Adding oral E to my already existing regimen of injectable E and progesterone

[KayXo]

My doctors pretty much give me the freedom to try different HRT combinations as I've earned their trust and respect through numerous discussions.

I recently added a small dose of oral estradiol to my injectable estradiol valerate and oral micronized progesterone. Today marks one week since the change and I noticed the following:

- increased energy.
- breasts feel more firm and tender. My right breast is now aching again while my left breast is not.
- skin is a little drier than usual.

This is interesting and surprising given the minute amount of estradiol I've added to my already existing regimen.

[Dena]

Two thoughts come to mind. Something discussed on the site is the effect of fluctuating levels causing better development that consent levels.

The second thought is possibly estrone or the ratio of estrone to estradiol may affect development. It might be interesting to know what your ratios were before and after adding oral to the mix.

Pills may still have some advantage but the problem is going to be figuring out what the advantage is.

[KayXo]

Something discussed on the site is the effect of fluctuating levels causing better development that consent levels.

Oral typically delivers steadier levels than injections. This would suggest steadier levels are better and perhaps, if I shortened my injections intervals to, say 3 days instead of 5 days, this would help. Any thoughts?

p.s.: from day 3 to day 5, my levels substantially drop, from 2,500 pg/ml to 1,300 pg/ml.

The second thought is possibly estrone or the ratio of estrone to estradiol may affect development. It might be interesting to know what your ratios were before and after adding oral to the mix.

On injections, my ratio is estradiol 2 times as much as estrone which is what you would expect. On oral, it's the other way around, where estrone is many times higher than estradiol so one should expect less results but, in my case, it's the opposite!

[Sophia Sage]

This is of course anecdotal, but may highlight just how variable all this is.

I knew a thin ciswoman who was completely flat-chested throughout her twenties.  Finally, though, she got pregnant, and in nine months developed completely full C-cup (at least) breasts.  My sister, on the other hand, didn't grow at all in her pregnancies, despite have full B-cup breasts, both of which have practically disappeared after breast feeding. 

[Dena]

Oral typically delivers steadier levels than injections. This would suggest steadier levels are better and perhaps, if I shortened my injections intervals to, say 3 days instead of 5 days, this would help. Any thoughts?

p.s.: from day 3 to day 5, my levels substantially drop, from 2,500 pg/ml to 1,300 pg/ml.

It would be interesting to compare the results between pellets and somebody who doses 2 or 3 times a day with pills. Possibly each swing causes development by presenting "clean" receptors for the next dosage.

I really can't explain it because I just don't know enough about it. I do know that even with my body at menopause levels for estradiol, I am still developing and I can't explain that one either. I guess it's possible with such a low dosage the receptors are greedy for any stray estradiol that comes along.

Bigger may not always be better.

[MissGendered]

I found the combination of micronized bio-identical progesterone, oral Estradiol, and injectable Estradiol Valerate to be the most effective for my development and mental health. My dosing reflected my cyclic needs, with the appropriate peaks of E and P at intervals reflecting a natural menstrual cycle.

I intend to return to this method as soon as I can get an insurance override for injectables again.

As it is, I still dose with oral E and vaginal P suppositories to match my cyclic needs.

Once I have the injectables, I am considering simulating pregnancy levels for 9 months, in order to hopefully stimulate more breast growth.

Good luck with your experiments, I am always surprised by how few MTFs make any pro-active efforts to maximize their HRT experiences, especially considering the very wide range of opinions held by various prescribers. I have never been one to just accept a declaration as untestable truth. Without giving feedback to our prescribers, we are likely to be subject to a very generalized treatment plan that may, or may not, actually be in our best interests. The seemingly 'default' approach is to prescribe as little as possible, with as little variability as possible. For me, that was never going to work out well, as I do cycle. Today is the first day of my new cycle, and I feel palpably better, though I am still bloaty, and my ankles are swollen, but for the most part, my back, leg, and abdominal aches are relenting. If I still had my uterus, I would have started bleeding today. If you have been reading my posts during the last weeks, you may have noticed that the bottom fell out for me emotionally about a week ago, and despair and depressive thoughts had darkened my mood on several occasions. This is the norm. In a week or so, you will likely see me tending toward more sexual thinking, lol, as my Venus week begins and I move toward my peak in two weeks. For about the next 5-6 days afterward, my mind will be happy, and very sensitive, but in a very sexualized way. I also have a very randy time at the end of my cycle, like I did earlier today, lol, where penetration is very important to me. All these are standard features for any woman that cycles. This was apparent to my trauma therapist even before I noticed it, since she and I met several times a week during most of my early transition. I like it. As a woman, it is part of what I am as well as who I am, regardless of my intersex status..

