I went to my therapist the other day and told her about my HRT regimen of spiro/estradiol pills and I asked her opinion on the best time to take them and how to divide the dose. She told something I had not expected to hear. She stated that for optimum feminization, its best to take all of the pills at once (under the tongue) right before bedtime because the body is relaxed. My therapist is Dr. Kathleen Farrell (look her up!) who is very very big in the TG community and she's an expert on our issues, especially with transition.
I just wanted to point this out and hear some feedback! I'm definitely following her advice.
in *theory* that would be best since t levels peak during morning and fall from there
in practice, most want the meds divided into 2 times a day
so the alt would be morning and night estrogen for stable blood serum levels, with all spiro at night to stop the t
my 2 cents
No longer having the "T" factories, I take my Estradiol in the morning and under the tongue. Spiro is no longer part of my regiment.
Janet
I guess my concern would be that if the original prescription was intended to be taken orally, then such things as "first pass metabolism" would have been taken into account regarding the dosage prescribed...and in how high the hormone levels are that the doctor was intending.
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While taking an oral medicine sublingually would certainly boost its potency, one may have to be careful about the other end of the pendulum swing if such a method of administration wasn't discussed with the physician/endo.
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I don't know for sure, since I'm not a medical professional. Anyone here know whether such a concern is valid?
I think the conventional wisdom is divided doses. Taking all the spiro in the evening is interesting, but I dunno. I did, however, look up your doctor and am very impressed.
QuoteThe Power of One Little Pronoun (Spring 2004) by Kathleen L. Farrell, Ph.D. ( Dr. Farrell's experience as a therapist with pronoun use)
It has been over two months since I experienced one of my most embarrassing moments as a therapist, and the memory still stings. In group therapy, I made the mistake of using the wrong pronoun. Strangely, I didn't hear myself do it. But I noticed her retreat. Since it was her first time in the group, after trying unsuccessfully to pull her into the discussion, I decided it was related to a low comfort level and let it go.
After the meeting she asked to speak to me. She seemed angry. I was tired after a long day, but I tried to listen. Despite years of experience in dealing with every kind of emotion aimed at me, including anger and disappointment, I felt myself become defensive. At first I could not believe I had used 'him' instead of 'her.' I was in denial and said, "Are you sure that was what you heard? I am extremely sensitive to this issue. I don't think of you as male. I think of you as female."
Later I would analyze this and recall what I noticed when Margaret came in. The seating was such that I saw her primarily in profile. For the first time, I noted she was right about her nose. Many times in individual therapy, she expressed the desire to have a nose job and she thought her jaw line could be improved surgically. That evening, as the group gathered, I studied her, silently agreeing with her about her nose and disagreeing about her jaw line. I don't remember exactly how I phrased my thought, but it was something like, "She's right, her nose is detracting from a more feminine appearance." In retrospect I am 99% certain my thoughts matched her presentation. I thought of her as she.
From time to time, when seeing a male-to-female who is pre-op and dressed in fem, I have been struck by the thought, "She still has male body parts!" I stay very focused on the gender presentation of the person. As a genetic, right-brained female, it is easy for me to relate to other female brains. This is not to say that I do not notice when someone misses the mark. When Grizzly Adams is sitting in front of me and tells me he is planning to transition, I find myself pondering the improbability and thinking, "Perhaps I could refer this person to a colleague."
Sitting across from Margaret and feeling bad about being confronted, I found myself zeroing in on my feelings rather than concentrating on hers. Lost in denying my culpability, I could neither comfort her nor relate to how upset she was by what she believed she heard. Then something in her certainty gave me pause. I struggled out of my denial, and, flushed with embarrassment, I began a feeble apology. I was so flattened by my own error, I did not process her emotional distress. She left, and I was in shock. Then I noticed she left the book behind that she had intended to borrow. I grabbed it and ran to the parking lot. She was at her car some distance away. I called her name and indicated the book. She shook her head in refusal and quickly drove off. I was left holding the tangible thing that could have brought her back.
