Susan's Place Transgender Resources

I was watching a show not too long ago on the Discovery Channel, I think it was titled "Changing Sexes."  The program interviewed several transgendered individuals, all at various stages of their transition, and the program even had Dr. Marcy Bowers on it (she's a top SRS surgeon in the mid-west).

One of the girls interviewed had been on high doses of HRT (administered orally) for so long that she ended up in the hospital because of health complications (her body was shutting down or something).  She had to stop HRT for several months before she was healthy enough for HRT again.  This time she recieved her hormones through a trans dermal patch.  The program said that orally administered hormones are rendered 90% ineffective once they pass through the liver, but with a trans dermal patch the hormones go right into the bloodstream and are much safer to take than pills.

Can anyone else verify this?  I am considering seeking this option if it is more cost-effective that oral hormones (effects are faster which means less patches, versus pills that are 90% ineffective once ingested). 

~Fae

Any time you don't put a load on your liver to remove what it considers foreign and therefor something it is designed to remove, you are better off.

Typically drugs are given orally with a slight overdose to help compensate for the "first-pass" scenario in the liver, and this is why it's also recommended to NOT ingest grapefruit in any form during medication administrations.

It seems that the liver gets a shut down or very diminished command to remove what it considers foreign in the blood stream. You would then get a serious overdose of the medication going against pharmaceutical design.

Yes..trans dermal admission is very liver-friendly and oral ingestions are not so nice to the liver.

Thankfully the liver is very self-repairing and can make tremendous inroads to better health if it's not asked to work so hard in the future. I don't advocate pushing it's buttons just "so far" to get what it is you want to achieve in gender issues..you only get ONE liver.

I was concerned about taking oral hormones as well, but my endocrinologist assured me that because I am so young and don't drink alcohol I would be fine.  I also tend to forget things I don't do daily, so the pills are just more convenient form me in that sense.  Although I might switch later  :P

Unless you've got liver damage prior to HRT, which is why its good to get a liver panel done, and you take very high doses of E orally of the wrong kind (ethinil estradiol is by far the worse offender), the liver risk is minimal.

Usually the risk from orals (in particular premarin and ethinilestradiol) is DVT, the liver produces by products with processing those E's that are not like biological E in females than increases the clotting risk (some with genetic predisposition are particularly at risk).

Orals, if your under 40, in good health, use biologically similar to natural estrogens, sublingually, and do not use more than a well known safe max limit, are very safe.

To compensate for the first pass through the liver reducing effectiveness when not taken sublingually, they usually boost the dose a lot.

The synthetic Ethinil estradiol is very very hardy and is not degraded easily by the liver, that's why its both potent (effective at low doses) and dangerous (easy to abuse and take 10 or 100x the safe dose ).

Quote from: Kat on August 02, 2007, 02:26:51 PM
I was concerned about taking oral hormones as well, but my endocrinologist assured me that because I am so young and don't drink alcohol I would be fine.  I also tend to forget things I don't do daily, so the pills are just more convenient form me in that sense.  Although I might switch later  :P

I used to drink socially one in a while, but stopped last year because I began anti-depressants (alcohol just made me feel tired and dizzy with the anti-depressants).  My endo said the same thing, since I don't drink, I'm young and healthy the risk of HRT is minimal.  My blood work has been coming back fine so I'll stick with the oral administration for now.

Was just curious what others thought.  :)

~Fae

Quote from: Fae on August 02, 2007, 12:26:23 AM
Can anyone else verify this?  I am considering seeking this option if it is more cost-effective that oral hormones (effects are faster which means less patches, versus pills that are 90% ineffective once ingested). 

Transdermal systems are more expensive than pills, but yes they are that much more effective.  This is true of all pills, not just estrogen.  The majority of the medicine is ether eliminated when you go to the bathroom or filtered out by the liver.

According to my doctor, the patches work better than swallowing, however, they are much more expensive. I hear injections also work well, but the cost and then having to stick a needle into you all the time.

As for my medication, Estrace (Estradiol), I dissolve it under my tongue. The estrogen is adsorbed into your blood stream, and your liver doesn't need to process it. You also retain a higher dose of estrogen because it isn't going through the digestive tract. The good news is that Estrace isn't very expensive, and as far as I know, similar to a trans-dermal patch in effectiveness and risks.

Premarin (horse pee) is designed to be swallowed and you can't dissolve it under your tongue (where estrace is designed to be disoloved under the tongue). The coating on Premarin is supposed to protect the estrogen until it passes your stomach and then into your digestive system. Estrace doesn't have a protective  coating.

I stopped taking Premarin because I got some side effects from it. Estrace, for me at least, hasn't given me any negative side effects.

