What is the right age for starting HRT? Am I too old? Am I too young? by Dr. Debmalya Sanyal

I am 40 years old, can I start my HRT now? I am not 18 yet, how long do I have to wait for starting HRT? Is there any way that I can start HRT before I turn 18? These are some of the many questions that come to our minds often and Dr Debamalya Sanyal is here to answer all of them.

How old is too old for HRT?

If you have just decided that you want to start HRT but you are worried that it is too late then don’t worry. It is completely normal to start HRT later on in one’s life. Dr Sanyal says, “You can start when you are 40, given all your vitals are normal.”

After a proper evaluation of all the risk factors involved, which is standard procedure, we can start.

There are cases where patients have gone through their surgery but haven’t taken any HRT which has negatively affected their bone health but they have sustained, Dr Sanyal recalls.

“We have started at 40, 43, 45 also we have started. After one is 50, transdermal estrogen patches are what is preferred. But up to 50 one can carry on with the oral tablets of each. But obviously one needs to decrease the dose of estrogen as we age.”

Post GRS average dosage of HRT required

The best part post-surgery is that most of us will not require any anti-androgens or GNRH. This results in a decrease in the cost of taking HRTs as well. Also what is seen is that after one has successfully undergone bottom surgery, and their gonads have been removed then the dose requirement comes down. These results are to be published shortly as well, Dr Sanyal informs.

So what we then prescribe, says the doctor, is 2-4 mg of natural estrogen like estradiol valerate. 2-4 mg is the average dosage but it can extend up to 6 mg. Some require up to 8 but that is very rare. But generally for maintenance dosage, the requirement is 2-4 mg in most of the patients.

And once one reaches the proper level of development that one desire then the dose can be brought back down.

What if I lower my dose and the development goes away?

It is a thing to wonder that if I cut my doses then the development that I have gone through will also go with it. Well, Dr Sanyal says that it is rare that the dosage will be cut to that significant a level.

For example, if a patient is taking 4-6 mg then you can come back to 4 mg or you can decrease from 4 to 3 mg. So that is what, you can cut back on the dose a little.

What if I am too young?

If you are a young trans person looking to start HRT and cannot wait till you are 18 then Dr Sanyal says, “In the Indian context, our adulthood age is 18 so we can start GnRH and Leuprolide. But starting HRT is after attaining adulthood. So some countries where the age of adulthood is lower there they start early but in our country and I, start HRT at the age of 18.”



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