Patches, injections, or pills?

[April221]

Ughhh.


Jello in my veins...

Actually, it's worse. Think more like clumps. It's more like a hard mass of coagulated blood.  Blood clots that can break free and travel to other parts of the body, such as the brain. DVT can be fatal or require emergency surgery.  I once worked with a man who had fallen as a child playing baseball. He suffered a blood clot in his leg which required amputation. While the accident happened many years ago; modern surgery may have been able to save his leg, it illustrates the threat posed to the body by blood clots.

Whatever form is used, pills, patches or injections, as Keira so clearly explains, estradiol valerate is the safest form of the various available drugs. While each manner of administration has its' supporters, in the end, it's all a question of the correct dosage and time.   

[Karen_A]

Currently I'm on low level estradiol patches as these are considered to be the safest for older people. Since I'm taking warfarin, DVT is not really a problem.

[lisa01707]

Hi

I am a 28yr transexual and I am going on patches soon and I have been on pills for 3years and nothing really much has happened I took them orally but just swallowed them progenova do u think its better to place under tongue then?  Now patches am thinking of using them in conjunction with taking pills asn I will be monitoring my change carefully on this.

What u think?

Lisa x

[JoanneL]

I do not think it advisable to mix pills and patches. Patches and gel nmaybe OK

Joanne

[vanna]

I know some take pill's to suppliment at the end of their patch or injectible cycle is that what you meant Lisa? or on a daily basis

[Keira]

Pills are often used at the end of cycle.
The problem with injections is that depending on how you inject
and your estrogen metabolism which depends
on environmental factors (food, activity, etc), estrogen
can run low before the next injection. It doesn't happen all
the time, but when it happens you'll have a strong energy and mood
crash.

Another solution is to inject at closer intervals.
But, then you get more spiking, since  serum estrogen
levels in the days after injections can be very high
which can make you nauseous and other side effects.

Some people have a higher sensitivity to those variations than
others. Some people will have wild mood and energy swing during
their cycle and thus need something more stable like patches, pills,
gels, etc.

Unless taking much patches, you won't get as high a dosage with
patches as taking many sublingual pills. Remember, one patch is
used to get menopausal levels, so, to get GG level you'll need a
lot of patches.

If using patches, using an anti-androgen is I believe
kinda necessary to accentuate the regulatory
feedback loop affect that eventually
shuts down the testes and counters the T from the adrenals
which with higher E dosage would not be a problem in
feminisation, but could be at a lower dosage.

[Flan Princess]

The biggest problem with hormones taken PO that I haven't seen mentioned in the thread is that the body will (and relatively consistently with oral drugs) attempt to regulate any spikes in hormone levels by countering with SHGB.

And you can guess what happens next

[Keira]

The countering in non-linear, and usually only happen at high sustained levels,
which are not prescribed by most doctors. That's why there is a diminishing
return on higher levels of estrogen, added to receptors becoming saturated
and that response to estrogen at the receptor depends on genetics of the
tissue having these receptors (muscle, fat, etc).

Some can respond strongly to low levels while others won't respond
to the highest of levels.

If the spikes are short, this is not usually not a big issue.

[lisa01707]

Yeah at the end of the cycle thats what I ment.
Also My Dr, Dr Curtis has not perscribed any anti enrogens (poor spelling), why could this be? 

Am thinking am still not going to get anywhere by using patches then pills at the end as I would need something to reduce my testosterone  level.

Am seeing my GP 2morrow for the patches am going to ask him also will ask best place to place patches.

I just need enough to round out my arse and thighs and also get me some breast tissue ready for my implants next year

Thanks for the info.

Lisa x x x   

[deviousxen]

Ughhh.


Jello in my veins...

Actually, it's worse. Think more like clumps. It's more like a hard mass of coagulated blood.  Blood clots that can break free and travel to other parts of the body, such as the brain. DVT can be fatal or require emergency surgery.  I once worked with a man who had fallen as a child playing baseball. He suffered a blood clot in his leg which required amputation. While the accident happened many years ago; modern surgery may have been able to save his leg, it illustrates the threat posed to the body by blood clots.

Whatever form is used, pills, patches or injections, as Keira so clearly explains, estradiol valerate is the safest form of the various available drugs. While each manner of administration has its' supporters, in the end, it's all a question of the correct dosage and time.   

