MTF Part sublingual / Part oral?

[gallux]

Hi Ladies,

MtF here: I just started my HRT last week, and have been reading mixed reviews about taking my E sublingually instead of orally.

- It adds the benefit of bypassing the liver, which lowers a risk of liver toxicity which have been making me a little concerned (using cypro as AA) and considering I like to have some beers on weekend usually (2L on each day Fri, Sat, Sun).
- On the other hand, taking sublingually causes spikes on E availability and the overall availability is lower than taking it orally, which evens it throughout the day, but is harder on the liver.

- I'm thinking of proposing the following to my doc: Once I get my full dose, take it part oral, before bed, and part sublingual throughout the day, so I would improve my E availability during the night AND benefit with the spikes during the day, without hitting my liver so hardly.

What are your thoughts? Does any of you have a similar regimen? Do I need to be so concerned with my liver taking a usual full dose and my beer "addiction"?

[Devlyn]

After the novelty wears off, you'll probably have as hard of a time remembering to take them twice a day as I do. I seriously doubt you'll keep that rigamarole up for long. 

Hugs, Devlyn


Edit to add: It's long term exposure to estradiol in the normal female range that causes the changes. Just let the magic happen. 

[Cassi]

After the novelty wears off, you'll probably have as hard of a time remembering to take them twice a day as I do. I seriously doubt you'll keep that rigamarole up for long. 

Hugs, Devlyn


Edit to add: It's long term exposure to estradiol in the normal female range that causes the changes. Just let the magic happen. 

Wow, "Rigamarole, is a word I have not heard in years.  Wonder where it originated?

[Devlyn]

After the novelty wears off, you'll probably have as hard of a time remembering to take them twice a day as I do. I seriously doubt you'll keep that rigamarole up for long. 

Hugs, Devlyn


Edit to add: It's long term exposure to estradiol in the normal female range that causes the changes. Just let the magic happen. 

Wow, "Rigamarole, is a word I have not heard in years.  Wonder where it originated?

Honey, when I was growing up "Stegasaurus, run!" was an everyday comment! 

Hugs, Devlyn

[Cassi]

Wow, "Rigamarole, is a word I have not heard in years.  Wonder where it originated?


Honey, when I was growing up "Stegasaurus, run!" was an everyday comment! 

Hugs, Devlyn

You're just a whippersnapper!

[Dani]

Getting back to the original question, oral or sublingual? It really makes little difference. You have listed the advantages and disadvantages of both methods. Both methods are effective and will get you where you want to be in a few years.

You just need to be consistent and take the pills daily as your doctor directed.

I take my Estradiol sublingual because I do not want to risk any liver damage at my age. Topical or injectable would be just as safe.

[Cassi]

Getting back to the original question, oral or sublingual? It really makes little difference. You have listed the advantages and disadvantages of both methods. Both methods are effective and will get you where you want to be in a few years.

You just need to be consistent and take the pills daily as your doctor directed.

I take my Estradiol sublingual because I do not want to risk any liver damage at my age. Topical or injectable would be just as safe.

Thank you.

[KayXo]

I have yet to read anything about bio-identical estradiol causing liver damage, even in quite high doses, even in older individuals...I, myself, have been on high doses (orally and non-orally) over the years and have never seen any change in liver enzymes but that's me. The fear of liver toxicity seems to be based on reports in those taking high doses of non bio-identical forms of estrogen, as in ethinyl estradiol in transwomen, for instance combined with cyproterone acetate.

I saw no difference as far as feminization and breast growth whether I took my pills sublingually or orally despite the fact that studies unequivocally show higher overall concentrations with sublingual delivery over 24 hours. Some do report a difference so YMMV, as always. What mattered for me the most was that the dose I took was appropriate for me. When I finally found that right dose orally, things took off...at lower doses, things were stagnant.

Decide with your doctor what is the best course for you. Best of luck.

[gallux]

Thanks all for the responses, I am surely following the doc's prescription (oral) and at day 4 I am definitely seeing changes in the skin and the whole body feels "plumpy" if I may say. Looks like the E is doing its work.
I will ask my doc if, when raising the dose, sublingual would be more secure and give me the same effects or better.

As for alcohol consumption, what are your takes on this? Having let's say about 2L of beer each weekend day something of concern? Should I lower my booze consumption?

Thanks!

[KayXo]

Alcohol might affect the absorption/pharmacokinetics of the medications and hormones you take orally, reducing or increasing their effects and side-effects. Check with the pharmacist/doctor. Depends on how healthy your liver is, as well.

I find I don't do well on alcohol but I'm post-op and on estrogen, no AA. I tend to significantly bloat on it, regardless if it's beer, wine or just hard liquor. Feel great at first but then for the following 24 hours, I feel kinda yuk.

Have a talk with your doctor and see what they say. Everyone's situation is unique.

[Laurie]

Hi gallux,

  Congratulations on having started your hrt. Good for you!! That is awesome. The ride has started. As for how to take it I prefer to put mine between the upper gum and cheek. To me it is easier to keep it there for awhile. I can still talk and drink with it there. Eating dislodges it but usually by then it's been there awhile and the good stuff had had lot of time to be absorbed. I am one of those that want to minimize the chance of a clot. My liver probably thanks me also because I abused it with alcohol for a long time. I drank far more than anyone should and I quit almost 19 years ago.
   You mentioned 2L/day on the weekend. That is a bit of an odd way to state how much you drink. Is there a reason you save your drinking to Friday - Sunday? Is it a way to control the amount your drink?
  Enjoy your ride Hun.

