Is it true that the shots are more effective that the pills?

[wannalivethetruth]

Is it true that the hormone shots are more effective than the pills? How often do you most likely have to take the shot?

[Randi]

Like most everything else it is different for everybody. The shots had a profound effect on me when combined with Spiro. That's the ticket for me-Once a week.

Randi

[pebbles]

I've not tried E pills so I can't say for sure, however I've been taking E shots for 15months and I'm still an A-cup I suspect it's just another way of getting estrogen.

[Janet_Girl]

I will take the other side from Pebbles.  I have been on the pills for the last 39 months and I am a B cup.  But nothing real has happened in the butt/hip area.

It all comes down to YMMV.

[AmySmiles]

They are potentially more effective - I'm sure when taking pills, some gets filtered out by the liver.  However, as long as your levels are correct, I'm sure you will get what you're going to get.  The more important difference is the injections are supposed to be safer because they don't pass through the liver.  Injections are taken either once per week or once every two weeks.

[Padma]

I've definitely heard that patches are 3x more effective than pills (because you lose a lot in the digestive system) - I don't know about shots.

[Caith]

Oral use (swallowing) of estradiol tablets doesn't provide good absorption of your dosage, because of your digestive system and first-pass through the liver.  This is the least effective method of delivery.
Sublingual (beneath the tongue) use of estradiol tablets provides approximately 80% delivery of your dosage.  For most people, it's a very effective method of delivery.
Intramuscular injections are generally more effective, providing almost 100% delivery of your dosage.  Many people don't care for the effort and trouble of weekly injections.  Some people have issues when their weekly dosage runs short a day or two before their next injection.

Sublingual delivery has been good for me, personally.  I'm similar to Janet Lynn in that I've had decent breast development, but no effects whatsoever in the areas of hips or bottom.

[JennX]

Is it true that the hormone shots are more effective than the pills? How often do you most likely have to take the shot?

There's no way to make such a general, all encompassing, blanket statement without some sort of empirical evidence to back it up. And there isn't any. No long term scientific study to gauge the merits of injectables over oral or transdermal delivery has ever been performed in MTFs. There have been a few which show both oral and injectable routes are more effective than patches, but that's it.

The downside to injections is that your body will experience peaks and valleys (excess and deficits) in your E2 levels, and that's not ideal. They won't remain constant. This can make it hard to accurately gauge your E2 level when testing your blood. Your E2 level will peak right after an injection and fall off halfway thru until your next injection. Now, in an ideal world, daily injections would be the most effective and ideal delivery method.

I've definitely heard that patches are 3x more effective than pills (because you lose a lot in the digestive system) - I don't know about shots.

This is why if you take the oral delivery route, micronized estradiol is the best option as it's absorbed under the tongue and goes directly into the bloodstream. Taking micronized E2 orally is definitely a more effective delivery route as compared to patches.

And for the record, I've been on oral meds for about 8 months, and have had very good results. So as with all things, your mileage may vary depending on the individual and their physiology.

[cynthialee]

I have tried pills, patches, gels and shots.
Personaly I think the shots work best. Also I only have to worry about my HRT once every 2 weeks.

[Jacelyn]

The downside to injections is that your body will experience peaks and valleys (excess and deficits) in your E2 levels, and that's not ideal. They won't remain constant. This can make it hard to accurately gauge your E2 level when testing your blood. Your E2 level will peak right after an injection and fall off halfway thru until your next injection. Now, in an ideal world, daily injections would be the most effective and ideal delivery method.

The peak when it sustained may cause estrogen receptor to be saturated, and develop resistance to further estrogen absorption. There is cases where injection were taken which result in less effect to the breast than when oral estradial tap is resumed. Oral estradial tap taken sublingually approximate effective absorption rate of injection but less the over saturation effect.

Sublingual (beneath the tongue) use of estradiol tablets provides approximately 80% delivery of your dosage. 
Intramuscular injections are generally more effective, providing almost 100% delivery of your dosage. 

Caith, can you cite reference to your data?

Thanks.

[rieko]

There aren't many clinical studies on effects of cross-sex hormone therapy, and I haven't seen any concerning the effectiveness of different methods of delivery for Estradiol. Doctors prescribe based on opinion and experience.

My doctor, who has quite a bit of experience with transgender HRT and therefore my trust, has the opinion that, given the dosage is right for the person, there is no difference between oral and injectable other than cost. Moreover, he believes the transdermal patch is ineffective for the purpose of transgender HRT, and should only be prescribed when the other methods are deemed unsafe for the patient.

