Susan's Place Transgender Resources

Hello everyone,

Since I have my first endo appointment in a few days, I wanted to get some feedback on peoples experiences with different methods of administering HRT.   I am a little concerned because I was hoping to go down the pill route; however, I heard pills are not as effective.  Perhaps that's a myth, but I've seen that concern pop up before.  Yet, I would prefer using pills because I hear they are cheaper than patches and know I can't inject anything into my body.  I have a major phobia of needles and fear even getting the blood work done.  So, injections are a big no no.  But I want to hear everyone's opinions before I start and choose a method.  Because I have no personal experience and can only have indirect knowledge on hrt, I wanted to see how things worked out for others here. 

So my questions are as follows:

Are pills as effective?  If you use them, have you found them to work successfully?
Out of all the methods of administering hrt that you have tried, which did you prefer and why?
Which method was the most affordable?

Thanks for any input and/or suggestions. 

To the mods, I am hoping this topic is appropriate to the forum.  I checked the forum rules and didn't see any issues with posting this topic, but I apologize if this is a prohibited discussion.

If you don't want to do injections, pills. Patches are not as effective and mainly used in over 40 trans women at risk for DVT or liver disorders. Injections would bypass the liver disorders but not DVT. I imagine if you were on HRt for a long time patches would be fine for anyone as all you would need to do is maintain femininization.

Oral estradiol is cheap but has the liver risks all oral drugs have.
Injectable is safe when administered correctly but a bit shaky with dosages (too much to too little).
Patch is safe but expensive.
Gel is somewhere between patch and injectable but it's messy and has a small transfer risk to others and on clothing. May not be covered by insurance because of no generic form.
Pellet is arguably the best but insurance coverage is iffy and have to have an office visit for administration.

My endo took a look at my liver values, laughed, and put me on pills. :P

While it is indeed true that oral drugs give your liver a slight workout, estradiol does not seem to be a major issue. The anti-androgens, or at least androcur, can supposedly be a bit harsher, but at modern doses are usually fine too. Basically, as long as your liver values are all in the green, and you don't have binge drinking for a hobby, pills seem to be a lot less terrible than their reputation. My liver values are still stellar after 3 1/2 months, so for now I enjoy the comfort of the simple oral application; and I don't usually let them slowly dissolve under my tongue either, I simply swallow them first thing in the morning together with the rest of the stuff I take, i.e. androcur, finasteride, and in my case thyroid hormones.

As always, YMMV. The most important thing is to get your blood work done beforehand, and then base your decision on that. :)

I use E implant and oral Spiro.

The implant does mean a trip to the surgery for an incision in my tummy, under a local, I've never ever felt anything. and it is closed with one stitch that I cut after 48 hrs with a scalpel bade give to me at the time. The implant lasts for about 6 months, and costs about $AUS200 for the implant and procedure.

I was on E pills but had an unexpected reaction to them as my E levels went into the thousands and wouldn't drop. Not a good thing health wise.

The good thing about the implant is that you don't need to think about it. I'm not sure how it stacks up cost wise as drug costs vary so much around the world.

Thanks everyone,

Quote from: Cindy. on May 31, 2013, 05:23:12 AM
I use E implant and oral Spiro.

The implant does mean a trip to the surgery for an incision in my tummy, under a local, I've never ever felt anything. and it is closed with one stitch that I cut after 48 hrs with a scalpel bade give to me at the time. The implant lasts for about 6 months, and costs about $AUS200 for the implant and procedure.

I was on E pills but had an unexpected reaction to them as my E levels went into the thousands and wouldn't drop. Not a good thing health wise.

The good thing about the implant is that you don't need to think about it. I'm not sure how it stacks up cost wise as drug costs vary so much around the world.

I don't like the idea of any incision or anything along those lines.  Plus, I imagine in the US it would be quite an expensive procedure.  Though, I'm glad it works for you :)

Quote from: Theo on May 31, 2013, 05:15:46 AM
My endo took a look at my liver values, laughed, and put me on pills. :P

While it is indeed true that oral drugs give your liver a slight workout, estradiol does not seem to be a major issue. The anti-androgens, or at least androcur, can supposedly be a bit harsher, but at modern doses are usually fine too. Basically, as long as your liver values are all in the green, and you don't have binge drinking for a hobby, pills seem to be a lot less terrible than their reputation. My liver values are still stellar after 3 1/2 months, so for now I enjoy the comfort of the simple oral application; and I don't usually let them slowly dissolve under my tongue either, I simply swallow them first thing in the morning together with the rest of the stuff I take, i.e. androcur, finasteride, and in my case thyroid hormones.