Its always fascinated me that our bodies kill themselves for random reasons...

[vanna]

I go to Dr Curtis

is it based on your blood work, i would have a chat to him about your wish for AA's

Yeah at the end of the cycle thats what I ment.
Also My Dr, Dr Curtis has not perscribed any anti enrogens (poor spelling), why could this be? 

Am thinking am still not going to get anywhere by using patches then pills at the end as I would need something to reduce my testosterone  level.

Am seeing my GP 2morrow for the patches am going to ask him also will ask best place to place patches.

I just need enough to round out my arse and thighs and also get me some breast tissue ready for my implants next year

Thanks for the info.

Lisa x x x   

[Hypatia]

A couple weeks ago I switched from pills to injections and very quickly observed a dramatic difference. Within a few days my nipples had doubled in thickness and length, while my breasts became discernibly larger. They have also been constantly more tender since then. I had my second shot tonight. I had been warned that I might feel the drop in E during the days before a shot, but I did not notice anything lacking. I am very pleased with the results after only one shot. Waiting to see how much more growth I will be getting now. I wish I had started injections years ago instead of wasting my time on pills. The only downside is the cost: I'm now paying about four times as much per month for E as I did when I took pills. Good thing it's worth it.

[Mari]

I will be strting HRT in few weeks and my endo will give injections cuz she
thinks they are superior method of estrogen delivery to any other. I would like to
hear from you, like Hypatia who are already using injections; your experience.
Do you andimister injections yourself?
My idea was to have someone, a nurse, teach me and/or to be there when i inject
myself for the first couple of times, cuz i want to learn to self inject?
Do you do it or you have someone give you injection? What is safer?
I mean can you lern to self inject that good that there is no need for nurse or anything
else. I found some online tutorilas but they seem to be overly complicated.
Anyway...  would like u guys to share your experience 

[Keira]

Hypatia, I don't doubt what your saying,
but are you actually getting the same dose as before?
If in fact you're getting twice the physiological dose, then
your recent result has nothing to do with injection VS pills.

You can ALWAYS get similar results to injection with pills if
you take enough of them. That's a fact.

I often hear people hail injections as more efficient when
in fact when I see their dosage, its much higher than with
pills.

Maybe the doctor is simply giving you a higher dosage because
there is no first pass through the liver and thinks its safer
to go higher.

[Hypatia]

Hypatia, I don't doubt what your saying,
but are you actually getting the same dose as before?

Beats me! I e-mailed my endocrinologist to ask:

How do you compare the quantity of estrogen effectively delivered to the tissues by (such and such amount in ml) of biweekly injected Delestrogen vs. (such and such amount in mg) of daily oral Estrace?

He never answered my question. It's imponderable to me. Do you know the answer, Keira?

All I know is the results since I started injecting really rock & roll.

[Flan Princess]

Hypatia, I don't doubt what your saying,
but are you actually getting the same dose as before?
If in fact you're getting twice the physiological dose, then
your recent result has nothing to do with injection VS pills.

You can ALWAYS get similar results to injection with pills if
you take enough of them. That's a fact.

I often hear people hail injections as more efficient when
in fact when I see their dosage, its much higher than with
pills.

I beg to differ
Using Estradiol Valerate as an example because it is available in both oral and IM forms, over a 7 day period, the patient must consume over 4 times (or more) the amount of drug in pill form compared to its IM administered counterpart to have the same approximate pharmakenetic effect. Some of it gets SHGB bound, some is converted into substances not usable where we want them, but the biggest killer of all oral drugs is the GI tract. That is why so many pills are needed.

Maybe the doctor is simply giving you a higher dosage because
there is no first pass through the liver and thinks its safer
to go higher.

If Hypatia where being RX'ed a higher dose then is necessary ONLY because the claim of hepatic safety, then that is nothing more that a waste of drug (at best, at worst overdosing may reduce the sensitivity of the receptor sites) because, as you mentioned earlier, bodily tissues can only uptake a certain amount of free estrogens, (regardless of current SHGB levels) the rest to put it bluntly, gets pissed away.

Hypatia, I don't doubt what your saying,
but are you actually getting the same dose as before?

Beats me! I e-mailed my endocrinologist to ask:

How do you compare the quantity of estrogen effectively delivered to the tissues by (such and such amount in ml) of biweekly injected Delestrogen vs. (such and such amount in mg) of daily oral Estrace?

