uk diy hrt quick start guide

# uk diy hrt quick start guide
This is a resource with the practical steps for taking HRT in the form you choose in the UK.

You should have autonomy over your body. HRT is not complicated. As a community we have more than the necessary expertise. DIY HRT is both safe and easy.

The NHS pathway involves decades long waiting lists, and is only likely to be further restricted. Private services are increasingly costly and oriented around profit rather than the best outcomes for you.

A vial of estrogen that can last 2-3 years costs around £60-100, and supplies (alcohol wipes, needles) for 2+ years (100 injections) cost around £15. There are mutual aid groups who can help with these costs.

This page was created by trans people for trans people.

Here are some links to buy estrogen, testosterone, and puberty blockers:
- https://hrt.coffee/
- https://hrtcafe.net/
- https://diyhrt.market/
- http://lena.kiev.ua/ev/
- https://vannapharma.cc/

skip to testosterone

For puberty blockers, WPATH has some guidelines https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf#page=39

There is a legal loophole in the UKs recent attempt to ban puberty blockers: importing puberty blockers for personal use (not sale or supply) seems to be legal: https://twitter.com/JolyonMaugham/status/1799006675778888149?t=4KK8n-G06J7HYQTzgK76Ig related: https://twitter.com/JolyonMaugham/status/1799015624825516106

## estrogen
Below you will find the basic information necessary to access and start taking estrogen as HRT.

There are three estrogens which exist in your body: estrone, estradiol and estriol. The important one for HRT is estradiol. Remember estradiol is just an estrogen for this guide.

This table compares doses and routes: https://transfemscience.org/articles/e2-equivalent-doses/#table-of-comparable-estradiol-dosages

You can start as low or high as you like but it is commonly recommended to start with a low dose and increase every 6 weeks to a moderate dose. For example if you were taking pills you might start on 2mg daily, increase to 4mg after 6 weeks, then again to 6mg after another 6 weeks. From there you can take blood tests, and evaluate how you feel in your body, and increase or decrease your dose as necessary.

While excess testosterone can form estrogen in your body, this does not occur the other way around; excess estrogen can not become testosterone.

### estradiol injections
You will need:
- a vial of estradiol
- 27 gauge needles
- alcohol wipes

The needles and wipes can be bought easily online, e.g. from https://www.medisave.co.uk

It is also possible (but complex) to synthesise estrogen yourself https://groups.io/g/MTFHRT/wiki/29602.

To dose your injections you need to know
- Concentration (?mg/ml) of estradiol in the vial you are purchasing e.g. 50mg/ml
- Ester of estradiol (next paragraph).
- Target blood estrogen level (?pmol/L)

Below are four common esters. Different esters can have faster or slower releases which may affect how regularly you inject. Soon after you inject you will have a peak amount of estrogen in your body, the list below shows the rough number of days it takes after injection for your blood estrogen level to fall to half of the peak level. And the frequency to inject if you want to stay above half of the peak level.
- estradiol valerate: 5 days (3 times every 2 weeks)
- estradiol cypionate: 11 days (once every week)
- estradiol enanthate: 13 days (once every 1-2 weeks)
- estradiol undecylate: 31 days (once every 3-4 weeks)

Be aware of the oil your ester is suspended in, some can be more viscous than others. Castor oil is thick like honey, MCT oil is thinner almost like water. Thicker oil is harder to inject and needs a larger gauge needle.

There is a reasonably low risk of allergic reaction but if it does happen, antihistamines can help. You probably shouldn't keep using an oil suspension if you are allergic to it, but try another.

Let's do an example calculation:
- If you're aiming for 900pmol/L blood estrogen level
- Use the calculator to see what dose (in mg) gives that blood estrogen level. 4mg estradiol enanthate every week gives approximately 900pmol/L https://sim.transfemscience.org/?e=een&d=4&r=y&di=7&u=mlr&xm=90
- Divide the mg dose by the concentration (?mg/ml) to find the ml dose. 4mg divided by 50mg/ml is 0.08ml.
- This is the amount you should draw into the syringe and inject. Your syringe will have ml numbers on the side.

