HRT Changes

[Hannah.Emma]

OK so I have been on the same HRT regiment for a long time. I don't know exactly how long I've been on the same regiment but it's been very stable and I've been decently happy with everything.

Yesterday however I went to my new endocrinologist because I just moved to Florida and he wanted to change everything. Which I did not understand at all being that my numbers are very stable and there is no reason to change anything about when I'm already been on it for at least two years.

First he wanted to change me off of estrogen injections and put me on a patch. I flat out said no to that because I'm sorry I don't care what you may do for other patients but I've been on injections way too long to suddenly have to change everything and find the right balance. it's just not going to happen. I've been on estradiol valerate but he Decided to put me on Estradiol Cypranate.

Which leads me to my first question

From my limited research I see that the dosages that people take for EV is usually higher than dosages for EC. He left me on my same dosage so is it truly one to one or am I about to take a whole lot more estrogen that I'm used to?

One change that he did give me is that he allowed me to go back onto Progesterone though he argued the fact that he wanted me on the pills instead of the injections. I really wanted progesterone back so I agreed to the pills but now I'm left to wonder if he screwed up my Estrogen dosage Then did he really prescribe me the correct dosage of progesterone.

If anybody has any insight to all of this I would appreciate a reply so that maybe we could talk about it.

[Kirsteneklund7]

Why not consider bioidentical estradiol ? It comes in all the traditional administer forms - injection, pill, transdemal, implant ect. It is as potent as other estrogens as well .
   Hope that helps, Kirsten.🦋

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[Hannah.Emma]

My medical care is through the VA.  I don't get much choice in what version the subscribe.

[Harley Quinn]

I also go through the VA.  I have no idea why the push for patches and pills recently.  I am getting the same issues in Seattle.  I'm going to assume that part of the injection "issue" is going to be the added cost of needles, syringes, and disposal.  My second thought on the switch is that they know that with injections your E2 levels are going to be very high initially and that they taper over a week or so.  I have a feeling that the "spike" is their issue.

Side note: Estradiol Valerate is a bioidentical hormone as I recall.

If there are a lot of others that are being pushed away from EV IM injections, I'd assume that they are probably trying to remove it from the formulary.  Which would make it a special order, and a more expensive medication.  There have also been a few instances of limited availability, which may be influencing the change to a more readily available method of administration.

The biggest issue I have with the proposed switch is "quality of life".  I'm on weekly injections and I find it far easier to manage a once a week injection than to remember to pack around extra pills, or patches.  Remembering to take them on time, remembering to check if the patch is still on and hasn't come off.  I'm also on prometrium with other transition pills (finasteride, and spironolactone), I'm a little embarrassed to say that I constantly forget to bring them with me (or take them in the mornings).  However, I always remember my injections (mainly because I feel terrible at the end of the week.)

I can't speak to the potency of EC vs EV, but if you have the moderators move the post to the Hormone section I am certain you'll get your answer.

Best advice is to stick to your guns on why you don't wish to change.  I've successfully won that battle consistently over that last 3 years, and am still on injections.  It recently reared its ugly head again. With my upcoming GRS, they want to switch me to pills because my dose on injection would be very small...  sigh....  I am still pulling the "quality of life" card. With constant dosing, I can't really live my life.

[PurplePelican]

Yes, EC should be dosed differently to EV, generally either as actual dose (more common) or by period between shots (less common).

The push away from injectable estrogen in the US is most likely related to the supply issues. Perrigo, the manufacturer of the generic products, has advised that there is no longer any issue with supply and that stock should now be available.

Why not consider bioidentical estradiol ? It comes in all the traditional administer forms - injection, pill, transdemal, implant ect. It is as potent as other estrogens as well .
   Hope that helps, Kirsten.🦋

Both Estradiol Valerate and Estradiol Cypionate are bio identical estrogens, they are different esters of the same drug.

I also go through the VA.  I have no idea why the push for patches and pills recently.  I am getting the same issues in Seattle.  I'm going to assume that part of the injection "issue" is going to be the added cost of needles, syringes, and disposal.  My second thought on the switch is that they know that with injections your E2 levels are going to be very high initially and that they taper over a week or so.  I have a feeling that the "spike" is their issue.

If there are a lot of others that are being pushed away from EV IM injections, I'd assume that they are probably trying to remove it from the formulary.  Which would make it a special order, and a more expensive medication.  There have also been a few instances of limited availability, which may be influencing the change to a more readily available method of administration.

It's interesting, in other areas of medicine, those estrogen levels aren't considered "very high". The main cause of the push for pills and patches has been a lack of availability of generic EV - and your insurance companies didn't like paying for the brand name, which had no supply issues, just 4x the price. And I can't see it being removed from the formulary, it's too well used in other areas of medicine, like oncology, for that to happen.