Sublingual vs Injected

[NancyDrew1930]

I don't see my clinician for a few months, however I am thinking of asking to be switched from sublingual pills to injections.

I'm just wondering what others who have switched from pills to injection found.  I've read that the injections tend to provide more feminization than just being on pills does.

[Lori Dee]

The difference is in what is known as "first pass". Oral medications must first pass through the liver before getting into the bloodstream. This means that higher doses are required to achieve optimum levels in the blood.

Injections and even patches bypass the liver, so lower doses are more effective at maintaining those levels.

I had issues with oral and switched to patches. My levels continued to be too low. Between my Primary doctor, Endocrinologists, and Gynecologist, we figured out that I metabolize hormones very quickly. So my body was processing and eliminating them before they could reach optimum levels.

Now that we figured that out, I was switched to injections. So far, three lab tests show my levels are exactly where they need to be. I have another lab appointment tomorrow, so we will see when those results come back in a couple of weeks.

I hope this information is helpful.

[Chloe]

I'm just wondering what others who have switched from pills to injection found. 

If switching be sure to have doc check "Sex hormone-binding globulin (SHBG)" -> 202 H[ (Reference Range: 22-77 nmol/L) mine was wayyy too high due "pills" thus the lower you can it the more effective injections will eventually be (ie: was on extreme low injection dose until this came down)

[NancyDrew1930]

The difference is in what is known as "first pass". Oral medications must first pass through the liver before getting into the bloodstream. This means that higher doses are required to achieve optimum levels in the blood.

Injections and even patches bypass the liver, so lower doses are more effective at maintaining those levels.

I had issues with oral and switched to patches. My levels continued to be too low. Between my Primary doctor, Endocrinologists, and Gynecologist, we figured out that I metabolize hormones very quickly. So my body was processing and eliminating them before they could reach optimum levels.

Now that we figured that out, I was switched to injections. So far, three lab tests show my levels are exactly where they need to be. I have another lab appointment tomorrow, so we will see when those results come back in a couple of weeks.

I hope this information is helpful.

Isn't the first pass for is you are swallowing the pills, not dissolving them under your tongue?

[ChrissyRyan]

I have been doing sublingual for a number of years.

[Northern Star Girl]

@NancyDrew1930   cc: @Chloe
You are very correct with your statement and advice:

Sublingually administered medications are dissolved underneath the tongue before
passing directly into the bloodstream. Unlike swallowed oral medications, they
don't have to pass through the GI tract or liver. This means they work quickly and
aren't affected by how well the GI tract or liver works.

HUGS, Danielle [Northern Star Girl]

Isn't the first pass for is you are swallowing the pills, not dissolving them under your tongue?

[Myranda]

Hi @Nancy!

I was on sublingual estrogen for about 3 or 4 years, when I made the switch to injections.  Looking back on it, I recall feeling like the switch restarted development, or at least gave it a good boost.  I feel like I had stalled out, and shortly after the switch, my chest started to feel itchy and achy again, all signs that things were re-awaking again and growth was happening again.  In the 5 years since (damn it's been 5 years?!?) I feel like my breasts are continuing to continue to grow and develop, slowly but steadily and filling out a bit. 

As for other changes, I can't say that I have really noticed any other changes.  Though it has definitely shrunk and doesn't really get hard anymore, thank god!

[Lori Dee]

Looking back on it, I recall feeling like the switch restarted development, or at least gave it a good boost.  I feel like I had stalled out, and shortly after the switch, my chest started to feel itchy and achy again, all signs that things were re-awaking again and growth was happening again.  In the 5 years since (damn it's been 5 years?!?) I feel like my breasts are continuing to continue to grow and develop, slowly but steadily and filling out a bit.

That has been my experience, too, when I switched from patches to injections. By changing progesterone to three times daily, the breasts are also becoming more shapely. I love it.
 
 

[Tills]

I don't see my clinician for a few months, however I am thinking of asking to be switched from sublingual pills to injections.

I'm just wondering what others who have switched from pills to injection found.  I've read that the injections tend to provide more feminization than just being on pills does.

Hi Nancy,

This is not what you were asking, but as well as patches there is a fourth option which are gels. I was switched from oral/sublingual to Sandrena gel and it has been absolutely brilliant for me: steady state estradiol levels in female range.

The only issue is that you have to wait for the gel to dry but it has become so much part of my daily routine that I don't notice it now. I am prescribed it twice daily to keep the levels consistent, which isn't really necessary as you can do it in one go in the morning if your physician is happy.

xx

[ChrissyRyan]

I do like the longer time it takes for the sublingual dissolving as it reinforces in my mind my transitioning.  It is a minor, yet affirming daily act.  Not as much as dressing for the workday in an appropriately feminine way but still quite affirming.

Chrissy

[NancyDrew1930]

Hi Nancy,

This is not what you were asking, but as well as patches there is a fourth option which are gels. I was switched from oral/sublingual to Sandrena gel and it has been absolutely brilliant for me: steady state estradiol levels in female range.

The only issue is that you have to wait for the gel to dry but it has become so much part of my daily routine that I don't notice it now. I am prescribed it twice daily to keep the levels consistent, which isn't really necessary as you can do it in one go in the morning if your physician is happy.

xx

I'm hesitant with the gel, since I do have eczema, (and I'm allergic to polysporin so if there are any ingredients from polysporin in the gel, i could break out, which would cause the estrogen to not get past my skin) so I have to be careful with what I put on my skin.

[Mrs. Oliphant]

I'm 73 and live on a fixed income. The VA is my primary healthcare provider. My therapist informed me that VA will not cover HRT. I do have Medicare. Will Medicare help pay for HRT? Is there a ballpark number I can use to financially plan for out-of-pocket costs if I decide to proceed with HRT? And, considering my age, would HRT be effective? There's so little I know about who I am. I am so grateful I found a safe space to learn.

[Lori Dee]

I, too, get all of my healthcare from the VA.

If you already have a diagnosis of gender dysphoria and are receiving treatment (HRT) then your treatment will continue. If you have a diagnosis but have not started treatment, they won't start it.

Check out our Military Veterans Confab board. I post there regularly with the latest updates. Also, if you are up for it, post a bit about your service in the Roll Call forum at https://www.susans.org/index.php/topic,247502.0.html

[kat2]

I suppose its also about the right type of Oestrogen and what your body can do with it cyproterone and premarin, produced a weak prostenagenic effect and my body made good use of that for many years

[NancyDrew1930]

I suppose its also about the right type of Oestrogen and what your body can do with it cyproterone and premarin, produced a weak prostenagenic effect and my body made good use of that for many years

That's why back in 2023 when I started HRT I went with Cyproterone because of its progestin effect.

Of course, for Estradial via injection, from what I see here in Canada, cypionate is only available in Canada for veterinary purposes—-in other words, Health Canada has not approved it for human use only use in like horses and animals.  However Valerate has been approved but only as a compounded medication so looks like I only have the valerate option in Canada, and I'll have to go to a compounding pharmacy.  However, if I'm reading things right, vale rate is the subcutaneous one that has to be injected weekly.

[Lori Dee]

Interestingly, different areas have different availability.

I was switched from Valerate to Cypionate due to availability in the U.S. Yes, it is subcutaneous once weekly but the packaging indicates it can be given intramuscularly. 

Devlyn recently posted that her oral estradiol capsules are also from a compounding pharmacy due to availability in Spain.