Susan's Place Transgender Resources

Hey all,

I apologize for yet another question about maximizing efficency here, but I'm feeling a bit desperate and bummed out about my situation lately.  I was wondering if there is an benefit to taking all hrt pills at once rather than splitting them throughout the day.  According to my therapist, taking them together could mimic the spikes of injections and that intrigued me a bit.  Now, I happen to take it 3 times a day and let it dissolve under my tongue, so I'm not sure if this is wise or safe.  I've currently been taking two at a time in the morning and one in the evening.  Can't I just take all 3 at once?  Is that really bad?  Because we can't discuss doses, I apologize for being vague, though I am on a high dose if that helps.  Thanks.  I really appreciate any assistance because I've been going blind with my hrt regimine foor o long that I'd like to finally be proactive about ensuring everything works. 

YES that is bad to do. Take all prescription medications as they are prescribed. No other way at all.

I should note that I care more about efficiency of hormones than potential risks or health issues.  After all, I'm not going to live forever, so thats my main focus of these questions.  I've been told that it's okay by others in the trans community that have done it this way, so I'm just seeing if there is any truth to it working better.

Quote from: learningtolive on June 27, 2014, 06:32:56 AM
I should note that I care more about efficiency of hormones than potential risks or health issues.

This scares the stuffing out of me. The reason to take them three times a day is to keep a steady supply in your body and not shock your liver or have severe ups and downs. I have seen people online say it is safe to jump from your roof into a swimming pool as well, but I sure am not going to do it. Your doctor knows what is best for you and has your best interest and development at heart. Listen to him, not the internet.

Then separate doses as evenly as possible.  If you have three tablets take them evenly spaced.

Quote from: Jessica Merriman on June 27, 2014, 06:38:39 AM
This scares the stuffing out of me. The reason to take them three times a day is to keep a steady supply in your body and not shock your liver or have severe ups and downs. I have seen people online say it is safe to jump from your roof into a swimming pool as well, but I sure am not going to do it. Your doctor knows what is best for you and has your best interest and development at heart. Listen to him, not the internet.

I've got to be honest in that I'm not sure how much my doctor understands transcare.  They've said questionable things that make me wonder how much they understand about MTF transitioning outside of some basic generalities.  They also never instructed me how to take my hormones other than prescribing them.  All these medications must follow a certain guideline in order for pharmacys to fill them or the insurances to cover it.  That doesn't mean that the dosage itself is invalid or unsafe.  I deal with pharmacys for medical clarification all the time.  I'm going for a second opinion, finally, but I was even told by my therapist who deals with many trans patients that taking two at a time would be fine.  Why not three?  If there is a valid health reason or limitation to the effectiveness than I am willing to listen.  I just asked the question and am trying to learn up on it.  I'll probably switch to injections soon, but I want to see what can be done and whether it should be done.

I know your trying to help Jess, so please don't take my questions here personal.  I'm just trying to educate myself and see if anything can be done at the moment to increase my low levels.

Quote from: kira21 ♡♡♡ on June 27, 2014, 06:39:22 AM
Then separate doses as evenly as possible.  If you have three tablets take them evenly spaced.

I was doing this but I was told that taking them all together could create a spike in my levels like injections and that may help me.  My last two lab results showed low E levels with this method, so I'm trying to see what I can do to remedy this.

I've taken mine both as a single dose and split doses throughout the day.. Over 3 months, there was less than 10% difference in serum levels. My doctor rold me to take them all at once.

And I hate to say this, LtL, some of us just don't react well to E, regardless of delivery method, levels, etc.. I've had quite sub-standard results and nothing my dr and I have tried has made any difference.

Quote from: kelly_aus on June 27, 2014, 06:59:27 AM
I've taken mine both as a single dose and split doses throughout the day.. Over 3 months, there was less than 10% difference in serum levels. My doctor rold me to take them all at once.

And I hate to say this, LtL, some of us just don't react well to E, regardless of delivery method, levels, etc.. I've had quite sub-standard results and nothing my dr and I have tried has made any difference.

Thanks for the honest answer.  Yeah, I fear I may be less receptive to E than others.  I'll likely give the 3 pills at once a try and go to a follow up appointment to see about injections.  Somethings got to give at this point.  I've offically been taking E for a year with poor results to show.

Quote from: learningtolive on June 27, 2014, 06:29:27 AM
I've currently been taking two at a time in the morning and one in the evening.  Can't I just take all 3 at once? 

Quote from: kira21 ♡♡♡ on June 27, 2014, 06:39:22 AM
Then separate doses as evenly as possible.  If you have three tablets take them evenly spaced.

Quote from: learningtolive on June 27, 2014, 06:47:27 AM
I was doing this

No, you have not been doing this. You have been bunching the first two. If you want the best effect, then stabilise the level and split three ways if you have three tablets. You can check that with your Dr. (but I would be very surprised if they did not agree).

I know you can't post dosages and really it doesn't matter as its the amount in your blood that counts. What are your T, E and SHBG levels?

Quote from: kira21 ♡♡♡ on June 27, 2014, 07:16:09 AM
I know you can't post dosages and really it doesn't matter as its the amount in your blood that counts. What are your T, E and SHBG levels?

My last two E levels were 120 and 70.  Those are both pretty low.  The 70 was probably because I forgot to take my pills before getting my labs done.  My last t level was 16 and somewhere in the 20s the time before that.  I've only started bunching the two pills in the morning more recently in response to this in order to create a spike in my levels; although, I would only space them between about 2-3 hours before then.  I'm wondering if all three at onc could increase my levels to an acceptable range.  I'm probably going to go on injections cause it doesn't seem to be working for me.  I've had response to the hormones but I should be having so much more, especially at 25. 

I only take one pill for E, for a while I cut it into two so that I could spread the doseage around but, it didn't seem to actually change anything. I now take it all at once, but seeing as they don't even make E pills to my knowledge in doses that would be small enough for your 3 to be less or equal to mine I can only imagine you are taking much more than I am, therefore the response might be different.

I am controlling my own hormones with some doctor supervision, and when asking questions as for how I should take it so far everyone suggested just taking the pill rather than cutting it up to try and get a more even dose. Like I said thier advice might not be applicable to someone on a higher dose though.

Honestly what every one else is saying makes purfect sence, I however bunch all my meds at the beguining of my day. I persinoly dont feel the slight ups and downs of the hormone levels. now when i miss a dose or take late then i start to. I can sat the my hormone levels as last checked, just a few weeks ago, showed that my T is low even for a cis woman, and me E is on par if not just a little low but still in normal range.  now this could be the actual medications that i am taking virsus the timing however there is my experiance.

Btw, I have read that eating an icecream every time You take E pill makes transition process, in general, more enjoyable.

Please describe "poor results". What were you hoping for after being on HRT for a year? I ask because I wonder if you aren't expecting too much. In the scheme of things one year is not much time... most cis girls have to wait two or three years into their puberty to get decent breast growth.

I say this with no medical knowledge at all, but I wonder where this fascination with spiking comes from. When I used to be on injections of Primogen Depot I had minimal breast growth, and the only noticeable effect was that I was an emotional wreck... that's my experience with a form of spiking. These days I'm on regular oral doses and also have an implant - that's a constant stream of E 24/7 straight into my blood - and I've had more breast growth and feel more emotionally stable than under any previous regimen.

Quote from: Hikari on June 27, 2014, 07:24:03 AM
I only take one pill for E, for a while I cut it into two so that I could spread the doseage around but, it didn't seem to actually change anything. I now take it all at once, but seeing as they don't even make E pills to my knowledge in doses that would be small enough for your 3 to be less or equal to mine I can only imagine you are taking much more than I am, therefore the response might be different.

I am controlling my own hormones with some doctor supervision, and when asking questions as for how I should take it so far everyone suggested just taking the pill rather than cutting it up to try and get a more even dose. Like I said thier advice might not be applicable to someone on a higher dose though.

Thanks for sharing.  Yeah, I'm not sure what to think cause of the dosage difference.

Quote from: Sheala on June 27, 2014, 07:24:20 AM
Honestly what every one else is saying makes purfect sence, I however bunch all my meds at the beguining of my day. I persinoly dont feel the slight ups and downs of the hormone levels. now when i miss a dose or take late then i start to. I can sat the my hormone levels as last checked, just a few weeks ago, showed that my T is low even for a cis woman, and me E is on par if not just a little low but still in normal range.  now this could be the actual medications that i am taking virsus the timing however there is my experiance.

Thanks for sharing.  Just took my third for the day, so I'm going to see if I get the same experience.

Quote from: ♡ Emily ♡ on June 27, 2014, 07:33:29 AM
Btw, I have read that eating an icecream every time You take E pill makes transition process, in general, more enjoyable.

Ice cream and I don't get along well, lol.  It put on way too much weight for my liking, but I'm crazy and only eat dinner.

Quote from: Ms Grace on June 27, 2014, 07:34:16 AM
Please describe "poor results". What were you hoping for after being on HRT for a year? I ask because I wonder if you aren't expecting too much. In the scheme of things one year is not much time... most cis girls have to wait two or three years into their puberty to get decent breast growth.

I say this with no medical knowledge at all, but I wonder where this fascination with spiking comes from. When I used to be on injections of Primogen Depot I had minimal breast growth, and the only noticeable effect was that I was an emotional wreck... that's my experience with a form of spiking. These days I'm on regular oral doses and also have an implant - that's a constant stream of E 24/7 straight into my blood - and I've had more breast growth and feel more emotionally stable than under any previous regimen.

Poor results would be my appearance, lol.  You've seen it, so you should know, lol.  But seriously, my levels are low.  That's a problem and probably why I'm experiencing so much difficulty.  And it's hard to compare because you do have the implant.  Those seem to work very well, so that might be why you are having even more benefits.  But I want the spiking in order to finally have normal levels for a bit. 

But these "normal levels" will only last for a few hours, just after you take the dose. Then you start to go down, probably ultimately lower than if you took it spaced three times during the day.

You're disappointed by your looks, fair enough, I know what that feels like too - but what were you expecting your looks to be looking like. That seems to be as much a part of this issue for you.

Quote from: Ms Grace on June 27, 2014, 07:51:25 AM
But these "normal levels" will only last for a few hours, just after you take the dose. Then you start to go down, probably ultimately lower than if you took it spaced three times during the day.

You're disappointed by your looks, fair enough, I know what that feels like too - but what were you expecting your looks to be looking like. That seems to be as much a part of this issue for you.

But isn't this true of the injections as well?  Is there a difference between the injection and pill route is this regard?  I honestly don't know. 

Looks are important to me, but it's not like a beauty contest or anything.  I'm just sick of being seen as a man.  I hate it so much.  It makes me want to just end it all.  Nothing wrong with being a guy or anything, I love men, but being seen as one causes so much internal grief for me and I can't take it anymore.  If I can't pass, that's all I'll ever be in the eyes of society: a messed up man. 

from my understanding injection is a larger initial dose with a much higher high, bo then tapers off throughout the time untill your next dose. pills have less high and less low.

The best thing for feminization is a steady, consistent dose that's held up over months and months and months, and one that gets into the blood stream as directly as possible. Screwing with the dosages forces the body to adjust to things all over again, which will mess with your moods, and possibly mess with your body's levels of SHBG which would only stall feminization rather than making it better.

I messed with my own hormones a few times in the very beginning because I was so sure that something was off, that the anti-androgens I was taking weren't enough, that the E pills weren't enough, but my blood tests disproved me every single time.

Just be patient. If you genuinely feel like one E method isn't working, maybe you can talk to your doctor about switching to patches pellets or injections, because those are all more effective. (Not because of dose, but rather because the E is going directly into the bloodstream.) But messing with dosages is almost always a bad idea.

I'm going to make a few comments and then leave this thread alone.

1.  There is a reason doses of medications are spread.  It is to maintain sufficient plasma levels for efficacy, and also to lower risks.
2.  These are not magic pills - they take time to work - if one mode of delivery does not agree with you, then look at switching.
3.  Changing the way you dose according to advice on this forum is not advisable.  We have no idea what your dosages are, what state your general health is, and what your full blood assay results are like.  Also from a legal point of view, we cannot advise, only make suggestions for you to discuss with your health care provider.
4.  Depending on your dose, if you do spike, you risk your liver.  Not good, not advisable.  You are going through all this to improve your quality of life, not to destroy it.

I'm really sorry if I offended anyone, but I do so on the basis of caring about the long term results.
Luna

I should probably add that all modifications I've done to my HRT have been done in consultation with my doctor.

And just to add to my previous post, I had an implant, levels came back about the same as my levels while on pills.

And, Grace , my sub-standard results? Minimal facial changes, fat still accumulates in male places, breast development ceased before I even got to a AA cup..

Body hair is no longer a problem, but that's attributable to the Androcur I take..

I don't know about the effect spacing tablets out will have so i'll trust what others have said.
With regards to taking all your pills, DON'T!! When it comes to medical matters either discuss with a GP or Pharmacist. If you don't trust their opinion then please trust what Jessica has said, out of all the people I know on this forum she probably has the most experience with all things medical, I would trust her advice in medical issues (& most other issues) above all others.
That girl has a good head on her shoulders.

Edit: If I took all of my pills at once my GP would refuse to prescribe more pills until the date they were due to run out & if that happened to you you may find yourself having to go without for a prolonged period.

My GP insisted that when my last prescription ran out I should have had 10 days worth left even though i've stuck to the dosage they've set, I don't know if someone screwed up or I lost a strip but it meant I had to go 5 or 6 days with nothing & it was horrible.

