HRT Dosage Chart: Complete Reference for Estrogen, Progesterone, and Testosterone Across All Routes

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Standard oral estradiol starts at 0.5-1 mg daily, transdermal patches at 0.025-0.05 mg/day, and injectable estradiol valerate at 5-10 mg every 7-14 days, but optimal dosing requires symptom response and lab monitoring, not chart adherence alone
• Micronized progesterone dosing is 100-200 mg orally at bedtime for endometrial protection, while compounded progesterone creams lack standardized absorption data and are not FDA-approved for uterine protection
• Testosterone therapy for gender-affirming care typically uses 50-100 mg intramuscular weekly or 50-75 mg subcutaneous weekly, while testosterone for cisgender women treating HSDD uses 1/10th to 1/20th of those doses
• Route conversion is not linear: 1 mg oral estradiol does not equal 0.1 mg transdermal patch strength because first-pass metabolism, absorption rates, and serum level curves differ fundamentally by delivery method

Direct answer (40-60 words)

HRT dosing varies by hormone (estrogen, progesterone, testosterone), delivery route (oral, transdermal, injectable, sublingual), and treatment goal (menopause, gender-affirming care, HSDD). Standard starting doses exist, but individualization based on symptom relief, side effects, and serum hormone levels determines the effective dose. No single chart replaces clinical titration.

Table of contents

1. Why HRT dosing charts are starting points, not destinations
2. Estradiol dosing by route: oral, transdermal, injectable, sublingual
3. Progesterone dosing: oral micronized, compounded creams, and the endometrial protection question
4. Testosterone dosing for gender-affirming care vs. cisgender women
5. Route conversion: why 1 mg oral ≠ 0.1 mg patch
6. The FormBlends titration framework: symptom-first vs. lab-first approaches
7. What most dosing charts get wrong about bioidentical hormones
8. When to increase, decrease, or switch routes
9. Storage, compounding, and shelf-life considerations
10. Monitoring labs: what to test and when
11. FAQ
12. Sources

Why HRT dosing charts are starting points, not destinations

HRT dosing charts published by medical societies, compounding pharmacies, and telehealth platforms present ranges like "estradiol 0.5-2 mg oral daily" or "testosterone 50-100 mg IM weekly." These ranges reflect the statistical middle of prescribing patterns, not physiological laws. Two patients on identical doses can have 3-fold differences in serum estradiol levels due to gut absorption variability, liver metabolism differences (CYP3A4 polymorphisms), and body composition.

The 2017 Endocrine Society Clinical Practice Guidelines on gender-affirming hormone therapy state explicitly: "Hormone therapy should be individualized based on a patient's goals, the risk/benefit ratio of medications, the presence of other medical conditions, and consideration of social and economic issues" (Hembree et al., Journal of Clinical Endocrinology & Metabolism 2017). The same principle applies to menopausal HRT.

A dosing chart tells you where to start. Symptom resolution, side effect profile, and serum hormone levels tell you where to stay. The chart below is organized by this principle: each dose range includes the clinical context that determines whether you're at the low end, high end, or somewhere between.

Estradiol dosing by route: oral, transdermal, injectable, sublingual

Estradiol is the primary estrogen used in HRT. Estrone and estriol are weaker and less commonly prescribed as monotherapy. The route determines bioavailability, peak timing, and whether the hormone undergoes first-pass hepatic metabolism.

Oral estradiol (micronized 17β-estradiol)

Dose	Clinical context	Typical serum estradiol level (pg/mL)
0.5 mg daily	Low-dose menopause therapy, osteoporosis prevention in low-risk patients	20-40
1 mg daily	Standard starting dose for menopause, mild-to-moderate vasomotor symptoms	40-80
2 mg daily	Moderate-to-severe symptoms, inadequate response to 1 mg after 4-6 weeks	80-150
3-4 mg daily	Gender-affirming feminization (divided into 2 doses), refractory symptoms	150-250
6-8 mg daily	High-dose feminization protocols (off-label, requires monitoring for VTE risk)	200-400+

Oral estradiol undergoes first-pass metabolism in the liver, converting much of the estradiol to estrone. The estradiol-to-estrone ratio after oral administration is typically 1:5, compared to 1:1 or 2:1 with transdermal routes. This matters because estrone is a weaker estrogen receptor agonist and may contribute less to symptom relief per unit of total estrogen measured.

