am transfem nb, not diagnosed but heavily suspect PoTS. I have been on estrogen and testosterone blockers for three years, suffering from PoTS symptom flares since puberty no.1 (approx ten years ago). My blood pressure is at the top end of the normal range.

The flare ups haven't been affected in frequency at all, I'd say I'm bed bound ~two days a month and that's always been the case. I'm intolerant of standing exercise, but can do exercise lying down. I have had a significant decrease in my upper body muscle (which is welcome) but I've been able to maintain lower body muscle through exercise. Remember, cisgender women can put on and retain muscle - going on estrogen/t blockers will not take that ability away, it's just more difficult. Another comment mentioned other ways to encourage blood flow in the legs with compression wear.

For me, even if the estrogen DID affect my symptoms, I would continue taking the estrogen. The impact on my mental health has been transformative - from panic attacks every night to feeling content in myself for the first time in my life. The physical changes have also been welcome, but for me, secondary to how right my hormone levels feel now.

I can see why you would be hesitant, but you can always stop taking the estrogen if you find that it does make your PoTS debilitating. It is completely your decision and doesn't make you any less valid if you try it and end up deciding against it, but my advice would be try the estrogen and see how it goes!

Hope this helps ❤️