Is it safe or wise to take all HRT pills at once?

[luna nyan]

I'm going to make a few comments and then leave this thread alone.

1.  There is a reason doses of medications are spread.  It is to maintain sufficient plasma levels for efficacy, and also to lower risks.
2.  These are not magic pills - they take time to work - if one mode of delivery does not agree with you, then look at switching.
3.  Changing the way you dose according to advice on this forum is not advisable.  We have no idea what your dosages are, what state your general health is, and what your full blood assay results are like.  Also from a legal point of view, we cannot advise, only make suggestions for you to discuss with your health care provider.
4.  Depending on your dose, if you do spike, you risk your liver.  Not good, not advisable.  You are going through all this to improve your quality of life, not to destroy it.

I'm really sorry if I offended anyone, but I do so on the basis of caring about the long term results.
Luna

[kelly_aus]

I should probably add that all modifications I've done to my HRT have been done in consultation with my doctor.

And just to add to my previous post, I had an implant, levels came back about the same as my levels while on pills.

And, Grace , my sub-standard results? Minimal facial changes, fat still accumulates in male places, breast development ceased before I even got to a AA cup..

Body hair is no longer a problem, but that's attributable to the Androcur I take..

[Jayne]

I don't know about the effect spacing tablets out will have so i'll trust what others have said.
With regards to taking all your pills, DON'T!! When it comes to medical matters either discuss with a GP or Pharmacist. If you don't trust their opinion then please trust what Jessica has said, out of all the people I know on this forum she probably has the most experience with all things medical, I would trust her advice in medical issues (& most other issues) above all others.
That girl has a good head on her shoulders.

Edit: If I took all of my pills at once my GP would refuse to prescribe more pills until the date they were due to run out & if that happened to you you may find yourself having to go without for a prolonged period.

My GP insisted that when my last prescription ran out I should have had 10 days worth left even though i've stuck to the dosage they've set, I don't know if someone screwed up or I lost a strip but it meant I had to go 5 or 6 days with nothing & it was horrible.

[kira21 ♡♡♡]

Yep, medical practitioners say to space them. That's what ltls doc said and everyone has said that they are very likely to be right in doing that and ltl should listen to them. :-)

[Sheala]

Yep, medical practitioners say to space them. That's what ltls doc said and everyone has said that they are very likely to be right in doing that and ltl should listen to them. :-)

I wouldnt go as far as to say all, cause mine left it in my hands to decide to space or not. I tried spaced to start with now take just in AM. I have found, and this is just me, no diffirence between the two.

[kelly_aus]

I wouldnt go as far as to say all, cause mine left it in my hands to decide to space or not. I tried spaced to start with now take just in AM. I have found, and this is just me, no diffirence between the two.

There's 2 of us who had no difference, Sheala...

And my doctor told me to take them all at once - it was my suggestion to space them..

[Megan Joanne]

Keep it balanced. Take it all at once may produce a spike, but could also be dangerous. I had been off of the hormones for over 2 months, finally got back on them yesterday, going from injectable to pill, and just with that very first one, it was a big scary jolt to my system. Even now after my second pill with no crazy shocking effects, no way would I ever think to taking more than one at a time. This is some potent stuff, not to be messed around with. I can understand your impatience with results, see any posts regarding how I felt the past 2 months, I was starting to go into the deep end. But I'm on the hormones again, finally, and now that my mind is where it should be, the rest will come in time. Rush it and you can make a grave mistake.

And injections may put it all in you at one time, but is delivered throughout your body in a gradual process, so there is a big difference with taking that and popping a bunch of pills at once.

[Megan Joanne]

Hey all,

According to my therapist, taking them together could mimic the spikes of injections and that intrigued me a bit.

That therapist of your's is wrong, he/she should not be giving out medical suggestions, wrong field of study. Leave that to a qualified doctor, or common sense. Keep safe, give it time, you'll be alright.

[Hideyoshi]

Fwiw, I space my estradiol and Spiro. I take my finasteride and medroxyprogesterone in the morning since the pills are a pain to break.

I feel like it would be better to eat a smaller meal twice a day than gorge on a huge one once a day :p

[Rachel]

I follow the directions on the bottle with one exception. I do sublingual for E and P

[KayXo]

I was wondering if there is an benefit to taking all hrt pills at once rather than splitting them throughout the day.

Since half-life of oral estradiol is about 14-17 hours, on average and MUCH shorter on sublingual, taking them once daily, even orally, will result in levels that fluctuate much more which could, in some, cause highs and lows in mood. I'm assuming you want to take it all at once to perhaps cause that very fluctuation to hopefully increase bodily response/sensitivity but since you are already taking pills sublingually, even thrice daily, that fluctuation is there already and is pretty significant, so really what is the point? You get peaks 3 times a day already.

According to my therapist, taking them together could mimic the spikes of injections and that intrigued me a bit.

