I strongly suspect the whole thing is nonsense in the way any good convincing nonsense is.
By which I mean, there is some truth to it, but its been dragged out of proportion to the point of being almost a myth.
Allow me to clarify. I am sure it is true that injections have a lower risk of long term complications to your liver. But while that part is true, you have to keep these things in their perspective and context.
If you are a young otherwise healthy person with no outstanding reason to be concerned about hepatic problems, the likeliness of you having any kind of permanent hepatic (liver) complications in the course of oral HRT are pretty unlikely. I mean keep this in mind, the medical community routinely keeps people on oral medications that are specifically indicated as being potentially dangerous above the average to the liver, for years and years. Obviously the reason for this is often that the risk to you from the hepatic complications are not as great or serious as the risks to your health from not getting the medication, which may be unsuitable or cost prohibitive to provide as an injection.
Now keep in mind that bioidentical HRT, and spironolactone (however not cyproterone) is not especially indicated for liver toxicity. Now of course that doesn't rule out the possibility that it can cause liver or other organ damage in the long term or exacerbate damage from other causes, it simply means it is not especially likely to do so compared to other oral medications more broadly.
Now I'm not saying there are never reasons people would be best to use injections over oral medication. Older people and especially older people with existing liver complications or a history of potentially liver damaging behavior (drinking, some drugs, obesity perhaps) may well be serving their health much better to start with and use injections.
But if you're not in one of those higher risk brackets (something you should discuss with your doctor), then despite what you hear, oral HRT is not especially dangerous. It is not risk free either, but risks must be sensibly evaluated with respect to the overall picture.
Using injections when you are have no outstanding risks and injections are costly for your economic status or too mentally distressful for you, simply because oral HRT is supposedly so dangerous, simply doesn't stand up to the science currently available as I've seen it.
Of course by all means you should verify things you read and discuss them with your likely better experienced and trained doctor. Just keep things in perspective.
Then of course there's the question of injected HRT efficacy. Are injections better for your transition goals than oral HRT?
Again I don't think the science stands up. Let me put it this way, ultimately the general point of taking a drug is to have that drug enter your blood stream so your cells can interact with it. So assuming the drug is chemically the same with all delivery methods, or metabolizes into the same drug, and isn't affected by first pass metabolism in a way that would reduce effectiveness. Then provided your blood levels of the drug are the same over a similar course of time, there's no obvious reason one should be more effective than the other.
Ultimately what's required is competent and initially frequent blood tests.
And of course there are many many more subtle factors with all of this, this is only intended to provide a general picture of the situation.
And of course none of this means if you can afford it and injection is your preference that it's not worth using.
