Dr. Reed, What are your Hormone Therapy recommendations for Transgender women? Is this a service you provide? Will I need to continuously return to your office for followup?
Yes, we do hormones. A letter of therapy clearance is required by a licensed therapist with a doctoral degree. Our fee is 250 for consultation, and 600 per year to follow you with needed lab tests, office visits, prescriptions,counselling, numerous telephone calls, and medical records documentation.
Lab tests are an out of pocket expense as is the medication. We may recommend a laboratory, but you can have them done at a nationally recognized laboratory of your choice.
We tend to favor sublingual micronizable estradiol as opposed to patches or injections. Injections produce a peak and trough level. If you are on injections blood tests should be done mid cycle, and if on sublingual tables, as close to 8 AM the following day (before you take any estradiol that day, then of course continue as prescribed).
Estrogens are potentially coagulopathic so ideal ranges for a trans who has not had an orchiectomy is 125 to 150 pg/ml and for those who have 100-125 pg/ml. As a rule of thumb, after orchiectomy you can reduce your well modulated estradiol by a third.
The National Health Institute has advised that estrogens not be used on women over 55 again because of coagulopathic potential. Any MTF who insist on taking estrogens needs a letter of medical clearance with reference to an EKG, ideally should not be a smoker, hopefully will comply with one baby aspirin (Ecotrin 85 mg) daily , and accepts a further reduction of estrogen levels.
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami