Starting HRT and what to expect

[Alora]

Hey ladies,

I'm getting really excited, I have my appointment with my doctor to finalize my blood work and go over paperwork and then I get to start HRT.

I know it comes down to personal preference, but my doctor said that I have 3 choices when it comes to meds: oral, patch or injectables. In your experiences, what kept your E levels the steadiest? What were some of the first things you noticed as far as changes go: mental or physical? How long did it take before you started noticing breast development.

Thanks ladies

Loves 💋❤💋

[Inarasarah]

I have been doing injectables for years now and love it, but there has been a national shortage lately, which sucks big time.  My local pharmacy found me some, somewhere.  My backup is the sublingual, but I definitely feel injectables work better for me.

[Michelle_P]

Hi, Alora.  Getting started with HRT is a big step, and pretty exciting.  It wi what had the biggest impact on my state of mind.

Generally, the patches will give you the steadiest level of estradiol.  Drawbacks are keeping the pesky things in place, as the edges will catch on clothing and cause the patch to lift.  I use some taping tricks to eliminate this.

https://www.susans.org/forums/index.php/topic,215714.msg1910024.html#msg1910024

Other patch drawbacks are the cost, about $10 a patch if you are paying the bill.  Insurance may help.  The strongest patches are still aimed at treating post-menopausal and oophrectomy/hysterectomy patients, and only add roughly 50-80 pg/mL serum estradiol in many cases.  In a AMAB body, there is precious little to start with and one patch is unlikely to do the trick. (I never got above 50 pg/mL.)  I'm currently on two twice a week patches at a time, $40 US a week in patches.  I'll get the level re-checked in February.

Pills are cheap, but they put a bit of a load on the liver as oral delivery involves a first pass through the liver that patches and injections bypass.  Delivery can be fairly smooth, particularly when splitting a dosage to take the pills twice a day.

Intra-muscular injection is cheaper than patches, and you KNOW the stuff is getting into your system, very reassuring.  It has the largest swings in serum level, when given at the typical 14 day interval.  The doctor can prescribe more frequent, smaller injections, which smooths things out, but means more trips to the doctor or injection center unless you learn to do it yourself.  Traveling with vials of estradiol and syringes can be problematic, particularly international travel.

I bet others will be along shortly to provide vast quantities of data.  This is just my subjective opinion and the results of my research into what I wanted.  Your mileage may vary.  Content are sold by weight not volume. Content may settle during shipment.  The plastic bag is not a toy.

Mental relief:  I started spironolactone antiandrogen about 3 weeks before estradiol, and I still haven't gotten to a transition level of estradiol after 7 months.  The spiro swatted my testosterone levels down fairly quickly.  Around 11 days in I started to feel periods of calmness, a sort of quiet as the mental noise of flickering, distracting thoughts faded away.  This happened more often over the next month and became my new normal state.  Estradiol gave me a little bit of a lift, a feeling of more energy.  I was on one biweekly patch per week, and if you look at how these patches work, the E delivery drops off pretty quickly after 84 hours/3.5 days. By Day 7 I definitely felt irritable.

Breast tissue growth: I noticed the formation of breast buds, and the soreness and puffiness around the areola about 2 months in.  I had a running start in breast growth from 6 years on finasteride and gynecomastia .

- Michelle

[Claire_Sydney]

Exciting - your first days on HRT! Congratulations. The good news is you are on the road to transition. The bad news is that nothing happens fast.

I've never tried injectable E, but I have done oral tablets, gels, and patches. At the moment I use pure crystallised estradiol  implants, which I don't think are available in the USA. They are amazing. They have elevated my E level well beyond what I had with the maximum dose of gels AND oral together and they keep my levels very steady which is good for my emotional wellbeing.

As others have said, oral medication gives pretty steady levels but can put some strain long term on the liver which has to break it down. Of the choices you have, they would be my first preference. I sometimes also mix a small amount of the gel into my facial moisturiser. My endo says it's not entirely clear whether it can have a topical effect on skin, and most high-end cosmetics contain a small amount of estrogen anyway.

In terms of effects, here is a bit of a rough idea of my timeline:

- I had some weird dreams the first few days and some emotional changes. My sense of smell changed a bit.

- after about a week, the emotional changes intensified a bit.

- Within about a month my sex drive fell dramatically. My nipples were very swollen and very itchy. I lost a lot of drive, determination, mental focus and will to win. I never had an unwanted erection since then.

