DR Z PHD Interviews Dr Kristen Vierregger.
In this comprehensive medical interview, Dr. Z speaks with Dr. Christian Vierregger (Dr. V), an endocrinologist who has been providing specialized transgender healthcare in Orange County, California since 2014. Having seen over 1,300 gender-diverse patients, Dr. V brings extensive clinical experience and a patient-centered approach that prioritizes how people actually feel on hormones—not just what their lab numbers show.
This conversation addresses the critical gap between accessing hormone therapy and actually feeling good while on it. Dr. V explains why understanding medication half-life is essential for anyone on injections, revealing how the standard "inject every two weeks" protocol often leaves patients feeling fantastic for a few days then progressively worse as hormone levels crash—essentially experiencing mini-menopause cycles every two weeks.
Key medical topics include: why oral estradiol gets converted to weaker estrone in the liver (potentially blocking feminization at an 8:1 ratio), the scientific evidence supporting injections over pills for better feminization results, why pellets may be the closest thing to internal hormone production, micro-dosing options for non-binary individuals seeking subtle changes, maintaining sexual function on feminizing hormones, and why current medical research shows no need to discontinue HRT before gender-affirming surgeries.
Dr. V addresses common fears head-on: Will testosterone make you an angry person? (No—if anything, resolving dysphoria often reduces anger.) Will estrogen cause massive weight gain? (No—5-10 pound fluctuations are normal, but significant gain is not inevitable.) She explains how to advocate for yourself with providers who may have outdated protocols, why the informed consent model transformed transgender healthcare, and the critical importance of individualized hormone regimens rather than cookie-cutter approaches.
This interview also explores emerging options like SERMs (selective estrogen receptor modulators) for non-binary patients, the reality that healthy women (cis and trans) should have healthy sex drives, and why adequate testosterone levels (around 25 ng/dL for women) matter for libido and sexual function regardless of gender.
Dr. V reveals why transgender medicine remains so understudied despite growing patient populations—including shocking facts like medical schools spending only 5 hours total on all LGBTQIA topics, and research on women and children only being mandated by NIH in the early 2000s. She discusses her exciting clinic expansion to a comprehensive one-stop transgender health center offering electrolysis, laser, voice therapy, and primary care alongside endocrinology.
This interview provides science-backed, clinically-tested guidance for anyone on hormone therapy, considering starting hormones, or frustrated with their current regimen. Dr. V's compassionate expertise and willingness to listen to patients—trusting that they often know their bodies better than protocols suggest—offers hope for truly personalized, effective transgender healthcare.
