injectable, patch, or sublinual/oral?

[Keira]

Kalt,
I don't know where you get your info.
They all can be taken
in non oral form, progestin AND progesterone!!!!!

Natural Progesterone
(progesterone is a more fragile molecule than estrogen, that's why its not in powder form, which
  makes it not ideal for sublingual use since the liquid will not stay there    😀 )
- Capsule form (Promethium, Microgest, etc)
    - Can be taken orally
           (but absorbtion in stomach is not that good (food, etc)
                 and the progesterone is fragile and can be destroyed by the stomach environment )
    - Can be taken as a suppository (its in the leaflet in the box I had)
             (good absortion since that area is highly vascular and the environment is much more benign)
- Gel Form, Crinone
- Cream Form (less concentrated than the gel, people just use more)
   - The progesterone creams; I believe it can be bought anywhere over the counter in the US.


Provera is a progestin, has some of progesterone's effects but has many other possible side effects.
Provera exists in Depot form. Depot-Provera. Under the skin. Lasts a while. Used for birth control.

Duphaston is the progestin with the best side effect profile.
Duphaston exists in Depot form, proluton depot. Again, non oral.

There is a host of other progestins that used to be used, and some still are in
birth control pills, but they have bad side effect profiles (worse than provera).
They are particularly androgenic.



The reason people like pills rather than sublingual or swallowing a capsule rather
than using it as a suppository is ease. The doctors allow it because what they want
most is compliance in meds taking. The most important thing about a medication, is actually taking it.

There is a greater chance that people will actually take their medication at a specific time a specific
day if its no bother. So, even though pills like estrace can be taken sublingually, its
less bother just swallowing it even if the effects will be slightly more random, same
thing with a suppository; what do you prefer sticking a capsule up your butt or swallowing it!
Well, most people will swallow it, even taking higher oral doses to compensate for the
loss in effectiveness rather than going the other route. Even in pill form, many people
forget to take their meds all the time; its a big problem.

[kalt]

So, thus far this thread has basically come up to:

The poll favors injectable hormones.  What kind, we can't know, since the voters didn't post.

The posters seem to be all for sublingual methods.  Sublingual method seems to be valid, but I still am wary of the, "little blue pill" being the same 17 beta estradiol used in the studies.

It's pretty much agreed that the body can plateau on certain dosages, and that even minor dosage adjustments and times taken can restimulate receptivity to the treatment.

Kiera(who's been amazing in this thread), pointed out that she's noticed certain body types to be more receptive to estrogen.  Specifically people with little muscle mass, while their counter parts(those with lean muscle mass) seem to not take it up so well.  This could indicate that metabolism, caused by more lean muscle mass in the body, has something to do with estrogen reception.  Something that should be dug into is whether or not injectable or transdermal prescriptions are better absorbed in these individuals.  I'd also like anyone who was physically fit and capable when starting HRT and has been on it for a lengthy period of time to speak up!

Sublingual absorption has just about been ripped apart, but we're still not doing too well on transdermal methods, whether it be by cream or by gel.

So, battle isn't over yet folks!

[Tanya1]

^ I defiently agree that the receptivity of estro is less the more muscle mass one has.

Other factors include obesity.

Sure- fat will help taking in estrogen BUT remember- if you have fat on your waist and start HRT that isn't good!


For example- someone like Shaquel O'Neal is not very likely to do well because he has very little fats and too much muslce mass.

I suggest you should have very little muscle mass and "some" fat but NOT obese.- this is the perfect body- cardio is excellent as circulation I believe will improve receptivity.- like 3-4 times a week- not too much.


Kalt I really don't suggest you do wieght training as even natal females get T up from it sometimes.

I suggest cardio and yoga for you not lifting wieghts. Just a suggestion, do more research...

[Keira]

I wasn't talking about muscles and E sensibility being related.
Was talking that muscles are more VISIBLE pre HRT, even at nornal weight
and with normal size muscles
if you've got a low E sensibility.

Inside the abdominal cavity fat, visceral, disrupts fat metabolism and
distribution in the body; estrogen cannot steer most fats to the
thighs, legs and buttocks, part get stored in the middle.

Normally estrogen will keep fats away
from the middle, but if you don't exercise fat will start accumulating
behind the stomach muscles even in thin women,
which creates the characteristic bulging out
from the sternum to the waist. Look at non active thin women,
this area bulges out even if you can't pinch anything on them.