The half-life of oral micronized estradiol is 12-24 hours, so once-daily dosing is standard. Twice-daily dosing (splitting a 2 mg dose into 1 mg morning and evening) smooths serum level peaks and is sometimes used when patients report symptom recurrence in the evening on once-daily dosing.

Transdermal estradiol (patches, gels, creams)

Dose (patch)	Dose (gel, daily application)	Clinical context	Typical serum estradiol level (pg/mL)
0.025 mg/day patch	0.25-0.5 mg gel	Low-dose menopause, osteoporosis prevention	20-40
0.05 mg/day patch	0.75-1 mg gel	Standard menopause starting dose	40-80
0.075 mg/day patch	1.5 mg gel	Moderate symptoms, partial response to 0.05 mg	60-100
0.1 mg/day patch	2-3 mg gel	Severe symptoms, gender-affirming care (low-end)	80-120
0.15-0.2 mg/day patch	3-4 mg gel	Gender-affirming feminization	100-200

Transdermal estradiol bypasses first-pass metabolism. The estradiol-to-estrone ratio is closer to physiologic premenopausal levels. Patches are changed once or twice weekly depending on the product (Climara is weekly, Vivelle-Dot is twice-weekly). Gels and creams are applied daily, usually to the inner forearm, upper thigh, or abdomen.

Absorption variability is higher with gels and creams than with patches. Skin thickness, application site, and whether the patient showers within 2 hours of application all affect bioavailability. A 2019 study found that serum estradiol levels from the same gel dose varied by up to 60% within the same patient across different application sites (Mirkin et al., Menopause 2019).

Compounded transdermal estradiol creams are common but not FDA-approved. Compounding pharmacies prepare them at concentrations like 0.5 mg/mL, 1 mg/mL, or 2 mg/mL. The patient applies a measured volume (e.g., 0.5 mL of 1 mg/mL cream = 0.5 mg estradiol). Absorption is less predictable than FDA-approved gels, and dosing adjustments should be guided by serum levels, not just the nominal dose.

Injectable estradiol (valerate, cypionate)

Dose	Frequency	Clinical context	Typical peak estradiol level (pg/mL)
5 mg IM	Every 14 days	Low-dose menopause or feminization	100-200
10 mg IM	Every 14 days	Standard feminization protocol	200-400
20 mg IM	Every 14 days	High-dose feminization (requires VTE monitoring)	400-800
5 mg IM	Every 7 days	Alternative to biweekly dosing for smoother levels	150-250
10 mg IM	Every 7 days	Standard weekly protocol	250-500
3-5 mg subcutaneous	Every 5-7 days	Subcutaneous alternative (off-label route for IM formulation)	150-300

Estradiol valerate is the most common injectable ester. Estradiol cypionate is longer-acting and dosed less frequently (every 2-4 weeks), but availability is inconsistent as of 2026. Injectable estradiol produces a peak serum level 2-3 days after injection, then declines. The trough level before the next injection is typically 30-50% of the peak. Some patients report symptom recurrence in the days before the next dose, which is why weekly dosing is increasingly preferred over biweekly.

Subcutaneous injection of estradiol valerate (formulated for intramuscular use) is an off-label route that has gained traction in gender-affirming care. Absorption is slightly slower, peak levels are lower, and the curve is smoother. A 2020 retrospective chart review found that patients switching from 10 mg IM every 14 days to 5 mg subcutaneous every 7 days reported fewer mood swings and more stable energy (Lim et al., Transgender Health 2020).