By taking them sublingually, you are already having spikes. With injections, spikes and declines will actually be much less compared to sublingual with high levels persisting for much longer and estradiol exceeding estrone all the time vs 1-2 hours after sublingual intake.

[KayXo]

And I hate to say this, LtL, some of us just don't react well to E, regardless of delivery method, levels, etc.. I've had quite sub-standard results and nothing my dr and I have tried has made any difference.

The only thing I can come up with is perhaps that dosages are too weak, still and should be increased to give better results BUT only if your doctor deems it necessary and without risks. What has your doctor said so far in regards to results? Would she/he be willing to increase dose? Have you discussed this with him/her?

[KayXo]

Thanks for the honest answer.  Yeah, I fear I may be less receptive to E than others.  I'll likely give the 3 pills at once a try and go to a follow up appointment to see about injections.  Somethings got to give at this point.  I've offically been taking E for a year with poor results to show.

Until you haven't tried other routes or perhaps higher doses (or even adding progesterone, for instance), with your doctor's agreement, you cannot say this for sure. There is still much to be done, I think. Just switching to injectables has done plenty for me!

Checking levels of E on sublingual is of little use given the fact that levels increase and decrease so much over 24 hours. Levels can also be misleading as the same level may do lots for one person and yet nothing for the other. HRT should be tailored, I think, to the individual and their own particular situation which I assume your doctor is doing anyways.

[kelly_aus]

What were the delivery methods you used? And were the doses high enough? I know doses cannot be mentioned here but perhaps this should be discussed with doctor. Have you really tried everything is what I wonder...have you taken bio-identical progesterone? What is your anti-androgen, if any? Have you tried another? Were doses of the AA effective enough? Again, something to research on your own and discuss with your doctor. Please don't mention dose of AA here.

My E levels are fine. My T level is perhaps a tad lower than either my gyno or I would like.. P made no difference except to make me feel like crap. I just haven't reacted the way wither I or my gyno expected. My general health is fine. Weight diet, etc is also fine..

[KayXo]

When I used to be on injections of Primogen Depot I had minimal breast growth, and the only noticeable effect was that I was an emotional wreck... that's my experience with a form of spiking. These days I'm on regular oral doses and also have an implant - that's a constant stream of E 24/7 straight into my blood - and I've had more breast growth and feel more emotionally stable than under any previous regimen.

Could be that the dose given intramuscularly was either not adequate (too low) or spread out too much. Usually, it's best to take weekly and many women complain of feeling down after 10-14 days due to a significant decline in levels. But, whatever the case might be, what matters is that what are you taking right now is working for you. Good. You are making a good point though that injectable might not necessarily give better results. It will depend on the individual (sensitivity, metabolization) and also the dose, how frequently it is taken, etc. You also make a VERY good point about expectations. Could be that expectations are TOO HIGH.

Injectables really has been good for me, thus far. No complaints, much better than oral. I take them every 5 days to maintain a certain stability in levels. I've never been on pellets though.

[KayXo]

But seriously, my levels are low.  That's a problem and probably why I'm experiencing so much difficulty.

Levels are not always low. They are probably much, much higher the first few hours after you take your tablet sublingually so if you took an average of your levels during 24 hours, you would probably get a VERY different picture. This is why there's no point in taking levels on sublingual. In any event, results are the main criteria that should be used, I think. If you are getting no breast development, still have very little in the way of feminization, then I can understand your concern. Hopefully, a change in dose or route of administration as suggested by your doc will do the trick.

And it's hard to compare because you do have the implant.  Those seem to work very well, so that might be why you are having even more benefits.  But I want the spiking in order to finally have normal levels for a bit.

Implants and oral, quite different. The estradiol:estrone ratio is very different, even how stable levels are, especially if you take them sublingually. I think implants also give usually much higher levels of estradiol, on average vs orals at the doses we usually take them.

[KayXo]

But isn't this true of the injections as well?  Is there a difference between the injection and pill route is this regard?  I honestly don't know.

Levels remain significantly high usually for 6-7 days. There is a peak the first couple of days but still, levels remain quite high after. Not like sublingual at all where within just 2-4 hours, levels go up and down significantly. 

[KayXo]

from my understanding injection is a larger initial dose with a much higher high, bo then tapers off throughout the time untill your next dose. pills have less high and less low.

Unless taken sublingually...

[Hideyoshi]

Not to derail the thread, but Kay, pls combine all responses into one post, and not septuple-post, ya do this a lot :p

[KayXo]

Yep, medical practitioners say to space them. That's what ltls doc said and everyone has said that they are very likely to be right in doing that and ltl should listen to them. :-)

I only know of one doctor who told their patient it was ok to take it all at once daily and so far (several years), the woman in question hasn't complained and is doing well on this. Many menopausal women also take it once daily, as prescribed by their doctor and recommended in leaflets that come with pills. So, it does vary quite a bit...but usually transwomen take their pills twice daily due to half-life.