E Injections vs Pills

[Melinda@heart]

My doctor offered to switch me to injections instead of pills, but I have a couple of questions for those of you who have tried both. I have researched what I could find online and I will be speaking to my doctor again. I would just like to hear first hand accounts.

What are the benefits?

Did you notice more/better feminization results from one or the other?

Does there still tend to be a shortage of injectable E? If so do you then go back to pills?

Did you experience side effects?


Thanks!

~Mindy



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[Jill E]

There was a shortage a couple years ago, and I moved to pills for about a year because of it. I've been on IM injections again since. I had read in an article in Vice or Vox that the shortage was essentially caused by needing FDA approval on something about the medicine being changed to another manufacturer, I believe it was something silly like a part of the vial. I don't recall specifics, so that might be somewhat inaccurate. Currently the FDA lists it as being in shortage. I use brandname and don't have an issue. If you have questions on specifics, message me.

As far as benefits, it only makes one pass through your liver (rather than 2, like with the pill) - you'll have lower risk for blood clots. As far as benefits you can actually see/notice.. you might find that your mood fluctuations differ from before. On pills, I felt tired and emotional towards the end of every day..I'm also super sensitive to medications though. With weekly shots I was just experiencing that towards the end of my shot period, but it wasn't as bad. I've since moved to shots injected twice a week (same volume in syringe, but half the concentration). I feel great all of the time now. I find in general I feel happier on shots than on the pill, and have way more energy.

*edit - my mood has been stabilized enough to be able to go off of antidepressants since switching back. However, everyone's body is different and might not experience the same benefits


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[Devlyn]

My doctor offered to switch me to injections instead of pills, but I have a couple of questions for those of you who have tried both. I have researched what I could find online and I will be speaking to my doctor again. I would just like to hear first hand accounts.

What are the benefits?

Did you notice more/better feminization results from one or the other?

Does there still tend to be a shortage of injectable E? If so do you then go back to pills?

Did you experience side effects?


Thanks!

~Mindy

Same molecule, delivery method is usually tailored to the individual's health, lifestyle, and availability.

[Margarine]

I have done both, pills for a month then onto injections. I split my 7 day dose in half and take it every 3.5 days. My mood is overall stable, I also take injectable progesterone. I can not given an example which is better, I did not like the pills and from what research I did there was reduced risk of DVT with IM. If any questions please pm me.
Take Care,
Margaret

[tgirlamg]

Hi Melinda!

I have been injecting over 5 years now... I can't compare results to other delivery methods since I only took pills for about a month but... I am happy with my feminization results!

I have had to change where I filled my prescription and as far as I know... only brand name ( non generic)  is currently available unless you have it compounded for you if that is an insurance/financial concern... I have never been unable to fill my prescription somewhere

No side effects to speak of.... unless you count boobs??? 🤪

Onward we go brave sister!!!


Ashley 🙋‍♀️💕🌻

[Dani]

The main benefit for injectable Estradiol is the Estradiol goes to your body first, then will eventually circulate through your liver for metabolism. If you swallow your Estradiol tablet it is absorbed by your stomach and then it will go straight to your liver where much of it is metabolized, then on to the rest of your body. This is the first pass effect. Every time your Estradiol passes through your liver some of it will be metabolized and the rest will continue to the rest of your body. No matter how you take your Estradiol, it will be continuously circulating with multiple passes through the liver until the amount remaining in your blood system is completely metabolized.

Each method of administration of Estradiol has its own half-life. This depends on how the Estradiol is released by the oily substance mixed in with the Estradiol. Tablets taken sublingual avoid the first pass through the liver, just like injectable Estradiol and go directly throughout your body. However, unlike injectable Estradiol, there is no oil based reservoir to continually release the Estradiol into your blood system. The results is that the half-life of sublingual tablets is much shorted than injectable Estradiol.

Estradiol patches work like Injectable except that the drug reservoir is in the patch sticking to your skin, with a similar release rate.

Feminization really depends on your blood levels and how long you have been on Estradiol. Each route of administration has produced outstanding feminization, given a proper blood level for at least a year. Some of us need more than one year of Estradiol.

Any risk of blood clots, such as DVT, stroke or cardiac issues is about the same for all routes of administration except for the older Ethinyl Estradiol which was used in birth control pills. Smoking made things worse.

Each route of administration has it's own proponents and detractors.  Some people find one route preferable for any number of reasons and the only way to find out how you respond to Estradiol is to try it. Good luck and no matter which route you chose, it will work. You just need to be aware of the side effects and keep an open line of communication with your doctor. Changing a prescription is done all the time.

[AnneK]

I'll be getting pills, as that's what's covered with the drug plan.

[HollyKay]

I have been on Estradiol Valerate for about a year and a half, and before that about a year on E2 pills. I found that fat distribution has been much better with EV than E2. I have noticed that my moods are much more consistent with an EV shot every three days.  There is a reason for this.  It has to do with what type of injectable Estradiol you are taking, and the speed at which it spikes, and then metabolized by your body. This is a graph that shows the spikes, and the rate of metabolism.

The most common these days seems to be Estradiol Valerate.  You can see from the graph that it peaks at day 3.  Hence why my decision for a 3 day cycle was introduced. I tried every 5 days, but by day 5, I was very irritable.

If you can handle needles, the EV is way better in my opinion. Would I go back to E2? Nah.  I do carry a backup supply of pills just in case, but mostly to appease my anxiety of not having anything in the event of a disaster, whether natural or man-made.  I buy mine from a compounding pharmacy, and it is cash out of pocket. Even with that in mind, I consider it a necessity and can most easily justify the cost.