Yep, medical practitioners say to space them. That's what ltls doc said and everyone has said that they are very likely to be right in doing that and ltl should listen to them. :-)

Quote from: kira21 ♡♡♡ on June 27, 2014, 08:52:11 AM
Yep, medical practitioners say to space them. That's what ltls doc said and everyone has said that they are very likely to be right in doing that and ltl should listen to them. :-)

I wouldnt go as far as to say all, cause mine left it in my hands to decide to space or not. I tried spaced to start with now take just in AM. I have found, and this is just me, no diffirence between the two.

Quote from: Sheala on June 27, 2014, 08:54:19 AM
I wouldnt go as far as to say all, cause mine left it in my hands to decide to space or not. I tried spaced to start with now take just in AM. I have found, and this is just me, no diffirence between the two.

There's 2 of us who had no difference, Sheala...

And my doctor told me to take them all at once - it was my suggestion to space them..

Keep it balanced. Take it all at once may produce a spike, but could also be dangerous. I had been off of the hormones for over 2 months, finally got back on them yesterday, going from injectable to pill, and just with that very first one, it was a big scary jolt to my system. Even now after my second pill with no crazy shocking effects, no way would I ever think to taking more than one at a time. This is some potent stuff, not to be messed around with. I can understand your impatience with results, see any posts regarding how I felt the past 2 months, I was starting to go into the deep end. But I'm on the hormones again, finally, and now that my mind is where it should be, the rest will come in time. Rush it and you can make a grave mistake.

And injections may put it all in you at one time, but is delivered throughout your body in a gradual process, so there is a big difference with taking that and popping a bunch of pills at once.

Quote from: learningtolive on June 27, 2014, 06:29:27 AM
Hey all,

According to my therapist, taking them together could mimic the spikes of injections and that intrigued me a bit.

That therapist of your's is wrong, he/she should not be giving out medical suggestions, wrong field of study. Leave that to a qualified doctor, or common sense. Keep safe, give it time, you'll be alright.

Fwiw, I space my estradiol and Spiro. I take my finasteride and medroxyprogesterone in the morning since the pills are a pain to break.

I feel like it would be better to eat a smaller meal twice a day than gorge on a huge one once a day :p

I follow the directions on the bottle with one exception. I do sublingual for E and P

Quote from: learningtolive on June 27, 2014, 06:29:27 AM
I was wondering if there is an benefit to taking all hrt pills at once rather than splitting them throughout the day.

Since half-life of oral estradiol is about 14-17 hours, on average and MUCH shorter on sublingual, taking them once daily, even orally, will result in levels that fluctuate much more which could, in some, cause highs and lows in mood. I'm assuming you want to take it all at once to perhaps cause that very fluctuation to hopefully increase bodily response/sensitivity but since you are already taking pills sublingually, even thrice daily, that fluctuation is there already and is pretty significant, so really what is the point? You get peaks 3 times a day already.

Quote from: learningtoliveAccording to my therapist, taking them together could mimic the spikes of injections and that intrigued me a bit.

By taking them sublingually, you are already having spikes. With injections, spikes and declines will actually be much less compared to sublingual with high levels persisting for much longer and estradiol exceeding estrone all the time vs 1-2 hours after sublingual intake.

Quote from: kelly_aus on June 27, 2014, 06:59:27 AMAnd I hate to say this, LtL, some of us just don't react well to E, regardless of delivery method, levels, etc.. I've had quite sub-standard results and nothing my dr and I have tried has made any difference.

The only thing I can come up with is perhaps that dosages are too weak, still and should be increased to give better results BUT only if your doctor deems it necessary and without risks. What has your doctor said so far in regards to results? Would she/he be willing to increase dose? Have you discussed this with him/her?

Quote from: learningtolive on June 27, 2014, 07:09:24 AM
Thanks for the honest answer.  Yeah, I fear I may be less receptive to E than others.  I'll likely give the 3 pills at once a try and go to a follow up appointment to see about injections.  Somethings got to give at this point.  I've offically been taking E for a year with poor results to show.

Until you haven't tried other routes or perhaps higher doses (or even adding progesterone, for instance), with your doctor's agreement, you cannot say this for sure. There is still much to be done, I think. Just switching to injectables has done plenty for me!

Checking levels of E on sublingual is of little use given the fact that levels increase and decrease so much over 24 hours. Levels can also be misleading as the same level may do lots for one person and yet nothing for the other. HRT should be tailored, I think, to the individual and their own particular situation which I assume your doctor is doing anyways. ;)

Quote from: KayXo on June 27, 2014, 07:07:13 PM
What were the delivery methods you used? And were the doses high enough? I know doses cannot be mentioned here but perhaps this should be discussed with doctor. Have you really tried everything is what I wonder...have you taken bio-identical progesterone? What is your anti-androgen, if any? Have you tried another? Were doses of the AA effective enough? Again, something to research on your own and discuss with your doctor. Please don't mention dose of AA here.

