디드로게스테론

孕激素 C

Dydrogesterone

Dydrogesterone

Oral

Dydrogesterone is a retro-isomer of progesterone with significantly higher oral bioavailability than micronized progesterone. Used as an alternative progestogen option in transfeminine HRT, though clinical evidence specific to transgender care remains limited ^[1] .

Mechanism

Dydrogesterone is a structural analog of natural progesterone with highly selective progestogenic receptor activity:

• High oral bioavailability: ~28% (vs ~10% for micronized progesterone)
• No anti-androgenic activity: Unlike CPA or spironolactone, does not directly affect androgens
• No glucocorticoid or mineralocorticoid activity
• Half-life: ~14-17 hours

Comparison with Micronized Progesterone

Feature	Dydrogesterone	Micronized Progesterone
Type	Retro-isomer (synthetic)	Natural/bioidentical
Oral bioavailability	~28%	~10%
Sedative effect	Minimal	Significant (hence bedtime dosing)
Routes	Oral only	Oral/rectal/vaginal
VTE risk	Insufficient data	Neutral or very low
Evidence level	C	C

Dosing

Indication	Dose	Notes
HRT progestogen supplementation	10-20 mg/day	Usually 1-2 times daily
Cyclic regimen	10 mg/day x 14 days/month	Mimics luteal phase of menstrual cycle

Progestogens in HRT: The Controversy

WPATH SOC 8 notes that the benefits of progestogens in transfeminine HRT “have not been sufficiently demonstrated” ^[1] . Some users report progestogens help with breast development and mood, but evidence is primarily anecdotal and community-based.

Brands & Availability

Brand	Strength	Region
Duphaston	10 mg	Widely available globally (including mainland China)
Generics	10 mg	Select regions

Monitoring

• PRL (prolactin): Every 6 months. Progestogens may mildly elevate prolactin
• No additional liver monitoring needed (dydrogesterone has very low hepatotoxicity)

Contraindications

• Dydrogesterone allergy
• Unexplained vaginal bleeding (cisgender indication — rarely applicable in trans context)
• Acute hepatic porphyria