*No Dosages Please*

[Melinda@heart]

Thank you all for your replies! This has answered most of my questions.

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[PurplePelican]

Oral admin of estradiol esters is known to cause a high level of E1(estrone) in comparison to E2. This is not at all an ideal situation.


E2 is Estradiol.. EV is an ester of Estradiol.. EV is a prodrug of estradiol, using a prodrug like this gives better resistance to first pass metabolism and leads to better bio-availability. The pills would have been either EV or estradiol hemihydrate.

Basing your cycle on single dose data is not good science, as it gives no indication as to what can be expected from multiple doses. In all my reading, I've never come across a 3 day cycle before, 5 seems to be the average - although dose for those seems to vary from person to person. I take sublingual EH daily, without an antiandrogen, but that's only due to injectables being unavailable easily.

[mako9802]

3 days does seem like overkill....but you know your body so....

[HollyKay]

@mako9802
Yeah, it wasn't based solely on the absorption rate, I went down in steps until I found the sweet spot for my moods. It is overkill for some, but each body is truly different. Each interaction between different medications can vary greatly between different people, too.

@PurplePelican
I used the shorthand comparison when describing EV and E2. I'm sorry for not being clear enough in my description. I used "E2 pills" to simply describe them and to denote that I was talking about the pills that have E2 stamped on them.

Regarding my own frequency, I used the graph to have an idea of why I felt my symptoms with coming down, and to try to gauge how I could aliviate them. Since switching to a 3 day cycle,  my moods have stabilized and that's had a very positive effect on me, and those around me   Another gal, @Margarine has also mentioned that she does the 7 day split as well, so I don't feel like it is that uncommon. On occasion when I feel my levels are still too high, I may do my shot on the 4th day, instead.  My endocrinologist monitors my levels and is very much okay with my self-guided approach.  He said to me on our last appointment, "Holly, this is your transition. You are the guide. I'm just here to make sure that you're safe".

I am also fortunate to have my EV compounded on site at my pharmacy, so there are never shortages.  I hope I've clarified what I was trying to explain a little better. Best.

Edit:  I forgot to mention that I get regular blood requisitions completed, so I have an idea on how the changes have affected my counts.  That is not a catch all, but it has given me a really good idea of my own metabolism.

[Margarine]

3 days does seem like overkill....but you know your body so....

I have been splitting my 7 day dose for almost 2 years now. I get blood work done every 3 months, my PC, Endo and Gyno all can see the results. In the end I have been happy, they have been happy. My co workers, friends and partner are happy with almost no mood swings. My additional out of pocket for every 3.5 days vs one every 7 days is less than a US dollar for disposables. Every body is different and what works for one may not work for another.... I have managed to build a bit of a reserve, just had my MD write for one multi inject bottle of Delestrogen and on multi inject bottle of Progesterone and month since clinical protocol is to discard 28 days post 1st puncture.

[PurplePelican]

It's also occurred to me that all the women I know on a 5-7 day cycle are also not taking any antiandrogens, the E2 itself provides that function. Different philosophy too, I guess. This approach tends to get the E and T numbers "right" first, then smooth out the ride.

Myself, I'm a sublingual girl.. Works for me. OK, yes, it's a dose and resulting E level that causes some doctors and others here to have a minor stroke, but my doc and I are both in agreement about the risks - very little.

[Margarine]

These are the numbers at day 3 post injection for me. I feel great and my former endo would have died from an MI over these numbers. She wanted me to swallow my pills, no sublingual and wanted my levels between 55 and 125 PG/ML. She is no longer my ENDO My Current ENDO, Gyno and PC are ok with my numbers. I have lost 83 lbs, dropped my BP to low adult normal ranges and have low normal cholesterol now. My A1c went from 9.8 to 4.2 over the past 2 years. I think it is mostly that I give a damn about myself now.
ESTRADIOL (ADULT)
482 pg/mL
0 - 55 pg/mL
H
FEMALE: PREMENOPAUSAL ...... 13 - 498 PG/ML
POSTMENOPAUSAL ..... 0 - 55 PG/ML
MALES: .................... 8 - 43 PG/ML

[KayXo]

I also feel better on injections vs pills. More energy, feel happier, skin soft. No issues. I inject every 3 days.

[Sophiaprincess2019]

Hello girls, glad I found this thread because I start HRT (first Endo appt) Thursday and was curious about different routes of administration. I now see how individual the route of administration is, particular to individual needs or body. I read one Doctor who even factored how many receptors a woman has.

[jill610]

Hello girls, glad I found this thread because I start HRT (first Endo appt) Thursday and was curious about different routes of administration. I now see how individual the route of administration is, particular to individual needs or body. I read one Doctor who even factored how many receptors a woman has.

Age also is a factor, many do not like pills after age 40 and will steer you towards patches and injections just based on that.

[Sophiaprincess2019]

Hi Jill, I read that someplace also, but also read another woman (here) who said at age 66 she was taking pills. Guess it's all part of her Doctor's regimen. Either way I'm getting more and more anxious/excited to start HRT.

Sophia

[Sophiaprincess2019]

Hello again ladies, JUST got back from the Endo Dr and Pharmacy with my initial HRT prescriptions. My Dr have me pills (I'm 50) with no health conditions. I asked her about route(s) of administration and my Dr said (and Pharmacist confirmed) pills vs injections vs patches are based on each individuals body chemistry and state of health. My primary care MD said I'm in perfect health and I should have no problem taking pills and that's exactly what my Endo put me on.

One thing my Endo Dr DID say was I might want to try switching to injections from pills if mood swings become a problem, she's willing to write me any prescription I need for success HRT route wise.

Onward.

Sophia