This may or may not be helpful to you but, at my 2-month checkup, my doc assessed my progress as inadequate. Instead of increasing Estradiol or Spironolactone, he added Medroxyprogesterone, to which he believes some people respond better than Estradiol alone. Medroxyprogesterone also has anti-androgenic effects. We'll see in another month and a half if it does the trick.

[Padma]

Moreover, he believes the transdermal patch is ineffective for the purpose of transgender HRT, and should only be prescribed when the other methods are deemed unsafe for the patient.

Did your doctor give reasons for this? I'm interested because I've heard the opposite, but that seems to be the case with most anecdotal info about HRT, that people have very differing experiences. I'd heard that patches deliver much more efficiently than pills, for example.

[rieko]

Did your doctor give reasons for this? I'm interested because I've heard the opposite, but that seems to be the case with most anecdotal info about HRT, that people have very differing experiences. I'd heard that patches deliver much more efficiently than pills, for example.

I know, right? It's so hard to make decisions when there's scarcely any facts upon which to base them. I feel that the best you can do with HRT is pick an experienced doctor and just trust their judgement. My doc didn't give any specific reasons for his opinion on the patch; I'm sure it's based only on his experience, so he could be wrong.

[Padma]

Sure - the folk I know who've been on the patch say it's a nuisance, because they come off easily in the shower or whatever, but that they needed a much higher dose on pills, and that with injections they experienced much bigger swoops of high-to-low, with accompanying emotional switchback. On the other hand, injections are improving all the time - my trans men friends are delighted with more recent injections that have far less swoop factor, for example, so things are moving on all the time. As you say, all we can do is rely on expert opinion and regular monitoring. I can't wait .

[Mariposa]

I was on pills for years before I decided to switch over to injections. For me, I had a lot more significant development than I ever did with pills alone. Another effect I had was that I became a little more emotional at times; especially when I watched sappy romance movies.

[Corey]

I really hope the injections don't make pills a bad alternative. I'm deathly afraid of needles.

[Jacelyn]

I'd heard that patches deliver much more efficiently than pills

Let me cite a study from: http://www.maturitas.org/article/PIIS0378512299000213/abstract

The bioavailability of oestradiol gel (1.5 mg) is 61% of the tablet (2mg). As the bioavailability of oestradiol tablet (taken orally not Sublingually) is 1%. Thus oestradiol gel is 0.61%.

The bioavailability of oestradiol gel (1.5 mg) is 109% of the oestradiol patch. The bioavailability of oestradiol tablet (taken orally not Sublingually) is 109%+39%=148% of oestradial patch. Hence, bioavailability of oestradial patch is 1/1.48=0.67%

As matter of effectiveness / speed of absorption, the following ranking of methods applied (No.1= fastest):

1. Inhaling
2. Sublingually (8-10%)
3. Rectally
4. Intramascular injection (10%)
5. Skin implant
6. Orally (1%)
7. Skin patch (0.67%)

Moreover, he believes the transdermal patch is ineffective for the purpose of transgender HRT, and should only be prescribed when the other methods are deemed unsafe for the patient.

The cited study / figures support this view.

[sarahg]

Well, this is something that many of us have wondered about.  And I have a decent amount of experience with both forms, intramuscular and sublinqual estrogens.  I have found that I can feel it more in my body and especially breasts when I take orals under the tongue.  When I switched to IM, about 9 or 10 months into transition, I was really disappointed that I could not feel it at all...anywhere.  So for me, I am right now doing a test by experiementing again with pills and seeing what happens, after about 14 months of intramuscular injections.  I do live and work as a woman, but I was beginning to become passable at 5 months.  And at that time, I was taking pills.  It seemed to work pretty well for me.   

But the truth of the matter is that there is virtually no credible evidence that says IM injections are more effective at feminization.  Nothing exists that can tell us that, unfortunately.  And while I think depot preparations are great, I'm thinking that pills maybe be more effective for me.  I am not sure of that yet, but I suspect that to be the case...  And I also suspect that this is very much an individually based reality; it works better for some, but perhaps not for others...

[A_Dresden_Doll]

I effin' love to shoot up. Right between the toes....OHHHH YA...good stuff.

I've been on shots for 6 months, now, and I think I'm doing fairly well. If you can afford it, and don't mind needles, I would earnestly suggest it.

[Tazia of the Omineca]

Well in all honesty I have read some studies and reports (although I am much to lazy to look them up) that say no method and no oestrogen is more affective than the next.
All across the spectrum as I have read in the reports I come across say that it is relatively even (although with room for debate as with anything).

I believe this theory and oral is probably the easiest and most sure fire way of taking oestrogen, As I think none has more feminizing effects than another.

I have said the same thing over and over like the school board trustees.