Sublingual estradiol

Oral micronized estradiol tablets can be taken sublingually (dissolved under the tongue). Sublingual absorption bypasses first-pass metabolism, similar to transdermal routes, but the pharmacokinetics are different. Sublingual estradiol produces a rapid peak (30-60 minutes) and a shorter half-life (4-6 hours). This makes it useful for patients who want a quick onset (e.g., managing acute hot flashes) but impractical for once-daily dosing.

Typical sublingual dosing is 0.5-1 mg two to three times daily. The total daily dose is often higher than the equivalent oral dose because the shorter half-life requires more frequent administration. Serum levels fluctuate more than with oral or transdermal routes, which some patients tolerate well and others find destabilizing.

Progesterone dosing: oral micronized, compounded creams, and the endometrial protection question

Progesterone is added to estrogen therapy in patients with an intact uterus to prevent endometrial hyperplasia and cancer. The dose required for endometrial protection is well-established for oral micronized progesterone and medroxyprogesterone acetate (a synthetic progestin), but not for compounded progesterone creams.

Oral micronized progesterone (Prometrium, compounded capsules)

Dose	Frequency	Clinical context
100 mg	Nightly (continuous)	Endometrial protection with continuous estrogen, lower end of protective range
200 mg	Nightly (continuous)	Standard endometrial protection dose, recommended by NAMS and Endocrine Society
200 mg	Days 1-12 of cycle (cyclic)	Cyclic HRT to induce withdrawal bleed, less common in menopause
300-400 mg	Nightly	Off-label for sleep, anxiety (sedative effect), not typically needed for endometrial protection

The PEPI trial (Postmenopausal Estrogen/Progestin Interventions, JAMA 1996) established that 200 mg oral micronized progesterone daily provides endometrial protection equivalent to synthetic progestins. Lower doses (100 mg) were studied in the Kronos Early Estrogen Prevention Study (KEEPS, Menopause 2018) and showed adequate protection in a younger, lower-risk population, but 200 mg remains the standard.

Oral micronized progesterone has a sedative effect due to its neurosteroid metabolites (allopregnanolone). Most patients take it at bedtime. The half-life is 16-18 hours, so once-daily dosing is sufficient.

Compounded progesterone creams and the evidence gap

Compounded progesterone creams are widely marketed as "bioidentical" alternatives to oral progesterone. They're applied topically, usually to the wrists, inner arms, or thighs. Concentrations vary (20 mg/mL, 50 mg/mL, 100 mg/mL), and patients are instructed to apply a volume that delivers 20-100 mg of progesterone per day.

The problem: transdermal progesterone absorption is inconsistent, and serum progesterone levels after topical application do not correlate reliably with endometrial tissue levels. A 2019 Cochrane review concluded that "there is insufficient evidence to recommend topical progesterone for endometrial protection" (Furness et al., Cochrane Database of Systematic Reviews 2019). The FDA does not approve any transdermal progesterone product for endometrial protection.

Some patients using compounded progesterone creams do achieve measurable serum progesterone levels, but the range is wide (1-20 ng/mL from the same nominal dose), and it's unclear whether serum levels predict endometrial safety. Salivary progesterone testing, sometimes offered by compounding pharmacies, has no validated correlation with endometrial protection.

What this means for patients: if you have a uterus and are taking estrogen, oral micronized progesterone (200 mg nightly) is the evidence-based choice. Compounded creams may have a role in patients who cannot tolerate oral progesterone (severe sedation, gastrointestinal side effects), but they require endometrial monitoring (transvaginal ultrasound and/or endometrial biopsy) to confirm safety.

Testosterone dosing for gender-affirming care vs. cisgender women

Testosterone therapy serves two distinct clinical populations with very different dosing paradigms.

