Community Conversation > Hormone replacement therapy

Gel vs Patches vs Pills

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Mandy M:
Hi everyone,

I realise this has probably been discussed to death but I wondered if folks could give me their latest thoughts on patches vs gels vs pills?

I'm currently on a morning regime of Sandrena gel which is great but I find takes a good 30 minutes to dry. I can handle that within my morning coffee routine but there's no way I'd want to repeat a gel again in the evening. It's just not practical for me. So at the moment I'm also taking a pill of estradiol valerate in the evening: swallowed, not sub-lingual partly because I really don't like the peak and trough that I think sub-lingual gives.

There was some discussion with my therapist as to whether it matters about mixing different methods? Has anyone done that I wonder? And of course also the perennial issue of whether EV is a blood clot risk.

So the question of patches was also raised and whether I would be interested. I might be but the one thing I definitely want to avoid is peaks and troughs. I get very anxious if my hormones dip as I've had bad experiences of getting spaced out.

Any thoughts, shared experiences, medical science, personal journeys etc. etc. very very gratefully received.

Thank you in advance :)

xx

Jessica_Rose:
I have been using patches since the start of my journey. Compared to pills, gels, and injections, I think patches deliver the most consistent dose of hormones. With regular use there should be little issue with peaks and troughs.

Some people are sensitive to the adhesives, and others have had issues with patches falling off due to excessive moisture (sweat, long showers). The only issue I have experienced is that there is usually some adhesive residue left behind when a patch is removed. Judicious use of baby oil helps with cleanup.

Love always -- Jessica Rose

Rakel:
I am an advocate of sublingual, mainly for economic and availability reasons. I do not endorse swallowing any form of Estradiol since most of the Estradiol is metabolized into inactive molecules during the first pass through the liver. Sub-lingual, topical gels, patches and injectable forms of Estradiol all avoid the first pass through the liver.

Since you mentioned that peaks and troughs really upset you, then patches are your best bet. They give the most consistent blood levels and are considered the safest form of HRT.

Estradiol Valerate is a form of Estradiol that is not active until the Valerate portion of the molecule is cleaved off in the body. The remaining Estradiol is bio-identical and the cleaved off Valerate portion has not been known to cause any problems.

Basically your choice depends on what is most important to you, consistent blood levels, sticking yourself with needles, or wearing a patch for several days. The important thing is to maintaine safe blood levels as prescribed by your doctor.

Mandy M:
Thank you both!

Some of the wariness around oral administration of estrogen appears to be a throwback to the bad old days of conjugated estrogen. Blood clot risks are much lower with bio-identical estrogen and as I’m sure you all know, there is currently quite a movement to kick out what are seen as old-fashioned prejudicial views about this, often perpetuated by male doctors acting as gatekeepers over women’s health.

My concern about sublingual administration is not just that the pills are not designed to be taken that way (i.e. no clinical trials) but that it is is proven that it gives a much sharper concentration spike, typically within the first hour of administration and then a rapid decline after 3 hours. Oral administration is much more steady with less of a peak and trough experience. Anecdotally I certainly notice this. I used to take estrogen sublingually for about 3 years and I came to notice a big dip and trough 3 or 4 hours after administration. In terms of the pharmakinetics, because estradiol validate is micronized, there’s a much better bioavailability of estrogen. The fact remains too that oral administration is by far the most common route by which cis women take HRT.

Whilst I like the bioavailability of gel, I do find it quite a faff to be honest. Sandrena does NOT in my experience dry in 10 minutes as the manufacturers claim. It takes a good half an hour and it has to be applied to the inner thigh or abdomen which is a pain in the proverbial frankly. There is no way that I would do this in the evenings as well: that would be an hour a day sitting somewhere half naked waiting for the stuff to dry. It's just not practical and isn't exactly helpful for wellbeing.

Therefore that’s really useful information about the patches. I take it that we’re talking about the second generation matrix patches rather than first gen reservoir ones? I really like the sound of the consistent delivery of estrogen and having looked at some links and graphs this does look like an excellent method for me. Thank you so much for advising this as a possible route, which echoes what my treating therapist has suggested. For some reason I had it in my mind that you get a dip as the effects of the patch start to 'wear'. I think this is because I had something similar when I used to take estrogen subcutaneous injection (Depo-estradiol): I used to get a massive estrogen surge followed by a decline so that by the end of the timescale I'd be on virtually zero hormones. Argh. Horrible!

All-in-all it seems to me that given your very helpful advice it would be good for me to take up the patches suggestion. I see my endocrinologist in 6 weeks and I will take forward this advice. My treating team are aiming for a range of 400 to 600 pmol/L and ‘certainly above 300 pmol/L.’

Thank you so much.

xx

Kalandrina:
Hi

I don't find any issues with the sandrena Gel, it dries fairly fast and you can basically apply it anywhere according to my specialist. I tend to use the thigh and arms, the only issue i find is the annoyingly small sachets and the rubbish.
I prefer using the Oestrogel Pump, which is cleaner, dries faster and is not so messy, and comes in a lovely Pump Pack that lasts 64 pumps :)

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