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Injectable Estradiol Formulations Available for Transfeminine People in the United States

By Aly W. | First published June 3, 2020 | Last modified August 8, 2021

Notice: This page was originally posted as a thread on Reddit and has not yet been properly or fully revised since being moved to Transfeminine Science.

Preface

This page is up-to-date as of June 2020. It is likely to become outdated with time.

Introduction

Injectable estradiol is available for transgender people in the United States largely in the forms of oil solutions of estradiol cypionate (brand name Depo-Estradiol) and estradiol valerate (brand name Delestrogen plus generics). These compounds are estradiol esters and are prodrugs of estradiol that are converted into estradiol in the body. They are administered by intramuscular or subcutaneous injection and have a depot effect providing an extended duration of action.

Injectable estradiol is available for transfeminine people in the United States domestically in pharmaceutical formulations from conventional pharmacies and in compounded formulations from compounding pharmacies. Injectable estradiol preparations are also available internationally (generally without a prescription) from online pharmacies as well as from certain members of the online transgender community in the form of unregulated homebrewed formulations.

Pharmaceutical Formulations

The only pharmaceutical formulations of injectable estradiol marketed in the United States are oil solutions of estradiol cypionate and estradiol valerate. They include the following (Drugs@FDA):

  • Depo-Estradiol (estradiol cypionate 5 mg/mL in oil) by Pharmacia & Upjohn (FDA)
    • Average $155 (or $130 w/ coupon) for one 5-mL 5 mg/mL (25 mg total) vial (GoodRx)
      • Works out to $135 (or $113 w/ coupon) per month for a dosage of 5 mg/week
  • Delestrogen (estradiol valerate 10, 20, and 40 mg/mL in oil) by Par Sterile Products (FDA)
    • Average $180 (or $140 w/ coupon) for one 5-mL 10 mg/mL (50 mg total) vial (GoodRx)
      • Works out to $78 (or $61 w/ coupon) per month for a dosage of 5 mg/week
    • Average $230 (or $200 w/ coupon) for one 5-mL 20 mg/mL (100 mg total) vial (GoodRx)
      • Works out to $50 (or $44 w/ coupon) per month for a dosage of 5 mg/week
    • Average $400 (or $315 w/ coupon) for one 5-mL 40 mg/mL (200 mg total) vial (GoodRx)
      • Works out to $44 (or $34 w/ coupon) per month for a dosage of 5 mg/week
  • Generics of estradiol valerate 10, 20, and 40 mg/mL in oil by American Regent (FDA) and Hikma Pharmaceuticals (FDA)
    • No prices found for 5-mL 10 mg/mL (50 mg total) vial (GoodRx)
    • Average $140 (or $45 w/ coupon) for one 5-mL 20 mg/mL (100 mg total) vial (GoodRx)
      • Works out to $30 (or $10 w/ coupon) per month for a dosage of 5 mg/week
    • Average $215 (or $65 w/ coupon) for one 5-mL 40 mg/mL (200 mg total) vial (GoodRx)
      • Works out to $23 (or $7 w/ coupon) per month for a dosage of 5 mg/week

Brand-name formulations (i.e., Depo-Estradiol and Delestrogen) are identical to generic formulations and hence the generics, which are less expensive, should be preferred where available. Although generics of estradiol valerate are available, unfortunately no generic formulations of the longer-lasting (and hence more convenient) estradiol cypionate remain marketed.

There have been recurrent problems with shortages of pharmaceutical formulations of injectable estradiol valerate in the United States (The Guardian/Redden, 2016; TAG, 2016; The Philadelphia Inquirer/Friedman-Rudovsky, 2016; Geffen et al., 2018; Vice/Blum, 2018; RPR/Krohn, 2019).

Compounded Formulations

Injectable estradiol valerate in oil can be obtained quite inexpensively from certain accredited compounding pharmacies in the United States. Many transfeminine people in the United States obtain their injectable estradiol valerate in this way. Examples of compounding pharmacies that sell estradiol valerate include AnazaoHealth in Las Vegas, Nevada and New Era Pharmacy in Portland, Oregon. Other compounding pharmacies may also sell injectable estradiol formulations. Compounding pharmacies are often useful avenues during pharmaceutical estradiol valerate shortages. It should be noted that while perfectly legal, compounded drugs are not subject to the same regulations and standards as pharmaceuticals and hence their quality is not guaranteed to the extent that pharmaceuticals are.

International Sources

Pharmaceutical Formulations

Pharmaceutical injectable estradiol is also available in the United States via internationally-shipping online pharmacies located outside of the United States. See the r/TransDIY Wiki for a list of pharmacies.

Homebrewed Formulations

Unregulated homebrewed formulations of injectable estradiol are sold online by individuals like Lena in Ukraine and Lilian of “Otokonoko Pharmaceuticals” in Brazil (Aly W., 2019). These homebrewed products are created from powders presumably obtained from sources like online Chinese chemical sellers. Online homebrewers sell estradiol valerate as well as the longer-acting estradiol enanthate (Aly W., 2019) and other estradiol esters and ship their products internationally. It should be cautioned that although these injectable preparations are used by many DIY transfeminine people, they are not subject to regulations, and their quality, efficacy, and safety are questionable and cannot be guaranteed.

Other Formulations

Estradiol benzoate in oil is a shorter-acting estradiol ester that may remain available from certain online pharmacies. Other estradiol esters such as the long-acting estradiol undecylate in oil and polyestradiol phosphate in aqueous solution have been discontinued and are no longer available from any source. Microcrystalline aqueous suspensions of estradiol esters, which have longer durations than oil solutions but also entail more painful injections, were previously sold by certain online pharmacies but likewise appear to no longer be available for people in the United States (Aly W., 2019).