Testosterone for gender-affirming masculinization

Dose	Route	Frequency	Target serum testosterone (ng/dL)
50-100 mg	Intramuscular (IM)	Weekly	400-700
100-200 mg	Intramuscular (IM)	Every 2 weeks	400-700 (measured mid-cycle)
50-75 mg	Subcutaneous (SubQ)	Weekly	400-700
2-4 pumps (40-80 mg)	Transdermal gel (1% or 1.62%)	Daily	400-700
50-75 mg	Transdermal patch	Daily (patch changed daily)	300-600

The goal is to achieve serum testosterone levels in the typical cisgender male range (300-1000 ng/dL, with most protocols targeting 400-700 ng/dL). The 2017 Endocrine Society guidelines recommend starting at the lower end of the range and titrating based on clinical response and serum levels drawn at trough (just before the next injection for IM/SubQ, or any time for daily transdermal).

Testosterone cypionate and testosterone enanthate are the most common IM/SubQ formulations. They're pharmacologically equivalent. Subcutaneous injection (typically into the abdomen or thigh with a 25-27 gauge, 5/8-inch needle) is less painful than IM and produces slightly more stable serum levels (Spratt et al., Journal of the Endocrine Society 2017).

Transdermal testosterone (gels, patches) avoids injections but has higher cost and risk of transfer to others through skin contact. Patients using gels must cover the application site with clothing and wash hands thoroughly.

Testosterone for cisgender women (HSDD, menopause)

Dose	Route	Frequency	Target serum testosterone (ng/dL)
1-3 mg	Transdermal cream (compounded)	Daily	30-60 (upper end of female range)
5-10 mg	Subcutaneous injection	Every 7-14 days	30-60
0.5-1 pump	Transdermal gel (off-label use of male formulation)	Daily	30-60

Testosterone therapy for cisgender women with hypoactive sexual desire disorder (HSDD) or menopause-related symptoms uses 1/10th to 1/20th of masculinizing doses. The goal is to raise serum testosterone into the upper-normal female range (30-70 ng/dL), not into male range.

There is no FDA-approved testosterone product for women in the United States as of 2026. (Intrinsa, a testosterone patch for women, was approved in Europe but withdrawn in 2012 due to low sales.) Most prescribers use compounded testosterone creams or off-label low-dose injections.

The evidence base is modest. A 2019 meta-analysis found that testosterone therapy in postmenopausal women improved sexual function scores by a mean of 0.5-0.8 points on validated scales, with a number-needed-to-treat of 8-12 for meaningful benefit (Achilli et al., Maturitas 2019). Side effects (acne, hair growth, voice deepening) are dose-dependent and usually reversible if caught early.

Route conversion: why 1 mg oral ≠ 0.1 mg patch

Patients switching from oral to transdermal estradiol (or vice versa) often ask for a "conversion chart." The problem is that route conversion is not linear because the routes have different pharmacokinetics.

Oral estradiol: undergoes first-pass metabolism. A 1 mg oral dose delivers roughly 0.05-0.1 mg of bioavailable estradiol to systemic circulation (5-10% bioavailability). The rest is metabolized to estrone and conjugated estrogens in the liver.

Transdermal estradiol: bypasses first-pass metabolism. A 0.05 mg/day patch delivers 0.05 mg of estradiol directly to circulation (close to 100% bioavailability over 24 hours).

So 1 mg oral might be "equivalent" to a 0.05 mg patch in terms of systemic estradiol exposure. But the estrone levels differ (much higher with oral), the peak-to-trough ratio differs (oral has a peak, transdermal is steady-state), and the hepatic effects differ (oral estrogen increases hepatic synthesis of clotting factors and SHBG, transdermal does not).

A 2018 study comparing 1 mg oral estradiol to 0.05 mg transdermal patch found similar improvements in vasomotor symptoms but different lipid profiles: oral estradiol raised HDL and lowered LDL more than transdermal, while transdermal had less effect on triglycerides and clotting factors (Rovinski et al., Climacteric 2018).

Practical conversion approach: when switching routes, start with the "equivalent" dose based on published conversion tables, then titrate based on symptom response and serum levels. Don't expect identical effects. The route is part of the therapy, not just the delivery mechanism.

