are Injections better than pill form

[Rachel4now]

just wondering getting sick of having doctor / Nurse injecting me because i cant do it right
myself.  id like to but i do it wrong every time i try.
and the gender center im at is understaffed amd always running late
i have be here at a certain time and of course they make me wait up to 1-2 hours in the lobby!

considering taking pills  because of situation!

thanks in
advance
Rachel

[Denise]

I'm not an expert but...
Pills are harder on your body (kidneys? Liver?...)
How about implants ?


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[mako9802]

Where were you told to inject?  into glutes or thigh area?  I would try to stick to injectables if possible like was already mentioned injectables stress the liver way less than pills do.  The liver is the last thing you want to burn out.

[KayXo]

Oral bio-identical estradiol has never been associated, in studies, with deteriorating liver function. The issue is more whether clotting can be adversely affected and considering the findings so far, the doses would need to get pretty high to start posing a risk and it would also depend on the individual, whether old or predisposed, smoking or not, etc. In general though, oral bio-identical estradiol seems quite safe but not without risks, of course. Injecting seems somewhat safer, up to a certain dose. So, in the end, it's you and your doctor's call. I was on oral for several years without health complications and sometimes on quite high doses. Everyone reacts differently though.

I did feel better on injections, skin/hair looked better so I preferred this route to oral although the latter produced better breast growth. I inject in my butt, it barely hurts and is quite easy. Nurses taught me at first. Had a few sessions and then was on my own.

[Pisces228]

I asked my Dr about this at my 9 month checkup yesterday.  She said injections bypass the liver, but if you don't have liver damage you don't have to worry about bioidentical estradiol causing liver harm.  It's only if you had preexisting liver disease.  She said that apparently shots can cause higher prolactin levels as well.

[AutumnLeaves]

There is almost a hysteria online about taking oral estradiol and the supposed risk to your liver function, but in reality it is a very safe drug and liver issues are very rare. This is one of those myths from the "old days" (when people used to take much riskier drugs like ethinyl estraditiol in huge doses) that just won't die. You're way more likely to suffer liver issues from much more common drugs like Tylenol than you ever will from today's oral estrogens, so that is not a concern I would even put on the table.

Having said that, when you swallow pills they do break down into different compounds than if you take them non-orally. Oral estrogen tends to lead to lower levels of estradiol and higher levels of the less-active estrone. Injected and transdermal estrogen bypasses this and leads to higher levels of estradiol. Many people, myself included, find that the injections work faster and better due to the very high levels of estradiol you can achieve. However, most people over the years have transitioned on pills and do just fine, and injections have the drawback of requiring needles and, in my experience, causing way more side effects. If you are doing great on the shots I would stick with them, and I agree with the advice to try and do it yourself. Why not find a trusted friend that the nursing staff can train to give your injections at home, if you cannot? The doctor's office taught my husband how to do them, so he does mine once a week, and we are currently in the process of showing my other partner how to do the injections as well in case my husband is not available. I used to do my own in my thigh but find it's much easier emotionally and physically to just let somebody else inject me in my glutes.

[Barb99]

Ask you doctor about subcutaneous injections.
A subcutaneous injection is a shot given into the fat layer between the skin and muscle.

This uses a smaller diameter and much shorter needle and is injected just an inch or two from you belly button. The needle is so fine most of the time I don't even feel it. Your injecting right in front of yourself so it is very easy to see and manipulate the syringe.

[KayXo]

She said injections bypass the liver, but if you don't have liver damage you don't have to worry about bioidentical estradiol causing liver harm.  It's only if you had preexisting liver disease.

I personally question this as I have never read anything in the literature suggesting oral bio-identical estradiol is harmful to the liver. Doctors sometimes assume because this may be an issue with other forms of oral estrogen such as ethinyl estradiol or Premarin, the same is true for oral bio-identical estradiol when the latter has been found to be much safer in several studies.

She said that apparently shots can cause higher prolactin levels as well.

