Just to reiterate, bio-identical estradiol, even delivered by way of pills, does not, at least in those doses typically prescribed to us, adversely affect liver function/health. Alcohol is, by far, more toxic to the liver. What it does affect and only very slightly is clotting since when estradiol passes through our liver, it triggers change in the production of clotting enzymes/proteins so that clotting is increased. So far, I have seen no mention of use of oral bio-identical estradiol leading to increased risk of DVT or pulmonary embolism. The only studies that have found an increased incidence have been with forms of estrogen that are NOT bio-identical (like Premarin, conjugated estrogens and Ethinyl Estradiol), often combined with progestins that are not the same as bio-identical progesterone. We cannot base ourselves on those studies alone since the form of estrogen is quite different and affects clotting to a much larger extent. When your doctor does mention this to you, ask them what they base themselves on for asserting this and you will see...
Bio-identical estradiol delivered non-orally does not affect clotting or increase risks but the difference with oral is very small, even perhaps insignificant. The advantage of non-oral is a higher ratio of estradiol to estrone and whether this more favorably affects us, our feminization, our health is questionable. Oral bio-identical estradiol also results in steady levels over 24 hours, even if taken once daily so in that respect, estrogel is no better or worst. Some even contend that a slight fluctuation of levels over time is best as this may avoid desensitization of cells to too stable levels of estradiol.