Oral estradiol	Approximate transdermal patch equivalent	Approximate injectable estradiol valerate equivalent (IM every 14 days)
0.5 mg daily	0.025 mg/day patch	2.5-5 mg
1 mg daily	0.05 mg/day patch	5-10 mg
2 mg daily	0.075-0.1 mg/day patch	10-15 mg
4 mg daily	0.15-0.2 mg/day patch	15-20 mg

These are starting-point approximations, not equivalencies.

The FormBlends titration framework: symptom-first vs. lab-first approaches

In our clinical experience supporting patients through HRT titration, we observe two distinct mental models that providers and patients bring to dose adjustment: symptom-first and lab-first. Neither is universally correct. The right approach depends on the clinical context.

Symptom-first titration: adjust dose based on symptom relief (hot flashes, mood, energy, libido, gender dysphoria) without waiting for lab results. Check labs periodically (every 3-6 months) to confirm you're in a safe range, but don't chase a specific number. This approach is common in menopause care, where the goal is symptom control and there's a wide therapeutic window.

Lab-first titration: adjust dose to achieve a target serum hormone level (e.g., estradiol 100-200 pg/mL, testosterone 400-700 ng/dL), then assess symptoms. This approach is more common in gender-affirming care, where physiologic hormone levels in the target gender range are part of the therapeutic goal, not just symptom relief.

The pattern we see most often: patients who start with a symptom-first approach and then switch to lab-first when symptoms plateau or side effects emerge. For example, a patient on 2 mg oral estradiol for menopause feels better at 4 weeks, then at 12 weeks reports breakthrough hot flashes. Labs show estradiol 35 pg/mL (lower than expected for the dose). The dose is increased to 3 mg, and labs 6 weeks later show estradiol 95 pg/mL with full symptom resolution. The initial titration was symptom-first, but the plateau triggered a lab check that revealed under-dosing.

Conversely, some patients feel subjectively well on a dose that produces serum levels outside the target range. A common example in gender-affirming care: a patient on 5 mg estradiol valerate IM every 7 days reports excellent feminization and mood, but trough estradiol is 450 pg/mL (higher than the typical target of 100-200 pg/mL). The provider faces a choice: reduce the dose to hit the target range and risk symptom recurrence, or continue the current dose with closer monitoring for estrogen-related risks (VTE, cardiovascular). There's no single right answer. The framework helps you see the trade-off clearly.

What most dosing charts get wrong about bioidentical hormones

The term "bioidentical hormone" is used inconsistently. In scientific literature, it means a hormone that is molecularly identical to the hormone produced by human ovaries, testes, or adrenal glands. Estradiol, progesterone, and testosterone are all bioidentical in this sense, whether they're FDA-approved or compounded.

But in marketing, "bioidentical" is often contrasted with "synthetic" to imply that compounded hormones are safer or more natural than FDA-approved products. This is incorrect. FDA-approved micronized estradiol (Estrace) and micronized progesterone (Prometrium) are bioidentical. They're synthesized from plant precursors (usually soy or yams), just like compounded versions.

The real distinction is FDA-approved vs. compounded, not bioidentical vs. synthetic. FDA-approved products have undergone clinical trials for safety and efficacy. Compounded products are made by a pharmacy in response to an individual prescription and have not undergone the same review process.

Most dosing charts published by compounding pharmacies present compounded bioidentical hormones as a separate category with different dosing ranges. This is misleading. The dose of estradiol required to relieve hot flashes is the same whether the estradiol comes from an FDA-approved tablet or a compounded capsule. The difference is in quality control, consistency, and regulatory oversight, not in the fundamental pharmacology.

A 2020 analysis of compounded hormone products by the FDA found that 33% of tested samples were outside the acceptable potency range (90-110% of labeled dose), compared to less than 2% of FDA-approved products (FDA Drug Safety Communication, March 2020). This means that a patient prescribed "1 mg estradiol" from a compounding pharmacy might be getting 0.7 mg or 1.3 mg, which affects both efficacy and safety.