She's right and so what? My prolactin levels significantly increased when I switched to shots because my estradiol levels also significantly increased. This is normal and to be expected. The same occurs in pregnant and lactating ciswomen and we don't bat an eye. My doctors aren't concerned. If prolactin increased for no apparent reason and was associated with symptoms such as vision problems, chronic headaches, galactorrhea, then that would be reason for concern. Prolactinomas (pituitary tumor due to high prolactin) are very rare in transwomen (8 cases) despite very aggressive doses of estradiol in the past. Always in association with non bio-identical forms of estrogen or progestogens and sometimes on low dosages of estrogen (that's a reason to be concerned!). Pregnancy or estrogen has never been shown to cause prolactinomas, sometimes pregnancy with very high levels of prolactin helps resolve tumors.

There is almost a hysteria online about taking oral estradiol and the supposed risk to your liver function, but in reality it is a very safe drug and liver issues are very rare. This is one of those myths from the "old days" (when people used to take much riskier drugs like ethinyl estraditiol in huge doses) that just won't die. You're way more likely to suffer liver issues from much more common drugs like Tylenol than you ever will from today's oral estrogens, so that is not a concern I would even put on the table.

+1

Ask you doctor about subcutaneous injections.
A subcutaneous injection is a shot given into the fat layer between the skin and muscle.

This uses a smaller diameter and much shorter needle and is injected just an inch or two from you belly button. The needle is so fine most of the time I don't even feel it. Your injecting right in front of yourself so it is very easy to see and manipulate the syringe.

I personally tried subcutaneous and I found there were two problems:

1) leakage (i.e. loss). None on intramuscular. I use Z track and it makes no difference.
2) a hard lump forms and takes a few days to disappear.

So I went back to intramuscular. Some assert that absorption may actually be faster subcutaneously and be more erratic. Some say the opposite.

[Dani]

!

considering taking pills  because of situation!

thanks in
advance
Rachel

Rachel,

I take estradiol pills, but I do not swallow them. I place the tablet under my tongue and let it dissolve there. I do not eat or drink for about 30 minutes or so. I also try to not swallow and just let the dissolved tablet sit under my tongue. This is called sublingual. Estradiol is bio-identical and the uncoated tablets dissolve within a few minutes after they are placed under the tongue. The most common makers of uncoated estradiol are Mylan, Teva and Watson. All 3 makers produce a good product. I know, since I am a Pharmacist.

Taking estradiol sublingual works just like injectable as the hormone does not go through your liver right away. The estradiol goes into the general blood circulation and from there goes to the entire body, where it does a body good.    Then later on, it will eventually pass through the liver, be metabolized and excreted by the kidneys. 

Injectable estradiol is in a oil vehicle and will last 14 days, with relatively steady blood levels. With sublingual, you get a peak level within the hour and you will have high levels for about 12 more hours. At first, I was taking estradiol twice a day, but now, 2 years later, just once a day is fine with me. I have not seen any studies where constant blood levels are equated with feminization. The facts are that feminization happens with long term use of estrogens by any route. It is just much safer if you avoid the first pass through the liver. So for safety sake, injectable, sublingual or topical patches are all just fine.

One other option for those of us who just do not like needles is estradiol patches. They are just as effective as sublingual but cost a bit more than estradiol tablets.

So, for cost, convenience and effectiveness, My choice is sublingual.

I do not like needles and I prefer to take my estradiol sublingual. It works for me!

[LShipley]

I agree with Dani and follow the same route of taking it.

I dont mind needles but I just dont want to inject myself for the rest of my life. That said, a sublingual 3x a day is time consuming and can get annoying.

Im surprised there isnt some sort of implant for longer periods of time. Or are there?

[jentay1367]

I've been on transition dosages of both. They both have their pluses and minuses. As far as being even tempered and more able to cope on a daily basis? I'll take the pills. As far as physical feminization in a hurry? I'll take injections. Regarding the possibility of contracting Prolactinoma? I'd take pills to lessen that chance of occuring.. As far as DVT possibility and potential organ damage? bring on those injections. Convenience? injections win again. Possible administration issues? the pills win.  Cost? the pills. Availability? the pills? Breast growth? the injections. It just goes on and on like that and in the end? I suspect they'll both get you to your desired destination. But by different means. The important thing is that you're healthy, happy and moving along the spectrum towards whatever goal you've chosen with the least amount of health issues and drama. Cuz' in thee end, if you're always ill or miserable, what the hell is the point?

