Transdermals Better Than Injections?

[Julie Marie]

I've been on injections for almost three months now.  My estradiol level went from 24, on transdermals, to a high of 903 on injections.  But that was the day after I injected and yes, my doctor made adjustments.  So the blood tests showed injections work better than transdermals.

Now my personal observations since switching to injections.

Physically: My breast tenderness is gone.  There even seems to be some loss of breast size although it's hard to say for sure.  I haven't noticed any other changes.  Zero, zilch, nada!

Emotionally: While I was on transdermals I enjoyed an emotional high I had never felt in my life.  Within a week of beginning injections that was gone, completely.  And it hasn't returned.  In fact I am often down for no apparent reason.  I can go from feeling okay to being totally down in the dumps in a matter of minutes.  It happens most often when I leave work and no longer have that to preoccupy my mind.  Once I'm alone I am succeptable to depression.  I've never had problems with depression.  I'm usually a pretty positive person.

And lately I've had thoughts of not furthering my transition, just staying where I am.  The problem is I don't FEEL like a woman anymore.  This is something totally new to me since coming out of denial.  I know I don't want to return to my old life.  That's totally depressing!  But this feeling of just staying where I am has me baffled.  I was committed to totally transitioning and the thought of completing it made my heart soar.  Now it's like, "Who cares?", a sign of depression.  And all this has happened since I started injections.

I heard so many girls, and even my doctor, say injections put your transition in hyperdrive.  For me it's been more like I've blown an engine.  On transdermals both the physical and emotional changes were positive.  I went from two BBs on a breadboard to a small B cup on transdermals even though my estradiol level went from 54 to 24.  And emotionally I was happier than I had ever been in my life.  The only thing I didn't like was dealing with the adhesive from the patch.

Some girls have said they can feel the rush from an injection.  I feel nothing.  You'd think after almost three months I'd notice something positive but all I noticed was what I stated above.

Has anyone NOT noticed any positive effects from injections?

[Julie Marie]

Kiera, I told him a couple of times and he wants me to wait a bit longer before making any changes.  I'm on a pretty typical regimen for those who inject.  When I saw him in August we discussed the transdermal results of the blood test.  He said. "The patch just isn't working."  I asked him how I got to where I am today if my estradiol was so low.  He responded with an I don't know.  There is a girl on another site who had similarly strange reactions.  Her doctor was just as baffled. 

They don't call it the practice of medicine for nothing.  A doctor has to go with what he knows and what he has seen is my estradiol level went up substantially when I began injections.  But I understand there are other forms of estrogen that aren't normally tested and the transdermals could be higher in one of those types.

I have always reacted poorly to medications usually requiring 50% - 100% over the suggested dosage.  And I tend to build up an immunity quickly.  When I was at 903 my doctor said that was way too high yet I didn't feel any difference.  Some girls have told me they can feel the difference after they inject.  That may be psychological.  For me, right now I feel I am just going through the motions.  If after say six months or so, if I still see no changes, it will be time to seriously reassess.

Thanks for your concern Kiera.

Julie

[tinkerbell]

Hi there Julie!

According to the patient information of the PDR (physicians' desk reference) manual, this is the information:

Micronized estradiol (Estrace)
Esterified estrogen (Estratab)
Conjugated equine estrogens (Premarin)
Estropipate (Ogen, Ortho-Est)
Ethinyl Estradiol (Estinyl)
Quinestrol (Estrovis)


Estrone (Premarin, Ogen and other brands) is the most popular oral estrogen, but estradiol (Estinyl, for instance) is gaining in popularity. Both are effective and generally well-tolerated. For a variety of reasons some women are unable to take oral estrogen. And in some rare cases, oral estrogens are ineffective and useless.

Many people find the pill form very convenient as it is something they are comfortable with. However, it may not be the most efficient form of introducing hormones where you want it to be.

Many pills disintegrate in the stomach, and may not enter into your system. Newer micronized products in oil base help protect the product from the acids in the stomach and helps the hormone make its way intact into your system for a better blood level.

