Sublingual vs Injected

[Devlyn]

I don't agree with not committed if one is on a certain application.  This may be the only means of application for a certain individual due to certain circumstances.  If this what people actually think.

Just to clarify, those are not my beliefs. They are my observations from the last fifteen years I've spent on this site.

Hugs, Devlyn

[Annaliese]

Just to clarify, those are not my beliefs. They are my observations from the last fifteen years I've spent on this site.

Hugs, Devlyn

Yes I understand. Some of these are sure out there

[hazelkitty]

This discussion of sublingual vs injected feels so pretentious. It's like the ->-bleeped-<- expert phenomenon.

That being said, I prefer the pill method because in the event of an apocalypse or civil war, pills are easier to come by and take up less space. Months of estrogen in a small pocket as opposed to one month in a small box. If I were ever homeless, that's a problem.

[Allie Jayne]

Studies have shown that sublingual or buccal oral E does not prevent first pass through the liver as much as commonly believed due to the amount of E dissolved in saliva and swallowed. Some people have advocated spitting out saliva, but this just wasted available E.

Transdermal methods are preferred by many clinicians and can provide excellent results. Remember, we should be guided by our doctors as they know our medical histories and should be aware of complications and drug interactions. Injections are suitable for many, but are not without problems. Many doctors prescribe injection intervals longer than the half life of the estrogen, causing patients to suffer highs and lows between each dose. People have problems injecting like hitting blood vessels or leakage.

Probably the premium method is inserted pellets as they give the most even doses for periods up to 2 years. This has the added benefit of feeling more like natural hormone supply, and can reduce dysphoria in people who feel daily or weekly doses remind them they are not cis. Pellets are available in the US, but may not be covered by insurance.

In the end, there are many methods, and we need to work with our doctors to find the best suited fos us. There is evidence that changing methods every couple of years can wake up receptors and restart development, and short periods on orals can make other methods more efficient. No doctor prescribed method is any more valid than the others as we all have different needs.

Hugs,

Allie

[Devlyn]

Studies have shown that sublingual or buccal oral E does not prevent first pass through the liver as much as commonly believed due to the amount of E dissolved in saliva and swallowed. Some people have advocated spitting out saliva, but this just wasted available E.

Transdermal methods are preferred by many clinicians and can provide excellent results. Remember, we should be guided by our doctors as they know our medical histories and should be aware of complications and drug interactions. Injections are suitable for many, but are not without problems. Many doctors prescribe injection intervals longer than the half life of the estrogen, causing patients to suffer highs and lows between each dose. People have problems injecting like hitting blood vessels or leakage.

Probably the premium method is inserted pellets as they give the most even doses for periods up to 2 years. This has the added benefit of feeling more like natural hormone supply, and can reduce dysphoria in people who feel daily or weekly doses remind them they are not cis. Pellets are available in the US, but may not be covered by insurance.

In the end, there are many methods, and we need to work with our doctors to find the best suited fos us. There is evidence that changing methods every couple of years can wake up receptors and restart development, and short periods on orals can make other methods more efficient. No doctor prescribed method is any more valid than the others as we all have different needs.

Hugs,

Allie

I'm not a doctor,  but I'm pretty sure women don't experience steady hormone levels for two years...or even a month for that matter.

Hugs, Devlyn

[Lori Dee]

This is a debate I have had with two Endocrinologists, one of whom taught Internal Medicine doctors in the specialty of Endocrinology.

First, WPATH guidelines and the hormone protocols established by the Endocrine Society state that the purpose of hormone therapy in transgender individuals is to "maintain sex hormone levels within the normal range for the person's affirmed gender".

OK, Doc. Let's go back to Human Reproductive Biology 101:



As you can see, hormone levels are not in a steady state. So why are hormones prescribed in a steady state and not cyclic like the human body?

Because transgender women do not have a uterus. The fluctuations in hormone levels serve as signals in the body to perform various functions in the uterus to prepare for menses or pregnancy. Birth control pills came in packages of 28 pills. 21 of which contained a synthetic progestin and 7 were placebo (sugar pills). This was to mimic the 28-day monthly cycle (see graphic above).

OK, so these hormones ONLY affect the uterus and do nothing else? No, that isn't true either. These hormones play a crucial role in BREAST DEVELOPMENT and maturity, something that transgender women are interested in achieving, right?