[EmmaLoo]

I've always injected for convenience and I've had to switch to pills on a couple of occasions over the years due to availability. I never really noticed any real difference other than finding the pill a pain to take every day. The injectable cost seems negligible at the dosage I take, (post-op) even if I paid retail.

It seems to me that your real issue here is simply learning how to give yourself a shot correctly. By your own description, the injectable was your first choice but you felt you couldn't get the shot right. If I were you I'd find someone who might be willing to give to some tips to make it quick and painless since you are looking at taking this for the rest of your life. There are methods and locations to give yourself a shot. In the beginning, I was taught to do it in the thigh muscle. Eventually, I switched to the butt cheek. The other thing you might look at are the needles you are using to draw and inject with. That can make a big diffefence as well.

If you have injected for very long, you find what works best for you. If injecting was your initial plan you might want to revisit your technique. I would go into more detail but I don't want to cross any lines on the HRT issue. If you want more info, I would be happy to explain via private message. If discussing self-injection techniques is ok, I'd be more than happy to toss mine in the ring too.

[rmaddy]

I have always injected, mostly because I forget to take pills fairly often.  I forget my spiro all the time.  A few thoughts:

1.  I inject weekly.  This means not as much fluctuation in level as with every other week.  When I'm going on vacation I take a two week (doubled) dose on the last injection before I leave, meaning that unless I'm gone for more than two weeks, my supplies never leave my cupboard.
2.  I agree that subcutaneous injections tend to leak the drug back out.  I gave up on them because I found intramuscular was more reliable and...
3.  IM shots don't hurt very much.  About 1/4 weeks my injection site will line up with a nerve and sting a bit more than average.
4.  Getting used to the shots took me a couple of weeks until I generated a routine.  Before that, I spent a lot of time hesitating before injecting.
5.  Consider East Coast Medical Supply to get your syringes and needles online.  I generally use a 23 gauge 1" needle.  Estrogen is syrupy, so it can take a while to draw it out of the bottle, but it injects instantly.  If you want, you can purchase larger gauge needles to draw out of the vial, but I found that this chewed up the rubber stopper on the vial after awhile.  Since a vial lasts me about 6 months, I decided to draw it up with the 23.  Works for me.

[KayXo]

Estradiol is bio-identical and the uncoated tablets dissolve within a few minutes after they are placed under the tongue. The most common makers of uncoated estradiol are Mylan, Teva and Watson. All 3 makers produce a good product. I know, since I am a Pharmacist.

All tablets containing MICRONIZED estradiol can be taken sublingually. If the outer part of the pill can dissolve, then it can be taken sublingually.

Taking estradiol sublingual works just like injectable as the hormone does not go through your liver right away. The estradiol goes into the general blood circulation and from there goes to the entire body, where it does a body good.

I think that taken sublingually, inevitably, some will be swallowed and enter the digestive tract, then liver. This would seem to explain why even sublingually, estrone eventually surpass estradiol levels.

Injectable estradiol is in a oil vehicle and will last 14 days, with relatively steady blood levels.

That depends on the form of estrogen. Estradiol valerate will usually be good for at most 7-10 days, before causing PMS in the vast majority of women. In some, levels already significantly decline by days 5-6. Levels tend to not be that stable as they peak and quickly fall relative to other forms (i.e. cypionate, enanthate, undecylate/undecanoate or polyestradiol phosphate). From day 3 to day 5, my levels went from 2,500 to 1,300 pg/ml! Estradiol cypionate, on the other hand, yields more constant levels, peak levels are reached more slowly and it can be good for longer, up to 10-14 days.

With sublingual, you get a peak level within the hour and you will have high levels for about 12 more hours

Not quite. Levels peak and fall rapidly. One study found levels to be at approximately:
1 hour: 450 pg/ml
2 hours: 200 pg/ml
3 hours: 115 pg/ml
4 hours: 80 pg/ml
12 hours: 40 pg/ml

In just 3 hours, levels fell by more than 500%. With sublingual, don't expect steady high levels. There is a rapid drop and this is why blood tests for estradiol are so inaccurate in this context.

In my own personal experience, I had the same results (i.e. mental/physical) on sublingual vs oral.

It is just much safer if you avoid the first pass through the liver. So for safety sake, injectable, sublingual or topical patches are all just fine.