The daily dosage is much higher than in the cream form. The higher amount is necessary to compensate for the large percentage that is excreted by the liver. The absorption of the pills depends on many factors including how well your digestive system is operating and the health of your liver. All these factors requires that the oral dose be higher than the transdermal doses to create the equivalent biologic effects.

Advantages
Highly effective in combating physical and emotional symptoms.
Tablets containing estrogen, progesterone, and testosterone are available.
The appropriate dose will offer a high level of protection against osteoporosis.
You can stop taking it immediately if it doesn't suit you.
You are responsible for your own medication.


Disadvantages
You may experience side effects such as breast tenderness, nausea, headaches and digestive irritation and swelling
You may experience breakthrough bleeding if you forget to take a tablet.
May be unsuitable if you have a history of high blood pressure, blood clotting, or liver disorders.




Intramuscular Injections.
estradiol cypionate (Depo-Estradiol )
estradiol valerate (Delestrogen , Estraval)


Estradiol in oil is most commonly used since it is absorbed slowly and needs be given only at 2 to 4-week intervals. Injected estrogen goes directly into the circulation without first passing through the liver. This has both good and bad effects. There is also some question about the predictability of absorption rates. The main drawbacks of intramuscular injections, however, are the discomfort of regular injections plus the peaks and valleys of estrogen levels that such a system inevitably produces.



Transdermal Patches.
transdermal estradiol (Estraderm, Climara)


A medicated adhesive is attached to your abdomen, where it releases estradiol, a pure form of estrogen thought to be less cancer causing. Estradiol bypasses the liver and is best for women who can't take HRT orally but who have severe hot flashes and vaginal problems. The patches are worn constantly (below the waist and, by many women, on the buttocks and flanks) and are changed twice weekly. With this method, the estrogen is released through the skin in a consistent manner. The alcohol in the patch drives the hormone through the skin and into the blood vessels.

Their distinct advantage of the patch form is that it introduces a relatively constant and even flow of estrogen into the body day and night, with no peaks or valleys and, thus, fewer side effects related to over or undersupply. Early studies indicate that the patch may protect the bones and heart.

The major problem with patches at this time is that a significant number of women develop skin irritation and may be forced to discontinue their use.

Advantages
As effective as oral HRT in treating most menopausal symptoms.
Preserves bone in 85-95 percent of women. Easily changed and simple to stop using if you decide to discontinue treatment.
Since the dose of hormone is absorbed very gradually, the patch has fewer side effects than some other routes of administration.


Disadvantages
A very few women develop red, itchy skin at the site of the patch. This may get worse in a hot climate.




Subcutaneous pellets

Pellets of estradiol are inserted beneath the skin- subcutaneously-under a local anesthetic. There are several problems inherent in this technique.

The duration of action is variable. Could be as long as 6 months. The pellets are difficult to remove should they prove disagreeable in any way.

Advantages
Excellent relief from physical symptoms. Some women find that problems such as depression and irritability disappear more readily than with other forms of HRT.
You can forget you are on HRT because the implants are changed so infrequently. Testosterone can also be given as an implant. Protection against osteoporosis is high.


Disadvantages
Wrong doses cannot be adjusted.
Some women experience symptoms at ever-decreasing intervals – too frequent implants lead to hormone overdose. If you decide to stop using HRT, implants are difficult to remove.
You need a minor surgical procedure for insertion of the implant.
Some people experience severe side reactions that may not be correctable - excessive weight gain, extreme inflammation of the breast, etc.

I hope this infomation is helpful to you.


tinkerbell

[cindianna_jones]

Julie, it is always a good idea to reassess.  So don't worry about that.  For what it is worth, I didn't get a whole lot from HRT prior to surgery.  There were many times when I felt like you.  And there were many times I took a step back to reexamine my decisions... sometimes at great personal and mental harm. 

When I hear someone playing up how wonderful HRT is, I always think "what's with that?"  For in my personal experience, HRT did almost nothing. And you know... in all likelyhood, I seriously believe that there are many just like me who are afraid to admit it. We do have a culture, like it or not, where we feel we "must" show something for our efforts.  What happens when there is no progress?  What do we have to "brag" about?  What do we have to show ourselves that what we are doing is showing positive results?  Does it matter? ... really?

