A fact that UK trans women should know is that the NHS typically prescribes much lower doses of estrogen than American providers.

https://en.wikipedia.org/wiki/Template:Target_ranges_for_hormone_levels_in_hormone_therapy_for_transgender_women#cite_note-SunderlandNHS2016-10

We don't have lots of good comparative studies of estrogen dosages and methods. We are making this up as we go along. The most comprehensive surveys I know of are made by DIY trans women:
- https://transfemscience.org/articles/transfem-hormone-guidelines/
- https://transfemscience.org/articles/e2-equivalent-doses/

We don't know what the long-term effects of different hormone regimes are going to be. We don't know what factors make different bodies respond differently to regimes. We have patchwork guidelines and community information.

All transition is DIY transition. Any doctor who tells you there's one right way to do it and they know what it is is lying. To get what you want, you need to talk to your community, do your research, put your safeguards in place, whether or not you have NHS support.

Good doctors can provide helpful information, medical knowledge and support. Bad doctors can provide false certainty and damaging treatments. The same is true of strong and weak DIY communities. All transitions deserve strong, informed, affirmative support.

Ordering a random trans pill off the internet without checking up on it with your sisters is highly risky. So is going to a random gender psych without any prior research or community support.

One of the worst effects of the "DIY is really dangerous!" narrative is the false belief that the NHS is safe. The NHS does not typically provide informed, affirmative transitions. We need shared information, harm reduction startegies, &community support, however you transition.

I don't know whether US-typical dosages are necessarily better than UK-typical dosages! I can tell you what I'm doing, if you'd like to talk, & I can show you where I go to learn more. & we can campaign for better research, informed consent, & affirmative support.

Some morning notes:

(1) NHS guidelines vary region to region, GIC to GIC. I'm finding evidence of a shift towards international standards on this, but also regions still recommending lower ranges. I'm not saying "the NHS is always too low"; I'm saying there's questions to ask.

(2) I'm definitely not saying that more estrogen always equals a better transition, and please don't up your dosage on the basis of this one thread. High estrogen levels have risks, and can cause transition issues as do low levels, and "high" and "low" vary body to body.

(3) But I am saying that if your levels are at the lower end of these ranges, and you're not experiencing the physical changes you want, and/or your mood and energy are low, then aiming for a higher E level might be something to look into, and to talk to docs/communities about.