What didn’t work

For an introduction to SERMs, check out this web article. The rest of transfemscience.org is a great resource for transfemme hormone therapy in general, too. It’s still my main source of information for all things related to hormone therapy.

That said, my first attempts to establish a SERM regimen, following some of the discussion there, weren’t successful. I believe that was mostly due to two factors: insufficient testosterone suppression, and using raloxifene vs. tamoxifen. In short, the sources above regard raloxifene as the most promising SERM for suppression of breast development. But tamoxifen turned out to be way more effective for me. In addition, the first few regimens I received didn’t manage to suppress my testosterone enough.

Estradiol and spironolactone

The first regimen I received was a standard regimen for transwomen at the beginning of their medical transition, consisting of up to 0.1 mg estradiol per day (as transdermal patches), up to 100 mg spironolactone per day (orally), and 1 mg finasteride per day (orally). I was not able to get SERMs initially because I didn’t have a provider who felt comfortable prescribing them, but I wanted to get started anyway. Spironolactone unfortunately never had a measurable effect on my testosterone levels. I just got very dehydrated and as a result, sometimes dizzy. This may be different for you – a friend of mine reacted so strongly to spironolactone that they felt breast growth happen even without estradiol. For myself, it just didn’t work, and in terms of results, my libido never came down, for example. However, adding estradiol to spiro resulted in tenderness in my nipples, so there was definitely beginning breast development. I stopped using this regimen when the effects became quite obvious after about 2 months.

Estradiol, spironolactone and raloxifene

I had contacted some of the authors of the Xu et al. paper linked at the end of the web article, and they seemed to indicate that in their experience, giving raloxifene without estradiol lead to insufficient feminization. So when I first found a provider who was willing to prescribe raloxifene, I was glad that they gave it to me in addition rather than replacing the combination of medications above. This regimen consisted of up to 0.05 mg estradiol per day (as transdermal patches), up to 200 mg spironolactone per day (orally), 1 mg finasteride per day (orally), and 60 mg raloxifene per day (orally). Unfortunately, the results ended up being quite the same: testosterone didn’t come down, and apparently raloxifene wasn’t successful in counteracting the estradiol acting on my breast tissue – I felt the same tenderness and slight elevation of my nipples. I abandoned this regimen, again, after 3 months.