--- title: "Estrogen Therapy Guide | The Gender Hormone Clinic" description: "A daily oestradiol gel applied to the inner thighs or lower abdomen, our default starting point for feminising HRT." url: https://thegenderhormoneclinic.com/patient-resources/medication-guides/estrogen-therapy/ --- [Home](https://thegenderhormoneclinic.com/) / [Medication guides](https://thegenderhormoneclinic.com/patient-resources/medication-guides/) / Estrogen Therapy TRANS-FEMININE HRT · MEDICATION GUIDE # Estrogen Therapy therapy, a clear guide. Sandrena gel is our default first-line oestrogen for feminising hormone therapy. Transdermal delivery (gel or patch) carries a significantly lower risk of venous thromboembolism than oral oestrogen, particularly for smokers or those with cardiovascular risk factors. [Begin your journey](https://thegenderhormoneclinic.com/make-an-enquiry/) [See payment plans](https://thegenderhormoneclinic.com/patient-resources/payment-plans/) (image: Estrogen Therapy therapy, clinical reference image) Drug class Oestrogen / oestradiol Used for Feminising HRT Routes Topical, patch, oral, sublingual Frequency Daily (gel) Prescription Specialist initiation Targets Oestradiol 400-800 pmol/L On this page[Overview](#ma-overview)[How it works](#ma-how-it-works)[Forms & dosing](#ma-forms)[Effects timeline](#ma-timeline)[Side effects](#ma-side-effects)[Cost](#ma-cost)[FAQ](#ma-faq) OVERVIEW ## What estrogen therapy does, in plain English. Oestrogen is the primary feminising hormone we prescribe. Sandrena (and similar transdermal gels) deliver it through the skin in a controlled daily dose, which gives steadier serum levels than oral routes and avoids first-pass liver metabolism. Most feminising patients also take a testosterone blocker initially. Many transition off the blocker once oestrogen levels are well-suppressed. Affirming, not gatekeeping. We follow our normal informed-consent pathway. You don't need to prove anything to access oestrogen. What you need is a clinician who listens, and a plan that's safe and right for you. HOW IT WORKS ## The way it actually works. Oestrogen binds to oestrogen receptors in skin, breast tissue, fat, bone, vocal cords, and the brain. Sustained therapeutic levels trigger a second puberty: breast development, fat redistribution, skin softening, reduced libido, and a slowing of body and facial hair growth. Our targets are oestradiol 400-800 pmol/L and testosterone <3 nmol/L. Suppresses testosterone Especially with a blocker; oestrogen alone at the right dose can also suppress. Triggers breast development Begins within 1-3 months; continues for 1-3 years; final size is genetic. Steady levels matter Big peaks and troughs cause mood swings; smooth, steady levels are the goal. Lower VTE risk than oral Transdermal routes avoid first-pass liver metabolism and the associated clot-risk increase. FORMS & DOSING ## Multiple ways to take it. Your choice, our guidance. There's no single right answer. What matters is what fits your life. Most patients start on the simplest option and switch later if it suits. Topical · Daily Sandrena gel Sandrena · Oestrogel · Divigel A clear gel applied each morning to the inner thigh or lower abdomen. Default first-line. Typical dose: 1 mg daily for 3 months, then 1.5 mg/day (1 mg am, 0.5 mg pm) until first review. Pros Steady daily levels Lower VTE risk than oral Easy to stop or pause Watch-outs Daily routine required Sub-optimal absorption in low-BMI / very-low-cholesterol patients Avoid skin-to-skin contact for several hours Transdermal patch · Twice weekly Evorel patches Evorel · Estradot A 100 mcg patch worn on the lower abdomen or buttocks, changed twice a week. Typical dose: 100 mcg, changed twice weekly. Pros Steady levels Set and forget for 3-4 days Lower VTE risk than oral Watch-outs Skin irritation in some patients Patches can fall off in heat / pools Visible if uncovered Oral or sublingual · Daily Oral / sublingual oestradiol Zumenon · Progynova · Estradiol valerate Tablets used either swallowed whole or dissolved sublingually for faster absorption. Typical dose: 2-6 mg daily, titrated to bloods. Pros Cheap and widely available Useful when transdermal absorption is sub-optimal Easy to dose-adjust Watch-outs Slightly higher VTE risk than transdermal Not first-line for smokers / cardiovascular risk Levels fluctuate with timing EFFECTS TIMELINE ## Changes over time. Timelines vary between individuals. This is a typical picture of what most patients experience. Phase 1-3 Months Skin softening Skin thins slightly and becomes softer; pores reduce. Body odour Becomes less acrid as testosterone falls. Libido and erections Both reduce; some patients welcome this, others find it adjustable with dose. Emotional changes Many patients describe feeling emotionally fuller: easier crying, calmer headspace. SIDE EFFECTS & RISKS ## What to watch for, and what to tell us. Most feminising patients tolerate oestrogen well. The biggest risk to monitor is venous thromboembolism (VTE), much reduced with transdermal routes. Common Breast tenderness + Especially in the first months as breast tissue grows. Usually settles. Mood changes + Some patients feel more emotionally fluid. If it's distressing, raise it at your next review. Reduced libido and erections + Common and expected. Adjust dose or add progesterone if it's a problem for you. Site irritation (patches) + Rotate sites; switching to gel often resolves it. Less common / serious VTE / blood clots + Risk is small but real, much lower with transdermal than oral routes. Smoking, age, and cardiovascular risk factors increase it. Liver enzymes + Mild rises sometimes seen with oral oestrogen. We monitor LFTs. Migraines + Some patients experience migraines, particularly with oral routes. Switching to transdermal usually helps. Monitoring schedule We catch things early. Here's the routine you can expect. Most of the testing is front-loaded while we fine-tune your dose. Once your levels are stable, it's usually just once a year. Baseline Full hormone panel FBC, U&E, LFTs Lipids, BP 3–6 months Oestradiol level Testosterone LFTs 6-monthly while adjusting Oestradiol, testosterone LFTs Prolactin Yearly once stable Full panel BP, weight Symptom review COST ## What estrogen therapy costs you, monthly. Sandrena gel is one of the more affordable feminising options privately. NHS shared care drops the cost further. Sandrena gel (private) ~£30 per month Private prescription Evorel patches (private) ~£40 per month Private prescription Once on shared care £9.90 per item Standard NHS Rx charge HRT pre-payment certificate £19.80 per year Listed NHS HRT items (not testosterone/anti-androgens) [See full payment plan](https://thegenderhormoneclinic.com/patient-resources/payment-plans/) FREQUENTLY ASKED ## Questions, answered. This guide isn't a substitute for clinical advice. We'll talk you through everything at your appointment. [Make an enquiry](https://thegenderhormoneclinic.com/make-an-enquiry/) ## Ready to take the first step? Send us an enquiry and we'll be in touch within two working days. [Make an enquiry](https://thegenderhormoneclinic.com/make-an-enquiry/)