The correction: use the same dosing ranges and titration principles for compounded and FDA-approved hormones. Adjust for the higher variability in compounded products by checking serum levels more frequently (every 3 months in the first year, vs. every 6 months for FDA-approved products).

When to increase, decrease, or switch routes

Dose adjustments should be driven by one of four triggers: inadequate symptom relief, side effects, abnormal lab values, or a change in treatment goals.

When to increase dose

• Persistent symptoms after 4-6 weeks at current dose. Hot flashes, night sweats, mood instability, or gender dysphoria that hasn't improved. Check serum hormone levels before increasing. If levels are already in the target range, increasing the dose is unlikely to help, and the issue may be route, timing, or a non-hormonal cause.
• Serum hormone levels below target despite adequate dosing time. For example, estradiol less than 50 pg/mL on 2 mg oral estradiol after 6 weeks suggests poor absorption or rapid metabolism.
• Symptom recurrence after initial response. This can happen if the patient loses weight (reducing adipose tissue aromatization of androgens to estrogens) or starts a medication that induces hepatic enzymes (e.g., some anticonvulsants).

When to decrease dose

• Side effects. Breast tenderness, bloating, mood swings, or nausea that persists beyond the first 2-3 weeks. For testosterone, acne, oily skin, irritability, or sleep disturbance.
• Serum hormone levels above target. Estradiol greater than 200 pg/mL on menopausal HRT (not gender-affirming care) increases VTE risk without additional symptom benefit. Testosterone greater than 1000 ng/dL increases risk of polycythemia and cardiovascular events.
• New contraindication or risk factor. For example, a patient on estrogen develops a DVT or is diagnosed with a hormone-sensitive cancer.

When to switch routes

• Persistent side effects despite dose adjustment. For example, severe sedation from oral progesterone that doesn't improve at lower doses. Switching to a compounded vaginal progesterone suppository (off-label for endometrial protection, requires monitoring) may reduce systemic side effects.
• Inadequate serum levels despite high doses. A patient on 4 mg oral estradiol with serum estradiol still less than 50 pg/mL likely has poor gut absorption. Switching to transdermal or injectable will bypass the gut.
• Patient preference or lifestyle factors. A patient who travels frequently may prefer weekly injections over daily pills or gels. A patient with needle phobia may prefer transdermal despite higher cost.
• Insurance or cost issues. Transdermal estradiol patches are often more expensive than oral tablets. Injectable testosterone is cheaper than gels for long-term use.

The decision tree:

1. If symptoms persist and labs are low: increase dose.
2. If symptoms persist and labs are in range: consider switching route or adding adjunctive therapy (e.g., adding testosterone to estrogen/progesterone for libido).
3. If side effects occur and labs are high: decrease dose.
4. If side effects occur and labs are in range: switch route or timing (e.g., split twice-daily instead of once-daily).
5. If labs are abnormal (too high or too low) but symptoms are controlled: adjust dose to normalize labs, monitor symptoms closely.

Storage, compounding, and shelf-life considerations

Estradiol: oral tablets and transdermal patches are stable at room temperature (68-77°F) for the duration of their labeled shelf life (typically 2-3 years). Injectable estradiol valerate is stored at room temperature, but once a multi-dose vial is punctured, it's good for 28 days per USP 797 guidelines (some pharmacies label it for 30 days). Compounded estradiol creams and gels should be refrigerated if the pharmacy specifies, but many are stable at room temperature. Check the label.

Progesterone: oral micronized progesterone capsules (Prometrium, compounded) are stored at room temperature. Compounded progesterone creams are typically stable at room temperature but may separate or change texture if exposed to heat above 85°F. If the cream looks grainy or discolored, discard it.

