Hormone Levels¶
Reference ranges and MtF-on-HRT targets for the hormones most commonly tested during feminizing hormone therapy. Use this to read your lab results — not as a replacement for clinical advice.
Quick reference¶
Are my levels right? Two questions:
- Estradiol (E2):
- With anti-androgen: 100–200 pg/mL (367–734 pmol/L)
- Monotherapy (estrogen alone): ≥ 300 pg/mL (≥ 1100 pmol/L)
- Total testosterone: < 50 ng/dL (< 1.7 nmol/L)?
Both meeting target → HRT is doing its primary job. Either short → keep reading.
| Hormone | MtF target (HRT) | Cis female range | Cis male range |
|---|---|---|---|
| Estradiol (E2) | 100–200 pg/mL (combo) / ≥ 300 (mono) | 30–250 (cycle-dependent) | 15–60 pg/mL |
| Total testosterone | < 50 ng/dL | 6–86 ng/dL | 270–1100 ng/dL |
| Free testosterone | follows total T | 0.3–1.9 ng/dL | 9–30 ng/dL |
| SHBG | rises on oral E2 | 18–114 nmol/L | 7–50 nmol/L |
MtF targets fall into two camps:
- Combo regimen (Endocrine Society 2017): keep E2 in the premenopausal female range (~100–200 pg/mL); the anti-androgen handles T suppression directly.
- Monotherapy: rely on E2 negative feedback alone to suppress T, which requires meaningfully higher estradiol. Community consensus minimum is ~300 pg/mL trough; some protocols (e.g. the Powers method) target higher still. Not currently endorsed by the major endocrine guidelines, but widely practiced.
The 'in range' trap — are you being underdosed?
Your lab flags E2 against the full cis female range (~30–250 pg/mL). An E2 of 40 pg/mL will print as "in range" — but that's the postmenopausal / early-follicular end, not a feminizing target.
You are likely underdosed if either is true:
- Total T above 50 ng/dL (regardless of E2 level).
- E2 below the target for your regimen: < 100 pg/mL on combo therapy, or < 300 pg/mL on monotherapy.
The usual fix is a higher E2 dose, a different route (injection or patch instead of oral), or adding/changing an anti-androgen. Bring the guideline citation (below) to your appointment.
Timing matters for injectables
On injections, E2 peaks 24–48h after the dose and troughs just before the next. Always note draw timing on the result. A low number at trough may be normal; a low number at peak means the dose is too small. Pellets and patches give steadier levels.
Lab results vary
Each lab calibrates its own equipment and publishes its own "normal" ranges, so a value flagged high or low at one lab may sit comfortably mid-range at another. Always interpret your result against your lab's reference range, printed on the report. The numbers below are typical ballpark figures, not absolutes.
US labs report results in mass/volume units (pg/mL, ng/dL); labs in the UK, EU, Australia, Canada, and most of the rest of the world report molar/SI units (pmol/L, nmol/L). Both are shown in the per-hormone tables below.
Estradiol (E2)¶
The primary feminizing hormone. Drives breast development, fat redistribution, and — at sufficient levels — suppresses testosterone via negative feedback on the pituitary. Estriol and Estrone are also estrogens but are usually not measured because they're metabolites of E2.
| Population | pg/mL | pmol/L |
|---|---|---|
| MtF target (HRT) | 100–200 | 367–734 |
| Cis female, follicular | 30–120 | 110–440 |
| Cis female, ovulatory | 130–370 | 477–1359 |
| Cis female, luteal | 70–250 | 257–918 |
| Cis female, postmenopausal | 15–60 | 55–220 |
| Cis male | 15–60 | 55–220 |
Test timing matters for injectables: peak is 24–48h post-injection, trough just before the next dose. Pellets and patches give steadier levels. Oral estradiol shows highly variable serum levels and underestimates tissue exposure — many clinicians prioritize T suppression as the functional readout instead.
Total testosterone¶
The androgen feminizing HRT seeks to suppress. Below ~50 ng/dL is considered effectively suppressed; persistent values above this usually mean the estrogen dose, route, or anti-androgen needs adjustment.
| Population | ng/dL | nmol/L |
|---|---|---|
| MtF target (HRT) | < 50 | < 1.7 |
| Cis female | 6–86 | 0.2–3.0 |
| Cis male | 270–1100 | 9.4–38.2 |
Conversion: ng/dL × 0.0347 = nmol/L.
Free testosterone¶
The ~2% of testosterone not bound to SHBG or albumin — the "bio-available" fraction acting on tissues. More clinically meaningful than total T when SHBG is unusual (e.g. very high on oral estradiol). Healthy free fraction is around 2.5%; below 1% indicates near-absent androgen activity.
| Population | ng/dL | pmol/L | % free |
|---|---|---|---|
| Cis female | 0.3–1.9 | 10–66 | 0.4–2.4 |
| Cis male | 9–30 | 312–1041 | 1.6–2.9 |
On HRT, free T tracks total T suppression. If total T is < 50 ng/dL, free T will normally be in the cis female range without separate intervention.
