Hormone Replacement Therapy HRT guidelines

Dr. Reed,

I am an MTF patient seeking hormones. My therapist is not licensed to prescribe medications.  What guidelines do I need to know?


Good morning Sarah,

Yes we do HRT (hormone replacement therapy) or more fairly stated hormone therapy.  If you have testes you should consider a testosterone blocker. We recommend spironolactone.  Spironolactone which is also a diuretic or “water pill” holds on to potassium.  So you’ll want to review high potassium foods on the Internet which should be minimized in your diet.

Next if you are over 55, National Instiitute of Health has issued advisory warnings about the side effects of estrogens including coagulopathy (heart attacks and strokes) and gall bladder disease, etc.  Better to start low and work up to normal based upon lab tests which initially are drawn every 3 months.

Other lab tests include serum estradiol, serum potassium (mentioned that), liver function studies, and a CBC initially.  For non-orchiectomized patients we like to keep estradiol levels at 125 to 150 pg/ml, and for patients who have been castrated, 100 to 125 pg/ml.  We are continually surprised how many patients either under medical care or self care are not having this done.

When to draw blood is equally important as false lows or false highs won’t help you.

Call our office for more details (305-865-2000) or E-mail

Have a sunny Sunday,

Harold M. Reed, M.D.


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