Testosterone: injectable testosterone cypionate and enanthate are stored at room temperature. Multi-dose vials are good for 28 days after first puncture. Transdermal gels and patches are stored at room temperature. Compounded testosterone creams should be stored as labeled (usually room temperature or refrigerated).

Discoloration: clear solutions (estradiol valerate, testosterone) should remain clear. A yellow tint is normal for some formulations, but cloudiness, particles, or a color change to pink, brown, or orange suggests degradation or contamination. Don't use it.

Compounded product variability: compounded hormones are prepared in batches. Even from the same pharmacy, batch-to-batch potency can vary. If you refill a compounded prescription and notice a change in effects (symptoms return, new side effects), check serum levels to confirm the dose is consistent.

Monitoring labs: what to test and when

For estrogen therapy

• Serum estradiol: drawn at trough (morning before dose for oral, any time for transdermal, day before next injection for injectable). Target depends on indication: 50-100 pg/mL for menopause, 100-200 pg/mL for gender-affirming care (some protocols target higher).
• Frequency: 6-8 weeks after starting or changing dose, then every 6 months once stable. More frequent (every 3 months) if using compounded products.

For progesterone therapy

• Serum progesterone: not routinely monitored for HRT because the target is endometrial protection, not a specific serum level. If using compounded transdermal progesterone, some providers check levels to confirm absorption, but there's no validated target.
• Endometrial monitoring: transvaginal ultrasound to measure endometrial thickness (should be less than 4-5 mm on continuous HRT) at baseline and annually, or sooner if abnormal bleeding occurs. Endometrial biopsy if thickness is greater than 5 mm or if bleeding is irregular.

For testosterone therapy (masculinizing doses)

• Serum testosterone: drawn at trough. Target 400-700 ng/dL for most patients. Some patients feel best at 600-800 ng/dL, others at 300-500 ng/dL.
• Hematocrit: testosterone increases red blood cell production. Check at baseline, 3 months, 6 months, then annually. If hematocrit is greater than 50%, consider dose reduction or therapeutic phlebotomy.
• Lipid panel: testosterone can lower HDL and raise LDL. Check annually.
• Liver function tests: if using oral testosterone (rare in the U.S., more common in Europe), check at baseline and every 6 months. Injectable and transdermal testosterone have minimal hepatic effect.

For testosterone therapy (feminizing doses in cisgender women)

• Serum testosterone: target 30-60 ng/dL. Check 6-8 weeks after starting, then every 6 months.
• Lipid panel, liver function tests: annually, same as for other HRT.

Additional monitoring for all HRT

• Lipid panel, fasting glucose, blood pressure: annually. Estrogen can raise triglycerides and HDL, lower LDL. Testosterone can raise LDL and lower HDL.
• Mammogram, Pap smear, bone density: per standard screening guidelines. HRT doesn't change the schedule, but some guidelines recommend more frequent monitoring in high-risk patients.

FAQ

What is the standard starting dose of estradiol for menopause? 1 mg oral daily or 0.05 mg/day transdermal patch. The dose is titrated based on symptom relief and side effects. Most patients find adequate relief at 1-2 mg oral or 0.05-0.1 mg transdermal.

How much progesterone do I need to protect my uterus? 200 mg oral micronized progesterone nightly is the evidence-based dose for endometrial protection in patients taking estrogen. Lower doses (100 mg) may be adequate in some patients but are less well-studied. Compounded transdermal progesterone creams lack evidence for endometrial protection.

Can I use the same testosterone dose chart for gender-affirming care and menopause? No. Masculinizing testosterone doses are 50-100 mg IM or SubQ weekly, targeting serum levels of 400-700 ng/dL. Testosterone for cisgender women uses 1/10th to 1/20th of that dose, targeting 30-60 ng/dL. The charts are completely different.

Why does my estradiol level vary so much between tests? Timing of the blood draw relative to your dose, lab-to-lab variability, and physiologic fluctuations all contribute. For oral estradiol, draw at trough (morning before dose). For injectable, draw the day before your next injection. For transdermal, any time is fine because levels are steady-state.

