Estradiol Valerate Injection Safe Levels Confusion
I (25y/o transfem) switched from sublingual tablets to injections about 6 months ago. My initial dose was 0.3ml weekly of estradiol valerate 20mg/ml into my abdomen (subcutanous). After 3 months I had my levels tested at 4 days after my weekly injection (mid point in the cycle) and my estrogen level was 743pg/ml and my testosterone was 7ng/dl. This caused my doctor to freak out because they were worried about blood clots and cut my weekly dose in half to 0.15ml and wanted to retest in a month. After a month, again testing at the 4 day point in my weekly cycle, I was at 407pg/ml of estrogen and 32ng/dl of testosterone. My doctor still wasn't happy with this and wanted me to go to 0.05ml weekly and retest in a month again. I was concerned about dropping my hormones so drastically and raised this concern with them, but they were adamant that I was still at risk of blood clots and they could raise my levels after they got me into the safe estrogen range. I decided to instead drop to 0.1ml weekly (cutting my dose by 1/3 instead of 2/3 like they wanted), and am waiting for the blood test results from my most recent test after a month of being on 0.1ml weekly.
In the meantime, I've been doing research on my own, and have found multiple sources saying the risk of blood clots is only for tablets and doesn't apply to injections or only applies to older formulations of estradiol. I also saw that the recommended starting dose of estradiol valerate was the 0.3ml I started on and 0.15ml is the minimum dose (though dosage wise I'm usually on the lower end since I'm 120lbs and 5'11"). I also know that when I was on the 0.3ml, I saw the first significant breast growth of my transition, and generally felt better.
So, question time: Is my doctor just misinformed about HRT and incorrectly trying to keep my levels in a range they don't need to be in, or are they right to be trying to get my levels down with such urgency?
Also, side question that came up while I was looking through my stuff for this post, does it matter than my prescription says "For intramuscular use only" but I'm doing it subcutanously (I looked back and it's always said that, I only noticed it now)? With this prescription my doctor told me to do subcutanous and I had a whole injection training thing, so I'm not sure if they just prescribed me the wrong version or it doesn't matter.
Thanks so much!!
Posted Apr 15, 2025, 7:27 PM UTC