A greater sense of disappointment in myself and a lesser concern for Margaret followed me as I went through the motions of closing the office and driving home. I answered the telephone calls that were waiting on my voice mail, all the while thinking about how I had reacted to Margaret. It was not until the next morning, after a sleepless night, that I began separating my feelings and assessing the clinical damage. My thinking became focused on the emotional toll it had cost Margaret, really looking at what I might have taken away from her and how this would affect her self-esteem in her battle to become herself. I hoped this would become an opportunity, since ideally the therapeutic process provides a safe environment in which to open up all emotions and examine them. While I hoped she would make her next appointment, I had a sinking feeling that she would not—that when her therapist slapped her by calling her him that was the end.
You are lucky to have such a person on your side, and on a sliding fee no less.
Honey you really need your spiro, did it show up today?
Quote from: Princess_Jasmine on November 16, 2009, 09:57:35 PM
I went to my therapist the other day and told her about my HRT regimen of spiro/estradiol pills and I asked her opinion on the best time to take them and how to divide the dose. She told something I had not expected to hear. She stated that for optimum feminization, its best to take all of the pills at once (under the tongue) right before bedtime because the body is relaxed. My therapist is Dr. Kathleen Farrell (look her up!) who is very very big in the TG community and she's an expert on our issues, especially with transition.
I just wanted to point this out and hear some feedback! I'm definitely following her advice.
Under the tongue? never tried that before and I've been on HRT for over a decade! and all of the tablets? not sure I wanna take the whole packet at once? ;)
Quote from: Becca on November 17, 2009, 12:22:32 AM
Honey you really need your spiro, did it show up today?
No, but I put in orders at 3 different places, so just a little crazy till it gets here;D-
I can't even freaking imagine what it must be like. A while back I got ocd about this very thing and stocked up on enough hormones to feminise a rhinoceros. Hafta remember to rotate lol.
Quote from: Naturally Blonde on November 17, 2009, 08:25:12 AM
Under the tongue? never tried that before and I've been on HRT for over a decade! and all of the tablets? not sure I wanna take the whole packet at once? ;)
Yes under the tongue but I don't mean the whole packet at once lol I meant your whole day's worth of pills, not month!
I am very lucky to have Dr. Farrell and I thank God for her :)
Quote from: Princess_Jasmine on November 17, 2009, 04:10:08 PM
I meant your whole day's worth of pills, not month!
Presumably just the estradiol, not the spiro and dutasteride I hope?
Quote from: Becca on November 17, 2009, 03:47:36 PM
I can't even freaking imagine what it must be like. A while back I got ocd about this very thing and stocked up on enough hormones to feminise a rhinoceros. Hafta remember to rotate lol.
Lol, I'm gonna sandbag enough to open my pharmacy by X-mas.
Hey Dr. Farrell is my therapist too. Small world :)
Quote from: Becca on November 17, 2009, 04:14:46 PM
Presumably just the estradiol, not the spiro and dutasteride I hope?
She told me estradiol AND spiro. Im not sure what dutasteride is though so I cant comment on that but she said the best time is all before sleeptime.
Quote from: Kieri on November 17, 2009, 06:07:17 PM
Hey Dr. Farrell is my therapist too. Small world :)
Hey thats awesome! She's amazing :)
While there are good reasons to take the E under your tongue, there is not reason for the Spiro or things like Avodart etc that way. You have a great therapist, but she is wrong about that mix. As well... not sure it would be a good idea to dissolve all those at once under your tongue, there might be interactions between the meds. Even safer than the E under the tongue is IM shots. The timing of those is in days not which part of a day, so easy to arrange.
I have heard of Spiro at night to make sure and keep the T level down. I divide mine into two doses, just before bed and when I get up. Seems to work.
Quote from: Valeriedances on November 19, 2009, 07:30:48 PM
I have also been stockpiling since it would be a disaster running out.
A woman after my own heart 8)
My new doc switched me to a slightly smaller dose taken three times a day instead of twice as well. I have to admit I was skeptical but
they have kept growing and hurt more than ever so have faith! You might ask her again about sublingual because I've heard it really helps avoid side effects. How far into the hrt are you?