Bio-identical estradiol, IMO, based on several studies, seems quite safe so that sublingually, where some of it is inevitably swallowed, doesn't make a significant difference in terms of health risks. All other non-oral route are only *slightly* safer, I think.

I do not like needles and I prefer to take my estradiol sublingual.

I found sublingual quite inconvenient, having to wait for it to dissolve whereas with needles, I inject only once every few days and it's done. So easy and practical, for me. I had to overcome my fear of needles and it was totally worth it.

Im surprised there isnt some sort of implant for longer periods of time. Or are there?

In some parts of the world, there are. For quite some time, too.

I've been on transition dosages of both. They both have their pluses and minuses. As far as being even tempered and more able to cope on a daily basis? I'll take the pills. As far as physical feminization in a hurry? I'll take injections

I actually find that I'm calmer and more even tempered on injections vs sublingual/oral. Breast growth was better for me on oral/sublingual, by FAR, despite estradiol levels being much higher on injectables.

Regarding the possibility of contracting Prolactinoma? I'd take pills to lessen that chance of occuring.

Prolactinomas are quite rare among transwomen, only 8 reported so far. None on injections of estradiol taken alone, without any other form of non bio-identical estrogen or non bio-identical progestogen. Most prolactinomas were associated with the use of oral estrogen, only conjugated equine estrogens and ethinyl estradiol, usually with cyproterone acetate. Studies therefore don't substantiate your fear of getting a prolactinoma with E injections. One study in particular found no one developed a prolactinoma despite very high doses of estradiol valerate by injections. The same findings were shown in other studies where men and ciswomen were treated with high doses of injectable E.

As far as DVT possibility and potential organ damage? bring on those injections.

The risk of DVT appears to be infinitesimally small with oral bio-identical estradiol as compared to other forms of estrogen and if it occurs, there are always other factors present like smoking, cardiovascular predisposition, diabetes, old age, immobilization due to surgery, pre-existing clotting disorders/genetic mutation, obesity.

Organ damage, as far as I know, none reported with bio-estradiol in the scientific literature. And for sure, none in transwomen.

In the beginning, I was taught to do it in the thigh muscle. Eventually, I switched to the butt cheek.

Injecting in the buttocks for 3 years, with not much pain, if any during the process of injecting. No pain afterwards or VERY, VERY rare.

The other thing you might look at are the needles you are using to draw and inject with. That can make a big diffefence as well.

The higher the Gauge of the needle, the thinner and the less painful it is but the longer it takes to inject as the solution is oily and thick. I inject with a 22 gauge but 23-25 seems to work best for some.

I generally use a 23 gauge 1" needle.

In thigh, this might be fine but buttocks, this might be too short, end up in subcutaneous tissue and leak as it did for me. My butt is fatty. 

If you want, you can purchase larger gauge needles to draw out of the vial, but I found that this chewed up the rubber stopper on the vial after awhile.

+ 1. i drew with an 18 gauge. So chewed up, it was leaking.

I decided to draw it up with the 23.Works for me.

23 gauge takes too long for me. I personally prefer 21.

[Jessika]

I started on Oral Pills at 48. Now at 50 with an increased dose I am still doing good with no Liver or Kidney issues. *Knock on Wood*.

I do not Smoke. That does help.

We are all different and react differently.

People should not just yell "Omg..Oral is bad!"

For some people injections could be worse than Pills.

To each their own.

[LShipley]

I've been on transition dosages of both. They both have their pluses and minuses. As far as being even tempered and more able to cope on a daily basis? I'll take the pills. As far as physical feminization in a hurry? I'll take injections. Regarding the possibility of contracting Prolactinoma? I'd take pills to lessen that chance of occuring.. As far as DVT possibility and potential organ damage? bring on those injections. Convenience? injections win again. Possible administration issues? the pills win.  Cost? the pills. Availability? the pills? Breast growth? the injections. It just goes on and on like that and in the end? I suspect they'll both get you to your desired destination. But by different means. The important thing is that you're healthy, happy and moving along the spectrum towards whatever goal you've chosen with the least amount of health issues and drama. Cuz' in thee end, if you're always ill or miserable, what the hell is the point?

Can we just copy and paste this to all the repeat questions of pills/patch/injection? haha

Well said!