My endo also has bio-male MTFs that exhibit limited cyclic experiences, and he adjusts their HRT accordingly...

Just my experiences, and anecdotal feedback, always consult your doctor before making any changes to your prescription routines...

Missy

[KayXo]

Possibly each swing causes development by presenting "clean" receptors for the next dosage.

If that was the case, the fluctuations/swings present with my injections should produce good results when in my case, much steadier levels on oral are producing those good results. What's most surprising is that the oral dosage is so low and yet, bringing about substantially greater changes than on injections, mentally (i.e. energy levels) and physically (i.e. breasts)

I found the combination of micronized bio-identical progesterone, oral Estradiol, and injectable Estradiol Valerate to be the most effective for my development and mental health.

In my case, oral E is just simply better than injectable E when it comes to breast growth and overall energy levels. I used to just take Estrace, a high dose and had phenomenal results breast-wise but I switched over to injections because I felt anxious and my skin was VERY dry. This time around, just adding a small amount, 1/3rd to 1/6th the amount I was taking last time I was on oral E, is producing significant results.

Once I have the injectables, I am considering simulating pregnancy levels for 9 months, in order to hopefully stimulate more breast growth.

Pregnancy levels for 2 yrs on injectables did nothing for my breast growth but lower levels on oral E did plenty. Hope things pan out better for you.

Good luck with your experiments

Thanks. I'm working with one doctor in particular who wrote a book on female hormones and who is quite open-minded. She believes in taking hormones after menopause and never stopping them. She admitted to me to learning so much from her patients. It's really great having her on my team.

[MissGendered]

She believes in taking hormones after menopause and never stopping them. She admitted to me to learning so much from her patients. It's really great having her on my team.

My gyno/endo/trans/intersex specialist is on the same page. Someday this will be the norm, not the exception. When that day comes, my skin will still be smooth, my bones will still be strong, and my heart will still be beating strong.

Menopause is a preventable disease.

Missy

[AshleyP]

I recently added a small dose of oral estradiol to my injectable estradiol valerate and oral micronized progesterone. Today marks one week since the change and I noticed the following:

I know you said you are taking oral estradiol, but just for my clarity, are you taking the added estradiol sublingually or orally?

All the best,
--AshleyP

[KayXo]

Taking it orally.

[Dena]

Shooting in the dark but I had a couple of other thoughts to play with.

I tried doing some searches and couldn't find anything on it but I wonder if the body produces a natural blocking agent to protect against extremely high levels of estrogen. I know there are several manufactured compounds that do this but I can't find any reference to a naturally produced one. I also never expected mushrooms to be a possible estrogen blocker. Guess I have to watch my intake.

Second though. Premarin didn't do much for me and I have found cheap estradiol (estrace) is producing far better results at a lower dosage. Others had far better luck with Premarin so I have the theory that my body wasn't able to cleave Premarin effectively but my body loves the estradiol I am currently taking. If your pills aren't EV but your injections are, that could be the difference. Your body may just not respond well to EV and you might consider another form.

[KayXo]

I tried doing some searches and couldn't find anything on it but I wonder if the body produces a natural blocking agent to protect against extremely high levels of estrogen. I know there are several manufactured compounds that do this but I can't find any reference to a naturally produced one.

Dena,

my levels are between 1,000 and 4,000 pg/ml when pregnant women experience much higher levels, as much as 75,000 pg/ml. Their estradiol levels are, on average, higher than their estrone and estriol levels. Pregnant women need their levels to be high to produce the desired changes in anticipation of pregnancy. It wouldn't make sense that the body intentionally produces such high levels and then produces compounds to block it.

Premarin didn't do much for me and I have found cheap estradiol (estrace) is producing far better results at a lower dosage. Others had far better luck with Premarin so I have the theory that my body wasn't able to cleave Premarin effectively but my body loves the estradiol I am currently taking. If your pills aren't EV but your injections are, that could be the difference. Your body may just not respond well to EV and you might consider another form.

EV is inactive until cleaved and broken down into estradiol so it is the same exact thing as estradiol. It behaves exactly as estradiol would in the body. There is no difference between both compounds. EV does not bind to estrogen receptors, it works by being broken down (very quickly in the blood or intestines) into estradiol which then binds to receptors. EV is a pro-drug, a precursor, inactive, of estradiol.

On the other hand, Premarin contains equine estrogens that are active and actually bind to estrogen receptors. The major constituent of Premarin is estrone, followed by equine estrogens. There is barely any 17-beta estradiol in Premarin, less than 1%.

