Feminizing hormone therapy. | ||||
| Hormone Therapy | Dosage | Comments | ||
|---|---|---|---|---|
| Initial, low1 | Initial, Typical | Maximum, Typical2 | ||
| Estrogen | ||||
| Estradiol oral/sublingual | 1 mg/day | 2-4 mg/day | 8 mg/day | If >2 mg, dose should be divided and taken twice daily. |
| Estradiol transdermal | 50 mcg | 100 mcg | 100-400 mcg | Maximum available single patch dose is 100 mcg. Frequency of change is brand and product dependent. Patients may find that >2 patches at a time are cumbersome. |
| Estradiol valerate, intramuscularly3 | <20 mg every 2 weeks | 20 mg every 2 weeks | 40 mg every 2 weeks | May divide dose into weekly injections for cyclical symptoms. |
| Estradiol cypionate, intramuscularly | <2 mg every 2 weeks | 2 mg every 2 weeks | 5 mg every 2 weeks | May divide dose into weekly injections for cyclical symptoms. |
| Anti-androgen | ||||
| Spironolactone | 25 mg orally daily | 50 mg orally twice daily | 200 mg orally twice daily | |
| Finasteride | 1 mg orally daily | 5 mg orally daily | ||
| Dutasteride | 0.5 mg orally daily | |||
| Progestin | ||||
| Medroxyprogesterone acetate (Provera) | 2.5 mg orally each night at bedtime | 5-10 mg orally each night at bedtime | ||
| Micronized progesterone | 100 mg orally each night at bedtime | 200 mg orally each night at bedtime | ||
| Cyproterone acetate | 10 mg orally daily | Used outside of the United States | ||
1 Initial low dosing for those who desire (or require due to medical history) a low dose or slow upward titration.
2 Maximal effect does not necessarily require maximal dosing, as maximal doses do not necessarily represent a target or ideal dose. Dose increases should be based on patient response and monitored hormone levels.
3 Available as standard US Pharmacopia (USP) as well as compounded products.