Dr. Beal discusses a May, 2024 paper on estradiol valerate dosing guidelines and how this paper validates our clinical knowledge and practice. Hint: smaller dosages, twice a week, rather than once a week.
Tik Tok Video on Estradiol Valerate Dosing
Direct link to this video on TikTok.
Video Transcript:
It’s always really exciting to see when there’s some published literature
or research that agrees with things you’ve been saying for years
at least I am um
So this paper came out in May of this year um
talking about how the guideline ranges for estradiol valerate
are significantly higher, um than is actually needed to achieve safe and effective estrogen levels
supporting trans and gender diverse patients and how if you use the guideline ranges that are recommended, people end up with like dangerously high super physiologic levels of estradiol
putting them at increased risk of blood clots and breast cancer over time.
Um so I have been saying this for years.
it’s fascinating.
I was asked to contribute to Seattle Children’s dosing protocols and like
they use those ranges cause they just pulled them out of adult guidelines um and I was like “Do you ever actually use these doses though?”
and they were like “No, of course not.” and I was like “Yeah.”
So maybe like I don’t know why there’s this broken stair of these super high dosing guidelines, um in our field, but it’s there.
Um, also doing a presentation for an organization this week um
and actually went through their dosing protocols as well in preparation for that, and the same thing, um…
and so this paper found pretty similar to what I use in clinical practice:
you know for estradiol valerate, clinicians, honestly I find 4 milligrams a week puts us in a target range of like that kind of [blood] serum levels of like 200,
um and honestly, I
like a lot of my patients
do 2 mg twice a week for a total of four and a week um
but because it has that dosing curve that starts to tape rough around day five
it prevents that kind of crash that people can sometimes feel
if they try to dose it once a week.
Not everyone experiences that, and so we start at once a week
to see if we can get away with just doing a shot once a week
cause if you can just inject once a week, that’s kind of nice but um
yeah and I do find that the levels are a little more stable when um
and a little lower when it’s done IM versus sub q, but most of my patients prefer sub q injections.
And it’s such a small volume um, although it is a very viscous oil.
So some people have like more granularity with inflammatory reaction to it because of the viscosity of the oil, but if there not having that
it’s a tiny volume you’re doing like 0.1 ML or 0.2 ML.
…um and so it’s nice not have to do an IM shot.
More QueerDoc on estradiol (not just valerate):
The QueerDoc Blog Index: Estrogen/Estradiol
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