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Estradiol and Testosterone Levels with Oral Estradiol in Transfeminine People Based on Leinung et al. (2018)

By Aly W. | First published March 27, 2019 | Last modified October 5, 2020

Introduction

A study was published last year by Leinung et al. that quantified estradiol levels and suppression of testosterone levels with oral estradiol alone or in combination with an antiandrogen in 166 transgender women. Estradiol and testosterone levels were determined via a chemiluminescent immunoassay (CLIA). Here is the study:

  • Leinung, M. C., Feustel, P. J., & Joseph, J. (2018). Hormonal Treatment of Transgender Women with Oral Estradiol. Transgender Health, 3(1), 74-81. [DOI:10.1089/trgh.2017.0035]

This is a really great study because it provides data that can give us precise estimates of what estradiol levels should be achieved by different dosages of oral estradiol, how much testosterone levels will be suppressed by different levels and dosages of estradiol, and the influence of two antiandrogens—spironolactone and finasteride—on estradiol and testosterone levels achieved with oral estradiol, all in transgender women at that.

I’ve digitized and recreated the two main graphs of interest from the paper. These new graphs are higher image quality and have a better appearance than the originals in the paper. They aren’t perfect replicas of the originals (overlapping data points in the original graphs prevented this from being possible), but they should be quite close (e.g., ± 4 data points of 166).

In addition to the reproduced graphs, I made two new graphs from the figures in the paper. These new graphs are variants of the two originals that I think are more understandable and useful. All four of the graphs are below. The latter two can also be viewed/linked to on Wiki here and here. The spreadsheet with the data used to create the graphs can be found here.

Graphs

Recreated Graphs

From paper: “Figure 1. Serum 17-β estradiol versus estradiol dose. Serum 17-β estradiol levels while on estradiol only are represented by circles (blue): values obtained while on finasteride as well are represented by squares (red), and values obtained while on spironolactone are represented by diamonds (green).”
From paper: “Figure 2. Serum testosterone versus serum 17-β estradiol level. Serum testosterone levels while on estradiol only are represented by circles (blue): values obtained while on finasteride as well are represented by squares (red), and values obtained while on spironolactone are represented by diamonds (green). The panel on the right shows values for individuals obtained after surgery (vaginoplasty and/or orchiectomy).” Note: The dashed horizontal grey line is the mean testosterone level in a comparison group of gonadectomized transgender women (21.7 pg/mL).

New Graphs

Circulating estradiol levels (pg/mL) during therapy with 1 to 8 mg per day oral estradiol (E2) alone or in combination with 200 mg/day oral spironolactone in 166 transgender women. The “Oral E2 alone” group was actually with or without finasteride (5 mg/day); these two groups were combined because they showed no significant differences in estradiol levels. The error bars represent standard deviations from the mean.

Mean levels of testosterone (ng/mL) as a function of mean estradiol levels (pg/mL) (and their corresponding estradiol dosages, mg/day) during therapy with oral estradiol (E2) alone or in combination with finasteride (5 mg/day) or spironolactone (200 mg/day) in 166 transgender women. The dashed horizontal purple line is the upper limit for the female/castrate range (~50 ng/dL) and the dashed horizontal grey line is the mean testosterone level in a comparison group of gonadectomized transgender women (21.7 pg/mL). The error bars represent standard deviations from the mean.

Tables: Raw Values

Oral Estradiol Alone: Dosage and Estradiol Levels

DosagenMean E2 levels
1 mg/day539 ± 25 pg/mL
2 mg/day2462 ± 23 pg/mL
4 mg/day34102 ± 59 pg/mL
6 mg/day80125 ± 62 pg/mL
8 mg/day24159 + 76 pg/mL

Oral Estradiol Alone: Estradiol Levels and Testosterone Suppression

Estradiol rangenMean E2 levelMean T level
<50 pg/mL1133 ± 8.4 pg/mL160 ± 139 ng/dL
50–100 pg/mL2476 ± 15 pg/mL83 ± 106 ng/dL
100–150 pg/mL21125 ± 14 pg/mL50 ± 37 ng/dL
150–200 pg/mL8170 ± 15 pg/mL61 ± 57 ng/dL
200–250 pg/mL4227 ± 14 pg/mL44 ± 33 ng/dL

Addendum

For more information on oral estradiol, see here on Wikipedia. Kuhl (2005) is also a highly recommended read.