Patch dosage equivalents/efficacy over time

[Lucy Ross]

I've been on transdermal for 6 days, switching from sublingual.  On my first day I took a melatonin to sleep better - and spent the whole next day as a complete zombie!     I'm talking just constantly nodding off, it was amusing as all I had to was sit around anyway, but jeez.  Wonder what happened there.

Have you other gals had to deal with patches running down towards the end of their cycle?

[Dani]

How ever you get your Estradiol in your blood system is not the important factor. The really important thing is the amount of Estradiol as measured by your blood levels. You want to get your blood levels at least to 150 to 200 pg/ml on the average.  One fixed number for blood levels is not important.  The average blood level is important.

Estradiol is produced in many areas of the body. Ovaries are a major source, but also fat cells, brain tissue and male testes all contribute. Patches are marketed mainly for post-menopausal cis women. The blood levels produced by the patches are designed to provide just enough Estradiol to relieve the post menopausal symptoms. For cross gender HRT, many trans women need to apply two large dose patches to get the average blood level where it needs to be. Depending on how much Estradiol you produce naturally, your blood levels may be higher or lower than someone else on the same size patch.

Patches are designed to release Estradiol in a relatively consistent manner, but when the patch exhausts the reservoir of Estradiol, the release rate drops off dramatically.

[Marcieelizabeth]

Hi!  I am on the patch since it does not as you say go through the liver and it alos is the only form that has a lower risk for stroke and heart issues.  I have had it increased three times, but I am on a patch that is switched twice a week.  The once a week patch kept falling off.  The patch has worked well for me except sometimes coming off in the shower, but I have found I can take them off and then re-apply them after a shower and they stick and work well.

I definitely do feel a tweek and my nipples are sorer when I apply new patches.  My endo says that having at least one patch is better than not having any so if they fall out I sometimes have had to for a day or two have less delivery.  I know some on HRT transitioning think they feel more like a woman if there is a flux in Estradiol delivery.  I can do without the moodiness and changing mood if possible so I want to just keep them in place and on time!  I hope it goes well with you with a PCP - that I think can be tricky!

Love and Hugs Marcie

[Meghan]

I have same problem keep my patch in place, now I found the spot on my lower back keep stayed on for a full week


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[davina61]

The ones I use stick like a limpet, hard to pull of. Put them on my thigh as well changing in out left right twice a week

[Meghan]

I was having problem with stick patch until I find good place for it.

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[RobynTx]

I'm on a two patch system as well.  I change the one on my left side on Wednesday and the one on my right side on Saturday.  Sometimes I will have a patch that tries to come off early and I have a supply of Tegaderms that I use to keep them in place.  I've been on patches for over 8 months now and it is tricky to keep finding good places that will work.

[KayXo]

You want to get your blood levels at least to 150 to 200 pg/ml on the average.  One fixed number for blood levels is not important.  The average blood level is important.

This is a guideline set by the Endocrine Society that was somewhat arbitrarily chosen (an average was calculated but the female range varies widely, from 20 up to 1,000 pg/ml, depending on the source) and is not based on any kind of strong scientific evidence that this range produces optimal results in transwomen (as per a recent study) who are markedly different than ciswomen in many respects. Not all doctors abide by this guideline either as they realize individual sensitivity varies a lot. Some may feel good at this level, others not. Estradiol levels also fluctuate quite a bit so that blood tests may be unreliable and intracellular concentrations may not reflect serum levels.

It's important, I think, to understand where this number comes from.

Hi!  I am on the patch since it does not as you say go through the liver and it alos is the only form that has a lower risk for stroke and heart issues.

Stroke and heart issues were observed with non bio-identical forms of estrogen, often accompanied by the use a non bio-identical progestogen. Studies have found quite different results on bio-identicals, even when taken orally, results that would suggest a cardioprotective effect rather than a deleterious effect.

[Marcieelizabeth]

Stroke and heart issues were observed with non bio-identical forms of estrogen, often accompanied by the use a non bio-identical progestogen. Studies have found quite different results on bio-identicals, even when taken orally, results that would suggest a cardioprotective effect rather than a deleterious effect.
[/quote]

Bio-identicals have not been clinically tested thoroughly in trials that are accepted in the US, so data so to speak are either anecdotal or not under the strict protocol for pharmaceuticals.  Now I know some European studies that are not accepted by the FDA here do show safe use of bio-identical cream sources of various female (and male hormones) and I do trust using them, but CAREFUL though as they are not all standardized, or at least not by accepted sources. 

BUT I DO Trust my Endocrinologist, and according to her the only study showing differences in stroke and heart issues show that the patch has a lower risk of stroke than shots or pills, my understanding, and I am a biologist so I do understand good science, is that the pill has a lower risk albeit insignificant than the shots.  My family has a history of strokes so this really matters to me.  THANKS for the input!

Marcie

[Devlyn]

The ones I use stick like a limpet, hard to pull of. Put them on my thigh as well changing in out left right twice a week

I used the Sandoz patches, they stuck really good. There was always a lint ring where I removed one. Nurses put alcohol on medical tape to release it before they take it off, you could try that.

Hugs, Devlyn

[KayXo]

Bio-identicals have not been clinically tested thoroughly in trials that are accepted in the US, so data so to speak are either anecdotal or not under the strict protocol for pharmaceuticals.

There have been many clinical trials and/or studies in the US and the rest of the world, starting in the 1930's, with the use of pellets and injections delivering bio-identical estradiol. I've come across at least a few thousands since I started reading about it. As far as I can tell, from all the results gathered so far and knowing this is exactly the same hormone that is naturally produced in women since millions of years, it's a fairly safe hormone.

they are not all standardized, or at least not by accepted sources. 

They are if you get them from a reputable pharmacy.