[Cire]

I've been considering this:

Would it not be possible to use Prometrium vaginal suppositories anally? This would greatly reduce the dosage needed per the same efficacy if what I've been reading is correct. Both orifaces are warm, wet and lined with mucous membranes.

[Keira]

Yeah you can Cire. That's what I do. Look in the leaflet for your meds.
It should be be one of the proposed administration mode. Though,
even if its not, it should work anyway. Sometimes, the leeflet
doesn't mention it simply because the company didn't want
to have to test this mode and have it FDA approves (or
whoever approves the one you have) because it costs money.

[kalt]

Uck, body fat?  On me?  You've got to be joking.  Some people, like me, simply have a high metabolism and nothing stops it.  In fact, right now I'm eating a big slice of pound cake.  I have gone weeks eating nothing but ice cream, pizza, eggs and sausage and drinking soda and haven't gained a pound.

And what's this with sticking medicine up your butt?  Prometrium?

[Keira]

Never heard of a suppository? Plenty of medecine in capsule form have
this mode of administration. Its more efficient than swallowing the capsule.

[lisagurl]

Some people, like me, simply have a high metabolism and nothing stops it.

Enjoy it while you are young. 😉

[Keira]

Most of the difference in metabolism with age can be explained by
  1) Declining E and T levels, both are linked to metabolism
  2) Decreasing muscle mass
  3) Increasing visceral fats, which has a inpact on insulin levels (which regulate appetite
           and metabolism) and fat storage in the body.

Its possible to supplement 1), continued or increasing exercise helps (2 and 3) when coupled with 1)

[Audrey]

I started on the patches in combination w/ a small amt of oral like 1mg/day.  This worked quite well initially, breast development kicked in quickly as they were very sore, and my moods were very level. 

However, a few months into it my skin (very sensitive) developed a sensitivity to the adhesive in the patches.  It would be on for a day and the skin under it got very red and started itching so bad I couldn't handle it.  I had to pull it off.

After that I was changed to purely oral/sublingual with spiro.  To be specific Estrofem allowed to dissolve under the tongue.  My T levels are within female range.  My breast development has been adequate (A cup in a year).  But I know alot of this is controlled by genetics.

As far as muslce mass etc.  I was very lean and muscular as I have a very physically demanding job.  The hormones have really cut down on my muscle mass and definition.  Instead of a six pack I have a little tummy bulge, not bad but I am trying to watch what I eat now.  Before I could eat whatever I wanted, but I think it is starting to catch up with me.  I also have a layer of subcutaneous fat over my body, which is good as i am softening up.

Audrey

[Tanya1]

I wasn't talking about muscles and E sensibility being related.
Was talking that muscles are more VISIBLE pre HRT, even at nornal weight
and with normal size muscles
if you've got a low E sensibility.

Inside the abdominal cavity fat, visceral, disrupts fat metabolism and
distribution in the body; estrogen cannot steer most fats to the
thighs, legs and buttocks, part get stored in the middle.

Normally estrogen will keep fats away
from the middle, but if you don't exercise fat will start accumulating
behind the stomach muscles even in thin women,
which creates the characteristic bulging out
from the sternum to the waist. Look at non active thin women,
this area bulges out even if you can't pinch anything on them.

Ohhh so you meant that the "tone" of the muscles lightens and becomes less prominent. Excersice is good as it helps fat distrubution while on HRT faster and prevents the belly like you said- but I think you can get away from excersicing if you avoid junk food, fast food, trans food and stick to a very healthy diet.

[Keira]

No, even on a healthy diet, without exercise, any caloric imbalance will make fat got behind the stomach wall. That's what I said, even thin women who eat right will have it. Its due to inactivity and metabolic imbalance caused by it.

When I'm talking exercise, I don't mean anything heavy, a 30 minutes of walking at a decent speed is enough to keep this away or remove it if its not too extreme. If its extreme, it will take more exercise. This fat, responds almost not at all to dieting; it only responds to moderate intensity exercise. High intensity exercise will have a tendency to burn carbs, so its not the best for this.

