Susan's Place Transgender Resources

I'm currently on patches at the highest does made for my brand. Going to ask endo  to bump up my RX on my next visit as I feel like my E level is still too low assuming my blood work confirms this.

I've heard a lot of insurance companies will deny a double patch RX. So has anyone done patches combined with oral or injections to achieve a healthy happy E level?

Hugs

Kay

Why not just go straight to injections? Injections alone is going to give you highest possible Estrogen. I started in pills and switched to injections and noticed a huge difference. It's also nice in that I inject myself every two weeks and forget about it until 2 weeks later. I still take Spiro and Finasteride daily, but it's something less I have to worry about.

Ya I'm just not a fan of needles so...... :o

Yes I'm a baby!

:)

I find pills very convenient and easy. My E levels have been very easy to adjust via the pills and measuring the level via bloods is reliable too. My endo simply said to take them all in the morning and take bloods exactly 4 hours later. No spilt doses.

Since my endo is part of the UK's largest Gender Clinic and has had experience of thousands of MTF patients I suspect he knows what he is talking about.

So, 7am I take my daily dose. I can carry a blister pack of pills in my bag easily too.

Pellets then!  :D

I got tired of sucking on pills every day....

Quote from: luna nyan on August 18, 2014, 07:55:28 AM
Pellets then!  :D

I got tired of sucking on pills every day....

Suck?

They go down in one swallow. It takes me maybe 5 seconds to open the pill box, swallow the pills and some fresh orange to wash them down, close the pill box. Done.

She was probably taking them sublingually so as to increase the amount that would go directly into the blood and avoid/minimize the first pass liver effect. I've found injections to be far superior than either pills, sublingual or patches. I was a baby too and VERY scared. I overcame my fears and was totally worth it! :)

Yup, I was taking them sub lingual, more to reduce first pass liver than to increase the levels.  I found the amount of time it took was inconsistent, but nevertheless, my levels were pretty much the same over two years.

Pellets have been good, other than the small incision.  I don't feel bad about giving myself injections, but just didn't want all the associated paraphernalia around.  Once you get the hang of it, it hurts less than what you think it would.

I'm using the gel and am very pleased with it.  I'm not a fan of needles either and they wouldn't be convenient for me just yet.  I'm also using spiro and p.

As a newcomer to the board, one area I'm convinced about is the advantage of transdermal estrogen over ingesting estrogen pills.

After taking standard Estradiol pills for ~2 years, a sonogram (that was looking for unrelated issues) picked up a mass on my liver. An MRI revealed it as an hepatic adenoma. It's a benign tumor that is almost unheard of except in women taking birth control, and based on some quick searches, largely off everyone's radar here, too.

It turns out they're mostly found incidentally as they're minimally symptomatic (if at all) on their own. An HA has a low lifetime chance of turning cancerous, but can rupture spontaneously if it grows too large - which is actually somewhat dangerous with a ~10% fatality rate from HA-related internal bleeding. I hear ~5" is about the threshold for concern. Mine is less than half that size.

After being diagnosed about 4 years ago, my doctor switched me to compounded estradiol cream, the same kind commonly taken to relieve menopause symptoms. Usually doctors recommend tumor excision, especially if it can be done with keyhole entry, but mine is so small and central on the liver that the recovery would mean resecting half the liver and thus probably be more dangerous to my health than letting it be. My doc has a great reputation and recommended just a yearly MRI to check for changes.

In the time since being on estradiol cream, at least a year or more of which was spent on an estrogen dosage that my doctor later read from my blood levels as "too high", my tumor has not changed in size or nature, leading us to conclude in my case that this treatment is not having the adverse effects that estrogen pills did - and thus, anecdotally, that others in my situation may benefit from this knowledge as well.

We don't really see hepatic adenomas in this population, but they apparently can form with HRT. I suppose this is food for thought in case anyone is on the fence about how to administer estrogen (talk it over with your doctor, but at least for me, it's healthier.) I'd be curious to hear if others have had related experiences.

Rachelicious,

Thank you for sharing your issues with oral HRT.  This issue is one that I was completely unaware of, and I believe that you are likely one of the first to have had this issue over the 2 and a half years I've been on this forum.

The rate of incidence is pretty low, and a quick search seems to indicate a possible genetic component as well.

Regardless, it's an additional factor in deciding estrogen type and administration.

I'd be surprised if there was much in the way of reporting of this in the trans population other than the odd case report.

I'd like to second pellets.

Due to my age I was on patches for more than 5 years, and gel at some points. Apparently some people (me) don't absorb estrogen from patches very well, so I changed to pellets. The change is dramatic. I can't believe how much better I feel. My breasts had stopped growing, but they have started again with a vengeance and have not stopped hurting since I started - if i get 5 more years of growth, well, the mind boggles (no idea if that's possible, but I can dream).

Injecting myself terrifies me, and I'm not sure I could do it, but pellets are no problem. Its the biggest needle you can imagine -more like artillery, but its done with a local anesthetic so doesn't hurt at all, plus the endo does it which helps greatly (the local stings for a bit though). Even better its going to last at least 6 months, and when I get the next one its probably going to last more than a year. There's at least a few days of pain after the implanting pellet and a stitch that needs removing after a week (painless); its its more like minor surgery, but I don't have a problem with that.

I believe my blood levels are very constant, unlike all the other methods. I don't seem to get emotional ups and downs at all.

Psychologically I don't like taking medication every day, as it reminds me that I'm not genetic female. With pellets I can forget that as well. Its an illusion of course, but it works for me.

Finally, the thought of stopping HRT for SRS scares me, but you don't have to stop if you're using pellets. Its just gets better and better, and there's no way I'm ever going back.