BUT I DO Trust my Endocrinologist, and according to her the only study showing differences in stroke and heart issues show that the patch has a lower risk of stroke than shots or pills

If you can share this study with me by PM, I'd appreciate this. Thanks.

[Marcieelizabeth]

There have been many clinical trials and/or studies in the US and the rest of the world, starting in the 1930's, with the use of pellets and injections delivering bio-identical estradiol. I've come across at least a few thousands since I started reading about it. As far as I can tell, from all the results gathered so far and knowing this is exactly the same hormone that is naturally produced in women since millions of years, it's a fairly safe hormone.

PLEASE Share the sources by PM, MDs for the most part (some differ in their opinions) would say and have told me there are not standardized dosages and they will not prescribe them - Now naturopathic doctors certainly do, but most are not MDs. 


BTW what is a disreputable pharmacy?  Thanks

If you can share this study with me by PM, I'd appreciate this. Thanks.

[Dani]

BTW what is a disreputable pharmacy?

Internet pharmacies that do not require a prescription or any other place you may get substandard or counterfeit drugs.

[KayXo]

For studies, search on google scholar. Keywords: estradiol/estrogen, bio-identical, oral, pellets, implants, injections, gel, transdermal, patch, women, men. You'll find plenty! 

[Marcieelizabeth]

Internet pharmacies that do not require a prescription or any other place you may get substandard or counterfeit drugs.

Aha - well I see them as illegal, I guess that was my confusion.  Thanks for clearing that up!

[Marcieelizabeth]

If you can share this study with me by PM, I'd appreciate this. Thanks.

Hi KayXO -

Well its not a PM but I found this within the article "Dialogues Clin Neurosci. 2002 Jun; 4(2): 149–161.
"Estrogen and neuroprotection: from clinical observations to molecular mechanisms '
Dena B. Dubal, Department of Physiology, University of Kentucky College of Medicine, Lexington, KY, USA;
Phyllis M. Wise, Division of Biological Sciences, University of California Davis, Davis, Calif, USA;" as you say searching on Google Scholar...

That supports the difference in safety for delivery for transdermal which avoids the liver detoxification and is what I spoke of: 

"In contrast to protection, estrogen may, under some circumstances, impose an increased risk for stroke by influencing coagulation and fibrinolysis. Concerns of the thrombotic potential of estrogen arose from early observations that oral contraceptives appeared to increase the risk of venous thrombosis, pulmonary embolism, and stroke.51 Similarly, ERT in postmenopausal women appears to be associated with a higher risk of venous thrombosis during the first year of use.52 However, whether ERT imposes a risk for ischemic stroke in postmenopausal women is unclear. We now understand that the dose of estrogen administered and the route of estrogen delivery are key components in determining clotting potential. At higher doses, oral estrogen, which enters the body via the enterohepatic system, can stimulate the production of thrombogenic factors53,54 predominantly through its actions on the liver. Alternatively, lower doses of estrogen, delivered orally or transdermally, may not significantly affect hemostasis.53,55-57 Importantly, transdermal delivery of estrogen bypasses enterohepatic circulation and may thus prevent estrogen-mediated stimulation of thrombogenic factors in the liver. Collectively, these findings highlight the importance of low, physiological doses in estrogen replacement of postmenopausal women." Thrombogenic factors have been shown to increase stroke.

Love and Hugs, and Thanks  Marcie

[KayXo]

"Dialogues Clin Neurosci. 2002 Jun; 4(2): 149–161.
"Estrogen and neuroprotection: from clinical observations to molecular mechanisms '
Dena B. Dubal, Department of Physiology, University of Kentucky College of Medicine, Lexington, KY, USA;
Phyllis M. Wise, Division of Biological Sciences, University of California Davis, Davis, Calif, USA;" as you say searching on Google Scholar...



"In contrast to protection, estrogen may, under some circumstances, impose an increased risk for stroke by influencing coagulation and fibrinolysis. Concerns of the thrombotic potential of estrogen arose from early observations that oral contraceptives appeared to increase the risk of venous thrombosis, pulmonary embolism, and stroke.51 Similarly, ERT in postmenopausal women appears to be associated with a higher risk of venous thrombosis during the first year of use.52"

These findings are with non bio-identical forms of estrogen (ethinyl estradiol and conjugated equine estrogens).

"At higher doses, oral estrogen, which enters the body via the enterohepatic system, can stimulate the production of thrombogenic factors53,54 predominantly through its actions on the liver."

There are significant differences between bio-identical estradiol and other forms when taken orally. The impact is much less, as demonstrated in several studies with bio. It's important to make the distinction.

The more you read, the more you will realize it's a little more complex than what they state.

[Marcieelizabeth]

kAYXO - Unfortunately, since none of the doctors I have an option to see will prescribe Bio-identical forms that my insurance will pay for...it does not matter when it comes to my options. 

The reason STATED is the bio-identical forms are unregulated as far as the delivered amounts, and the studies done with them have not scientifically shown their safety - THAT IS THEIR OPINION, NOT MINE.  I realize that you will not agree with that and many "studies" outside the realm of the FDA and MDs do agree with your statements.  They are just not accepted by a majority of medical doctors.  I understand that that is a complaint of many people about our US medical system.  I trust it for better or worse. 

My own sister would agree with you, she sees a naturopath that is also a medical doctor and prescribes bio-identical forms, that she and her husband take!!!

However,  I really do not want an ongoing back and forth, you obviously are very knowledgeable about alternative options and I applaud that and thank you for the information! I myself have tried bio-identical forms prior to getting a prescription and they worked and I trusted them.  But I cannot get them paid for, and my physician will not keep me as a patient if I take them as they will not allow for her monitoring to be evaluated in a way she needs.  THANKS!

Love and Hugs, Marcie