Get injections and skip Spiro. All it did was make me wake up severely dehydrated every day and I got plantar fasciitis. You can do subq or intramuscular injection but I prefer subq. Get your t checked to ensure it's being adequately suppressed by the injections. If not you can try a higher dose or go on an antiandrogen, but going on a higher dose is probably preferable unless your E is consistently above 200 pg/ml in which case you could probably increase the dose but anti-androgens might be indicated. Get your E measured at the trough - that is, before you do your next injection, as it gives the baseline E level most accurately.
this post was submitted on 19 Nov 2025
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Not OP, sorry if I'm hijacking. Is Spiro the pills? Injections make me very nervous, and I don't know if I can handle doing it myself.
Spiro is some of the pills. It's an antiandrogen but also a diuretic and it honestly does a lot of stuff that you might not want. Mine were bitter and minty. It's short for Spironolactone.
Pills can also refer to bioidentical estradiol pills. You typically cannot use these to suppress testosterone and they are taken under the tongue or between the gums and the cheek. Pills are harder on your liver (but not that bad) and are absorbed less efficiently. They are better than nothing and cheaper than injections but injections are your best bet for suppressing t if you still have your testicles.
As for the fear factor you can try an auto-injector. However the best method if you can do it is to get over it.
spiro is a specific mediocre antiandrogen. there are better options (generic for bicalutamide or just doing monotherapy)
Okay, thank you!
Bicalutamide can harm your liver. In practice it means you have to get liver enzymes checked and stop taking it if they become elevated. You should then be able to recover from the minor liver damage most of the time. It works well if you can find someone willing to prescribe it.
You are taking the first steps, and I want you to know that I hope you get all the aid you need. I have no advice, only prayers and internet hugs 
theres a pinned post in this community with a lot of links: https://hexbear.net/post/3016455
heres one to start with: https://diyhrt.info/
best of luck on your journey
Hi, I don't want to cause a fight but "get injections and go straight to monotherapy" is not good advice to give to someone looking for a place to start.
There are a variety of options when it comes to feminizing HRT and the reality is that it comes down to preference and one's ability to regularly administer dosages. Injections can be intimidating, uncomfortable, and deliver less consistent levels than pills would, pills don't require sharps and are generally more available. There is this mystique around injections, they're sexy in a way but they're not meaningfully more effective in delivering results than other methods and may be worse in some ways. Spironolactone is... fine? Like really its fine, as long as you don't have any preexisting kidney or liver conditions its fine. You're definitely going to pee more often and some people report "brain fog" but your mileage will vary on that. To me, starting spiro felt like waking up for the first time in decades. The other thing about spiro is that it works in a very wonky way so blood testosterone levels aren't a great indication of how well its working.
That being said, there are other antiandrogens out there, and its your right as a person to try things out and see what works best for you. Transfeminine science has a very good introduction to feminizing HRT and I highly recommend reading it as well as the rest of the website. Those girls do good work. There is also a fun simulator that plots out a rough estimate of estrogen levels with different medications. Regarding actually getting HRT, independent journalist Erin Reed maintains a map of informed consent clinics that you may find useful if you haven't found a place for that yet. Planned Parenthood clinics offer gender affirming care and also have a sliding scale for how much they'll charge you.
Frankly, its going to take time to get comfortable presenting as oneself. There's a lot said about the "embracing the new" aspect of transitioning and the "discarding the old" part gets talked about much less, and the absence of the old can be much more uncomfortable than the presence of the new. I really hope that made sense. I am very tired. Be patient with yourself and hold faith in what the future has in store for you. The process of bodily feminization is glacial, agonizingly so, and it comes in spurts too. I promise that one day you'll look in the mirror, and as though by magic you'll see her there for the first time. The details like makeup and mannerisms and clothes and hair and all that will come to you eventually, it takes a little effort, and quite a bit of trial and error. You'd be surprised to find just how many people are willing to help a trans woman get oriented in these matters.
I have no idea where to put this part, so I'm putting it here. You should read this comment. The book Inanna, Lady of Largest Heart is wonderful and you owe it to yourself to go read it, or at least chapter nine, the linked comment mentions where to find it but if you want, DM me and I'll email it to you lmao. It is an incredibly powerful thing to see oneself in the words of a woman who lived five thousand years before you were even born.
In case no one has said this already, I'm so fucking proud of you. Yeah sure we're strangers but from what you've said here I can tell that you are already a very, very strong woman*. Thank you for finding it in you to persist and find this courage.
(If "woman" is not how you label your gender identity I deeply apologize and wish to correct myself.)
there are a lot of things in your control and things out of your control.
things like voice training, hormones, and eating enough to see changes in your body are in your control. focus on those unless you like 4chan dooming like a lot of the trans internet that dooms over their skull shape.
also hrt takes time to do things.
Hey. As a non-binary, I can speak to society. There are plenty of people who feel their masculinity or femininity threatened by my existence. I try to ignore them.
I focus on what makes me feel comfortable. Whether that is secrets like my underwear, details like my earrings, or a bigger statement like a skirt. If I feel comfortable, people around me feel more comfortable.
Also, dont take spironolactone. Its poison. Estradiol alone lowers your testosterone. And progesterone is great (and sleepy).