Trans fem HRT

Estradiol

In Spain there are 2 types of commercially available estradiol for trans fem HRT:

1. Pills
2. Transdermal

Pills

1. Progynova 1 mg: estradiol valerate
2. Estradiol Meriestra 2 mg: estradiol hemihydrate
3. Climen: combination of estradiol valerate + cyproterone acetate

Some doctors can write a prescription for a fórmula magistral, so that a pharmacy prepares “custom” pills specifically for you. This is unusual in general, but happens often at Trànsit in Barcelona.

Transdermal

1. Lenzetto spray: price is regulated and covered by the SS, but there is currently a supply shortage in Spain
2. Estradot patches: price is regulated and covered by the SS
3. Oestraclin gel: not covered by the SS, and the price is not regulated

Injections

There are no commercially available estradiol injections in Spain, and doctors generally recommend avoiding them, especially in the public system. However, it’s possible to get them prepared by a pharmacy lab as a fórmula magistral. For this prescription, you need to find a doctor who is willing to write it.

Anti-androgens

There are many drugs on the market, including DHT blockers, so I’ll only describe the main ones usually prescribed for trans fem HRT.

1. Androcur 50 mg pills (cyproterone acetate): one of the most common choices. Price is regulated and covered by the SS. Easy to get from your family doctor if you have a medical report listing it as your current treatment.
2. Triptorelin injections: another common blocker, available in 1-, 3- and 6-month doses. Some versions are price-regulated and covered by the SS, but it’s expensive if you buy it without insurance coverage.
3. Bicalutamide pills: available, but not a usual choice for providers
4. Spironolactone: available, but not a usual choice for providers

Cyproterone and meningioma

Since 2020, the European Medicines Agency has restricted the use of cyproterone because of the risk of meningioma (a usually benign brain tumour). The risk increases with higher doses and longer use, so doctors now aim for the lowest effective dose. Talk to your doctor about your dose.

Progesterone

Available in two forms: soft capsules (cápsulas blandas) and gel for use on the skin.

1. Utrogestan soft capsules (registered as vaginal capsules): 200 mg, 300 mg and 400 mg. Only the 400 mg pack of 15 capsules is covered by the SS; the 200 mg and 300 mg versions are not.
2. Seidigestan soft capsules: 100 mg and 200 mg. The 100 mg version in small packs is covered by the SS
3. Progeffik soft capsules: 100 mg and 200 mg. The 100 mg version in small packs is covered by the SS
4. Darstin topical gel: not covered by the SS