cross-posted from: https://lemmy.blahaj.zone/post/41790661
So, without context, this question sounds really strange. I’ve been on DIY HRT since the 15th of January, 2025 (started on estradiol valerate pills with cyproterone acetate). I switched to estradiol cypionate injections on the 6th of May, 2025, and have been using it since then. I’ve dialed in a stable EC dose for monotherapy that has given me adequate testosterone suppression (this month’s labs show 15ng/dL). I’ve been getting regular bloodwork, and have an exact timeline of my dosage adjustments since I started HRT. I’m also in the US, since that’s likely relevant.
I now want to start progesterone, and I want to just get a prescription for 2 reasons: price, and a letter of support for surgery showing I’ve been on HRT 2+ years by the time I get surgery (for insurance coverage). But if I’m to get a progesterone prescription, I’d also be getting an estradiol prescription. The problem is that I’m stable on EC, but even if my insurance were to cover it (under the brand name Depo-Estradiol, it’s a Tier 3 drug since it doesn’t have a generic), it would be $100 for a 90 day supply (3 vials). Uninsured, it’s $250/vial, and I find it likely it won’t be covered, as EV is a Tier 1 covered drug (they’d want me to take that instead because it costs the insurance less for a generic).
I have concerns with starting EV, because my dose would have to be dialed in again, and my estradiol levels would be far, far more erratic. EC has a much longer half-life than EV, so it keeps hormone levels much more stable. With EV at an “equivalent dose” (keeping the average over the week the same as the EC I’m currently on), I’d have much higher peaks, and much lower troughs, and I’m concerned that it will worsen my mood swings (I’m bipolar, but have been doing better with medication). There’s also the downside that Depo-Estradiol is only available in 5mg/mL concentration, so I’d be injecting 8x more volume than my 40mg/mL DIY vial.
So, if I were to get a prescription, here are my options (in no particular order):
- Switch to EV and be forced to dial in the correct dosage to adequately suppress testosterone while minimizing supraphysiological serum levels of estradiol
- Get an EC prescription and risk no coverage (and pay as much for 3 months as I do for 2 years DIY if it is covered)
- Get an EV prescription and fill the drug, but keep taking my EC
- Get an EV prescription and don’t fill it while continuing EC
- Get an EC prescription and don’t fill it while continuing DIY (because I don’t have that kind of money)
I believe the insurance will not be checking my prescription history, since I could choose not to use insurance at all for it; they just ask for a letter from my prescribing provider. I’m also aware that in the US, providers can check if you’ve filled a prescription (and sometimes even be notified when you fill/decline to fill a prescription). I’m apprehensive to discuss this with the provider I’ll be seeing, as they may become suspicious that I’m not following my treatment regimine, and thus may deny me a letter when the time comes.
So I’m kind of at a loss for what to do here. The option I feel most comfortable with is filling EV, but continuing EC, as EV is really cheap (<$10/month). That also leaves a trail of prescription history. But my labs might show unexpected serum estradiol levels, so my dosage may be adjusted, and then I may get questions about why my serum estradiol levels didn’t change when the prescribed dosage changed. I also feel like throwing out good vials of EV is a waste. So my next preferred option would be to get prescribed EC, and not fill it because it’s so expensive. That way, my bloodwork lines up, but again, prescription history wouldn’t match up.
I just feel a little overwhelmed.
` I may get questions about why my serum estradiol levels didn’t change when the prescribed dosage changed.´
I dont think this will raise any red flags. From my experience of HRT, med techs just want to get through the checklist as soon as possible.
So I had to check this, because I live in another country where prescriptions are almost free but good luck getting one.
Insurance companies frequently check your prescription history and if you’re found out to be cheating the system in any way, they will deny coverage and that sort of thing. If you’re going to need insurance for things like surgery, you’re going to want to fill the prescription even if you end up not taking it because they can also check if you’ve filled it. (At least that’s what I’d do). In terms of the excess valerate, I’m sure there’s a trans girl in Kansas or somewhere similar who’d be happy to take it off your hands at cost.
Insurance companies can also check your lab results so if you plan to continue cypionate, you should look up the prescribed dose of valerate on one of the pharmacokinetics calculators and adjust your cypionate dosage accordingly. So for example, if they prescribe 4 mg every 5 days ev then 5 mg ev every 7 days would occupy the bottom half of that range. Or you can use 3 mg every 5 days of you want to match the timing of the injections. I don’t know how closely they’ll inspect the labs.
But, if lab results are the only thing necessary to show 2 years of HRT, you might want to consider getting progesterone from DIY sources as it’s probably also cheaper that way. It’s something I’d ask about. (Actually I probably wouldn’t, I’m keeping my activities as private as possible in case my own country goes the same way as the US. I’m looking for a decent circuit diagram for an electrolysis setup as we speak and will be brewing my own enanthate at home from next year.)
Okay, good to know. My estradiol at trough is quite low, so I think my labs would likely end up fine. I’ll just make sure to get an EV prescription for 4mg every 7 days, as trough there is roughly equivalent to the 3mg every 7 days I currently take for EC. It’s kinda crazy that I have adequate testosterone suppression at 135pg/mL trough. For context, that follows the expectation at estrannai.se exactly (based on this month’s labs), and EC peaks at 172pg/mL where EV peaks at 318pg/mL and troughs at 112pg/mL. That’s a crazy difference in hormone fluctuation (hence my apprehension towards EV). As for the progesterone, it’s $10 for a 3 month supply. That’s going to be much cheaper (and less annoying) than sourcing it without a prescription. I guess I’ll look around and see if I can find someone who needs estradiol in the US, as it would be easy to mail. Honestly, it costs $10 for 3 vials, so I wouldn’t ask for money for it. I’ll just have to figure out how to find someone in need of it (if you have ideas, do let me know).
Good to know my paranoid fears weren’t unfounded, so I think I’m gonna go the route of getting an EV prescription then continuing my EC (I still have a year and a half left in my vial). Now I just have to hope I can talk my provider into monotherapy, bc I despise spironolactone (CPA isn’t approved by the FDA here). Given my labs and history, I feel like I’ve got a pretty decent chance of that.