6 months after my surgery, I finally noticed what a lack of testosterone was like.  My mind finally cleared and I no longer felt depressed ALL the time.  I didn't have that thing churning in my mind pushing me to do crazy things.  As I look back, I'm glad that I did have periods of introspection.  I'm glad that I did try to return those times. It helped me solidify my decision.  It has given my life a stronger drive to move ahead and not linger in non productive thought.

Unfortunately, as you have noted, there is no ruler against we can measure our progress physically or mentally.  The only measure we track is amongst the people we know.  And for that, our TG/TS community sometimes will drag us along to some degree.  I always advise not to get caught up in that aspect.  Caution is always best when considering such life changing decisions.

If you have doubts Julie, spend a weekend totally in drab.  See if it floats your boat. Slick back your hair and go spend a weekend in another city.  That may give you a better idea where you are going.  But don't worry about the HRT drugs.  In my opinion, there is way too much attention given to this part of the process.

Cindi

[cindianna_jones]

There were many times when I felt like you.  And there were many times I took a step back to reexamine my decisions... sometimes at great personal and mental harm.

Cindy, could you elaborate on what you mean by that???

Take a peek at my "Rise from the Fall" posts in my blog here.  That was my last incident of falling back. These 5 chapters are from my book where I chronicled the most important aspects of my change.  Yes, it took a book to tread through it all.

Cindi

[cindianna_jones]

WOW! You wrote an entire book?? Oh, I see now, under your posts!! I will definately look . . .

Thx, Kiera

Yup. A book.  I have other work published under my legal identity ... which shall forever remain nameless in my internet incarnation of myself.  

Cindi

[LynnER]

I think I remember readins somewhere that they discovered that the patches were giveing much higher dossages more quickly than they were supposed to... I dont have the resources or links to prove this right at the moment so this is just my two cents worth for the time being, but it might be worth looking into.

[Julie Marie]

If you have doubts Julie, spend a weekend totally in drab.  See if it floats your boat. Slick back your hair and go spend a weekend in another city.  That may give you a better idea where you are going.  But don't worry about the HRT drugs.  In my opinion, there is way too much attention given to this part of the process.

Cindi

Spend a weekend in drab?  No thanks!  I would never make it.  I have no doubts about transitioning Cindi, but I do wonder about injections.  The physical aspect isn't that important but the mental aspect is.  While I was on transdermals I was on an unbelievable high.  I had never been so happy in my life.  I expected at least the same from injections.  But as soon as I began the high ended.  Sure it could have been a coincidence.  But that it happened at the same time I began injections I have to consider that.  I'd just like to feel that high just once in a while but in three months it hasn't happened yet.  Since I'm usually a pretty happy person I find it a bit disconcerting that this is going on.  I love my doctor.  He's a wonderful person.  And while I may not be happy with what is going on with me others who have him for their HRT doctor are completely happy with him.  But as I said, I've always been resistant to medications.

If this comes across as doubt or worry or complaining I apologize.  That's not my intention.  But I will admit to being very curious if anyone else has experienced this.  I guess you answered that.  All in all I know I'm on the right track and I'll admit injections are nice where it's a few minutes a week.  Patches can get uncomfortable, the adhesive stays on your skin for several days unless you remove it with something to break down the adhesive.  And I was beginning to see redness around the perimeter.  I don't miss those things. 

Whatever the case, I'm going to be patient.  In three months I'll reassess.  I'm okay so long as the male traits I lost don't re-emerge. 

Julie

[cindianna_jones]

Good for you Julie.  I did want to make sure that others know that HRT doesn't do all that much for some people (like me).  Shoot, even the night before surgery in Trinidad, I had a wet dream.  How disgusting that was.

Cindi

[BrandiOK]

  I've heard good and bad about the patch...it is supposed to release a steady more manageable dose of estrogen which helps combat some of the high/low mood swings from injections.  As Lynn mentioned research showed that some of the patches tested were actually releasing very large doses of estrogen very quickly though.  I don't know if that has been corrected but I am aware of a class action lawsuit against a particular manufacturer for that reason. 

