I’m going into an appointment next week to ask for valerate injections. I’m already on sublingual monotherapy and was wondering how much injectable valerate to ask for instead?
im on 5mg/week estradiol valerate monotherapy and have sufficient testosterone suppression fwiw
Thank you. A follow up question, what needle size would I use for subcutaneous? I know most doctors automatically assign intramuscular injections.
i dont have any experience with subcutaneous so grain of salt here, someone else can chime in if i say something wrong. i do intramuscular because its supposed to provide more even levels and also laziness because i dont feel like changing things atm.
i have two needle gauges, 18g to get the solution out of the vial, and 23g to inject. the length of the 18g doesnt really matter just needs to be long enough to get the liquid, and its more a convenience than necessity. its really slow getting the solution out of the vial with the 23g needle. then i switch to the 23g needle to inject, which right now the ones i have are 1.5 inches since im doing intramuscular in the thigh.
i think for subcutaneous you wouldnt need such a long needle since you basically just need to get under the skin, but a long needle would work if its all you have. the 23g for injecting subcutaneous would still be fine. theres some helpful documentation somewhere on how to actually do the injection but im not sure where. if they give you needles and tell you to do intramuscular you can just nod along and use what they give you for subcutaneous. its much cheaper and easier to buy your own needles and syringes online though. usually the pharmacy will give you not quite enough and overcharge.
I’m doing 5mg every 5 days and my trough is at a good (high) level. I know a number of people on 5 mg per week and it’s working fine for them.
Regarding your question about the needles. I have 25g 1" for IM and 27g 1/2" for SC. They’re fixed point safety syringes, so I draw and inject with the same needle.
What is your experience in amount of time drawing for the smaller needles? I see a lot of posts saying to switch out needles to speed up drawing.
It doesn’t take long at all, like less than 10 seconds. I do inject air into the vial to create some positive pressure. The viscosity of the carrier oil in use will make a difference. The EV I’m using now is sesame oil.
I moved from patches to valerate because i wasn’t getting enough from the max dosage. I’m trying to approach average blood levels between 300-400 pg/mL which the current research seems to support as a good target, but yours might be different.
For that, I’m currently using 8mg/week, but still homing in on the perfect level. You’re unlikely to get it perfect the first time since everyone’s body is different. So the doctor should be able to give you a good starting dose. Then you can test and tweak over time. At least that’s the “right” way to do it.
isnt that like really high? even for cis women they peak in their cycle below 300 pg/mL on average. i thought going that high on estrogen concentration had some associated risks. would be curious to see what research is supporting such high levels.
Most of those risks were related to the old form of hormone therapy which had a high cancer risk, so they cut the recommended levels in half to compensate. Modern hormone replacement drugs don’t have that risk anymore. Even the US FDA has removed their cancer warnings on estrogen therapy. Also, there has been some controversy on the research that gave those accepted levels, even for cis-women, having too small of a sample size and not at all diverse to take into account age, race, location, diet, etc. And there really isn’t much research at all concerning levels during puberty, which is what mtf people are kind of trying to simulate in the first several years. And pregnant women are exposed to levels sometimes ten times as high as nonpregnant women, though admittedly for shorter periods of time.
The latest recommendations I originally found via Mount Sinai’s site from my original hormone prescriber just for estrogen blood tests in general, but unfortunately they’ve broken the link.
https://www.mountsinai.org/health-library/tests/estradiol-blood-test
Here’s a copy on way back machine. Though, without a lot of the content and links.
But this is the value they show as normal for all women including cis-women.
Female (premenopausal): 30 to 400 pg/mL (110 to 1468.4 pmol/L)
The other issue is that most of these risks are for post-menopausal cis-women. For example, in one major study, women who had a lifetime of higher estrogen levels showed 3% of them developed breast cancer in their lifetime than women who had lower levels. But that’s not applicable to us.
There are 0 direct studies on how estrogen therapy affects trans-women, mostly just after the fact and very small sample sizes. There are some additional risks to estrogen overall though, such as bone density reduction, heart attack, stroke, etc., but things like heart attack and stroke are way, way more likely to happen with even normal cis-male levels of testosterone, and even more likely from anti-androgens. So, you should definitely discuss it with a professional. I chose to accept any small risk of higher estrogen levels but that meant never needing anti-androgens (may not work if you’ve already started anti-androgens, though according to some research), and to actually get the full effect of estrogen on my body, like having more feminine emotional reactions. Unfortunately, I didn’t get much breast growth despite having a family with larger ones, lol. Probably because I was older when I started. But for me, with little personal medical issue history and the research my doctor had shared, her personal experience with HRT, and my own research reading many, many medical research journal articles wherever I could find them, it was well worth it. Again, YMMV, but the 100-200pg/mL recommendation is definitely out of date, and much of the rest of the research on risk is irrelevant to trans-women. There just isn’t enough research on trans-women to say for sure, so doctors often stay conservative on levels.