This website can help you think about dose and frequency: https://transfemscience.org/misc/injectable-e2-simulator/. However everyone is different and your experience may not match the information given there. In that calculator you can enter your ester, dosage, and frequency to see an estimate of your blood levels. You probably want to change the units to pmol/L and the time scale to at least 90 days.

Before you inject you should clean the target area and the rubber vial cap with an alcohol wipe. You should inject either into the fat on your tummy, or the fat on the upper outer quadrant of your bum.

Loosely pinch a patch of fat. Insert the needle at a 45 degree angle. press the plunger slowly. Wait a couple of seconds and then slowly remove the needle. Clean the site again with a fresh alcohol wipe.

Place the needle in a clearly marked used-sharps-box.

Congrats: You've started on estrogen!

You may get a small hard lump aroud the injection site, this will usually pass in a week. This is part of the reason for alternating sides.

### estradiol patches
There is currently a manufacturer shortage for Progynova 100 micrograms patches, check this link for updates https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/serious-shortage-protocols-ssps. You may want to choose another patch brand or try injections.

Patches are usually listed by the dose they release every 24hrs: 25/50/75/100 micrograms(mcg/ug).

Sometimes you will see them listed as an X mg dose. This varies for each brand based on how often the patch is meant to be replaced. For example, an Evorel 100mcg patch, which you need to replace twice per week, will have a lower total mg estradiol content than a 100mcg Progynova patch because the latter is meant to be replaced once per week.

Here are some common brands and the frequency with which you should replace the patch for a consistent dose:
- Progynova: weekly
- Evorel: 2x weekly
- Estradot: 2x weekly

Google the dose and brand. You should get a number of online pharmacies offering the patches at different prices.

Choose a site. You will often have to answer a short questionnaire on the site so that they can approve or deny your request. It is most effective to pretend to be a cis woman who is already prescribed the patches by your GP.

Some sites (not all) may need to verify your name and age (with an ID document). They won't contact your GP or anyone else about the information on the form unless you tick that you want them to do so.

When they arrive in the post have a wash and slap a patch on (thighs or tummy).

Congrats: You've started on estrogen!

(Also, use medical adhesive remover wipes to get the sticky residue off your patch sites)

### blood tests and hormone levels
If you want to "feminise" your body by taking estrogen you should aim for a serum estradiol count of at least 400 pmol/L and a serum testosterone level of less than 3 nmol/L.

Many people experience bodily changes with higher testosterone and lower estradiol. Some people take very low doses of estradiol simply because they find it helps their mental health.

You can visit CliniQ in London (by appointment on Tuesdays) for free serum estradiol and serum testosterone blood tests https://cliniq.org.uk/cliniq-kings-south-london/.

You may be able to persuade your GP to do the necessary tests https://www.gendergp.com/nhs-gp-guidance-transgender-patients/. If they won't do the tests, you should make a formal complaint https://www.transactual.org.uk/blog/why-should-you-complain-gp.

You can also order at-home postal kits to test your levels, though these cost money each time. They are easy to find with a google search.

## testosterone
### testosterone injections
You will need:
- a vial of testosterone
- 27 gauge needles
- alcohol wipes

The needles and wipes can be bought easily online, e.g. from https://www.medisave.co.uk

Unlike estrogen, testosterone is a controlled substance in the UK. It's illegal to sell. There are several sites selling vials. https://www.onlinepharmacy-bg.com/en is based in the UK so shipping is relatively fast.

If you can only get ampoules, you can then buy vials online and decant them for longer storage and use.

To dose your injections you need to know the ?mg/ml concentration of testosterone in the vial you are purchasing. For example, with 50mg/ml vials an injection of 0.1ml would be a 5mg testosterone dose.

Different suspensions can have faster or slower releases which may affect how regularly you inject. It is quite common for people to inject once per week.

Place the needle in a clearly marked used-sharps-box.

## support groups
- phone lines
- switchboard.lgbt
- mutual aid groups
- wales twitter instagram
- bristol twitter instagram
- manchester twitter instagram
- parents support groups
- mermaids
- gendered intelligence
- fflag

Now you know, teach your friends. Don't talk to journalists.