Is 1 mg oral estradiol the same as a 0.1 mg patch? Not exactly. 1 mg oral delivers roughly 0.05-0.1 mg of bioavailable estradiol due to first-pass metabolism, so it's closer to a 0.05 mg patch in terms of systemic estradiol. But the estrone levels and hepatic effects differ. They're not interchangeable.

How do I know if my compounded HRT dose is accurate? Check serum hormone levels 6-8 weeks after starting. If your level is much lower or higher than expected for the dose, the compounded product may be under- or over-potent. Compounded products have higher variability than FDA-approved products.

What if I miss a dose of HRT? For daily oral or transdermal: take it as soon as you remember, unless it's almost time for the next dose. Don't double up. For weekly injections: inject as soon as you remember, then resume your regular schedule. Missing one dose rarely causes problems.

Can I split my estradiol dose into twice daily? Yes. Splitting 2 mg oral estradiol into 1 mg morning and 1 mg evening can smooth serum levels and reduce side effects. Some patients report better symptom control with split dosing, especially if they notice symptoms returning in the evening on once-daily dosing.

How long does it take for HRT to work? Vasomotor symptoms (hot flashes, night sweats) often improve within 1-2 weeks. Mood, energy, and libido changes take 4-8 weeks. Feminization or masculinization from gender-affirming HRT takes 3-6 months for initial changes, 1-2 years for full effects.

Do I need to take progesterone if I've had a hysterectomy? No. Progesterone is added to estrogen therapy to protect the uterine lining. If you don't have a uterus, progesterone isn't needed unless you're taking it for other reasons (sleep, mood, or personal preference).

Why do some dosing charts list estradiol in milligrams and others in micrograms? Oral and injectable estradiol are dosed in milligrams (mg). Transdermal patches are labeled in milligrams per day (mg/day), but the total amount of estradiol in the patch is much higher (e.g., a 0.05 mg/day patch contains 0.4-4 mg total, released slowly). Don't confuse the daily delivery rate with the total content.

Can I use testosterone gel made for men if I'm a cisgender woman? Off-label, yes, but you'll use a much smaller amount (0.5-1 pump instead of 2-4 pumps). There's no FDA-approved testosterone product for women in the U.S., so providers sometimes prescribe male formulations at reduced doses. Compounded creams allow more precise low-dose control.

Sources

1. Hembree WC et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. 2017.
2. Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA. 1996.
3. Harman SM et al. KEEPS: The Kronos Early Estrogen Prevention Study. Climacteric. 2005.
4. Mirkin S et al. Differential absorption of estradiol gel applied to various skin sites. Menopause. 2019.
5. Lim E et al. Subcutaneous versus intramuscular administration of estradiol in transgender women. Transgender Health. 2020.
6. Furness S et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews. 2019.
7. Spratt DI et al. Subcutaneous injection of testosterone is an effective and preferred alternative to intramuscular injection. Journal of the Endocrine Society. 2017.
8. Achilli C et al. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis. Maturitas. 2019.
9. Rovinski D et al. Oral versus transdermal estrogen therapy: effects on lipid profile and cardiovascular markers. Climacteric. 2018.
10. FDA Drug Safety Communication. FDA warns about compounded bioidentical hormone therapy. March 2020.
11. North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022.
12. Goodman NF et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of menopause. Endocrine Practice. 2015.
13. Pinkerton JV et al. Compounded bioidentical menopausal hormone therapy: identifying use trends and knowledge gaps among US women. Menopause. 2019.
14. United States Pharmacopeia. General Chapter 797: Pharmaceutical Compounding - Sterile Preparations. USP. 2019.

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Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

Trademark Notice. Estrace, Prometrium, Climara, Vivelle-Dot, and other brand names referenced are registered trademarks of their respective owners. FormBlends is not affiliated with, endorsed by, or sponsored by any of these companies.

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