">
&emsp;&emsp; <i>Our Recommendation</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#antiandrogens">
<strong>Anti-androgens (AAs)</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#spironolactone">
&emsp; Spironolactone
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#cyproterone">
&emsp; Cyproterone Acetate (CPA)
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#bicalutamide">
&emsp; Bicalutamide
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#gnrh-agonists">
&emsp; GnRH Agonists
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#finasteride">
&emsp; Finasteride
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#homebrew-vs-pharmaceuticals">
<strong>“Homebrew” vs Pharmaceuticals</strong>
</a>
</div>
</div>
<div class="col-md-8 col-lg-9">
<h2 id="introduction">Introduction</h2>
<div class="row">
<div class="col mb-3">
<h1>Transfem HRT Guide</h1>
<div class="row">
<div class="col-md-4 col-lg-3 mb-3">
<div class="list-group">
<a class="list-group-item" href="transfem-hrt-guide.html#introduction">
<strong>Introduction</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#what-is-hrt">
&emsp; What is Hormone Replacement Therapy (HRT)?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#is-hrt-dangerous">
&emsp; Is HRT dangerous?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#what-does-hrt-do">
&emsp; What does HRT do?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#how-long-does-it-take">
&emsp; How long does it take?
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#sex-hormones">
<strong>Sex Hormones</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estrogens">
&emsp; Estrogens
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estradiol-info">
&emsp;&emsp; <i>Estradiol</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estrone-info">
&emsp;&emsp; <i>Estrone</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#androgens-info">
&emsp; Androgens
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#testosterone-info">
&emsp;&emsp; <i>Testosterone</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#dht-info">
&emsp;&emsp; <i>Dihydrotestosterone (DHT)</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#progestogens">
&emsp; Progestogens
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#progesterone-info">
&emsp;&emsp; <i>Progesterone</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#hpg-axis">
<strong>Hypothalamic Pituitary Gonadal (HPG) Axis</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#recommended-regimens">
<strong>Recommended Regimens</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estradiol-injection-monotherapy">
&emsp; Estradiol Injection Monotherapy
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#transdermal-gel-plus-blockers">
&emsp; Transdermal Gel + Blockers
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#estradiol-gels-plus-blockers">
&emsp; Estradiol Pills + Blockers
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#honorable-mentions">
&emsp; Honorable Mentions
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#blood-tests">
<strong>Blood Tests</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#baseline">
&emsp; Baseline
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#units">
&emsp; Units
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#target-levels">
&emsp; Target Levels
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#wpath-soc-v8">
&emsp;&emsp; <i>WPATH SoC v8</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#ucsf">
&emsp;&emsp; <i>UCSF</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#nhs-target-levels">
&emsp;&emsp; <i>NHS</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#will-powers-target-levels">
&emsp;&emsp; <i>Dr Will Powers</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#female-reference-ranges">
&emsp;&emsp; <i>Female Reference Ranges</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#our-recommendation">
&emsp;&emsp; <i>Our Recommendation</i>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#antiandrogens">
<strong>Anti-androgens (AAs)</strong>
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#spironolactone">
&emsp; Spironolactone
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#cyproterone">
&emsp; Cyproterone Acetate (CPA)
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#bicalutamide">
&emsp; Bicalutamide
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#gnrh-agonists">
&emsp; GnRH Agonists
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#finasteride">
&emsp; Finasteride
</a>
<a class="list-group-item" href="transfem-hrt-guide.html#homebrew-vs-pharmaceuticals">
<strong>“Homebrew” vs Pharmaceuticals</strong>
</a>
</div>
</div>
<div class="col-md-8 col-lg-9">
<h2 id="introduction">Introduction</h2>
<h4 id="what-is-hrt">What is Hormone Replacement Therapy (HRT)?</h4>
<p>Hormone Replacement Therapy is a broad range of treatments using a variety of drugs that all have one simple goal: to reduce Androgens (such as Testosterone) and increase Estrogen to standard female levels. Originally pioneered in the early 1940s to counteract the effects of menopause in older women, significant research didn&rsquo;t begin until the early 1970s when it was found that existing options came with significant cancer and clotting risks. It was around this time doctors started to realise the process could be used in AMAB Transgender people for its feminising effects.</p>
