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

[KayXo]

Keep it balanced. Take it all at once may produce a spike, but could also be dangerous.

I think it depends on individual and dose. Kelly and Sheala have no problems taking it all at once daily and several other women take it this way without a problem. In the end, the doctor must decide whether for that person, taking it once or twice daily is best or doesn't matter. Each situation is perhaps different. 

[KayXo]

Alcohol may reduce concentration of estradiol in the blood by increasing its metabolization. 

[KayXo]

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

Medroxyprogesterone acetate (MPA) and finasteride can be taken once daily because either their half-life is long enough (I think about 30 hours for MPA) or its effects longer lasting in the case of one dose of finasteride inhibiting DHT for quite some time. Both Spiro and estradiol have a shorter half-life in the blood so need to usually be taken twice daily although in the case of estradiol, as already mentioned, once daily seems fine with some.

[KayXo]

My E levels are fine.

Would your doctor be willing to try higher E levels or do they consider this to be risky or perhaps unnecessary? Because I know a few, like me, for instance, need quite high levels, above 1,000 to get really good results. Have you tried injectables? Who knows?! This could perhaps do the trick or even gel??? Just asking and offering some suggestions that you could share with doctor.

[KayXo]

P made no difference except to make me feel like crap.

That seems actually quite common, based on all my readings although a few also report mostly (or only) benefits from it. I'm still on the fence about it...there seems to be some good that comes of out it, some not so good. I take P twice daily. Did you take it once daily because due to short half-life, levels might go up and down too much if taken once daily so that could explain perhaps why you felt like crap...just speculating...or too low dose? taken cyclically or continuously? Was it bio-identical progesterone?

[KayXo]

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

Ok. Noted. Will do. My apologies to you all. Will read entire thread before replying. I was taking one reply at a time lol! Came late to the party, so many posts!

[kelly_aus]

Would your doctor be willing to try higher E levels or do they consider this to be risky or perhaps unnecessary? Because I know a few, like me, for instance, need quite high levels, above 1,000 to get really good results. Have you tried injectables? Who knows?! This could perhaps do the trick or even gel??? Just asking and offering some suggestions that you could share with doctor.

High levels make no difference.. Injectables made no difference.  Given my background and my gyno's experience, I'm confident that we've tried everything reasonably safe..

[AnneB]

First, I am not a doctor, but I do watch one on TV.   He has a cane, and a very sharp wit, works in a hospital in Princeton New Jersey... has a small Vicodin problem.. But that's not important right now..

When given meds (antibiotics, etc) that say, take three times daily... my docs and pharmacists have said, that means every. Eight. Hours.  Not one at breakfast, one at lunch and one at dinner.. unless they are eight hours apart, then it's fine.  If it says take twice daily, means every twelve hours., one, daily.. Well, you do the math.

If you have to take two, one in AM, then twelve hours later, one in PM.

[kelly_aus]

First, I am not a doctor, but I do watch one on TV.   He has a cane, and a very sharp wit, works in a hospital in Princeton New Jersey... has a small Vicodin problem.. But that's not important right now..

When given meds (antibiotics, etc) that say, take three times daily... my docs and pharmacists have said, that means every. Eight. Hours.  Not one at breakfast, one at lunch and one at dinner.. unless they are eight hours apart, then it's fine.  If it says take twice daily, means every twelve hours., one, daily.. Well, you do the math.

If you have to take two, one in AM, then twelve hours later, one in PM.

My prescription simply says to 'Take X daily.'

[Jennygirl]

Ok. Noted. Will do. My apologies to you all. Will read entire thread before replying. I was taking one reply at a time lol! Came late to the party, so many posts!

Yeah if you scroll down under the input box where you type the reply, you will see a history of the thread in reverse order. You can click "Insert Quote" which will append that comment to your input box, and you can reply to it there. That way it is super easy to do a bunch of quotes at once.

The best thing for feminization is a steady, consistent dose that's held up over months and months and months, and one that gets into the blood stream as directly as possible.

^^^ This!

If e is down, t will rebound. Happens with shots, too, according to my endo. That is why he advocates pellets.

[V M]

Is it safe or wise for a helicopter pilot to just crash the bird into an LZ or would it make more sense to land it proper?

[Jennygirl]

Is it safe or wise for a helicopter pilot to just crash the bird into an LZ or would it make more sense to land it proper?

Or how about an extended back massage as opposed to punching someone repeatedly but with less frequency? Same thing right?

