Microdosing (Low Dose) Estrogen Hormone Replacement Therapy (HRT), Explained by FOLX
Low-dose, or microdosing estrogen, is a way for those to experience slower, subtle changes on hormone therapy.
This article was reviewed by Jess Schwab, DNP. Images are illustrated by Leo Mateus.
Are you looking for the testosterone version of this article? Click here to learn about microdosing/low-dose testosterone!
Many people live outside the gender binary of woman and man. Nonbinary folks and other gender-expansive people within or beyond the binary can go about exploring bodily changes in all different ways, including starting transgender hormone therapy.
Many folks on the gender spectrum may consider—or currently are—taking estrogen gender-affirming hormone therapy (GAHT) as a tool for their body to reflect their truest self. With estrogen therapy, trans women and non-binary identities can expect common physical changes, including as a softening of the skin, decreased muscle mass, breast growth, and facial hair/body hair thinning.
We are seeing more and more people who are interested in subtle changes, or those who want to ease into hormone level changes to slowly see how they feel, opt for microdosing estrogen. GAHT has the ability to greatly reduce gender dysphoria and improve a trans person’s overall baseline of mental health, even when microdosing.
What is the purpose of microdosing estrogen?
Microdosing or low-dose GAHT has become a tool for many trans, nonbinary, and other gender-variant people to feel good in their bodies without committing to the faster secondary-sex changes that come with higher doses. Previously, many felt overwhelmed that GAHT was a kind of “no turning back” since healthcare providers were only familiar with prescribing high doses of feminizing hormone therapy to combat testosterone levels, to achieve a more “binary” type of appearance.
However, providers have more information on recommended guidance for those looking for slower changes than the traditional GAHT route. For instance, the World Professional Association for Transgender Health (WPATH) now includes nonbinary identities and the need for personalized approaches in their Standards of Care.
Why do some people microdose estrogen?
Some consider microdosing when they want certain effects of GAHT but not others. While it is hard to know for sure in advance exactly how changes will happen, we can work with people to try to achieve the best outcome with the tools we have.
Compared to standard doses of estrogen, these lower doses are often half, or less, that amount. This allows the physical changes to develop slowly and over a longer period of time. Other people will use GAHT to achieve certain effects and then discontinue before further effects take place, although some changes will recede once GAHT is discontinued.
How does microdosing estrogen work?
People seeking more “feminine” features may choose to go on low-dose estrogen and/or anti-androgens. Some will try a testosterone blocker like spironolactone (spiro) or finasteride alone first to see what a reduction of testosterone feels like without added estrogen (like estradiol); this can cause hot flashes, low mood or energy, and bone loss long-term. There is still some controversy about whether spironolactone stops breast growth early, the data is very inconclusive and while some prefer to start with low dose estrogen without taking spiro, the majority of providers will follow the guidance to start with E and spiro.
There are multiple options to microdose estrogen with FOLX.
There are just as many ways to adjust your estrogen levels by microdosing, just like there are for higher doses. The main difference is in the concentration of hormones taken. Typical low-dose regimens are listed below, but lower doses can be tried if desired. For estrogen, there are pill, patch, and injectable routes, along with oral routes of taking anti-androgens.
If you’re curious about how others have approached microdosing and low-dose GAHT, there are a few great anecdotes in recent years. In this piece by them, some share their medical transition, costs, and hurdles they face in the current medical system. Transfeminine Science is another great resource aggregated from various Reddit threads and includes personal experiences from the founders Aly, Lain, Sam, and Kay as well as medical literature.
For those ready to join FOLX for microdosing estrogen, the process begins here. For existing FOLX members with questions about their dosage, don't hesitate to message or schedule time with a clinician. For those with more questions, read up on estrogen here and/or reach out to us directly at firstname.lastname@example.org.