<h4 id="is-hrt-dangerous">Is HRT dangerous?</h4>
@@ -211,9 +353,9 @@
<p>Due to a lack of consistency in regimens, targets and recording by medical professionals, it is almost impossible to judge this objectively. Based on experiences shared within transgender internet communities a good rule of thumb is that many of the visceral mental effects such as reduced aggression and libido occur within the first couple of weeks and other mental changes follow over the next few months, while the physical effects develop gradually over 2-3 years, finalising around the 5-year mark.</p>
<h2 id="sex-hormones">Sex Hormones</h2>
<p>Since HRT involves manipulating sex hormone levels it&rsquo;s good to have a brief high-level understanding of them.</p>
<p><img alt class="img-fluid" src="https://upload.wikimedia.org/wikipedia/commons/1/1d/Biosinthesis_of_steroid_hormones_%28simplified_version%29.jpg"></p>
<p><img alt="" class="img-fluid" src="https://upload.wikimedia.org/wikipedia/commons/1/1d/Biosinthesis_of_steroid_hormones_%28simplified_version%29.jpg"></p>
<p>At a basic level, there are three primary groups we are interested in: Progestogens, Androgens and Estrogens. Estrogens are female hormones, Androgens are male hormones, while Progestogens are a more complicated family that play an important role in - among other things - reproductive function in AFAB individuals. We generally discuss Estradiol and Testosterone levels specifically when talking about HRT, but it should be understood that we are suppressing the group as a whole. This is particularly important when discussing 5-alpha reductase inhibitors and DHT, the main exception to this rule.</p>
<p><img alt class="img-fluid" id="steroidogensis-diagram" src="https://upload.wikimedia.org/wikipedia/commons/1/13/Steroidogenesis.svg"></p>
<p><img alt="" class="img-fluid" id="steroidogensis-diagram" src="https://upload.wikimedia.org/wikipedia/commons/1/13/Steroidogenesis.svg"></p>
<h4 id="estrogens">Estrogens</h4>
<h5 id="estradiol-info">Estradiol</h5>
<p>The primary Estrogen. Bioidentical Estrogen is always taken in the form of Estradiol.</p>
@@ -234,7 +376,7 @@ Standard Adult Female Range: 0.8-3.1 nmol/L<br>
<h5 id="progesterone-info">Progesterone</h5>
<p>Progesterone is a key signalling agent in AFAB reproductive function. Most female birth control takes the form of high-dose Progesterone. It has anecdotally been observed to have some positive effects on breast development in HRT, though hard evidence for this is lacking.</p>
<h2 id="hpg-axis">Hypothalamic Pituitary Gonadal (HPG) Axis</h2>
<p><img alt class="img-fluid" src="https://upload.wikimedia.org/wikipedia/commons/5/57/Hypothalamic%E2%80%93pituitary%E2%80%93gonadal_axis.svg"></p>
<p><img alt="" class="img-fluid" src="https://upload.wikimedia.org/wikipedia/commons/5/57/Hypothalamic%E2%80%93pituitary%E2%80%93gonadal_axis.svg"></p>
<p>The HPG axis is the primary regulation mechanism for Sex Hormone production. At a basic level it works like this:</p>
<ol>
<li>
@@ -355,37 +497,49 @@ Standard Adult Female Range: 0.8-3.1 nmol/L<br>
<p>Homebrew drugs are manufactured by individuals or small groups of trans people looking to do their part to help the community. These groups will purchase Estradiol or another active ingredient from a wholesale supplier in its raw powder form and manufacture it into whatever form is ultimately taken by a person such as an injectable oil, a swallowable pill, etc. It&rsquo;s important to understand the risks, there is a non-zero possibility of contamination or problems with the manufacturing process because these folks simply do not have the same resources that a multi-million dollar pharmaceutical company has.</p>
<p>On the other hand, the most trusted suppliers are eminently educated on these subjects often working in or adjacent to the pharmaceutical industry, or at the very least operating on guidance from others who are. If you&rsquo;re interested in reading more about this the guidance at <a href="https://hrtcafe.net/Homebrew/injection-tutorial.html"></a><a>hrtcafe.net</a> explains in intricate detail every single aspect of the process and most suppliers have a process largely comparable to that. At diyhrt.market we can vouch for having had this reviewed by a professional in the biomedical industry. Sites like this one and <a href="https://diyhrt.cafe/">diyhrt.cafe</a> vet suppliers, making sure there are months worth of satisfactory feedback from customers before listing anything from them. There have in the past been a very small handful of suppliers who have not reached that quality bar and been rejected by the community, so we know this community consensus approach works.</p>
<p>Put simply, homebrew drugs from suppliers listed here are safe and effective within the constraints of reasonable concerns, but we do believe it&rsquo;s important that you know what you&rsquo;re getting.</p>
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