From the Guidelines
Progesterone dosing for transgender patients is not recommended by the Endocrine Society, but if used, a dose of 100-200mg daily of oral micronized progesterone is typically considered. For transgender women (male-to-female), progesterone is often added after 1-2 years of estrogen therapy, though this timing is flexible based on individual goals 1. Progesterone can be administered orally, but some clinicians prefer the vaginal or rectal route for better absorption and potentially fewer side effects.
Key Considerations
- Injectable progesterone (such as medroxyprogesterone acetate 150mg intramuscularly every 3 months) is another option but may have different risk profiles.
- Progesterone use in transgender healthcare remains somewhat controversial as evidence for breast development benefits is limited, though some patients report improved mood, libido, and sleep 1.
- Side effects may include drowsiness, dizziness, mood changes, and potentially increased risk of cardiovascular issues or certain cancers with long-term use.
- Regular monitoring of hormone levels, liver function, and cardiovascular health is important, as suggested by studies on hormone replacement therapy 1.
Administration and Monitoring
- Patients should be aware that progesterone is often considered optional in transgender hormone therapy, unlike estrogen which is the cornerstone of feminizing treatment.
- The decision to use progesterone should be made on an individual basis, taking into account the patient's specific needs and health status.
- It is essential to follow the most recent and highest quality studies, such as those published in prestigious journals like the Annual Review of Medicine 1, to inform treatment decisions.
From the Research
Progesterone Dose for Transgender Patients
- The ideal progesterone dose for transgender patients is not explicitly stated in the provided studies, but various doses are mentioned in different contexts 2, 3, 4, 5.
- A study from 2023 mentions a randomized controlled trial where participants receive either 200 mg or 400 mg of oral progesterone daily, in addition to estradiol, for a duration of 12 months 3.
- Another study from 2022 discusses the potential benefits of bioidentical progesterone in gender-affirming treatment of trans women, but does not specify a particular dose 4.
- A narrative review from 2024 synthesizes existing literature on the administration of exogenous progesterone in transgender women, but does not provide a specific dose recommendation 5.
- An older study from 2003 investigates the effects of oral and transdermal estrogen/progesterone regimens on sensitivity to activated protein C among postmenopausal women, using a dose of 100 mg progesterone daily 6.
Potential Benefits and Risks
- The addition of progesterone to feminizing hormone therapy may have several benefits, including more rapid feminization, decreased endogenous testosterone production, optimal breast maturation, increased bone formation, improved sleep and vasomotor symptom control, and cardiovascular health benefits 2, 3, 4.
- However, the use of progesterone in transgender women is not without potential risks, and further research is needed to fully understand its effects and optimal dosing 3, 4, 5.