Evidence map›Paper›PMID 39797602›Full record

ArticleThe Journal of clinical endocrinology and metabolism2025

Injectable Estradiol Use in Transgender and Gender-Diverse Individuals throughout the United States.

Aaron L Misakian, Carly E Kelley, Erika A Sullivan, Julia J Chang, Gagandeep Singh, Sarah Kokosa, Jonathan Avila, Holly Cooper, Jane W Liang, Bren Botzheim and 21 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. [Gender-affirming hormone therapy: state of the art].Urologie (Heidelberg, Germany) · 2026
    Review
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

31 authors.

Aaron L MisakianDivision of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA 94304, USA.ORCID 0000-0001-6005-0630
Carly E KelleyDivision of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA.
Erika A SullivanDepartment of Family and Preventive Medicine, University of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Julia J ChangDivision of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA 94304, USA.
Gagandeep SinghDepartment of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55455, USA.
Sarah KokosaDivision of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA.
Jonathan AvilaDivision of Adolescent Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA.
Holly CooperDivision of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA 94304, USA.
Jane W LiangStanford University School of Medicine, Stanford, CA 94304, USA.
Bren BotzheimStanford University School of Medicine, Stanford, CA 94304, USA.
Meg QuintStanford University School of Medicine, Stanford, CA 94304, USA.
Athavi JeevananthanDivision of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA.
Ellenor ChiUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Madison HarmerUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Laurel HiattDepartment of Human Genetics, University of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Michaela KowalewskiUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Benjamin SteinbergUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Telisha TausingaUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Hannah TannerUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Tiffany F HoDepartment of Family and Preventive Medicine, University of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Bayarmaa MarkUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Brian ZengerUniversity of Utah, School of Medicine, Salt Lake City, UT 84108, USA.
Sophia HuDivision of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Amanuail GebregzabheirDivision of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Justin M PennyDepartment of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55455, USA.
Danielle F LoebDivision of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Tyler StricklandDivision of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Sean J IwamotoDivision of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Micol S RothmanDivision of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Ole-Petter R HamnvikDivision of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Danit ArielDivision of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA 94304, USA.

Funding

Endocrinology and Metabolism Training ProgramT32DK007012 · NIDDK · DUKE UNIVERSITY · PI DAVID A. D'ALESSIO · 1986 to 2026
$6.8M
NIDDK NIH HHS T32 DK007012University of Utah Department of Family and Preventive Medicine Health Studies Fund
6 · The paper itself

Abstract

contextGuidelines for use of injectable estradiol esters (valerate [EV] and cypionate [EC]) among transgender and gender-diverse (TGD) individuals designated male at birth vary considerably, with many providers noting supraphysiologic serum estradiol concentrations based on current dosing recommendations.

objectivesThis work aimed to 1. determine the dose of injectable estradiol (subcutaneous [SC] and intramuscular [IM]) needed to reach guideline-recommended estradiol concentrations for TGD adults using EC/EV; 2. describe the relationship between estradiol concentration relative to timing/dose of last estradiol injection and other covariates; and 3. determine dosing differences between IM/SC EV/EC.

methodsA cross-sectional retrospective study was conducted across 6 US medical centers including TGD adults on same-dose injectable estradiol for more than 75 days, with confirmed timing of estradiol concentration relative to last injection, from January 1, 2019 to December 31, 2023. Descriptive statistics were used to describe patient characteristics and weighted linear mixed models to evaluate relationship between various covariates and estradiol concentration.

resultsData from 562 patients were included. Among those injecting every 7 days who reached the guideline-recommended estradiol concentration (n = 131, 27.5%), the median estradiol dose was 4.0 mg (interquartile range, 3.0-5.0 mg). Among all patients, the majority reached supraphysiologic estradiol concentrations (>200 pg/mL [>734 pmol/L]) while dose and timing in the injection cycle were significant covariates for the estradiol concentration. There were no significant dosing differences between IM/SC EV/EC.

conclusionInjectable estradiol esters effectively reach guideline-recommended estradiol concentrations but at lower doses than previously recommended. Estradiol concentrations are best interpreted relative to timing of last injection. Route of administration and type of ester do not significantly affect estradiol concentrations.

Indexed as

EstradiolTransgender PersonsAdultCross-Sectional StudiesFemaleHumansInjections, IntramuscularInjections, SubcutaneousMaleMiddle AgedRetrospective StudiesUnited StatesYoung AdultEstradiolestradiol cypionateestradiol injectionsestradiol valerategender-affirming hormone therapytransgender

Identifiers

PMID39797602
PMCPMC12641524

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.