My E levels are fine. My T level is perhaps a tad lower than either my gyno or I would like.. P made no difference except to make me feel like crap. I just haven't reacted the way wither I or my gyno expected. My general health is fine. Weight diet, etc is also fine..

Quote from: Ms Grace on June 27, 2014, 07:34:16 AM
When I used to be on injections of Primogen Depot I had minimal breast growth, and the only noticeable effect was that I was an emotional wreck... that's my experience with a form of spiking. These days I'm on regular oral doses and also have an implant - that's a constant stream of E 24/7 straight into my blood - and I've had more breast growth and feel more emotionally stable than under any previous regimen.

Could be that the dose given intramuscularly was either not adequate (too low) or spread out too much. Usually, it's best to take weekly and many women complain of feeling down after 10-14 days due to a significant decline in levels. But, whatever the case might be, what matters is that what are you taking right now is working for you. Good. :) You are making a good point though that injectable might not necessarily give better results. It will depend on the individual (sensitivity, metabolization) and also the dose, how frequently it is taken, etc. You also make a VERY good point about expectations. Could be that expectations are TOO HIGH.

Injectables really has been good for me, thus far. No complaints, much better than oral. I take them every 5 days to maintain a certain stability in levels. I've never been on pellets though.

Quote from: learningtolive on June 27, 2014, 07:40:43 AM
But seriously, my levels are low.  That's a problem and probably why I'm experiencing so much difficulty.

Levels are not always low. They are probably much, much higher the first few hours after you take your tablet sublingually so if you took an average of your levels during 24 hours, you would probably get a VERY different picture. This is why there's no point in taking levels on sublingual. In any event, results are the main criteria that should be used, I think. If you are getting no breast development, still have very little in the way of feminization, then I can understand your concern. Hopefully, a change in dose or route of administration as suggested by your doc will do the trick. ;)

Quote from: learningtoliveAnd it's hard to compare because you do have the implant.  Those seem to work very well, so that might be why you are having even more benefits.  But I want the spiking in order to finally have normal levels for a bit.

Implants and oral, quite different. The estradiol:estrone ratio is very different, even how stable levels are, especially if you take them sublingually. I think implants also give usually much higher levels of estradiol, on average vs orals at the doses we usually take them.

Quote from: learningtolive on June 27, 2014, 08:00:30 AM
But isn't this true of the injections as well?  Is there a difference between the injection and pill route is this regard?  I honestly don't know.

Levels remain significantly high usually for 6-7 days. There is a peak the first couple of days but still, levels remain quite high after. Not like sublingual at all where within just 2-4 hours, levels go up and down significantly. 

Quote from: Sheala on June 27, 2014, 08:10:14 AM
from my understanding injection is a larger initial dose with a much higher high, bo then tapers off throughout the time untill your next dose. pills have less high and less low.

Unless taken sublingually...

Not to derail the thread, but Kay, pls combine all responses into one post, and not septuple-post, ya do this a lot :p

Quote from: kira21 ♡♡♡ on June 27, 2014, 08:52:11 AM
Yep, medical practitioners say to space them. That's what ltls doc said and everyone has said that they are very likely to be right in doing that and ltl should listen to them. :-)

I only know of one doctor who told their patient it was ok to take it all at once daily and so far (several years), the woman in question hasn't complained and is doing well on this. Many menopausal women also take it once daily, as prescribed by their doctor and recommended in leaflets that come with pills. So, it does vary quite a bit...but usually transwomen take their pills twice daily due to half-life.

Quote from: Megan Joanne on June 27, 2014, 10:37:54 AM
Keep it balanced. Take it all at once may produce a spike, but could also be dangerous.

I think it depends on individual and dose. Kelly and Sheala have no problems taking it all at once daily and several other women take it this way without a problem. In the end, the doctor must decide whether for that person, taking it once or twice daily is best or doesn't matter. Each situation is perhaps different. 

Alcohol may reduce concentration of estradiol in the blood by increasing its metabolization. 

Quote from: Hideyoshi on June 27, 2014, 02:18:12 PM
Fwiw, I space my estradiol and Spiro. I take my finasteride and medroxyprogesterone in the morning since the pills are a pain to break.

Medroxyprogesterone acetate (MPA) and finasteride can be taken once daily because either their half-life is long enough (I think about 30 hours for MPA) or its effects longer lasting in the case of one dose of finasteride inhibiting DHT for quite some time. Both Spiro and estradiol have a shorter half-life in the blood so need to usually be taken twice daily although in the case of estradiol, as already mentioned, once daily seems fine with some.

Quote from: kelly_aus on June 27, 2014, 07:17:25 PM
My E levels are fine.

