Allergic Response to Estrogen

[Tori]

I am on estridiol Valerate shots, biweekly. Switched from cottonseed oil to sesame oil. Same reaction.

Advice on what I should try next?

This is really bumming me out.

[justpat]

  I am sorry Tori that is a bummer and I don't have an answer. I am on patches since Christmas day don't know if they are working but I seem to be tolerating them ok.Good luck, some one will have an answer.

[DrBobbi]

Hives? What's you allergic reaction? You can try the non-generic (Brand) version, if that doesn't work try Alora Transdermal bi-monthly patches. Your adverse reaction can be caused by the delivery method. There's always pellets. If over age 40 you want to avoid oral estrogen because of risk of DVT or stroke. And if you're a smoker--Quit. Smoking and HRT is a deadly combination.

Here's the disclaimer: As always, check with your doctor for ALL MEDICAL ADVICE. If you feel you need to see a specialist see an endocrinologist specializing in HRT. 

[Tori]

I am nearing 40.

The reaction? Redness around the injection site. No hives thankfully. I got a shot in the upper arm, for five or so days, my entire bicep turns red, is hot to the touch, and hurts. Arm hurts to lift and sleep on. Butt injections are a pain in the a**. I have dealt with worse pain but it does not seem normal.

Other injections and blood tests do not seem to cause problems.

What really sucks is HRT is working, but allergies do not tend to get better, they either stay the same or get worse. Apart from the red sore area, my body and mind loves it.

Now, I am not looking for a Dr's advice here at Susan's. Just options. I am looking for ways to budget this with the least chance of lasting side effects. I will be consulting with my GP about this, I just like to do my homework before I talk to him when possible. Also, it may ease my mind, since I am pretty bummed out right now.

See? I can't remove a bi weekly injection. I have to ride it out... but it is localized, I fear a reaction to a pill, but I imagine it would not last as long. Don't want to implant or inject anything else unless I know I am not allergic... if that is possible.

And no, I do not self medicate. My insurance has covered me so far, and I fear that testing every estrogen on the market may set off some alarms that will get my coverage denied.

[DrBobbi]

Don't worry about your insurance company. Allergic reactions are a real concern, however redness, as you describe at the injection site is common. The buttock should be your best bet. Pellets are my personal favorite, lasting about two to three months and providing an even release of estradiol. Once you have SRS, the dose is substantially reduced to normal pre-menopausal levels. Hope this helps with your GP.

[Tori]

It helps ease my mind. Thanks. Do you know what form of estradiol is most commonly used in pellets?

But really? 5 days of redness and pain in a muscle is normal? If it is, thank God I do not get weekly shots!

[DrBobbi]

It can be, especially with the viscous oil suspension in a small space like the biceps. I personally experience localized hives twice a day from the injectables. Worse with exercise...I just grin and deal with it. Them the breaks. It does get better post SRS.

[Catherine Sarah]

Hi Tori,

......... Do you know what form of estradiol is most commonly used in pellets?

From what I've heard about injectables, this can be a common reaction. Implants are made from a bio-identical micronised oestrogen. College Pharmacy in Colardo should be able to provide more accurate information.

Hope you can find relief.

Huggs
Catherine

[Cindy]

I had a massive reaction to oral E and my endo, very experienced in trans medicine, put me on implants, best thing since sliced bread IMO.

[Tori]

*A note, every time I tried to post this i would get a new reply, I kept adding to this post to address the replies, some of it may now be a bit out of sequence. Sorry for the confusion.*

To clarify, can I get some feedback on pain and redness around the injection site?

I have been under the impression that it should be minimal, and not last very long. Instead it grows for four or so days then reduces on the fifth, and is mostly gone by the sixth.

I showed my arm to my therapist today, he saw how red it was and this was after taking an anthistamine.

My GP also thinks this is not normal. This is why he switched me from cottonseed to sesame seed.

But, perhaps I am being a baby. Further feedback from people familiar with injections would help a lot. Is this common? The last time I made a thread about this, everybody who replied seemed to think my reaction was abnormal.

I am getting mixed signals here.

Thanks though, I can handle the pain, it is the fear of being allergic to the very cure to my dysphoria.

Dr. Z, shots in the butt react similarly. Perhaps the pain lasts a day less, probably due to muscle concentration there. But I sit and sleep on my butt. My arm gets much less torture.