Hugs,
   Laurie

[Rachel]

Congratulations on stating HRT

Strap yourself in for a wild ride. A second puberty is an experience. Just remember in time your emotions will settle.

You say you are taking E twice a day and not up to your final dose. You may want to ask your Doc about taking it 3 times a day in the future.

I do not know about alcohol and HRT, I am clean and sober 19 years. If you enjoy beer then ask you doctor. There are a lot of factors and since you are getting blood tests for HRT then have the doc look at your liver enzymes and hA1c.

[Pisces228]

I take mine sublingually and split it between breakfast, lunch, and dinner doses.  I think I end up swallowing a small amount anyway so I always take it all sub and hope that most dissolves.  Alcohol has never seemed to interfere with my hrt results and my liver enzymes always look good despite being a moderate/heavy at times drinker and taking high doses of oral/sublingual estrogen.  I am not saying go drink how much you want, but I believe other vices (eg tobacco) can be more harmful in conjunction with hrt than moderate Alcohol use can.

[gallux]

Hi gallux,

  Congratulations on having started your hrt. Good for you!! That is awesome. The ride has started. As for how to take it I prefer to put mine between the upper gum and cheek. To me it is easier to keep it there for awhile. I can still talk and drink with it there. Eating dislodges it but usually by then it's been there awhile and the good stuff had had lot of time to be absorbed. I am one of those that want to minimize the chance of a clot. My liver probably thanks me also because I abused it with alcohol for a long time. I drank far more than anyone should and I quit almost 19 years ago.
   You mentioned 2L/day on the weekend. That is a bit of an odd way to state how much you drink. Is there a reason you save your drinking to Friday - Sunday? Is it a way to control the amount your drink?
  Enjoy your ride Hun.

Hugs,
   Laurie

Hello Laurie, thanks for the reply. I have an alcoholic father and I have had my episodes of heavy drinking and passing out in my 20s, until I met my now wife, who keeps me "strapped in the leash". I also tend to be a very logical and methodic person (maybe I should have been born a Vulcan lady?) and 2L (equals to 3 bottles or 5 cans)/weekend day keeps me still myself and prevent next-day headaches and hangovers, it have been years since I had any problems. Also, I can go 3-4 hours in an event socializing just fine, I think it is a way to keep it under control in a healthy/enjoyable manner, at least it worked for me until now.

Congratulations on stating HRT

Strap yourself in for a wild ride. A second puberty is an experience. Just remember in time your emotions will settle.

You say you are taking E twice a day and not up to your final dose. You may want to ask your Doc about taking it 3 times a day in the future.

I do not know about alcohol and HRT, I am clean and sober 19 years. If you enjoy beer then ask you doctor. There are a lot of factors and since you are getting blood tests for HRT then have the doc look at your liver enzymes and hA1c.

Hello Rachel, thanks for the reply. Actually my doc prescribed AA after waking up once, and E before bed once. I am at a medium dose, per what I could analyze, and I expect her to up it to the usual higher E dose in my next session, probably splitting it twice a day if oral. I will ask her about the sublingual option to put less stress on my liver until I can get orchi/GRS done, and get rid of the AA. If she agrees with the sublingual, I think I will be less concerned, it is my highest source of preoccupation right now, even though my preliminary examination and ultrasound showed no problem with liver enzymes, size, fat or scars.

I take mine sublingually and split it between breakfast, lunch, and dinner doses.  I think I end up swallowing a small amount anyway so I always take it all sub and hope that most dissolves.  Alcohol has never seemed to interfere with my hrt results and my liver enzymes always look good despite being a moderate/heavy at times drinker and taking high doses of oral/sublingual estrogen.  I am not saying go drink how much you want, but I believe other vices (eg tobacco) can be more harmful in conjunction with hrt than moderate Alcohol use can.

Hi there, That's good to know, what AA are you in? Spiro or Cypro? There have been some comments that Cypro has better results but there are reports of it being too heavy on the liver.
But I think YMMV... maybe I should not be concerned and I'm almost sure my alcohol usage is under a healthy limit. I don't intend to change my habits, but definitely will check with the doc and I am willing to make any sacrifice of my habits for my transition.

[Laurie]

Hi again Jackie,

  It looks like I began streak of a concern for your drinking habits with my questions. I'm sorry for causing that. Like Rachel I am clean and sober almost 19 years. My intent was just to get you to think about it. Trying to deliberately to limit the times and amount of drinking is a sign there may be a problem. Note I said "may" be  a problem not that thee is a problem. Again I sorry for bringing it up but after attending AA for many years it becomes kind of a habit.
  Back you your question I told you I'm a upper gum girl when it comes to estradiol. I asked my GP how I should take my dose. The instructions on the bottle says take x pills per day, but my doctor doesn't care how I take them as long as I take the amount prescribed. I spread mine out over the course of the day and put them between my upper gum and cheek. From the data I've read, it doesn't matter very much. Due to my age I went for the non-swallow method just to further reduce the possibility of clots. Getting it through the VA you're not given much of a choice on delivery methods.

  Enjoy the ride Jackie.

Hugs,
  Laurie

[Pisces228]

I'm on spiro