Gender-affirming care is a deeply personal journey, unique to each individual's needs, goals, and circumstances. In recent years, there has been growing interest in microdosing and taking a gradual approach to hormone therapy, especially in the transgender and non-binary communities. This method involves using lower doses of hormones and carefully selected antiandrogens to align more gently with one’s gender identity.

The Philosophy of Microdosing

Microdosing is based on the principle of 'less is more'. It involves administering smaller doses of gender-affirming hormones than those typically used in standard hormone replacement therapy (HRT). This approach is particularly appealing to those who wish to:

• Experience gradual physical changes.
• Maintain a balance between their assigned gender at birth and their identified gender.
• Have more control over the pace of their gender transition.

Benefits of a Gradual Approach

• Personalised Transition: Microdosing allows individuals to experience physical changes at a pace that feels comfortable and affirming for them.
• Minimised Side Effects: Lower doses can reduce the risk of potential side effects associated with hormone therapy.
• Emotional Adjustment: A gradual transition can provide more time to adapt emotionally and psychologically to changes.

Choosing Appropriate Antiandrogens

Blockers such as GnRha Blockers can be too effective at stopping natural hormone production, and are best avoided in those who want to go slow.

For people with testicles, antiandrogens play a role in blocking the effects of testosterone. In a microdosing regimen, selecting the right antiandrogen needs care. Options like Spironolactone, Finasteride, or Cyproterone may be considered, but in lower doses or less frequent dosing schedules.

For people with ovaries, it may be better to simply use a low dose of testosterone, without a blocker, allowing gradual changes and customisation.

The goal is to achieve desired effects and minimising any unwanted effects.

Lower Doses of Hormones

Estrogen or testosterone used in lower doses can bring about changes more slowly and subtly. This can include slower development of secondary sexual characteristics, giving individuals time to adjust and feel more in control of their transition process.

Individual Journeys and Informed Decisions

Every individual's journey is unique, and there is no one-size-fits-all approach to gender-affirming care. Decisions should be made in consultation with people who are knowledgeable and supportive of transgender health needs. Consideration needs to be given to:

• Regular monitoring of hormone levels and health parameters.
• Discussing the psychological and physical impacts of hormone therapy.
• Adjusting dosages as needed based on individual goals and responses.

Conclusion

Microdosing and a gradual approach in gender-affirming care offer a customisable pathway that respects the individuality of each person’s transition. It's a testament to the evolving understanding and respect for diverse gender experiences. As with any medical intervention, it’s important to work closely with specialist resources to ensure a safe and effective transition journey.