What worked

Things started working when I was able to talk to a provider who had some experience with SERMs. They acknowledged that spironolactone wasn’t working for me, and prescribed leuprolide injections. They also said they had no experience with raloxifene, but had used tamoxifen, a different SERM, in a previous patient. This turned out to be a lucky coincidence for me, because on tamoxifen, I definitely did notice some estrogenic effects, but not in my breasts.

Over the course of a few months, I worked up to my current regimen: 0.3 mg estradiol per day (as transdermal patches), 20 mg tamoxifen per day (orally), 1 mg finasteride per day (orally), and a 22.5 mg depot injection of leuprolide acetate every three months. With this regimen, I have been seeing fat redistribution from a masculine to a more feminine (or gender neutral) pattern, softer facial features, much diminished acne, lower libido, and an improved psychological well-being overall.

Unfortunately, my provider initially gave me an insufficient dose of leuprolide (roughly half of the above), which meant that my testosterone levels were all over the place, because due to the way GnRH agonists work, they cause a spike in testosterone whenever their effect sets in or wears off. But with the 22.5 mg doses, I finally saw my testosterone levels consistently drop, and my libido came significantly down. On this current regimen, my testosterone levels are now around 30 ng/dL (around 4 pg/mL free testosterone). In contrast, on spironolactone or the lower dose of leuprolide, my measured testosterone never went below 100 ng/dL.

Remarkably, I have not observed any breast growth since starting tamoxifen, even though I gradually increased my estradiol dose to three times the dose that had given me breast growth before (either without SERMs or in combination with raloxifene). On my current regimen, my estradiol levels are between 200 and 300 pg/mL.

While everybody is different and I can only provide an “anecdote” based on my own experience, these results seem quite significant, and I hope it might inspire some more research.

Transfemme nonbinary hormone therapy

Hi there! I’m Jay, a transfemme, nonbinary person in my early 40s. I started seriously considering medically transitioning more than two years ago, and began hormone therapy in November 2021.

In this blog, I want to describe the regimen I settled on – a mostly estrogen-based regimen, which also includes SERMs (selective estrogen receptor modulators) to prevent breast development. This regimen has been working remarkably well for me, so I hope this will be useful for you. I often meet people who are interested in SERMs, so this will be where I will point them for more information.

Like many other nonbinary folks AMAB, I’ve struggled with gender dysphoria stemming from some of my masculine physical features and my high libido. So my goal was always to reduce masculinity, but not necessarily to present as a woman. In particular, I have personally always felt indifferent towards having breasts.

For me, whether I wanted breast development or not has been a question that I always framed in terms of how other people see me. To be clear, I would like to live in a world free of prejudice and transphobia, where everyone can do with their body what they want, without being discriminated against or hated upon, but that’s unfortunately not the reality. So, it is quite sensible for a nonbinary person to want to have a way to “go stealth” as either binary gender, for example when traveling to places that may be hostile towards nonbinary people, or when passing a border with a binary gender marker in your travel document.

For that reason, I have been looking for a way to prevent breast growth, until perhaps at some point, I could be reasonably certain that I might “pass” as a woman if the situation requires it.

So, when I started hormone therapy, I wanted to get the “good” effects from testosterone suppression and estrogen supplementation, like a less masculine fat distribution, and lower libido, but wanted to prevent breast growth. I soon learned about SERMs, and started looking for a medical provider who would take me on this journey. It turns out finding a provider who has experience with this was not so easy, and in the process I tried some medication that didn’t work as expected.

This blog will hopefully help you get the results you want quicker than it took me.