I do not have a particularly low pain threshold. When I say it hurts, it hurts. It is hard to reach for things like an itch on my back. I'd rather cope with the itch. But if this is normal, I can cope with it too.

Catherine, thank you. I will take a good look at that site.

Cindy, I would love implants, I just do not know if they would be covered. Getting free coverage in the USA is a bit of a balancing act.

[DrBobbi]

It's fairly normal to have some swelling and redness at the injection site. This can last from 1 to 5 days because of the viscosity of the injected hormone. Because I can't see what you see you have to rely on what your GPA is telling you. Your GP is better equipped to deal with your concerns. It sounds like you're a candidate for pallets. It is a very minor surgical procedure that last just minutes. There is no pain involved. There can be localized swelling from the incision. There have been instances where there's been an inflammation caused by a progesterone pellet added to the trochar needle injection. The real concern is when the physician inserts a trochar needle to close, or over the sciatic nerve. Other than that, pallets are a very safe and efficient way to have your estradiol released into your system. Pellets usually last for two months, however three months can be possible. Some physicians believe that injectables offer a better method for maximizing the feminization process. But, there are no long-term studies to support this. It's just experience.

And, you should voice your concerns to your GP and do what he suggests. If you have any concerns about the experience of your GP and delivering hormone replacement therapy you should consider consulting with an endocrinologist specializing in hormone replacement therapy. Good luck and have a nice transition.

[DrBobbi]

Sorry about spelling errors :-( I use The dictation tool. Pellets, Too, and GPs can be male and female...sorry, but SIRI is not only a bad speller, she's also sexist.

[Tori]

My Doc is male, so SIRI was right about that one.

There is one other Doc in my town with more experience than my current one. Unfortunately, he is not taking new patients right now.

My current doc is known through my local trans community and he works on informed consent, which is a good sign that he treats his share of trans folk. He has the forms ready to sign, and the vials of E in his cabinet.

He is fairly young but he is passionate about treating trans patients. When I called him the first time, he said he didn't take my insurance, so I explained I was MTF and perhaps he could suggest someone else. He said, "Oh, I treat trans patients, we'll work something out."

He also, does his own endo work... for me, so far at least, so I do not need to see yet another person. This is convenient, and less confusing than listening to multiple medical opinions.

I think I will schedule a brief meeting with him like 4 days after my next shot so he can see the redness. Perhaps ask him to check with his other patients and see if they have similar reactions and just keep mum about it.

I have a few options here, but I live in Honolulu so it isn't like I can drive to the next state.

At least I now have a feeling this reaction is not the beginning of the end of my HRT.

Thanks Dr. Z for talking this out with me. Pallets or pellets.

[Beyond]

I fear a reaction to a pill, but I imagine it would not last as long. Don't want to implant or inject anything else unless I know I am not allergic... if that is possible.

Nobody is allergic to estrogen.  Everyone on the planet has estrogen in their body.  The problem is there is something in the base mixture that you're apparently allergic to.  You can try another base OR another method of administration (pills, patches etc).  For the record I have NEVER heard of anyone being allergic to the pills.  I have heard of some people being allergic to the adhesive used in some patches though.

[Tori]

People can be allergic to most anything.

Some allergies are more common than others. Some more or less intense than others.

Some you never hear of because the victims all die quickly.

I agree, allergies with my medication do not seem like the reaction to my naturally produced estrogen. Seems like the real stuff works fine. At least on me.

A couple years ago, we had a member who was allergic to a great number of treatments before finally finding something that worked. By her story, she was running out of options.

While I am coming around to thinking my reaction is not THAT bad, these types of allergies can and do happen.

I have also heard of a number of cis women who are allergic to their own hormones.

Just because your body makes it doesn't mean you can't be allergic (yay, a double negative). I was born with a penis, look what it got me.

[Tori]

I just wanted to give this thread a bump while a new crew of posters is online.

I am looking for multiple opinions, that is not to say the opinions I have already been given are bad. I just want as many as possible.

Thank you,
Tori

[stephaniec]

Patches work fine for me

[Jenna Marie]

It sounds like a reaction to the suspension used for the estrogen, yes. While it's not impossible to have a reaction to estrogen alone, I suppose, my suggestion would also be patches - totally different administration suspension (=the adhesive rather than oils), equally safe for the liver, and unlike injections and implants and creams, if you DO have a reaction you can yank the patch off and scrub down with alcohol and be safe from further exposure.