Dosage Calculators
Overview
There is no perfect "calculator" for HRT dosing — individual responses vary too much. However, the following tables provide starting point equivalencies and dose adjustment guidelines.
Estrogen Dose Equivalencies
Note: These are population averages. Many people achieve target levels with lower doses (e.g., 3–4 mg/week of EV). Always start low and adjust based on blood tests.
Approximate equivalent doses for achieving similar E2 levels:
| Oral Estradiol | Sublingual | Transdermal Patch | Gel | Injectable EV | Injectable EC | Injectable EEn |
|---|---|---|---|---|---|---|
| 2 mg/day | 1 mg/day | 50 mcg/24h | 2 pumps (~1.5 mg) | 2 mg/5 days | 2 mg/7 days | 4 mg/7 days |
| 4 mg/day | 2 mg/day | 100 mcg/24h | 4 pumps (~3 mg) | 4 mg/5 days | 3 mg/7 days | 5 mg/7 days |
| 6 mg/day | 3 mg/day | 150 mcg/24h | 6 pumps (~4.5 mg) | 5 mg/5 days | 4 mg/7 days | 6 mg/7 days |
| 8 mg/day | 4 mg/day | 200 mcg/24h | 8 pumps (~6 mg) | 6 mg/5 days | 5 mg/7 days | 8 mg/7 days |
Injection Dose Calculator
Estradiol Valerate (EV)
| Desired Trough E2 | Dose (every 5 days) | Notes |
|---|---|---|
| 100 pg/mL (367 pmol/L) | 2–3 mg | Below typical monotherapy threshold |
| 150 pg/mL (551 pmol/L) | 3–4 mg | May still need AA for T suppression |
| 200 pg/mL (734 pmol/L) | 4–6 mg | Monotherapy target for most people |
| 250–300 pg/mL (918–1,101 pmol/L) | 5–8 mg | Higher end rarely needed |
Estradiol Cypionate (EC)
| Desired Trough E2 | Dose (every 7 days) | Notes |
|---|---|---|
| 100 pg/mL (367 pmol/L) | 2–3 mg | Below typical monotherapy threshold |
| 150 pg/mL (551 pmol/L) | 2–4 mg | May still need AA for T suppression |
| 200 pg/mL (734 pmol/L) | 3–5 mg | Monotherapy target for most people |
| 250–300 pg/mL (918–1,101 pmol/L) | 4–6 mg | Higher end rarely needed |
Estradiol Enanthate (EEn)
| Desired Trough E2 | Dose (every 7 days) | Notes |
|---|---|---|
| 100 pg/mL (367 pmol/L) | 3–4 mg | Below typical monotherapy threshold |
| 150 pg/mL (551 pmol/L) | 4–5 mg | May still need AA for T suppression |
| 200 pg/mL (734 pmol/L) | 4–6 mg | Monotherapy target for most people |
| 250–300 pg/mL (918–1,101 pmol/L) | 6–8 mg | Higher end rarely needed |
Recent evidence: Multisite studies (2024-2025) found the median effective weekly dose for achieving both target E2 and T suppression is around 4 mg (IQR 3-6 mg). Doses above 6 mg/week consistently produce supraphysiologic E2 levels in most people. Start low and titrate based on blood tests.
Note on EC: Estradiol cypionate has a longer hydrocarbon tail than EV, making it more lipophilic with a longer duration and smaller peaks. Doses ≤5 mg weekly are typically sufficient. UCSF guidelines recommend a maximum of 5 mg/week for EC, compared to 20 mg/week for EV.
Concentration Calculations
Injectable estradiol comes in different concentrations. Always check your vial concentration.
| Concentration | 1 mg = | 5 mg = | 10 mg = |
|---|---|---|---|
| 10 mg/mL | 0.1 mL | 0.5 mL | 1.0 mL |
| 20 mg/mL | 0.05 mL | 0.25 mL | 0.5 mL |
| 40 mg/mL | 0.025 mL | 0.125 mL | 0.25 mL |
Formula
Volume to inject (mL) = Desired dose (mg) ÷ Vial concentration (mg/mL)
Example: You want 5 mg of EV from a 20 mg/mL vial
5 mg ÷ 20 mg/mL = 0.25 mLAnti-Androgen Dose Ranges
| Medication | Typical Starting Dose | Typical Maintenance | Maximum |
|---|---|---|---|
| Spironolactone | 25–50 mg/day | 100 mg/day | 200 mg/day |
| CPA | 10–12.5 mg/day | 10–12.5 mg/day | 12.5 mg/day |
| Bicalutamide | 25–50 mg/day | 50 mg/day | 50 mg/day |
Estimating Whether You Need an AA
A rough guide: if your E2 trough is:
| E2 Trough | Likely T Suppression Without AA |
|---|---|
| < 100 pg/mL | Possible (~43% achieve T < 50 ng/dL per Mount Sinai study) |
| 100–200 pg/mL | Likely (~75% achieve T < 50 ng/dL) |
| 200–300 pg/mL | Very likely (~89% achieve T < 50 ng/dL) |
| > 300 pg/mL | Very likely but supraphysiologic; rarely needed |
Remember: These Are Starting Points
- Individual response varies widely — one person's 4 mg EV may be another person's 8 mg
- Always test blood levels 4–8 weeks after any dose change
- Adjust based on levels, not calculations
- More is not always better — recent evidence shows doses above 6 mg weekly consistently produce supraphysiologic E2 levels without additional T suppression benefit
- Start low and go slow — 3-5 mg weekly is a reasonable starting range for injectable E2
References
UCSF Transgender Care. Feminising hormone therapy — dose adjustments. https://transcare.ucsf.edu/guidelines
Hembree WC, et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons. JCEM. https://academic.oup.com/jcem/article/102/11/3869/4157558