E and blockers

[Megan.]

I can't see it would matter that much,  but now I'm ready to start HRT,  does it matter if I start my E a few days before my AA? Also,  as they're starting me on a low dose (oral)  what are people's thoughts on splitting dose morning and evening for a steadier level?

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[fefi]

Hi Megan:
               I think that It does not matter if you start estradiol a few days before you get put on blockers. And talking about splitting doses, I advise you to do that way in order to get steadier levels. In my case, I take my estradiol pills sublingually, so I have to split my doses during the day as on sublingual levels fluctuate more. Anyways ask your doctor the best way you will feel in your transition.
               Best wishes!!!

[Megan.]

Thanks fefi. X

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[AnonyMs]

You usually start them separately just in case you have a problems, then its easier to work out what caused it.

[Dani]

Megan,

I have posted many other times promoting sublingual as easy and convenient way to take Estradiol. Initially, I was taking Estradiol twice daily at the start of my transition. Then once I was post op, I reduced to once daily, which was ok.  But I felt that my HRT was lacking, especially in the evening hours.

I asked my Physician to prescribe a lower dose twice a day, just to even things out.  Now I feel somewhat better emotionally and my breasts are tender again. I take that as a sign that this was a positive change for me. Actually, if I could arrange my daily activities for a convenient way to take my Estradiol three times a day, that would give me even more consistent blood levels.

Many of the girls who take their Estradiol by injection or patches have a very valid point in that their preferred route produces more consistent blood levels. I used to say that in the long run it made no difference how often you took Estradiol. Which is true. But now I am more aware of the subtle advantages of twice or even three times daily dosing.



   

[Megan.]

I know many here do,  but is there any scientific data to support sublingual over oral? I work for a major pharmaceutical business,  and my manager (a biochemist), cannot understand why it would have any measurable difference.

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[AnonyMs]

I know many here do,  but is there any scientific data to support sublingual over oral? I work for a major pharmaceutical business,  and my manager (a biochemist), cannot understand why it would have any measurable difference.

I believe its in this paper

Single-Dose Pharmacokinetics of Sublingual Versus Oral Administration of Micronized 17/3-Estradiol
http://www.sciencedirect.com/science/article/pii/S0029784496005133

I assume you can get hold of it.

[Dani]

... is there any scientific data to support sublingual over oral? I work for a major pharmaceutical business,  and my manager (a biochemist), cannot understand why it would have any measurable difference.

The difference is called the first pass effect. With oral administration, the Estradiol is absorbed in the stomach. It does not go into general circulation. It goes directly to the liver where much of the Estradiol is conjugated into metabolites.

With sublingual, injectable and topical, the Estradiol goes directly into the general circulation, producing much higher blood levels.

[KayXo]

Regardless of the different pharmacokinetics confirmed by various studies with sublingual vs. oral E, I found I had exactly the same effects (i.e. breasts, mood, skin) both ways on the same dose. So guess what? I went back to oral. Easier and just as effective.

Because the estradiol is bio-identical and much of it is metabolized to estrone in the gut, I tend to not worry about the hepatic markers being affected by estradiol when taken orally. Several studies also suggest, on the whole, that oral bio-identical estradiol is relatively safe.

[JaneEstelle]

It is wise to start one then the other to see if there are any side effects. I did the reverse of what you are doing, started spiro and then E patches three weeks later.
Either way does not matter as one is just starting and eventually you will be on both until surgery if you plan to have that.
My partner is a pharmacist and is quite adamant that splitting your dose is pointless but there are always those who insist that some study suggests otherwise.
There is simply no way to do a proper study unless the subjects being studied are identical twins.
Do you have a twin that can take the dose as prescribed while you split it to then compare results?
Constant use is how you establish and maintain your levels. The daily dose is meant to be enough until the next one.
Dose splitting is just another kind of hocus pocus. There is no magic involved, it's hormones. Take them, they work, it's really that simple.
KayXo, can you just answer the OP's question? Were they asking for a comparison of the different forms of E. They asked about splitting their dose. Just can't stop being a know it all can you?

[AshleyP]

I can't see it would matter that much,  but now I'm ready to start HRT,  does it matter if I start my E a few days before my AA? Also,  as they're starting me on a low dose (oral)  what are people's thoughts on splitting dose morning and evening for a steadier level?

While my doctor didn't start my HT with one medication before adding a second, I sort of did it intrinsically because I'd been taking spiro for many years to treat HBP and CHF. When I started HT, he doubled the spiro dosage and added estradiol. The initial prescription called for split dosing on the spiro and single dosing for the estradiol.

At the three month mark, I asked about splitting the estradiol dosing since I was taking the spiro twice daily. He said that it wouldn't make any difference. I also asked about sublingual, and he said it wasn't worth the trouble. I still do it from time to time, though.

Personally, I think it would be better to start one medication before the other. There's a chance you could have an adverse or allergic reaction to one or the other. It would make it easier to isolate the cause. In the grand scheme of things, I don't think a few weeks will make any difference. Much the same argument can be made for titrating the dosage.

Just my thoughts and experience; talk it over with your doctor.

All the best,
--AshleyP

[Megan.]

Thank you for all the responses, they're were all very useful and educational including KayXos. X

[SailorMars1994]

It is wise to start one then the other to see if there are any side effects. I did the reverse of what you are doing, started spiro and then E patches three weeks later.
Either way does not matter as one is just starting and eventually you will be on both until surgery if you plan to have that.
My partner is a pharmacist and is quite adamant that splitting your dose is pointless but there are always those who insist that some study suggests otherwise.
There is simply no way to do a proper study unless the subjects being studied are identical twins.
Do you have a twin that can take the dose as prescribed while you split it to then compare results?
Constant use is how you establish and maintain your levels. The daily dose is meant to be enough until the next one.
Dose splitting is just another kind of hocus pocus. There is no magic involved, it's hormones. Take them, they work, it's really that simple.
KayXo, can you just answer the OP's question? Were they asking for a comparison of the different forms of E. They asked about splitting their dose. Just can't stop being a know it all can you?

[/b]

Was it really needed to make that part of your post??

[Ellement_of_Freedom]

Was it really needed to make that part of your post??

I think Jane has a point.

[Megan.]

Mods,  please lock this thread. I have valued all the comments here,  but an unhelpful debate is forming. X

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