[Cindy]

Lets see, a mechanic tells you to change the engine oil every 15,000km we do it. A Doctor tells you how they want you to take medication that they prescribe that can have life threatening side effects so we ask advice on line to unqualified people.

Not sure that is alogical to be honest.

[Jennygirl]

Lets see, a mechanic tells you to change the engine oil every 15,000km we do it. A Doctor tells you how they want you to take medication that they prescribe that can have life threatening side effects so we ask advice on line to unqualified people.

Not sure that is a logical to be honest.

Actually what you describe is quite alogical indeed

[Cindy]

Ooops

To clarify, as we know.

Alogical is not synonymous with illogical in any sense. In the sense of "opposed to logic", where illogical is used for an abstraction (illogical reasoning, illogical decisions), alogical describes concrete subjects (alogical world, alogical person).

[V M]

Just a simple analogy, sorry if it was taken badly

Hugs

[Jennygirl]

So what you're saying is my use of the term alogical is rather illogical?

VM- I thought it was funny, just playing along with it!

And now imma stop hijacking the thread. Sorry y'all!

[V M]

Ah okay, no worries

Back on topic - Follow your prescription as prescribed

With HRT slow and steady tends to get the job done better, doubling up for a higher dose will not equal better results but rather a waste of your prescribed meds imo

[KayXo]

Yeah if you scroll down under the input box where you type the reply, you will see a history of the thread in reverse order. You can click "Insert Quote" which will append that comment to your input box, and you can reply to it there. That way it is super easy to do a bunch of quotes at once.

Thanks! Done.

If e is down, t will rebound. Happens with shots, too, according to my endo. That is why he advocates pellets.

Only happens with shots if not taken frequently enough. Say, once every 2-4 weeks. This is why it's best to take weekly.

I see three problems with pellets. One is cost, very expensive! Two is that levels may actually be too stable causing desensitization of receptors to estrogen. This was, in fact, reported in women given pellets where levels were quite high, between 400 - 1,000 pg/ml and yet they had menopausal symptoms like hot flushes. Third, scars from insertion of pellets. At least, with injections, levels fluctuate more. If prepared by a compounding pharmacy, can be quite cheap and they shouldn't leave a scar. BUT, to inject once a week is indeed much less convenient than just having one pellet inserted every few months.

Follow your prescription as prescribed

With HRT slow and steady tends to get the job done better, doubling up for a higher dose will not equal better results but rather a waste of your prescribed meds imo

Not necessarily. Sometimes, increasing dose can have quite a dramatic effect in certain people. It really depends. I think it's always good to have a second and third opinion, if you think your doctor might not be prescribing in your best interest...doctors disagree even amongst themselves so who's to say who's right and who's wrong? And they do and can make mistakes, they are human after all! But, that being said, in the end, it's wise to stick with the prescription of whoever you choose to be your doctor, give it some time to work and be patient. Opinions and feedback from others on such a forum can be helpful, can assist you in making the right decisions with your doctor but the deal breaker is what your doctor tells you to do and if you're not happy, like I said, find another one who is familiar with treating transsexuals. 

[luna nyan]

I see three problems with pellets. One is cost, very expensive! Two is that levels may actually be too stable causing desensitization of receptors to estrogen. This was, in fact, reported in women given pellets where levels were quite high, between 400 - 1,000 pg/ml and yet they had menopausal symptoms like hot flushes. Third, scars from insertion of pellets.

I'm going to raise a few points here regarding pellet treatment:
1.  For some of us, cost is not the main issue, efficacy and safety of treatment is the main concern.
2.  Where did you get the information re: receptor desensitization?  Is it out of a peer reviewed article or a systematic literature review?  If it is a single paper, what of other ones regarding efficacy of pellet treatment.  What type of E was used in the pellets? Not enough information here for my satisfaction, and I mean this as a matter of academic interest.  I personally weigh the results of a study based on the cohort, the duration of monitoring, etc.n
3.  Scarring can most certainly be an issue depending on genetic background, however a well placed incision that is sutured correctly afterwards with 5/0 or finer will have minimal scarring.  In the right area, it will not be visible 99% of the time.  (Unless you are wearing somewhat skimpy undrgarments and model them...)

Equally, other modes of delivery have their risks.  Oral admin has the increased liver stain,  variability if taken sublingual, etc.  Injectables are technically invasive, poor technique can cause issues, etc.

Thee is no ideal means of administration and I think it boils down to personal preference and the treating endo.  Perhaps someday we can grow the bits required and implant something, but that. Is a long way off, if ever.