Estrogen develops the internal structures of the breast, the ductwork leading to the nipple, and deposits fat to cause the breasts to elongate. Progesterone develops the alveoli (milk glands), which causes the breast to become fuller and rounded.

What happens during pregnancy? Both estrogen and progesterone rise together to very high levels, sometimes 10 times higher than baseline. This signals the breasts to get ready for lactation and the feeding of a newborn. The breasts begin to grow, develop, and mature much faster. What would have taken years of puberty now gets done in nine months.

When the baby is delivered, the placenta (which was producing the high hormone levels) is delivered and can no longer provide this function. The rapid drop in hormone levels signals to the breasts that it is time to start producing milk. Prolactin causes milk ejection, but progesterone blocks this while the breasts are developing. When progesterone levels drop postpartum, prolactin is no longer inhibited, and lactation can occur.

So, it would seem to me that fluctuating hormone levels affect more than the uterus, and whoever designed the human body had a reason for these fluctuations. Does that mean that a steady dose is bad. No, not at all. But if the goal is to "maintain sex hormone levels within the normal range for the person's affirmed gender" perhaps mimicking the same cycle might prove beneficial.

Cyclical dosing of hormones has long been accepted in the medical community (as in the birth control pills mentioned above), but is only recently being investigated as an approach to treat menopause. Perhaps, studies may show that it is equally beneficial for transgender people too.

[Tills]

Patches, gel: soft, not committed.

Pills: getting serious.

Injections, implants: grrrr, now you actually mean it.

Hugs, Devlyn

I know you meant that as a bit of a joke  Hopefully peeps reading it won't be offended.

Applying gels is by far the 'most committed' if we're playing this kind of game. And I write that as someone who has been on every single method going over the past 11 years. It's certainly true that once you jab yourself with an injection there's no turning back for a few months. When I self-sourced in Bangkok that was pretty scary and ill-advised.

Nowadays I wake at 4 am every morning to apply my morning dose which I administer on my lower torso so have to be naked from the waist down. And I have to wait 30 minutes twice a day for my gel to dry. It requires the greatest level of commitment to the cause of any method. (It's even more time consuming than dilation below.)

I find the afternoon dose the biggest pain in the proverbial. It does often affect my life in terms of what I can do and where I can be. Both doses also have a big impact on when you can and cannot wash.

But I'm used to it now.

My patches fell off. I'd probably go back to injectables. The easy-rider method for those less committed

xx

[Lori Dee]

For me, the oral and transdermal routes did not provide enough of the hormone to maintain my levels where they need to be. Injections fixed that. But my doctors determined that my body is a fast metabolizer, so apparently I need a higher dose in order to maintain my levels because my body processes and eliminates it quickly.

Obviously, this will not apply to everyone. Many people have success on oral doses, and some with transdermals (patches, gels). I don't mind injecting. 5 minutes and I am done and on my way. I think the take-away here is that if someone is having a difficult time maintaining their levels, switching to a different brand or different delivery method may be required.

[Devlyn]

Injections are contraindicated for me due to severe needle phobia. It's on my medical records.

Please, I don't want anyone telling me to put on my big girl panties. Needles trigger fainting in me as soon as they penetrate the skin (Vasovagal syncope). It's not a laughing matter. The size of my panties won't change anything.

Hugs, Devlyn

[Tills]

I think the take-away here is that if someone is having a difficult time maintaining their levels, switching to a different brand or different delivery method may be required.

I think there's a lot of truth in this.

I did read somewhere research suggesting that taking a break and returning to them does the same thing: it triggers the receptors into overdrive but I can't trawl the internet right now so, please, no one go down that route without medical oversight. If it's true it may be more because the body gets familiar with medication administration and dosage: all to do with drug tolerance.

There was a famous instance of this, of course, with Oliver Sack's 1993 book Awakenings about the L-DOPA drug treatment for encephalitis lethargica.

[Allie Jayne]

I think there's a lot of truth in this.

I did read somewhere research suggesting that taking a break and returning to them does the same thing: it triggers the receptors into overdrive but I can't trawl the internet right now so, please, no one go down that route without medical oversight. If it's true it may be more because the body gets familiar with medication administration and dosage: all to do with drug tolerance.

There was a famous instance of this, of course, with Oliver Sack's 1993 book Awakenings about the L-DOPA drug treatment for encephalitis lethargica.

