@cloud60 you can customize to what is effective, but it should be at least 6 or 7 clicks out of 8, and that also depends on things like your size. Your doc can test effectiveness. The goal should be full dose. If you cannot tolerate that then a click or two of the pen below 8 is better than nothing and for me, worked well. I am very small though. Ramping up addresses anxiety and also gives the body a chance to get used to the hormone, but the goal remains what is considered a therapeutic dose. I would not waste too much time ramping up. Go by how you feel, but try to tolerate some level of side effect because they tend to ease up.