3w ago

How unusual is it for no nipple soreness or breast bud development at almost 6 weeks of HRT?

Trying hard to trust the process, and while I have seen other expected changes in skin, hair, and mood, I am getting anxious that nothing is happening under my shirt. I had some minor sensitivity within the first two weeks, but never anything painful.

This Friday will be 6 weeks on HRT. 2mg Est, 4mg Prog, 200mg Spiro daily.

Edit: thanks for talking me off the cliff everyone, I'm much less anxious now 😅

57 comments

6 weeks isn't very long, and if you're just starting your likely on a lower dose as your doc ramps you up to whatever level works.
I'd talk to your doc or whoever prescribed you the meds about dosages and what your levels are, they usually monitor with bloodwork to try to get you in the normal ranges, and if you have concerns they will usually work with you to try to get the results you want.
But yeah. i didn't really notice breast development for a good few months(partially due to my weight too at the time), and they didn't really stop growing for a few years. It was just a lot of very slow growth over time.

This stuff comes in waves. I have been on hrt for close to five years at this point and I remember the first year, almost no breast growth. Year two, bit of a boom. Then very little growth but year 4 has been like 2-3 cups. Everyone's body is different. I would definitely make sure your doc is checking on your blood work cause I know for me, my T didn't get to an appropriate level till I hit the year and a half mark. And that T level can really slow down your progress.
- oof, your T suppression should not have taken a year and a half to occur. With sufficient estrogen levels it should happen rather rapidly. My testosterone and estrogen were both in cis-female levels by the time I did my next blood work two months later.
  I wonder what your E levels were as your T failed to reduce (I'm going to guess they were too low) 🤔 Were you on spiro?
  
  My T levels started really high (my T levels were higher than that of a teenager while I was 26), by the time I got my T levels to a proper level I was up to 300mg of Spiro (and on estrogen patches) and went into a sodium deficiency. After that I actually got to switch to Lupron which was great. Now I'm back on Spiro but only 50mg and my T levels are still at an appropriate level. I am also on injectable estrogen which I have found to be much better than patches. My doctors didn't want to put me on pill form estrogen due to concerns for liver health.

If you take estrogen as pills, don't swallow them. Out then under your upper lip or undr tounge and let them dissolve. The stomach destroys 80+% of estrogen
- I wouldn't recommend doing this if you have been prescribed oral estradiol (that is, taking the pill you are prescribed daily in a single sublingual dose). The significantly higher bioavailability of sublingual administration can cause incredibly high spikes, and the significantly shorter half life over oral necessitates taking the estradiol 3-4x daily to maintain (only semi) stable levels. This requires a dosage and schedule adjustment; it is not sufficient to simply take the same dose of oral prescription and start taking it sublingually once daily.
  Additionally, the stomach does not destroy estradiol. The reason behind the low bioavailability of oral estradiol (and by extension, also oral progesterone) is that it passes through the liver before entering the bloodstream. The liver processes the estradiol before it enters the bloodstream, resulting in significantly less E2 available in the blood. This also presents an additional long term problem that has been well documented at this point: liver flooding. The high concentration of estradiol entering the liver in a short amount of time puts an incredible amount of strain on the liver, and can cause long term liver damage. This is alleviated through sublingual administration.
  The sublingual route has its own pros and cons (mainly the incredibly spiky and unstable hormone levels and requirement of frequent 3-4x doses per day), and it is not advisable to recommend someone take the medication their doctor prescribed them in a manner that is not consistent with their prescription. OP's prescription was written with the intention of it being taken orally, thus the dosage has been planned for that, not for sublingual.
  I took mine sublingually for awhile, but I am now switching to injections, as I am not happy with the dosage frequency. I've missed doses because I also struggle with ADHD, and it's resulted in me feeling really off when my levels get too low. I would never do oral, as it isn't an effective way of taking estradiol. It's incredibly inefficient and presents its own health issues. Injections are the most convenient and most stable option (although I haven't looked too deeply into the implants, those may potentially be more stable, but estradiol cypionate allows me weekly injections that peak at ~175ng/dL and trough at ~135ng/dL, which is very stable inside my target range), as well as being quite cheap and well studied.
  TL;DR: Either talk to your doctor about adjusting dosage and scheduling for sublingual administration, or do the due diligence of reading about it. I recommend the meta-analyses from Transfeminine Science. The dosage and scheduling need to be adjusted if switching to sublingual.

I had breast soreness pretty quickly. Increased sensitivity could be right (that's how it was for me at first), but at some point it did become painful enough that I had to change how I slept, etc.
My advice: switch to injections (I recommend subcutaneous as you can use very small needles that can be painless).
As others have said, oral is a poor way to get estrogen - 80+% is eliminated by the liver, and the rest spikes blood levels and eliminates relatively quickly, creating vicious ups and downs without providing sufficient and consistent estrogen blood levels to estrogenize the body by. Anecdotally the people I know IRL who do pills have slower and less feminization than those who inject.
(I actually started hormones at the same time as an IRL friend, and a year later my friend still passes as a boy and boymodes full-time, and I ... wouldn't be able to pass as a boy anymore. The main difference is that they take oral and I inject.)
Highly recommend reading: https://transfemscience.org/articles/transfem-intro/
- Is there a reason not to do injections (unless you have bad enough fear of needles so that you can't do it)? To me it seems to be by far the best option in every way (at least price, effectiveness, frequency of administration, convenience) and I see no reason to pick anything else. Not that I personally have much of an alternative anyway because I'm doing DIY right now.
  
  Not really. Injections and implants really are the most convenient options (and injections are of course super cheap). That said, gel/spray isn't too bad, especially when first starting out or for those afraid of needles.
  