[Dena]

EV is inactive until cleaved and broken down into estradiol so it is the same exact thing as estradiol. It behaves exactly as estradiol would in the body. There is no difference between both compounds. EV does not bind to estrogen receptors, it works by being broken down (very quickly in the blood or intestines) into estradiol which then binds to receptors. EV is a pro-drug, a precursor, inactive, of estradiol.

On the other hand, Premarin contains equine estrogens that are active and actually bind to estrogen receptors. The major constituent of Premarin is estrone, followed by equine estrogens. There is barely any 17-beta estradiol in Premarin, less than 1%.

The point I am trying to make is normally the human body will respond in a set way to a drug but there is a very small portion of the population where a drug may not behave as expected. It's one of the reasons why a doctor may have to test several drugs before finding one that works best for you. Premarin didn't work well for me but it worked far better for others. I suspect in my case, it's due to my bodies love for estrone. My ratio of estrone/estradiol is about 12/1 so my body is very slow converting estrone back to estradiol. For most people, I suspect EV works well but there may be exceptions and if your pills are not EV, that is a possible explanation. If your pills are EV this argument doesn't apply to you.

After reading the data sheet on Premarin, I have become somewhat suspicious of what the hormone manufactures print about the action of their drugs. Premarin is supposed to be really great according to the manufacture but my results were far different. After seeing everything that was in it, I too was trying to find the estradiol. Given time, they may find exceptions to EV but only time will tell. For most people EV appears to work well but there may be that small portion of the population. . . . .

There very well may be another explanation and if so, feel free to discard this idea. I often discard many ideas in my work until I find the one that works so I am not attached to this idea. Tomorrow I may come up with something else to try that may be better than this idea. I only offer this as it's the best idea I have had so far.

[MissGendered]

There seem to be an endless sea of variables that can come into play here. Many get great results following generic prescribing practices. Those of us with extra considerations may find huge benefit from trial and error, without ever knowing the actual reasons plan A is so much better than plan B.

I know I am lucky to have had very open dialogue with my prescribers, and without such, my results and mental state would have been diminished significantly.

I doubt we will ever access exact answers for ourselves, let alone foolproof guiding principles that serve all of us equally well...

I hope we all find our way to full hormonal satisfaction!

Missy

[KayXo]

Premarin didn't work well for me but it worked far better for others. I suspect in my case, it's due to my bodies love for estrone. My ratio of estrone/estradiol is about 12/1 so my body is very slow converting estrone back to estradiol.

With both the Premarin and the oral estradiol, estrone is the predominant estrogen. Your high estrone to estradiol ratio might be due to estradiol being converted aggressively to estrone during the first pass and in the blood. Estrone to estradiol conversion is typically much less than the other way around.

You might this find interesting, by the way. There is a transwoman who reported having massive menopausal symptoms on Premarin, no matter the dose and feeling lousy on it. Switching to bio-identical estradiol, she felt better and finally got the results she was looking for.

For most people, I suspect EV works well but there may be exceptions

But you have not gone into the why EV would work less effectively than E2. EV is identical to E2 in that EV is quickly converted to E2 and EV, on its own, is not active and does not bind to receptors. The EV is clearly broken down in my body to E2 as my levels are high so what else might be going on?

I suspect that, in my case, levels may be dropping too fast with injections of EV and that is the problem. Injecting more frequently in order to get steadier levels will confirm whether I'm right or wrong. I will keep you updated.

Premarin is supposed to be really great according to the manufacture

Obviously. Why would any manufacturer not boast about their product? Clearly, there is bias.

I only offer this as it's the best idea I have had so far.

Thank you Dena. I appreciate your input and the time you've put into helping me figure out this matter.

[laurenb]

Kay, what else is going on in your world? I noticed an odd and anecdotal thing in my case: I'm a pesca-vegetarian so in general I eat less protein dense foods. When I'm low I crave protein and then eat sea food - fish usually. I did this last week. The next day my boobs were hurting. I thought maybe it needed some building blocks. I know - not scientific - but the point is to look at the big picture too. Another thing. Certain foods like grapefruit are synergistic; blocking the P450 enzyme in the liver and keeping the estradiol circulating. Hydration is key, too. The body is so complex; so many feedback paths.

[KayXo]

I eat plenty of meat, eggs almost every morning. Half a grapefruit a day. Eat plenty of fruits.

[Saki]

I thought about adding oral with my injections . But I wasn't sure how my body would react to it. I feel like my body wants more estrogen all the time.