As always, YMMV. The most important thing is to get your blood work done beforehand, and then base your decision on that. :)

Yeah, I really want to use pills.  I'm not too worried about my liver because I've heard the dosages are more moderate and manageable than they once were.  Still, I want to make sure I get the best effects and keep hearing they aren't as effective.  Also, I have to take another daily medication that I need which may create further strain on the liver.  Probably won't be too bad, but you never know.

Quote from: Flan on May 30, 2013, 09:47:16 PM
Oral estradiol is cheap but has the liver risks all oral drugs have.
Injectable is safe when administered correctly but a bit shaky with dosages (too much to too little).
Patch is safe but expensive.
Gel is somewhere between patch and injectable but it's messy and has a small transfer risk to others and on clothing. May not be covered by insurance because of no generic form.
Pellet is arguably the best but insurance coverage is iffy and have to have an office visit for administration.

It's looking like the only real affordable method that I can take is the pill.   

Quote from: Joanna Dark on May 30, 2013, 09:04:57 PM
If you don't want to do injections, pills. Patches are not as effective and mainly used in over 40 trans women at risk for DVT or liver disorders. Injections would bypass the liver disorders but not DVT. I imagine if you were on HRt for a long time patches would be fine for anyone as all you would need to do is maintain femininization.

I guess I could one day switch to patches after being on hrt for a while.  I am a little concerned about the effects pills may have on my liver, but I know the dosages are much more safer than they were in the past.  Overall, it seems like the pill is currently my best option.  No way in hell could I do injections.  Seriously, I cry around needles.

Very few docs presecribe injectable E in the USA do to liability and insurance issues anymore. They do not want you suing them basically if you do something wrong.

Oral via sublingual administration is probably the most popular. Patches usually for those over 40 years old. Gel is another good option, but the gel is very expensive... 3 to 4 times the monthly cost of pills. 

As far as effectiveness goes... It depends on the dosage and your metabolism and physiology. You can not predict such things. I've been on pills and have had good results. Some prefer injections, but unless you've tried them all you can not predict which route of administration will absolutely work best for you.

I have taken oral doses of estradiol for years without any increase in liver enzymes/toxicity and my estrogen and testosterone levels have always been consistent. Feminization initially was good and has been maintained. I do take my estrogen sublingually. No problems, no issues, and cheap. I remember initially it took some adjusting to get the dose right, but this did not have anything to do with the liver. In a healthy patient who is at least semi-active the risk for DVT is extremely low. If you are a smoker it significantly rises otherwise it is not sufficient reason to do injectable or transdermal.
Good Luck!

Thanks everyone.  It makes me feel better to know that pills are sufficient because I can't afford the other methods or handle them emotionally (I hate needles).

Quote from: learningtolive on May 31, 2013, 05:31:27 PM
Thanks everyone.  It makes me feel better to know that pills are sufficient because I can't afford the other methods or handle them emotionally (I hate needles).

You still need to have your hormone levels tested every 3-4 months...which still requires a needle. But I see what you mean...I personally couldn't deal with a needle every two weeks.

On the plus side, pills and patches are easier to monitor. Injections make your hormone levels fluctuate more, so it's harder to gauge how much more/less estrogen you need.

I'm tempted to ask my doctor for pills because at some point I'm going to be covered in patches...I'd rather deal with a few pills a day vs. making sure the patch doesn't keep falling off. And, pills are cheaper.

Your best bet for pills is the 17 Beta estrogen ones, they are bio identical so they have even less impact on the liver than other types of estrogen. You also need to take less because they are bio identical, which also saves the liver a bit of extra work. :)

Quote from: Skye-Blue on May 31, 2013, 05:42:35 PM
You still need to have your hormone levels tested every 3-4 months...which still requires a needle. But I see what you mean...I personally couldn't deal with a needle every two weeks.

On the plus side, pills and patches are easier to monitor. Injections make your hormone levels fluctuate more, so it's harder to gauge how much more/less estrogen you need.

I'm tempted to ask my doctor for pills because at some point I'm going to be covered in patches...I'd rather deal with a few pills a day vs. making sure the patch doesn't keep falling off. And, pills are cheaper.

