Estrogen

  1. Injectable Estradiol Enanthate (EEn): These can be ordered from various home brewers. From international sellers, they usually come in stealth packaging (as Skincare or Essential Oil), and face no trouble from customs.
  2. Estranor: Oral tablets, white ones containing Estradiol Valerate (EV), 2 mg each. Do not take the brown ones in the box, throw those away.
  3. Progynova: Oral tablets containing EV, 2 mg each.
  4. Climen: Oral tablets. White ones contain only EV, 2 mg each. Pink ones contain 2 mg EV + 1 mg Cyproterone Acetate (CPA) each (discussed in Anti-Androgens).
  5. Gravibinan: Intramuscular injection containing 5 mg Estradiol Valerate and 250 mg synthetic progesterone (Hydroxyprogesterone caporate (17-OHPC)).

EEn is the most recommended option due to the stable levels you receive, ease of monotherapy (which avoids AA side effects), and only needing to administer doses once a week in most cases. A single vial will also likely last you over a year.

Pills are a fine option. Monotherapy on pills is not recommended though, too inconsistent. An anti-androgen is likely to be necessary with those.

There is currently a massive shortage of Progynova in Pakistan. You are likely to have to look for Estranor if you want pills.

Gravibinan is advised against during early stages of HRT due to the synthetic progesterone content, which may halt breast growth. Should be avoided later on too. Details are in the Progesterone subsection.

Anti-Androgens

  1. Aldactone: Oral tablets containing 100 mg Spironolactone (Spiro)
  2. Aldactone-A: Oral tablets containing 25 mg Spironolactone
  3. Androcur: Oral tablets containing 50 mg Cyproterone Acetate (CPA)
  4. Casodex: Oral tablets containing 50 mg Bicalutamide (Bica)

Risks and side effects are already covered very well by DIY HRT wiki.

Spironolactone is the most common option due to its high availability in Pakistan.

Cyproterone Acetate is the recommended option, especially early on, due to its effectiveness in nuking Testosterone, but also causes a complete loss of sexual desire for the duration in some people. It also suppresses the effectiveness of progesterone, and could be swapped out for a different AA when progesterone is introduced.

If taking CPA, you will need a pill cutter to divide the 50 mg Androcur pill into 8 or 4 parts (6.25 mg or 12.5 mg), as discussed in the DIY HRT Wiki.

Bicalutamide, although the preferred option due to its minimal side effects, is extremely expensive in Pakistan and often entirely unavailable.

Progesterone

  1. Cyclogest: 200 mg or 400 mg pessary, made for Rectal administration
  2. U-Progest: 100 mg or 200 mg oral capsule
  3. Progeffik: 100 mg oral capsule
  4. Gravibinan, as mentioned above (synthetic, not recommended at all).

It is very important to ensure the Progesterone is bio-identical. Gravibinan uses synthetic ones and is thus not recommended.

Progesterone is not required or essential to reach Tanner stage 5 of breast development, and is thus entirely optional. It potentially works as an enhancer, not as a key. Here’s why you should still add it to your regimen: https://docs.google.com/document/d/1OGiomfiMk18nPb3ITKZD9pWPvWRUlyI06enxahQpHBI/

It is recommended to reach Tanner stage 3 of breast development (usually 6 to 12 months) before introducing progesterone to your regimen, as it may hinder breast growth if introduced too early.

Monitor DHT levels when progesterone is added to your regimen. There are reports of it turning into DHT, albeit in very rare cases.