Quote from: Rachelicious on August 21, 2014, 04:50:58 PM
After taking standard Estradiol pills for ~2 years, a sonogram (that was looking for unrelated issues) picked up a mass on my liver. An MRI revealed it as an hepatic adenoma. It's a benign tumor that is almost unheard of except in women taking birth control, and based on some quick searches, largely off everyone's radar here, too.

what kind of pills were you taking? which form of estradiol did they contain? All estrogens are not made equal and appear to affect differently liver, coagulation and several other factors.

Quote from: AnonyMs on August 22, 2014, 06:05:06 AMInjecting myself terrifies me, and I'm not sure I could do it, but pellets are no problem.

I have the injections done by nurses and so far, I feel far better on them compared to pills.

Quote from: AnonyMsPsychologically I don't like taking medication every day, as it reminds me that I'm not genetic female. With pellets I can forget that as well. Its an illusion of course, but it works for me.

Very good point indeed. It must be great. :)

Quote from: AnonyMsFinally, the thought of stopping HRT for SRS scares me, but you don't have to stop if you're using pellets.

By that same token then, if one is taking estradiol in the same manner (non-orally) whether it be by injections, patches, cream, gel, then one shouldn't have to stop. Right? Similar to ciswomen who undergo major operations and who continuously produce estrogen in a way that it is delivered right into the blood. They aren't denied major surgery just because they have estrogen in their bodies. Food for thought...I'm not advocating anything here, just wishing to explore this point further, if anyone is interested. :)

Quote from: KayXo on August 22, 2014, 11:35:32 AM
what kind of pills were you taking? which form of estradiol did they contain? All estrogens are not made equal and appear to affect differently liver, coagulation and several other factors.

Basic synthesized bio-identical estradiol at a medium dose, always dissolving the pills under the tongue (but apparently some still enters the GI tract.)

I'm curious about pellets myself. So it absorbs through the fat layer akin to transdermal methods like patches, gels, or creams? If it does in fact release gradually and cycle through the bloodstream before hitting the liver that would be great. I'd of course be a little concerned about dosage since, well, I imagine it's a little involved to adjust  :-*

But in any case I'm happy with the click-applicator topical cream I use so if it's less than perfect for someone who apparently has to be concerned with how her estrogen is administered, that's no big deal to me.

I'm on a medium dose progunova pellet.   It requires replacement every 6 months, and on it, my last E levels were 490.  (That would be the 3 month peak).  The safety of pellet is well established, and the risk to liver is essentially eliminated.

Dosage is a bit more tricky.  If the endo knows roughly how much you need per day, an appropriate dosed pellet can be inserted.  It's a bit more of an issue for me (see my HRT thread), but for those transitioning, I don't really see a downside other than the incision and stitches,

Patches for me!!! The best way to get estrogen after pellets. Injections are no longer allowed in germany but also not recommended since they give you high peaks in you e2 levels and that's not good, 'cause steady levels of e2 are needed for feminization and better breast development. Cis girls also have steady e2 levels in their follicular phase. Maybe some peaks between ovulation and luteal phase, but not that much.

You are assuming that peaks are not good and steady levels better for feminization but is there any science behind it? I've been on injections and have noticed much improvement from when I was on pills and levels were much more steady. The same can be said of several other women, not only trans, basing myself on the several messages read on various forums.

I heard it was discontinued in several places because it just wasn't profitable, not due to health reasons.

Quote from: KayXo on September 08, 2014, 04:29:15 PM
You are assuming that peaks are not good and steady levels better for feminization but is there any science behind it? I've been on injections and have noticed much improvement from when I was on pills and levels were much more steady. The same can be said of several other women, not only trans, basing myself on the several messages read on various forums.

I'd be concerned about liver toxicity from the peaks, but then I have pre-existing conditions from ~2 years of pills :(

I have a question so my endo said there aren't any sub lingual forms to take so are yall just using the regular as sub lingual...also do you just do e like this or e and spiro?

Quote from: Pebblez on September 09, 2014, 09:36:03 PM
I have a question so my endo said there aren't any sub lingual forms to take so are yall just using the regular as sub lingual...also do you just do e like this or e and spiro?

FYI I have a liver tumor as a result of 2 years of taking pills in what I was completely convinced was a sublingual dissolving (by this I mean, I would literally not even move my mouth at all until I no longer sensed it there... enough of it still goes through the GI tract.) I do not recommend this method unless you're considerably desperate.

Quote from: Rachelicious on September 08, 2014, 05:40:48 PM
I'd be concerned about liver toxicity from the peaks, but then I have pre-existing conditions from ~2 years of pills :(

Injections bypass liver first pass effect so aren't quite the same as pills. Also, in pregnant women, levels peak up to 75,000 pg/ml.

Quote from: KayXo on September 10, 2014, 04:05:50 PM
Injections bypass liver first pass effect so aren't quite the same as pills. Also, in pregnant women, levels peak up to 75,000 pg/ml.

First-pass =/= 0% that the liver must handle. Hormone levels during pregnancy are irrelevant. Safety advocates using the lowest effective dosage, therefore I see no benefit to levels fluctuating from high to low. Surely one is too high, and one is too low.

This lack of control over dosage is why I will not try pellets/inject. Women generally experience bad symptoms from lack of control over monthly hormone levels. I enjoy having far greater power over my hormonal status than women who do not require HRT.

Women experience bad symptoms because their levels drop significantly but on injections, if done frequently enough, there is no such drop, levels remain quite high. I've not experienced bad symptoms. Some fluctuation could be beneficial in the sense that it could avoid desensitization of receptors to too constant levels.

Pellets deliver quite constant levels as compared to injections.