Your best bet for pills is the 17 Beta estrogen ones, they are bio identical so they have even less impact on the liver than other types of estrogen. You also need to take less because they are bio identical, which also saves the liver a bit of extra work. :)

Yeah, I know I have to get tested.  I have my first appointment Monday and I'm both excited and scared.  Scared because of the blood work.  I hope my endo or his staff don't mind if I ask them for me to hold their hands,lol. 

I'd have no problems with patches if it wasn't for the cost. 

I have been on all from Pills, Implant, Patches, and injectables far and away I prefer the injectables the pills worked fine while I was younger but I got worried as I got older that my liver would be damaged as I got over 40 so I converted first to patches as I tired to get my doctor to prescribe injections which took some time. I was very dissatisfied with the patches, too little delivery, and a lot of troubles

but I love my injections. I feel much better on them and they work very well for me. very inexpensive, also easy to track and do. surprisingly the injections do not hurt.

I'm not if anyone mentioned it but it seems  the route and form of HT isn't that important for effect, that seems to be a very personal genetic/physiology think. There are girls here who have had most impressive results from low doses and some who have little effect from high.

There doesn't seem to be much in a way of predicting the outcome either.

Quote from: Cindy. on June 01, 2013, 02:02:36 AM
I'm not if anyone mentioned it but it seems  the route and form of HT isn't that important for effect, that seems to be a very personal genetic/physiology think. There are girls here who have had most impressive results from low doses and some who have little effect from high.

There doesn't seem to be much in a way of predicting the outcome either.

That's good to know.  I guess I just worry a bit too much. 

Quote from: girl you look fierce on June 01, 2013, 07:55:45 AM
I've had baaad results with pills but that's all I've tried because I don't have other options right now. All I can say is just make sure your levels get to the right range...

Also ask about sublingual vs just swallowing them, everybody tells me to take my pills sublingually but I can't really just do that and suddenly have 20x my current E level so...

I mean this is the nicest way, but I think you can be really hard on yourself.  I've seen pictures of you, and I think you pass really well.  If pills will work as good for me as they have for you, I think I will be happy :)

Yeah, I will probably take them sublingually if my doctor approves.  And I am going to make sure my levels are in a good range.

Quote from: Cindy. on June 01, 2013, 02:02:36 AM
I'm not if anyone mentioned it but it seems  the route and form of HT isn't that important for effect, that seems to be a very personal genetic/physiology think. There are girls here who have had most impressive results from low doses and some who have little effect from high.

There doesn't seem to be much in a way of predicting the outcome either.

This is true for for almost all medications every human body is different so all medications have to be personalized, you need to know you or body and keep track of your reactions to everything

I am actually allergic to a whole lot of things

Here is some more info :)

I did some research on dosages (which I won't post here) and from what I know, estrogen patches are both expensive and ineffective because of the ridiculously low dose. But, patches are useful for people who smoke, or people who have medical contraindications.

Pills are super easy to monitor and change dosages as needed, but can be hard on the liver unless taken sublingually (17 beta estradiol is micronized). If the estrogen isn't micronized, you're basically just wasting your time taking it sublingually.

Injections are risky because you can't anticipate side effects, and you can't reverse them. But they are convenient and only have to be taken every two weeks.

As other people have said already, the dosages vary greatly from person to person. What your GP or endocrinologist is doing is all guess and check, albeit it's done in a logical and safe fashion. Even cis peoples' hormone levels are all different, and accordingly different amounts of hormones will affect each individual differently.

Quote from: learningtolive on May 31, 2013, 10:22:29 AM
I am a little concerned about the effects pills may have on my liver, but I know the dosages are much more safer than they were in the past.

It is important to remember that estradiol today has very little to zero effect on the liver. I have never seen nor heard of one single person talk about liver problems. Ethinyl Estadiol effects the liver because it is a synthetic hormone and as such can not be metabolized by the body so the liver produces obscene amounts of enzymes to get rid of it. This effects ALT levels. EE does produce better feminization than 17-b as a result of it's potency and long half life.

Point is don't worry about liver function on conventional methods.

###

Patients: From the start of the gender clinic in 1975 up to 2006, 2236 male-to-female and 876 female-to-male transsexuals have received cross-sex hormone treatment. In principle, subjects are followed up lifelong.

Interventions: Male-to-female transsexuals receive treatment with the antiandrogen cyproterone acetate plus estrogens (previously ethinyl estradiol, now oral estradiol valerate or transdermal estradiol). Female-to-male transsexuals receive parenteral testosterone esters. After 18–36 months, surgical sex reassignment including gonadectomy follows, inducing a profound hypogonadal state.