While there is no evidence that hormone cycles benefit Trans women development, some believe the closer to cis they can be helps them. There is some evidence that receptors get 'tired' when on the same dose year after year, and quite a few doctors recommend making a change can wake up receptors. The strongest effect seems to come from orals which create Estrone, which, while not being a feminising hormone, does react more strongly with receptors, and encourages them to take Estradiol once the Orals are stopped.

Ceasing hormones for any time is probably not a good idea as it is important for many other body functions. The half-life of estradiol valerate (EV) and estradiol cypionate (EC) are approximately 4 and 8 days, respectively, so not long term.

I have tried orals, patches, gels and pellets, and typically when changing methods I have noticed some breast pain or other subtle effects. Pellets have the greatest commitment as once inserted you can't alter the dosing for sometimes well over a year. This means you need to find your personal effective dose, sometimes by starting with a small pellet and adding more pellets later.

There is a belief that more is always better, but as we are all so different, it is not true. Some of us will have our best development on low doses, while some need higher doses, and to complicate this, some of us only notice development while our levels are rising. For those of us on other medications, drug interactions can affect our HRT in effect or in measured blood levels. Blood hormone levels show available hormones in the blood, but give no indication of what receptors are taking up, so in the end, we can only determine if our hormones are working by visible development.

I have started a range of medications a couple of years ago, and since then my blood levels have made no sense. I had menopausal symptoms after my pellets depleted, so we supplemented with gels, but my levels continued to fall. So my doctor doubled my dose, and my levels rose above our target, so he reduced my dose again, but my levels almost doubled! We tried a different lab, and the results were slightly lower, but we had to admit that for me, blood levels were just not a good indicator. I communicate with a hormone researcher, and when I told her the problems I was having, she said it wasn't the levels that were causing me to feel menopausal, but the rate of change in my dosing! So my doctor agreed we would disregard blood levels for 6 months and just go on how I felt, and it has improved my health.

This is where it is important to work with a doctor who tailors your medications to how you are feeling. Lack of research on actual trans people mean that most of the literature referred to to treat us was developed for cis people, and we are simply different!

Hugs,

Allie

[Devlyn]

Puberty, including second puberty, is a time constrained process. Women's breasts don't keep growing their whole lives. They don't do things to restart growth.

I've said it before and I'll say it again, there is a segment of our community who seem to reduce being a woman to a pair of breasts. 

Hugs, Devlyn

[ChrissyRyan]

Puberty, including second puberty, is a time constrained process. Women's breasts don't keep growing their whole lives. They don't do things to restart growth.

I've said it before and I'll say it again, there is a segment of our community who seem to reduce being a woman to a pair of breasts. 

Hugs, Devlyn

You make a good point there.

Chrissy

[Devlyn]

No, I make two good points.
And nothing else.     

[Tills]

Strangely my older sister, in her 60's, was telling me just the other day how her cancer treatment has made her breasts balloon.

These hormones are powerful things!

She's been given the all-clear now. Phew.

xx

[ChrissyRyan]

No, I make two good points.
And nothing else.     

Well I suppose breasts can be pointy matter to some of us.

Meanwhile, I giggle and only very slightly jiggle as I walk to the break room for some coffee.  I do not think that is visible.



Chrissy

[Lori Dee]

There is some evidence that receptors get 'tired' when on the same dose year after year, and quite a few doctors recommend making a change can wake up receptors.

We can also reach "saturation". For transdermal and injectables, the hormone is absorbed in the fatty tissue below the skin. Over time, the hormone levels in that area increase, which can cause problems with absorption. This is why it is recommended to change locations when applying new patches or injecting the next dose. That allows one location to deplete while the other is actively absorbing.

The hormone "leaks" into the bloodstream from the fatty tissue, where it finds its way to the receptors. So, there are many variables involved: how well it is able to penetrate the skin to get to the fatty tissue, how well the fat holds onto it, how fast it gets into the bloodstream, and how the receptors react to it.

The ultimate goal is what physical effects it is causing, so that is a good measure. Monitoring the serum levels tells the doctor how well the method is delivering to the bloodstream. In my case, it was found that there just wasn't enough in the serum to be effective. In your case, it was a different issue, so it makes sense that they would use a different method for monitoring progress.