He never answered my question. It's imponderable to me. Do you know the answer, Keira?

All I know is the results since I started injecting really rock & roll.

That is one of the problems with current lab technology which annoys me to no end.
To the best of my knowledge, there is no way of knowing how much of ANY administered drug is put to use by the body except by analysing the excreted waste and guessing the uptake rate based on the intake dose. (If anybody knows such a way please tell me, so that I can become less stupid)

[Rachel]

Just from what I have read, IM seems to absorb better, and while there are spikes, it can be taken care of.  It passes less through the liver, and even those spikes are a natural thing.  GG have hormone spikes all the time, its called a period.  As much of a no fun a period would be, it would make being stealth a lot easier.

[Keira]

Flan Princess,
My "claim" of hepatic safety (which makes no sense to me since bio estrogen
is not toxic to the liver at all)
of direct absorption (gel, injections, patches), is made all the time by doctors... And thus could
be a reason for lower dosage.

I said EQUIVALENT dosage, in pills is possible (that number varies a bit from person to person)
I can't discuss dosages here, but this has been discussed at length zillions of times
on the Yahoo DIY group.

Though, as you state, the random variation in absorption of pills
(swallowed or sublingual) will require a certain overshoot to
be approximately equivalent.

If it takes 4 times more estrogen to get the same level as the
injected one, so what? Pills are made with this loss in mind,
which can be somewhat bypassed by going sub lingual.

Swallowed progesterone capsules
also suffers massive losses, yet
if you take enough, you;ll get good levels.

Doctors think all estrogen is an equivalent DVT risks
and thus under treats in general, and in particular
in pill form.

[April221]

I've been self injecting Estrogen valerate for several months. There was someone at the clinic who watched over me for 3 lessons before I was given a prescription for my own syringes. No responsible doctor is going to allow anyone to self inject who hasn't been properly trained.

I prefer the injections for several reasons. I liked the patches, but they would not stay flat on my skin, so I needed an alternative. I was taking the pills for about a month, the dosage was considered to be maximum for the pills. With the injections, I inject once every two weeks. It took a bit of time before the body really became accustomed to the timing, and now I can feel the estrogen level dropping off at about the 10 day mark, but not enough to be a problem. Once I inject, it takes a day or so before the estrogen level rises to a noticeable degree. By noticeable I mean that I feel a little bit "better."  I've never experienced the mood swings that some people have reported. Either I feel "solid," or more stable emotionally, or when the estrogen level is low, I feel more like I felt before HRT. I do not experience highs or lows with HRT to the degree where it really affects my mood or behavior.

The dosage that I inject is the maximum. It really is high, my doctor is very much up to date on the current research and is extremely experienced and cautious. He doesn't take unnecessary risks; I trust him. Because of the high dosage, I have no interest in adding pills to the regimen. I'm not interested in adding anything else, my spiro is at the low average end, and everything seems to be moving along. I'm not expecting overnight results, breast growth is in spurts, my only problem is with weight gain. I will not say that injections are superior to pills. To make a statement like that from personal experience is impossible. I only know how different forms of estrogen administration affect me, no one else. I've had good results with patches and injections, insufficient time to evaluate the pills. It's all a question of the correct dosage as well as time, I would think. It's all a matter of personal preference, all methods work.

[iminadaze]

 Hi Mari,
I switched to injections just over a month ago, I asked him for the switch, I had been taking the pills for 10 months
and just got tired of putting them under my tongue twice every day, he felt that it was a good idea and asked if I was taught
how to do it could I inject myself to save me all the travel time. the first one the nurse did, explaining to me what to do, the second
time they had me do myself while at the clinic, and the last two I did myself at home. for me there is nothing to it, I dont even feel it.
I don't have an opinion on which is better I just got tired of the sublingual route, but the pills were quite effective. I would think that
most doctors would start any program with pills only because if there is an adverse reaction, the pills would be in your system for much less time. My body metabolizes estradiol rather fast so my doc has given me a lesser IM dose more frequently. At my next test which is
quarterly he will see how my levels are. But I am happy that I made the switch. I am sure that I get a spike just after the dose because the first two times I got a small headache but like Hypatia has stated I too do not feel any lows, perhaps it is because of the more frequent injections.