Would your doctor be willing to try higher E levels or do they consider this to be risky or perhaps unnecessary? Because I know a few, like me, for instance, need quite high levels, above 1,000 to get really good results. Have you tried injectables? Who knows?! This could perhaps do the trick or even gel??? Just asking and offering some suggestions that you could share with doctor.

Quote from: kelly_aus on June 27, 2014, 07:17:25 PM
P made no difference except to make me feel like crap.

That seems actually quite common, based on all my readings although a few also report mostly (or only) benefits from it. I'm still on the fence about it...there seems to be some good that comes of out it, some not so good. I take P twice daily. Did you take it once daily because due to short half-life, levels might go up and down too much if taken once daily so that could explain perhaps why you felt like crap...just speculating...or too low dose? taken cyclically or continuously? Was it bio-identical progesterone?

Quote from: Hideyoshi on June 27, 2014, 07:35:49 PM
Not to derail the thread, but Kay, pls combine all responses into one post, and not septuple-post, ya do this a lot :p

Ok. Noted. Will do. ;) My apologies to you all. Will read entire thread before replying. I was taking one reply at a time lol! Came late to the party, so many posts!

Quote from: KayXo on June 27, 2014, 08:11:30 PM
Would your doctor be willing to try higher E levels or do they consider this to be risky or perhaps unnecessary? Because I know a few, like me, for instance, need quite high levels, above 1,000 to get really good results. Have you tried injectables? Who knows?! This could perhaps do the trick or even gel??? Just asking and offering some suggestions that you could share with doctor.

High levels make no difference.. Injectables made no difference.  Given my background and my gyno's experience, I'm confident that we've tried everything reasonably safe..

First, I am not a doctor, but I do watch one on TV.   He has a cane, and a very sharp wit, works in a hospital in Princeton New Jersey... has a small Vicodin problem.. But that's not important right now..

When given meds (antibiotics, etc) that say, take three times daily... my docs and pharmacists have said, that means every. Eight. Hours.  Not one at breakfast, one at lunch and one at dinner.. unless they are eight hours apart, then it's fine.  If it says take twice daily, means every twelve hours., one, daily.. Well, you do the math.

If you have to take two, one in AM, then twelve hours later, one in PM.

Quote from: Paula Christine on June 28, 2014, 01:49:52 AM
First, I am not a doctor, but I do watch one on TV.   He has a cane, and a very sharp wit, works in a hospital in Princeton New Jersey... has a small Vicodin problem.. But that's not important right now..

When given meds (antibiotics, etc) that say, take three times daily... my docs and pharmacists have said, that means every. Eight. Hours.  Not one at breakfast, one at lunch and one at dinner.. unless they are eight hours apart, then it's fine.  If it says take twice daily, means every twelve hours., one, daily.. Well, you do the math.

If you have to take two, one in AM, then twelve hours later, one in PM.

My prescription simply says to 'Take X daily.'

Quote from: KayXo on June 27, 2014, 08:20:44 PM
Ok. Noted. Will do. ;) My apologies to you all. Will read entire thread before replying. I was taking one reply at a time lol! Came late to the party, so many posts!

Yeah if you scroll down under the input box where you type the reply, you will see a history of the thread in reverse order. You can click "Insert Quote" which will append that comment to your input box, and you can reply to it there. That way it is super easy to do a bunch of quotes at once.

Quote from: Carrie Liz on June 27, 2014, 08:16:55 AM
The best thing for feminization is a steady, consistent dose that's held up over months and months and months, and one that gets into the blood stream as directly as possible.

^^^ This! :)

If e is down, t will rebound. Happens with shots, too, according to my endo. That is why he advocates pellets.

Is it safe or wise for a helicopter pilot to just crash the bird into an LZ or would it make more sense to land it proper?

Quote from: V M on June 28, 2014, 05:40:27 AM
Is it safe or wise for a helicopter pilot to just crash the bird into an LZ or would it make more sense to land it proper?

Or how about an extended back massage as opposed to punching someone repeatedly but with less frequency? Same thing right? ;)

Lets see, a mechanic tells you to change the engine oil every 15,000km we do it. A Doctor tells you how they want you to take medication that they prescribe that can have life threatening side effects so we ask advice on line to unqualified people.

Not sure that is alogical to be honest.

Quote from: Cindy on June 28, 2014, 05:57:25 AM
Lets see, a mechanic tells you to change the engine oil every 15,000km we do it. A Doctor tells you how they want you to take medication that they prescribe that can have life threatening side effects so we ask advice on line to unqualified people.

Not sure that is a logical to be honest.

Actually what you describe is quite alogical indeed ;)

Ooops :-* :laugh:

To clarify, as we know.