Progesterone (Pg)¶
A steroid sex hormone. Use in feminizing HRT is contested: proponents cite breast lobular development, sleep, and libido; the Endocrine Society 2017 guideline does not recommend it routinely due to limited evidence. Progesterone also blocks 5-alpha-reductase (the enzyme that converts T → DHT) and may have neuroprotective effects.
| Population | ng/mL | nmol/L |
|---|---|---|
| Cis female, follicular | 0.2–1.4 | 0.64–4.45 |
| Cis female, luteal | 4–25 | 12.7–79.5 |
| Cis female, postmenopausal | 0.1–1 | 0.32–3.18 |
| Cis male | 0.1–1 | 0.32–3.18 |
Oral micronized progesterone has very low bioavailability — serum levels often remain near baseline even on therapeutic doses, so a low blood value doesn't necessarily mean ineffective dosing. Rectal administration produces dramatically higher serum levels.
Sex Hormone Binding Globulin (SHBG)¶
The blood protein that binds the bulk of sex steroids. Estrogen — especially oral estradiol — significantly raises SHBG, which lowers free T independently of total T. A high SHBG with suppressed total T is a sign that oral E2 is doing its job at the liver.
| Population | nmol/L |
|---|---|
| Cis female | 18–114 |
| Cis male | 7–50 |
LH & FSH (gonadotropins)¶
Pituitary hormones that signal the gonads to produce sex steroids. On effective feminizing HRT, both should be suppressed (often near or below the lower limit of the cis female range) by negative feedback from estradiol. Unsuppressed LH/FSH with persistent T production is a sign that estrogen levels are insufficient or anti-androgen is needed.
| Hormone | Cis female (follicular) | Cis female (ovulatory surge) | Cis male |
|---|---|---|---|
| LH | < 7 mIU/mL | > 20 mIU/mL | 2–18 mIU/mL |
| FSH | 3–20 mIU/mL | — | 1–18 mIU/mL |
After orchiectomy, LH/FSH often rise unless estrogen dosing maintains adequate feedback.
DHT (Dihydrotestosterone)¶
A potent androgen converted from testosterone by 5-alpha-reductase. Drives male-pattern hair loss and body/facial hair growth. Suppression of total T usually produces matching DHT suppression; 5α-reductase inhibitors (finasteride, dutasteride) block the conversion specifically.
| Population | pg/mL | pmol/L |
|---|---|---|
| Cis female, premenopausal | 24–368 | 83–1266 |
| Cis female, postmenopausal | 10–181 | 34–623 |
| Cis male | 250–990 | 860–3406 |
LDL cholesterol¶
Estrogen tends to lower LDL ("bad" cholesterol); androgen suppression also tends to favorably shift the lipid panel. Worth periodic monitoring as part of overall metabolic health on HRT.
| LDL (mg/dL) | Classification |
|---|---|
| ≥ 160 | High |
| 130–159 | Borderline |
| 100–129 | Near optimal |
| < 100 | Optimal |
Less commonly tested¶
DHEA-S, Androstenedione
Adrenal androgens. Mostly relevant for investigating unexplained androgenization (e.g. PCOS-like presentations, adrenal pathology) rather than routine HRT monitoring.
DHEA-S (µg/mL): cis female premenopausal 0.8–3.9; postmenopausal 0.1–0.6; cis male 1.0–4.2.
Androstenedione (ng/mL · nmol/L): cis female 18–49y mean 2.15 · 7.4 (range 0.7–3.5 · 2.4–12.1); cis male mean 1.75 · 6.0 (range 0.35–3.15 · 1.2–10.9).
Unit conversions¶
| Hormone | Conversion |
|---|---|
| Estradiol | pg/mL × 3.671 = pmol/L |
| Testosterone | ng/dL × 0.0347 = nmol/L |
| Testosterone | ng/mL × 3.47 = nmol/L |
| Progesterone | ng/mL × 3.18 = nmol/L |
| DHEA-S | µg/mL × 2.6 = µmol/L |
| Androstenedione | ng/mL × 3.45 = nmol/L |
| DHT | pg/mL × 3.44 = pmol/L |
Sources¶
- MtF target ranges — Hembree WC et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869–3903. doi:10.1210/jc.2017-01658
- Cis reference ranges — adapted from hemingways.org/GIDinfo/hrt_ref.htm, itself drawn from Immuno Biological Laboratories (IBL) ELISA assay datasheets and the University of Iowa Department of Pathology.