As always, I’m not a professional and anything I say is just suggestion based on my own research and personal experience…
Firstly, there is a saying here, you just have to “suck it and see”; you can’t know how hormones are going to affect you until you try them, but I do believe that one should attempt to maximise one’s chances of good feminisation.
From your description it sounds like you have a lot going for you, genetics play a large part in breast development. Being tall and slim though might not help, so don’t be afraid to eat. Avoid junk food, lots of sugar, saturated fats, and alcohol.
As for man-boobs, a good hormone regime should produce natural looking female breasts (genetics allowing), so don’t worry about that. Actually everyone has the blueprints for female breasts, but only females tend to get them because of their prolonged exposure to high estrogen levels. Some men get man-boobs because they get fat and perhaps have high phytoestrogen intake from copious quantities of beer. Perhaps some of the pictures you have seen are of not fully formed breasts, it can take 7 – 10 years to get full development. I’m about a double A cup after nearly 2 and a half years. That’s very small, but I’m happy with the shape and I certainly don’t think they look at all man-like. I do hope they will get bigger of course, but I don’t stress about it and am determined not to have implants, which everyone should be aware do not last forever. If you have surgery at your age, you’re going to need several revisions/replacements throughout the course of your life.
It’s not uncommon to see TS’s with conical shaped breasts, I believe this is a result of growth being too fast and/or lack of progesterone. Ethinylestradiol and Premarin can give quicker results; seemingly more effective, but not necessarily better in the long run, and they have serious health risks associated with them. Sorry to anyone who takes these, but I personally would avoid them.
Go bio-identical if you can: 17-beta estradiol and micronised progesterone. Avoid Provera (medroxyprogesterone acetate), all sorts of problems and side-effects reported with this. Generally I’d say your intended regime is on the right lines. Start with a low dose of estradiol and ramp up gradually (I take Estelle solo or Estrofem and I use an estradiol gel, all of which are 17-Beta). I took 2mg for 6 weeks or so, then 4mg for another 6 weeks, then 6mg, then eventually added the gel. If you notice good development on a low dose then stick with that. Most importantly – everyone is different. Measuring estradiol levels in the blood is of little or no use, there is no test for sensitivity to estradiol, no test for estradiol receptors; the only way to monitor how effective your feminisation is going is the obvious – be aware of the changes to your body and of how you feel mentally and physically. Other blood tests are recommended, such as liver function, prolactin etc. and potassium if you are taking Spiro.
Spiro: I took this for a year. I think at my age (early 40’s) it’s of little use, which is why I stopped. A reasonable dose of estrogen will severely inhibit testosterone production, my blood tests reflect this (keeping an eye on your testo levels is of more use than watching estradiol levels). One possible advantage of Spiro is that it may reduce DHT conversion, the hormone responsible for male pattern baldness, but Finasteride will do that too. See how your testo levels are, and how they change after a few months of estrogen, and you may decide the Spiro is unnecessary. THE most important thing about Spiro is to avoid any foods rich in potassium. Find out what they are and do not eat them at all, Can’t stress this enough. Excess potassium causes hyperkalemia which can be fatal. Spiro is potentially the most dangerous drug in your intended regime for this reason, do be careful. Apart from feeling I didn’t need Spiro, I missed my bananas!
I’ve posted some pics showing the progress of my breast development here. Very modest development as I’ve said, but they are still growing, albeit slowly. I’ve recently increased my estradiol dosage, and this seems to be helping. Some people need more, some people need less, just gotta suck it and see.
Good luck, Ivy, and please let us know how you get on.
xx

Joanne, the Oestrogel I used to get came in pump-dispensing tubes giving a measured dose of 0.75mg estradiol. I’m not sure if this has been discontinued now, but Inhouse Pharmacy now only supply regular type tubes, no pump-action. Instead you get a little ruler type thing with a groove in it, onto which you squirt a line of the gel. Not as accurate, but I guess it’s not that crucial. I’m trying to keep a check on how long a tube lasts, to see whether my lines of gel are the right thickness/length; if I use 4 squirts a day, a tube should last 26 days, I think, but can I be bothered…?

Ivy, I didn’t mean to scare you about the Spiro, but you do need to understand what exactly it’s doing to your body, and what you need to do to minimise any risks. Google “potassium rich foods” or something like that, and be prepared to give up those foods. Drink lots of water, and I seem to recall something about sodium intake, can’t remember whether you need to eat more salt or less, but the point is you need to research this sort of drug for yourself completely, before taking it.
Whether or not you need a higher intake of estrogen if not on an anti-androgens, may depend on your testo levels to begin with. As a general rule of thumb I would say that anti-androgens carry higher risks than estradiol, but they may be beneficial if you have high testo levels.
The right form of estradiol, if taken in the safest way should not carry many risks. Patches, gels or injections containing 17-beta estradiol are by far the safest form of HRT. It’s important to note that a lot of the supposed risks of HRT are based on old studies using such drugs as Premarin and ethinylestradiol. Even oral 17-beta estradiol is far, far safer than these forms of oestrogen.
Why, in this day and age, anyone would want to put horse oestrogen into their bodies is quite beyond me, but I digress…
You shouldn’t need a particularly high dose of estradiol to lower testo levels either, and you’ll know when it’s being achieved. I know of one girl who takes 14mg per day estradiol though, and swears by it, and has done for years. What’s more she’s post-op. I’m not saying estradiol is completely safe in high doses, that would be irresponsible, but I do believe it’s not as dangerous as some people seem to think. Not all HRT is the same!
Anyway, I think you’re being very sensible about your regime. Research as much as you can, and try to get your blood tested about once a year. Liver function is something else to watch out for when on orals.
Best of luck with it all.
xx