Alogical is not synonymous with illogical in any sense. In the sense of "opposed to logic", where illogical is used for an abstraction (illogical reasoning, illogical decisions), alogical describes concrete subjects (alogical world, alogical person).

Just a simple analogy, sorry if it was taken badly

Hugs

So what you're saying is my use of the term alogical is rather illogical? :D :D

VM- I thought it was funny, just playing along with it!

And now imma stop hijacking the thread. Sorry y'all!

Ah okay, no worries

Back on topic - Follow your prescription as prescribed

With HRT slow and steady tends to get the job done better, doubling up for a higher dose will not equal better results but rather a waste of your prescribed meds imo

Quote from: Jennygirl on June 28, 2014, 05:38:04 AM
Yeah if you scroll down under the input box where you type the reply, you will see a history of the thread in reverse order. You can click "Insert Quote" which will append that comment to your input box, and you can reply to it there. That way it is super easy to do a bunch of quotes at once.

Thanks! Done. ;)

Quote from: Jennygirl on June 28, 2014, 05:38:04 AM
If e is down, t will rebound. Happens with shots, too, according to my endo. That is why he advocates pellets.

Only happens with shots if not taken frequently enough. Say, once every 2-4 weeks. This is why it's best to take weekly.

I see three problems with pellets. One is cost, very expensive! Two is that levels may actually be too stable causing desensitization of receptors to estrogen. This was, in fact, reported in women given pellets where levels were quite high, between 400 - 1,000 pg/ml and yet they had menopausal symptoms like hot flushes. Third, scars from insertion of pellets. At least, with injections, levels fluctuate more. If prepared by a compounding pharmacy, can be quite cheap and they shouldn't leave a scar. BUT, to inject once a week is indeed much less convenient than just having one pellet inserted every few months.

Quote from: V M on June 28, 2014, 06:39:27 AM
Follow your prescription as prescribed

With HRT slow and steady tends to get the job done better, doubling up for a higher dose will not equal better results but rather a waste of your prescribed meds imo

Not necessarily. Sometimes, increasing dose can have quite a dramatic effect in certain people. It really depends. I think it's always good to have a second and third opinion, if you think your doctor might not be prescribing in your best interest...doctors disagree even amongst themselves so who's to say who's right and who's wrong? And they do and can make mistakes, they are human after all! But, that being said, in the end, it's wise to stick with the prescription of whoever you choose to be your doctor, give it some time to work and be patient. Opinions and feedback from others on such a forum can be helpful, can assist you in making the right decisions with your doctor but the deal breaker is what your doctor tells you to do and if you're not happy, like I said, find another one who is familiar with treating transsexuals.  :)

Quote from: KayXo on June 28, 2014, 07:54:40 AM
I see three problems with pellets. One is cost, very expensive! Two is that levels may actually be too stable causing desensitization of receptors to estrogen. This was, in fact, reported in women given pellets where levels were quite high, between 400 - 1,000 pg/ml and yet they had menopausal symptoms like hot flushes. Third, scars from insertion of pellets.

I'm going to raise a few points here regarding pellet treatment:
1.  For some of us, cost is not the main issue, efficacy and safety of treatment is the main concern.
2.  Where did you get the information re: receptor desensitization?  Is it out of a peer reviewed article or a systematic literature review?  If it is a single paper, what of other ones regarding efficacy of pellet treatment.  What type of E was used in the pellets? Not enough information here for my satisfaction, and I mean this as a matter of academic interest.  I personally weigh the results of a study based on the cohort, the duration of monitoring, etc.n :D
3.  Scarring can most certainly be an issue depending on genetic background, however a well placed incision that is sutured correctly afterwards with 5/0 or finer will have minimal scarring.  In the right area, it will not be visible 99% of the time.  (Unless you are wearing somewhat skimpy undrgarments and model them...)

Equally, other modes of delivery have their risks.  Oral admin has the increased liver stain,  variability if taken sublingual, etc.  Injectables are technically invasive, poor technique can cause issues, etc.

Thee is no ideal means of administration and I think it boils down to personal preference and the treating endo.  Perhaps someday we can grow the bits required and implant something, but that. Is a long way off, if ever.

Thanks everyone for your replies.  I understand this is a controversial topic, but I seriously just wanted the input of others who have been in the same shoes.  Sure, our doctors are trained and understand medications, but they lack personal experience.  Asking people that have been there and done that helps, especially since everyone here also has different opinions from their doctors which can vary.  At the end of the day, I just want results and nothing seems to be working.  Taking all three seperate, or in closer time frames didn't seem to matter.  Maybe taking them all together would.  In any case, I'm a bit shocked that the half life of estogen is so short that it must be taken throughout the day.  I would've assumed that there would be a early peak that would slowly drop off a bit until the next day.   I'm a bit surprised that the levels drop as dramatically as others are stating,, but I will take your word on it.   I'm still not sure what to do, however, as I'm still looking like a big mainly man and nothing seems to make me feel like I'll ever pass or be taken seriously as female.  I can't tell you how much this depresses me everyday.  In any case, I will be going for a second opinion, and go to a very respected endo in my area that works with most trans people I know.  The one I currently see is very nice and helpful, but I have concerns about where I am heading and want to get another opinion from someone that is highly respected by other transwoman.  Plus, I've decided that I'm going to try injections.  Got to get over my severe fear of needles.  Just hoping my insurance will cover it all. 

