One thing doctors are bad at is telling you when to get your blood tests in relationship to when you are taking your medication doses. Either they don't say anything about it or give bad advice. Some seem to think it doesn't matter at all, when it can actually have a huge effect on your test results and therefore dosing.

This following information is key if you don't want to get underdosed!

1. You should be spreading your dose out if you are taking multiple doses per day (gel, spray, or pills)
2. Your blood test should be done just before a dose, and you should delay a dose if you need to because of timing of the test.

For example if you take your HRT at 9am and 9pm every day, then you should try and get a blood test at 9am and if you cant get it until 10 or so, then delay the dose until after the test but you don't really want to stretch it out too long for a number you can do something on.

When you take any medication you have peaks and then a trough just before your next dose. The exact shape of this graph depends on the medication, metabolism speed, and dose method.

Hormones will peak within an hour or so of taking a dose and then quickly decrease back down. These peak levels don't really tell you much because they are so short, instead you mainly want to find out how low the levels get.

The minimum level in the trough will tell you if you are taking enough to stop your body producing its own hormones. For estrogen takers it also will tell you if its enough to avoid menopause if you are taking a blocker.

The exception to this is testosterone injections that aren't Testosterone Undecanoate. This is because T can be a source of E and high levels of T will cause higher aromatisation to E. In this case it's also suggested to test at the mid point between doses. This allows you to see how much E is being produced from the T, and in general the T doses given are always enough to suppress regular hormone production.

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A question that comes up a bunch in trans circles, should I take progesterone and why?

Generally, I suggest people try it and see how it goes. While most people are interested because of potential effects on breast growth, it's actually it's mental health benefits that are the main reason I would suggest it.

Some of the main metabolites of progesterone are anxiolytics (ie have an anti anxiety effect) and they also improve your sleep quality. The do this by increasing the impact of GABA in your brain.

For dosage I would suggest 100mg at night with dinner and 100mg in the morning with breakfast. swallowed not boofed (ie not as a suppository). As it has a short half-life spacing out the dosing helps with maintaining levels, and this is a common dosage for cis menopausal women.

Taking it in the morning doesn't make you sleepy because your GABA is normally lower in the morning and higher at night, and so works stronger in the evening because of that.

Taking it with food is also a good idea because it increases the absorption and serum levels according to the studies that have been done.

HOWEVER For a small number of people can can do the reverse, and cause insomnia and irritability because of GABA dysfunction, these people will have similar issues with benzos. According to papers on benzos that have reverse reaction it is likely to be less than 1% of people. The effect will last less than 24 hours because of it's short half-life, stop taking it if you find yourself struggling to sleep instead of sleeping better.

This is ignoring all the other stuff it does like other changes to neurotransmitters, reduction inflammation immune reactions, stronger bones, potential breast growth. Where we are less clear exactly on the details of how important these things are for trans people or how much progesterone is needed for them.

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