- after two months you could visibly see breast buds developing. My skin was slightly softer. My body produced much less sperm.

- by three months I was wearing two t-shirts and a puffy jacket to work to conceal the changes to my chest. The breast buds were more pronounced My bald sport began to grow back. My
lips were getting fuller and darker, and my skin was getting thinner and softer.

- after six months I got fitted for my first bra. My body stopped producing sperm altogether. My genitals were shrinking and the raphe line was growing and changing colour. I noticed my urine and body odour were smelling very different. The shape of my face continued to soften. My body hair was much softer and finer (where I hadn't removed it) and my pubic hair changed to a female pattern. My emotions were very intense and close to the surface, but that might be to do with progesterone as well as estradiol. I realised I had lost a huge amount of muscle and gained a lot of fat.

- at nine months, my appetite fell quite a bit. My skin was very soft and my facial features were softening very quickly. My bald spot filled in almost all the way, but seems to have stopped now. I found myself enjoying nature, sunsets, babies and animals much more. My body fat percentage had tripled since beginning HRT but I hadn't gained any weight.

- at 12 months I noticed a little bit of fat redistribution from my tummy to my hips and butt. I've always been into guys, but now the smell of men was driving me a bit crazy sometimes. Sex is also now a whole-body experience, and I can sometimes orgasm multiple times. My sexual interest is strongly tied to my emotional state but my sex drive is still much lower than it used to be. I got re-fitted for a new bra, and my breasts have grown to C-cup. The areola are much darker and continuing to grow outwards away from my nipples.

- at about 13 months now, my social and legal transition are complete. I get gendered correctly 98% of the time if I dress appropriately. I struggle a bit with physical tasks now and have to take manual work a bit slower. I don't know whether it's hormones or just age, but I'm really sensitive to loud noises too. I'm starting to wonder whether I should take some of the old photos off the wall in my apartment.


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[Pisces228]

Almost 5 months in and on tablets, but I am going to ask my Dr about injectable in February at my sixth month checkup.  I had noticeably softer skin after a few weeks and start having changes to my breasts at 2 months.  My butt has gotten a bit bigger since gaining some weight (usually weight goes straight to my belly).  That's really all I've seen so far.  Mentally I'm still a mess.  I have really bad anxiety and panic disorder so that's a whole other story 

[SadieBlake]

Patches or injected are easier on your liver and less risk of blood clotting, I have had no problems on weekly injections, I could imagine that biweekly could be more difficult.

At your age pills should be ok also, for my part I always want the most efficient delivery so injections are the only way. Patches would be impractical for me.

[Jill E]

I started on patches, moved to injections, and then recently moved to oral tablets(bc of a shortage of estradiol valerate and delestrogen). My favorite has been injections. My body seems to be incredibly sensitive to hormones, so my doctor has been pushing for me to move to oral tablets for some time.

Usually with the weekly shots I would feel great when my levels were a little higher than she wanted, otherwise I'd be feeling a little off by the end of the week. I have the same issue with oral tablets but it's a daily issue now (and it's more noticeable). I find that I start feeling slow mentally, I can't process, irritable, emotional, forgetful, and my attention span horrible. Usually I feel better after about 20 minutes or so from taking my evening pill.

As for patches, I loved them when I was on them and was afraid to switch, but in hindsight every other method I've used was better. My patches were falling off, despite supposedly being the best generic brand bc of their adhesive. We also had trouble getting my levels high enough with them. Showering was even a struggle, as getting the patch wet caused even more issues with it being able to stay in place until it was time for me to switch it.

My suggestion if you're given the choice between the three, go with injections (: assuming you're okay with giving yourself and IM injection. The needle is a little scary looking, but they're really not so bad.


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[Harley Quinn]

Very excited for you!! Well, patches will probably give you the most even levels.  The depot shot will have huge ups and down by comparison.  The nice part is that you don't have to worry about daily regiments.  I personally dont like the idea of pills.  They are harder on your liver than they should be. I like my liver...  With that being said, I do injections. I enjoy the fire and forget...  once every 2 weeks and good to go...  Thats worth it to me.  Id to implants if my doctor would go for it.  The less I have to remember the better. But definetly patches for the most even levels.

it took me about 3 weeks to have my breasts hurt like hell!  Other than that... Little rays of sunshine and happiness come raining down in every drop of estrogen.  Thats about it... good days and bad days ensue for the course of transition... when your levels are good you'll feel good, when theyre off... you are definetly going to know it!