By: Plume Community Member (she/her)
Many trans women, trans femmes, nonbinary and gender non-conforming (GNC) people, and folks who identify as MTF take estrogen. Estradiol pills are one form of gender-affirming hormone therapy (GAHT, also called HRT or hormone replacement therapy). This article will help you understand the basics of taking estradiol pills and how it might work for you during this part of your gender transition.
Do I have to divide my estradiol dose?
Typically, pills come in 2 mg tablets. You may take between one to three pills a day based on your hormone levels, your transition goals, and other factors. For your safety, it’s important to follow the directions of your medical provider and pharmacist when it comes to your dosing. Your medical provider will determine your dosing based on your bloodwork and your body’s response to estradiol. Regular lab work will also help you stay healthy while you are taking estradiol.
It’s recommended to take the pill with food to avoid an upset stomach. If you’re prescribed a dose that requires multiple pills, your medical provider may tell you to split up the dose throughout the day. For instance, if your dose is two 2 mg pills, you may take one in the morning and another in the early evening.
What time of day is best to take estradiol pills?
Estrogen is a hormone that everyone’s body produces in different amounts. It is naturally released by most people’s bodies in the morning. Taking estradiol will change your body’s hormone levels, which affects all of your body’s systems, including your sleep cycle. Estradiol might change how your body releases melatonin and other chemicals related to a good night’s rest. For this reason, you might want to avoid taking it too close to bedtime.
It’s also important to take your doses at the same time every day. (This applies to those taking E via injection or transdermal patch as well.) Most people taking E set a daily alarm to make sure they take their dose on a regular schedule. Being consistent will help you manage any unexpected effects, such as mood changes. It will also help you keep your gender transition on track.
For those of us who have a difficult time remembering to take a pill at the same time every day or are afraid of missing doses in general, there are alternative delivery systems to the pill. Estradiol can be administered via three uptake methods: pill (taken orally once or twice daily), transdermal patch (worn on the lower belly or upper buttocks, changed out every two to three days), or shot. If you want to change uptake methods, talk to your medical provider about your options.
Is taking estradiol pills better?
There are not a lot of studies that have been done on the overall effects of taking estradiol sublingually, but I chose this method because of its ease-of-use benefits. (I really dislike needles!) Taking a pill sublingually simply means placing the pill under your tongue and letting it dissolve. Do not drink water or eat food while the pill is dissolving. It will take between five to ten minutes to dissolve completely. This allows for the hormones to bypass your liver and enter the bloodstream directly, reducing the risk of blood clots and long-term liver damage.
Studies show that when taking estradiol sublingually, there is a large initial spike in hormone levels, but they drop to similar levels as when taken orally after a couple hours, so there is not a dramatic difference in overall hormone levels. Every uptake method will give you the same effects at more or less the same speed. One method will not make you transition “faster” than another. The important thing is to pick a method that works for you in terms of consistency, access, and comfort.
Some trans people who take E say they notice a more balanced hormonal cycle when taking estradiol via pills. This is because your body cycles through the hormones on a daily cycle rather than a weekly cycle with injections or a cycle every few days (as with the transdermal patch). The pill might also be good for those who are first trying out estradiol or who are interested in microdosing E. I started out microdosing with estradiol pills because it helped me adjust my dose slowly over time, until I felt comfortable with the amount I was taking.
Estradiol pills are just one form of estrogen that can support your gender transition. Pills are a wonderful delivery option for those of us who are squeamish about needles and don’t like the idea of wearing a patch twenty-four hours a day. Taking estradiol pills orally is the best option for some people. Your medical provider can help you decide whether this is a good fit for you!
This Plume Community Member (she/her) is a transfeminine creative and freelance writer. She lives in the Pacific Northwest with her wife and dogs.
As the largest provider of gender-affirming care for the trans and nonbinary community, Plume is committed to providing information about many types of information, including questions about hormones like estrogen and testosterone, gender transitioning tips and experiences, and guidance on social transition and self care.
While we strive to include a diverse range of voices and expertise, not everything will be for every person. Each individual’s experience is unique, and the information Plume provides is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always first seek the advice of your primary and/or specialist physician, the Plume Care Team, or other qualified health provider with any questions you may have regarding a medical condition, your mental health and emotional needs, or your health care needs regarding gender-affirming hormone therapy. If you are experiencing an emergency, including a mental health crisis, call 911 or reach out to Trans LifeLine.
