HRT 임상 경로

This pathway is based on WPATH SOC 8 ^[1] and Endocrine Society 2017 ^[2] , providing a standardized framework for transfeminine HRT initiation and maintenance.

WEEK 0

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阶段 0: Baseline Assessment

Before starting any medication, complete a full baseline panel to rule out contraindications and establish your personal reference values.

• Sex hormones (E2, T, SHBG, LH/FSH)

• Hepatic & renal function, lipid panel

• Coagulation panel & D-dimer

• Fasting glucose + CBC

INITIATION · 1-6 MONTHS

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阶段 1: Low-Dose Initiation

1-6 MONTHS

Route	Starting Dose	Source
Oral estradiol	2.0 mg / day	[2]
Transdermal patch	50-100 µg / 24h	[2]
Topical gel	1.5 mg / day	[2]
IM estradiol valerate	1-2 mg / week	[3]

Anti-androgen (if needed): CPA 5-12.5 mg/day or spironolactone 50-100 mg/day. [2] = Hembree et al. 2017 ^[2] ; [3] = Rothman 2024 ^[3]

Target E2

50-100 pg/mL

Target T Trend

↓ Declining

⚠️

Safety warning: Your body needs time to adapt to receptor changes. Never increase dose without blood work. Do not escalate even if you feel “nothing is happening.” Breast bud signals typically appear at 3-6 months.

3 MONTH

DECISION

✅ E2 30-100 pg/mL and T declining → Continue current regimen to 6 months

🟡 E2 <30 pg/mL → Consider escalating to Phase 2 dosing

🔴 Abnormal LFTs / PRL >30 / severe mood deterioration → Stop and seek medical care

TITRATION · 6-12 MONTHS

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阶段 2: Dose Titration

6-12 MONTHS

Adjust based on 3-month lab results. The goal is to reach the standard physiologic range for transfeminine individuals.

Route	Adjusted Dose
Transdermal patch	100-200 µg / day
Oral estradiol	4 mg / day
Topical gel	3 mg / day
IM estradiol valerate	2-4 mg / week

Target E2

100-200 pg/mL

Target T

<50 ng/dL

Progesterone (optional)

Consider based on breast development (Tanner 3+)

IM E2V 2-4 mg/weekTopical gel 3.0-4.5 mg/day

6 MONTH

STABILITY

✅ E2 100-200 pg/mL and T <50 ng/dL → Enter maintenance phase

🟡 T >50 but E2 on target → Adjust anti-androgen (do not increase E2 to suppress T)

🟡 E2 <100 pg/mL → Continue escalation within safe limits

STEADY STATE · 12 MONTHS+

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阶段 3: Long-Term Maintenance

12 MONTHS+

Once levels and physical changes stabilize, transition to low-frequency monitoring. Maintain the minimum effective dose to keep E2 100-200 pg/mL, T <50 ng/dL.

Monitoring Frequency

6

Months

Full hormone panel and VTE risk factors every 6 months. Annual lipids and fasting glucose. Consider bone density screening.

⚠️

E2 >200 pg/mL does not produce more feminization — it only increases risk (Endocrine Society 2017, Rec 2.2)

END OF INITIAL PHASE

Ongoing Monitoring