[kalt]

So Keira, is a strong metabolism a good or a bad thing now?  Visible muscle is due to a low bodyfat, which is due to a high metabolism.  Moderate intensity exercise... Surely spironolactone would block any testosterone released from weight lifting.  However, heavy lifting also releases miniscule amounts of HGH, but it's conceivable that in certain individuals it could be enough to effect things like widening of the hips, is it not?  Simply put, everyone has benefits to gain from weight lifting.  One will burn about 200 calories an hour running, but 800 calories an hour weight lifting, according to Men's Health studies.  Testosterone is the culprit for putting on muscle, not weight lifting.  I know girls that look like cheerleaders who are powerlifters and can outlift most men in most gyms.  The only difference between them and any other hot chick is their backsides are MUCH more aesthetically pleasing!
As far as losing weight goes, putting the body in a catabolic state is a must for trans women, especially those new to HRT.  That means putting a large physical demand on your body for over 45 minutes, till your body begins using protein for energy.  This can be done by doing half an hour of cardio before a moderately intense weightlifting session, or doing half an hour of one cardio and then a bit of another.
I still think that putting on muscle is a must, even if it's only on the thighs and butt.  We haven't got hips, so using everything possible to put some extra mass there is needed.
Besides, what's wrong with muscualr chicks?  I'm not talking about the roid heads, but models like Jamie Eason are absolutely BEAUTIFUL.  And for any transwoman that's not a hard thing to do, work thighs all the time and just do an upper body workout once a month or so, and you've got an athletic figure which allows much more forgiveness for broader shoulders or lack of hips or a poor waist-hip ratio.
As far as muscle behind the stomach goes, what about crunches?  I mean, I'm kind of avoiding all ab exercises in attempt to lose muscle mass off the waist, but high rep crunches can only do so much for putting on muscle, and even that will be negated by lack of testosterone for the large part of it.  A lot of fitness experts say that "spot reduction" is completely false, but I've seen some anecdotal evidence to the contrary.  I also know that an active torso DOES make it harder for the internal organs to put on fat, and it massages the internal organs and shakes up the veins and stuff a bit, helping blood flow.

I guess I'm still trying to figure out of exercise messes up receptivity to estrogen.


And Kiera, I'm looking very much forward to our meeting^_^  In fact, I'm thinking of cooking you something special that you can share with the family that night!  Do you like oriental or cajun or italian better?  I'm young and I'm proud, so shove off:-p  when I first got onto HRT years ago I was an anorexic, and within a week I was cleaning out the fridge.  The crazy appetite subsided eventually.  Even now, I'm TRYING to cut my calorie count down to lose muscle, but it's difficult.  I get this crazy sweet tooth I never had before and I practically DRULE when I see things like dark chocolate and expensive chocolates and such.  I mean, I was literally ringing someone up at the pharmacy and they had one for me to ring up and I moaned, I didn't know it until I got a bunch of weird looks...
I fail to see, however, the connection between estrogen and losing weight.  Losing muscle mass would actually CONTRIBUTE to weight gain, as far as I know and have been drilled into from personal training certifications and health education.  It's all very confusing, if anyone could explain the weight loss from HRT, please do!

Audrey, how muscular were you?  You said a physically demanding job and a 6 pack.  I mean, could you take your shirt off and have the ladies oooh and aaaaah?  I know that at any given point in time right now I could walk on a teen body building stage and place in the top 3.  It's gonna take forever to lose all of this, but hey, it's worth it.  As far as sensetive skin goes, blaaah.  But your doc had you taking estadriol sublingually?  How long did you hold it under your tongue?  Lol, this might be the close of this friggin sublingual thing that's like, never ending!


And one more thing concerning estrogen receptivity, to have a list to discuss with the doc.  Would it be better for oral medications, to take them twice a day, morning and night, or try and split it up so that there's a lunchtime dosage as well?  I'm asking because that would require requesting a different dosage so it could be done, but hopefully it could be done, ya know?  And what about food intake, is it better to take prescriptions on an empty stomach, or before/after a meal?  Any literature to support whatever the answer is?

I looked at the drug label for prometrium today, I didn't see anything about vaginal or anal absorption, but I did see peanut oil.  I'll be collecting labels from all the hormone types from now on and educating myself on it!

[Cire]

About the Prometrium:

Is there any kind of study/knowledge about the different absorbtion percentages of Prometrium with suppository vs oral? I'm not finding efficacy rates to get any dosage information to derive.

Example: is 100mg of Prometrium the same as 200mg oral? 300? 400?

[Keira]

There are studies, but you'll have to look for them. Could be quick or not and
I don't have time. Oral is less efficient than using it as suppository for sure.
Not sure about the dosage question, you'll get more if you use more and
there is no way you can get to the highest physiological levels through
any means. In pregnancy, P levels shoot through the roof. There is a posiitive
effect on the breast devellopment, but just how serum levels relate to effect has never
been studied and is not likely to be studied any time soon. One of the reason is the
difficulty of isolating Progesterone's effects from Estrogen's effects and the
fact that people have a different sensitivity to it. So, the ideal dosage for TS
is certainly not likely to be known or knowable. The more usefull, ideal E dosage is
also not known and knowable.