  I tried transdermals for a very short time....not long enough to make any judments on them though.  After going over the potential health hazards of the pills with my endo I switched to injections about a year ago.  On the plus side 1.  Theoretically safer than oral estrogen 2.  Very large change in breast growth  3.  Only have to inject every 2 weeks.  On the minus side 1. I do experience the mood swings that are common with injections 2.  I hate needles and giving myself injections is a mental battle each time LOL 3. Same as number two...

  Talk it over with your doctor...everyone has different results.  The best method of taking estrogen, if any, is whatever works best for you.  Despite the needle thing I still prefer injections perhaps someday I may try the transdermals again but I won't do it until they prove that the problems they have had so far have been corrected. 

  Obviously the effects of estrogen are different for everyone and something that hasn't been mentioned here is testosterone blockers.  Unless you have had an orchy or for whatever reason have minimal T levels, how well your blockers are working are going to affect your results also.  Personally I would rather run of my estrogen perscription than run out of blockers (shudder) the effects of not having them are very disturbing.

[Sandy]

If you have doubts Julie, spend a weekend totally in drab.  See if it floats your boat. Slick back your hair and go spend a weekend in another city.  That may give you a better idea where you are going.  But don't worry about the HRT drugs.  In my opinion, there is way too much attention given to this part of the process.

Cindi

Spend a weekend in drab?  No thanks!  I would never make it.  I have no doubts about transitioning Cindi, but I do wonder about injections.  The physical aspect isn't that important but the mental aspect is.  While I was on transdermals I was on an unbelievable high.  I had never been so happy in my life.  I expected at least the same from injections.  But as soon as I began the high ended.  Sure it could have been a coincidence.  But that it happened at the same time I began injections I have to consider that.  I'd just like to feel that high just once in a while but in three months it hasn't happened yet.  Since I'm usually a pretty happy person I find it a bit disconcerting that this is going on.  I love my doctor.  He's a wonderful person.  And while I may not be happy with what is going on with me others who have him for their HRT doctor are completely happy with him.  But as I said, I've always been resistant to medications.

If this comes across as doubt or worry or complaining I apologize.  That's not my intention.  But I will admit to being very curious if anyone else has experienced this.  I guess you answered that.  All in all I know I'm on the right track and I'll admit injections are nice where it's a few minutes a week.  Patches can get uncomfortable, the adhesive stays on your skin for several days unless you remove it with something to break down the adhesive.  And I was beginning to see redness around the perimeter.  I don't miss those things. 

Whatever the case, I'm going to be patient.  In three months I'll reassess.  I'm okay so long as the male traits I lost don't re-emerge. 

Julie

Julie in DRAB?!?!  Perish the thought!  I don't think she has it in her!

I started my HRT with the injection.  No patches, no pills (well the spironolactone).  I experienced changes pretty quickly.  What Julie calls hyperdrive.  And they are certainly welcome, really.  But I don't experience any sort of physical rush or high when I do my injection.  But to me, the act of injection is a ceremony.  I do have the emotional high that you mentioned Julie but that I think is from my "engine" is finally getting the proper "fuel".

To me it causes me to reflect deeply on what I am doing and to assure myself that this is in fact what I want.  I'm kind of glad I opted for the injections now.  If all I did was take a pill or change a patch, I don't think I would have reflected on my changes as much.  Now I know I have stopped pretending.

Hang in there Julie.  As you know, this is a second puberty.  And just like the first one, there will be times of great changes and times of small changes.  But this time, they are the RIGHT changes!  The ones that should have happened the first time!  Your patience will be rewarded, I'm sure of it!

-Sandy

[Julie Marie]

Brandi, I have read the same things about transdermals injecting too much estradiol into the system but all the studies I have read are for genetic females.  As I'm sure you know, we require substantially larger dosages than menopausal women.  My doctor believes transdermals aren't strong enough for the MtF individual.  My blood tests proved that.  My physical development didn't.

Sandy, I think you know all of this is inconsequential as long as we are happy. 

Julie

[Sandy]

Sandy, I think you know all of this is inconsequential as long as we are happy. 
Julie

Right on!  And happiness is something I never thought I would see!  WOW!

-Sandy