  I have a horrible needle phobia, and even so I did a lot to overcome it so I could do injections. Ultimately I agree, injections are the best method. Transdermal (patches or gel) isn't that bad of a route for lower doses, but pre-op I wanted to do monotherapy when bica didn't seem to help my biochemical dysphoria enough.
  Even post-op I still do injections, as my skin is very sensitive, so I was worried about getting rashes from the patches, and I also exercise a lot and worried about the patches coming off (they can be expensive to replace, this is just a major downside to patches).
  
  Denmark doesn't use injections for trans care, so it's simply not legally available
- How about spray/gel?
  
  still better than oral, and if you're on an anti-androgen or post-op it could work really well.
  Not as effective as injections at getting your estrogen blood levels up consistently though, so it's not practical for monotherapy, for example.

I think I really start noticing at 10 weeks? it's hare to remember because I didn't write anything down due to paranoia. I wasn't on Prog tho

Check out these two links:
https://diyhrt.wiki/transfem
https://transfemscience.org/articles/e2-equivalent-doses/
Cyv_ has already said everything that needs to be said about doctors and bloodwork, but I figure having a look at what are considered standard dosages might put your mind somewhat at ease.
Also, do consider what Kamills says about taking your pills sublingually (under the tongue). Taking estrogen orally is associated not just with absorbing less E, but also with a higher risk of blood clots and is generally considered the least safe and effective way of taking E within the DIY community. Sublingual lowers the risk, even if you still swallow some. There are studies on this, but most doctors aren't exactly up to date on this stuff.
Do be aware however that while most pills can be taken sublingually some can't. You can try looking them up online, sharing the name of the E you take here, or looking for the words "sub-lingual" or "micronized" on the packaging. Not all packages are marked with this even if they are.
- Lots of great responses! My E is from Estradiol, if that helps.
  
  We all mean estradiol when we say E here! I meant more the brandname and such.

Mine came at around 3 months in.

I just hit week 7. I'm not on the same dosing as you (4mg estradiol tablets, no prog, 50mg spiro) but have had no physical changes. Emotional for sure, and my spouse claims I no longer smell like a man, but that's all. I begged my doctor to put me on bica and injections, but they are all too cautious about adverse effects. I already had an episode of incredibly high heart rates this weekend that impacted activities, but that's apparently not enough to go to injections until month 3 for them. I started taking the tablets sublingual (dissolve them under the tongue) but that has had very little effect. I have had no soreness or sensitivity at all, and everything still looks like it did before. I'm not sure if this is normal or not, but I'm considering finding a new doctor. I don't want to switch to DIY and have them decline to provide referrals. It was enough of a chore to find this clinic in the first place!
- I begged my doctor to put me on bica and injections, but they are all too cautious about adverse effects
  Aaaand that's when you get a different doctor - the adverse effects would be from taking oral, which at least plausibly taxes the liver, while injections are practically risk-free by comparison. My current endo actually tries to get her patients off oral and suggests injections instead.
  I already had an episode of incredibly high heart rates this weekend that impacted activities, but that’s apparently not enough to go to injections until month 3 for them
  What's the reasoning here? There is no evidence injected bioidentical estrogen carries any heart risks, the closest thing would be that synthetic estrogen pills might increase risk because of those studies on Premarin, but that's a reason to do injections rather than oral (though the pills you take should be bioidentical now).
  but I’m considering finding a new doctor.
  please, please do!
  Even somewhere like Planned Parenthood that offers informed consent would be better. Your current doctor sounds transphobic and misinformed, they should let you be in control of your care especially with a decision like oral vs injections.
  I recommend meeting and talking to the local trans community and finding out who other people see and which doctors the community recommends, that can be a good way to find a doctor who actually knows something about trans care or at least will allow you to have more autonomy in your care (though ... don't expect even the good ones to know enough, unfortunately we're still at a place where trans people really have to educate themselves and take their care into their own hands).
  
  I like the patches personally but I wish insurance would cover the hrt implant pellets.
  
  The risk aversion is deviation from their standard plan and from possible mortality as a side effect of bica. Yes, I 'm aware that it's an exceedingly low chance. They are still stuck in the early 2000's for treatment plans.
  The risk of heart issues is actually the spiro, which appears to be happening but they still aren't responding to the request. I was over 190bpm during a distance run this weekend, and that's considered the red zone for ages 40 and up. I'm normally around 150 for a tempo run and 50 flat for resting. This is absolutely an anomaly for me.
  Your current doctor sounds transphobic and misinformed, they should let you be in control of your care especially with a decision like oral vs injections.
  My doctor happens to be a trans woman. Howewver, she transitioned more than a decade ago and is comparing everything to her experience. I'm not sure if she's bothered keeping up with things. I'm not here to judge, just to get myself in order.
  I recommend meeting and talking to the local trans community
  Try as I have, this part has been exceedingly difficult. The only meetups are youth oriented or singles mingles at bars. I'm married, don't drink, and too old for that. There's pride, annually, but this area isn't fantastic for just finding folx at local establishments being themselves. I also happen to work a later shift. It's quite lonely out here.
- If you do ever consider DIY we in the HRT chat in the matrix have lots of info and experience. We can help you with every step. It's safe and cheap, and tmk people aren't denied referrals or anything for being on diy in most countries.

Haven't read all of the other comments or seen your hormone levels but your doc starting you on 200mg spiro is diabolical, i started on 50 and most start between 50-100. everyone is different so maybe you need that much but i'd talk to your doc about that.
As for the actual question, it took me like 8-10 weeks and ymmv. I also started on 4mg estradiol/day rather than 2. Also make sure you're eating enough for fat redistribution. You'll get there girl, don't worry.
- does sound like a bad (or malicious) doctor, they shouldn't be starting someone at the max dose ... especially since spiro can cause serious side effects.

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