[Tanya1]

No, even on a healthy diet, without exercise, any caloric imbalance will make fat got behind the stomach wall. That's what I said, even thin women who eat right will have it. Its due to inactivity and metabolic imbalance caused by it.

When I'm talking exercise, I don't mean anything heavy, a 30 minutes of walking at a decent speed is enough to keep this away or remove it if its not too extreme. If its extreme, it will take more exercise. This fat, responds almost not at all to dieting; it only responds to moderate intensity exercise. High intensity exercise will have a tendency to burn carbs, so its not the best for this.

Okay, I'll do just that! thanks

[Wing Walker]

I wasn't talking about muscles and E sensibility being related.
Was talking that muscles are more VISIBLE pre HRT, even at nornal weight
and with normal size muscles
if you've got a low E sensibility.

Inside the abdominal cavity fat, visceral, disrupts fat metabolism and
distribution in the body; estrogen cannot steer most fats to the
thighs, legs and buttocks, part get stored in the middle.

Normally estrogen will keep fats away
from the middle, but if you don't exercise fat will start accumulating
behind the stomach muscles even in thin women,
which creates the characteristic bulging out
from the sternum to the waist. Look at non active thin women,
this area bulges out even if you can't pinch anything on them.

Hello, Keira,

Thank you for mentioning the fat behind the stomach muscles. 

I heard of this only once before in a talk about gender-based medicine delivered by Dr. Pamela Peake, a physician and nutritionist who was at the time associated with the University of Maryland, College Park Campus.  I never gave it any thought until I read your posting  and looked at myself.

In my case I have a goodly amount of padding on me.  My breasts are C-cup.  I have fat on my tummy, thighs, hips, and bum.  I also have way too much that I gather is behind my tummy.  Did I read correctly that this fat will eventually go from behind my stomach to other places on my body provided I exercise sufficiently?

I've been using the weather as an excuse for not walking but I believe that it's time that Cindy and I went to a large, local shopping mall and walk briskly for a half-hour and work our way up to an hour.  When the weather gets better we will be walking up the hills in the neighborhood.

I am anxious to see the results.  I don't want to lose from anyplace besides the area from my sternum to my pubic bone.

Thank you for the info and the help.  BTW, can you point me towards a diagram of the abdominal cavity of the female that shows the visceral fat?  It would explain a lot for me.

Sincerely,

Wing Walker

[Keira]

I'm afraid you'll lose fat from the breasts also. Its better to lose it now, before the breasts support and skin gets deformed from the weight and you get saggy breast when you lose weight later.

Besides, if you have less fat in the middle, smaller breasts stand out a lot more, so its not all bad. I went from 38B to 34B+ that's much smaller (though a good part of this loss is not fat but muscle) (in between B and C, though I wear B's because I hate bras with loose space in them).

In most men (and we live with that legacy), most of the fat is behind the stomach wall (there is some over it of course, the big bulging out is caused by intra-abdominal fats). The good thing, with moderate exercise, its also the first fat to go and you get very quick result on your waistline.

[Wing Walker]

I'm afraid you'll lose fat from the breasts also. Its better to lose it now, before the breasts support and skin gets deformed from the weight and you get saggy breast when you lose weight later.

Besides, if you have less fat in the middle, smaller breasts stand out a lot more, so its not all bad. I went from 38B to 34B+ that's much smaller (though a good part of this loss is not fat but muscle) (in between B and C, though I wear B's because I hate bras with loose space in them).

In most men (and we live with that legacy), most of the fat is behind the stomach wall (there is some over it of course, the big bulging out is caused by intra-abdominal fats). The good thing, with moderate exercise, its also the first fat to go and you get very quick result on your waistline.

Thank you for your confirming reply.

My breasts are made of very dense tissue.  It took more than one image to get a baseline mammogram for me.  There is fat on me up there but it's not much.  My chest was always around 42 to 44 inches around.  Since I have been on HRT since 2002 I believe that whatever muscle was to be lost, has been lost.

When I drop weight it's usually my face that shows it first.  It will be a nice change to see the abdominal fat go first.

Again, thank you for sharing that knowledge, Keira.

Sincerely,

Wing Walker