Main Outcome Measures: Outcome measures included morbidity and mortality data and data assessing risks of osteoporosis and cardiovascular disease.

Results: Mortality was not higher than in a comparison group. Regarding morbidity, with ethinyl estradiol, there was a 6–8% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens. Continuous use of cross-sex hormones is required to prevent osteoporosis. Androgen deprivation plus an estrogen milieu in male-to-female transsexuals has a larger deleterious effect on cardiovascular risk factors than inducing an androgenic milieu in female-to-male transsexuals, but there is so far no elevated cardiovascular morbidity/mortality. Low numbers of endocrine-related cancers have been observed in male-to-female transsexuals.

Conclusions: Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term, but solid clinical data are lacking.

Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience (http://jcem.endojournals.org/content/93/1/19.full)

Zero incidents of liver disorder. And this is with Ethinyl Estradiol. AND ANDROCUR!


EDIT: That dosage info was completely inadvertent and will pay better attention to what I quote. I was only paying attention to the liver info. I'm very sorry.  - Joanna


Removed dosage information.

Quote from: girl you look fierce on June 01, 2013, 02:01:14 PM
Well thank you so much for the compliment, lol, but my appearance is not thanks to HRT (sometimes a lucky photo, though I do pass well IRL), I don't really look very different at all, body or face wise, aside from minor cosmetic changes like my brows and stuff. I'm not being hard on myself but it's a reality that I only recently got out of (very) male hormone levels.

Not trying to make it about me, just saying, check your levels often!! I regret spending 6 months not even trying to fix bad levels and swearing the pills weren't working just because I didn't have my levels checked often enough.

Yeah, I intend on frequently checking my levels.  I want to make sure I do it right.

Quote from: Skye-Blue on June 01, 2013, 02:17:27 PM
Here is some more info :)

I did some research on dosages (which I won't post here) and from what I know, estrogen patches are both expensive and ineffective because of the ridiculously low dose. But, patches are useful for people who smoke, or people who have medical contraindications.

Pills are super easy to monitor and change dosages as needed, but can be hard on the liver unless taken sublingually (17 beta estradiol is micronized). If the estrogen isn't micronized, you're basically just wasting your time taking it sublingually.

Injections are risky because you can't anticipate side effects, and you can't reverse them. But they are convenient and only have to be taken every two weeks.

As other people have said already, the dosages vary greatly from person to person. What your GP or endocrinologist is doing is all guess and check, albeit it's done in a logical and safe fashion. Even cis peoples' hormone levels are all different, and accordingly different amounts of hormones will affect each individual differently.

Thanks for the warning about sublingual absorption.  I will make sure to ask about that before I start.  No need to waste anything,lol.

Quote from: Joanna Dark on June 01, 2013, 02:28:04 PM
It is important to remember that estradiol today has very little to zero effect on the liver. I have never seen nor heard of one single person talk about liver problems. Ethinyl Estadiol effects the liver because it is a synthetic hormone and as such can not be metabolized by the body so the liver produces obscene amounts of enzymes to get rid of it. This effects ALT levels. EE does produce better feminization than 17-b as a result of it's potency and long half life.

Point is don't worry about liver function on conventional methods.

###

Patients: From the start of the gender clinic in 1975 up to 2006, 2236 male-to-female and 876 female-to-male transsexuals have received cross-sex hormone treatment. In principle, subjects are followed up lifelong.



Main Outcome Measures: Outcome measures included morbidity and mortality data and data assessing risks of osteoporosis and cardiovascular disease.

Results: Mortality was not higher than in a comparison group. Regarding morbidity, with ethinyl estradiol, there was a 6–8% incidence of venous thrombosis, which is no longer the case with use of other types of estrogens. Continuous use of cross-sex hormones is required to prevent osteoporosis. Androgen deprivation plus an estrogen milieu in male-to-female transsexuals has a larger deleterious effect on cardiovascular risk factors than inducing an androgenic milieu in female-to-male transsexuals, but there is so far no elevated cardiovascular morbidity/mortality. Low numbers of endocrine-related cancers have been observed in male-to-female transsexuals.

Conclusions: Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term, but solid clinical data are lacking.

Zero incidents of liver disorder. And this is with Ethinyl Estradiol. AND ANDROCOUR!

Thanks for helping ease my concern about my liver.  I've been told that modern methods and dosage isn't as taxing on the body like it used to be.








Removed dosage information.