Again, thank you everyone for sharing your opinions and experiences.  And I apologize for sounding ignorant and stubborn.  I don't want to annoy anyone here and feel bad that I have this effect quite often.  I just really have no idea what to do with my life and how to fix things.  I'm quite certain transitioning is a huge part of improving my quality of life and leading me to happiness, but it's such a bumpy ride and I don't know how to navigate through all of this properly.

Quote from: learningtolive on June 28, 2014, 01:36:29 PM
Thanks everyone for your replies.  I understand this is a controversial topic, but I seriously just wanted the input of others who have been in the same shoes.  Sure, our doctors are trained and understand medications, but they lack personal experience.  Asking people that have been there and done that helps, especially since everyone here also has different opinions from their doctors which can vary.  At the end of the day, I just want results and nothing seems to be working.  Taking all three seperate, or in closer time frames didn't seem to matter.  Maybe taking them all together would.  In any case, I'm a bit shocked that the half life of estogen is so short that it must be taken throughout the day.  I would've assumed that there would be a early peak that would slowly drop off a bit until the next day.   I'm a bit surprised that the levels drop as dramatically as others are stating,, but I will take your word on it.   I'm still not sure what to do, however, as I'm still looking like a big mainly man and nothing seems to make me feel like I'll ever pass or be taken seriously as female.  I can't tell you how much this depresses me everyday.  In any case, I will be going for a second opinion, and go to a very respected endo in my area that works with most trans people I know.  The one I currently see is very nice and helpful, but I have concerns about where I am heading and want to get another opinion from someone that is highly respected by other transwoman.  Plus, I've decided that I'm going to try injections.  Got to get over my severe fear of needles.  Just hoping my insurance will cover it all. 

Again, thank you everyone for sharing your opinions and experiences.  And I apologize for sounding ignorant and stubborn.  I don't want to annoy anyone here and feel bad that I have this effect quite often.  I just really have no idea what to do with my life and how to fix things.  I'm quite certain transitioning is a huge part of improving my quality of life and leading me to happiness, but it's such a bumpy ride and I don't know how to navigate through all of this properly.

There's a reason I went with the doctor I did, apart from her professional reputation, she also has personal experience - she's a trans woman.

Quote from: kelly_aus on June 28, 2014, 01:58:08 PM
There's a reason I went with the doctor I did, apart from her professional reputation, she also has personal experience - she's a trans woman.

That would be ideal, but sadly I don't know of anyone that fits that bill around me.  I think there needs to be more of an emphasis on transcare than there usually is among the endos that treat us.  Not to say they aren't educated or understanding, mine certainly is, but it's harder when you are in the minority of your endo's usual clientel. 

LtL, even with her experience, she's still confounded by my results. And, being honest, while the poor results were initailly an issue for me, it's pretty much become a non-issue, as it seems the rest of the world seems to think otherwise. I live the life of a woman, my friends accept me as a woman - right down to the point of forgetting I'm trans..

Quote from: learningtolive on June 28, 2014, 02:03:26 PM
That would be ideal, but sadly I don't know of anyone that fits that bill around me.  I think there needs to be more of an emphasis on transcare than there usually is among the endos that treat us.  Not to say they aren't educated or understanding, mine certainly is, but it's harder when you are in the minority of your endo's usual clientel.

I think you nailed it on the head there.

Also congrats on getting over your fear of needles and switching to shots. Goooood decision, I'm sure I'm not alone when I say I'm very happy for you! :)

Quote from: V M on June 28, 2014, 06:39:27 AM
Ah okay, no worries

Back on topic - Follow your prescription as prescribed

With HRT slow and steady tends to get the job done better, doubling up for a higher dose will not equal better results but rather a waste of your prescribed meds imo

Not to mention it can totally screw you up if you end up under the supervision of dumb quacks that have no idea how to treat you properly. Mine doubled my dose solely on my insistence and it screwed me up, royally. My current endo would never do something that stupid. As others have said, slow and steady. As far as the results go...hey, you get what ya get. That's why some chicks have FFS and BA's done later on. I think my results have sucked, to be brutally honest, but, oh well. That's just life.