I know a lot of people who take Estrace and just swallow it. It will work, but as far as I know I think with estrace under the tongue is the best way to take it. A lot of people don't know that the pill is designed for that (well, people I run into and who are taking it). I know a few people who started dissolving it and have mentioned to me that it worked better for them.

So, anyway, those are some options for you to talk to your doctor about.

Posted on: August 04, 2007, 02:18:25 AM

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BTW Ethinyl estradiol is usually found in birth control, and I believe that the estradiol in Estrace is different. I might be wrong, but I'm pretty sure it's different. I think Estrace has 17B Estradiol, which is the easiest for your system to use because it's identical to human estradiol, and puts your body through less stress with a low risk of clots.

Patches for me!

Currently I'm on Vivelle/Estradot, which require changing every 3 or 4 days.  I haven't missed a change yet.  I also do a daily low dose estrace sublingually to provide a 'cycle' over 24 hours.

Both routes of administration go around the liver first-pass problem.

Karen

Quote from: gothique11 on August 04, 2007, 02:27:48 AM
According to my doctor, the patches work better than swallowing, however, they are much more expensive. I hear injections also work well, but the cost and then having to stick a needle into you all the time.

As for my medication, Estrace (Estradiol), I dissolve it under my tongue. The estrogen is adsorbed into your blood stream, and your liver doesn't need to process it. You also retain a higher dose of estrogen because it isn't going through the digestive tract. The good news is that Estrace isn't very expensive, and as far as I know, similar to a trans-dermal patch in effectiveness and risks.

Premarin (horse pee) is designed to be swallowed and you can't dissolve it under your tongue (where estrace is designed to be disoloved under the tongue). The coating on Premarin is supposed to protect the estrogen until it passes your stomach and then into your digestive system. Estrace doesn't have a protective  coating.

I stopped taking Premarin because I got some side effects from it. Estrace, for me at least, hasn't given me any negative side effects.

I know a lot of people who take Estrace and just swallow it. It will work, but as far as I know I think with estrace under the tongue is the best way to take it. A lot of people don't know that the pill is designed for that (well, people I run into and who are taking it). I know a few people who started dissolving it and have mentioned to me that it worked better for them.

So, anyway, those are some options for you to talk to your doctor about.

Posted on: August 04, 2007, 02:18:25 AM

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BTW Ethinyl estradiol is usually found in birth control, and I believe that the estradiol in Estrace is different. I might be wrong, but I'm pretty sure it's different. I think Estrace has 17B Estradiol, which is the easiest for your system to use because it's identical to human estradiol, and puts your body through less stress with a low risk of clots.

Needles freak me out, so that's a no-go.

Premarin would never be an option, as my friend loves horses (Premarin comes from pregnant mares) and it would break her heart if I took it.  She asked me not to and I'm respecting her wishes.

I am going to start dissolving Estradiol under my tongue.  I brought this up with my endo a while back and she said I could try it and see if it makes a difference, though she mentioned it might taste like chalk.  We'll see if it does because it feels like my boobs have stopped growing.  :o

~Fae

The Estrace is kind of sweat to me, but a bit chalky -- it doesn't take long to dissolve. Try not to talk when doing it (I'm bad for that, then it gets all over my mouth... You'd think that I could stop talking for one minute! )

Posted on: August 07, 2007, 04:20:55 PM

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oh yeah, and after it dissolves, which isn't long, just drink some water and any chalkiness that is there will go away quickly.

I'm in the transdermal camp.

Pros:  less to remember, constant dose of estrogen in the blood stream, better for your liver, good idea if you smoke or are over 40.
Cons:  more expensive, patches can fall off, can leave an adhesive outline that takes some effort to remove.

If you are going with the patch, spend the extra money and get Vivelle Dot (or ask your doctor).  They are smaller than the other patches and they do not fall off.

If you take higher doses of E, transdermal are way too expensive.
Maybe as maintenance doses after 10 year of devellopment doses they would be cost effective.

Quote from: gothique11 on August 04, 2007, 02:27:48 AM
BTW Ethinyl estradiol is usually found in birth control, and I believe that the estradiol in Estrace is different. I might be wrong, but I'm pretty sure it's different. I think Estrace has 17B Estradiol, which is the easiest for your system to use because it's identical to human estradiol, and puts your body through less stress with a low risk of clots.

From what I have read the difference is they added ethyl to the molecule so that your liver cant break it down. Thats why you always see that it is issued in very small doses  mcg vrs mg.  It is the same 17B Estradiol but much more powerful milligram for milligram.

Just a note I thought I should edit in: its my understanding that Ethyl Estradiol for some reason has a reputation for causing deep vein thrombosis when used in high doses need for transsexuals.


Kristina

I'm on patches and the only problem is you need about 3 to 4 of them to equal an acceptable dose of orals. I use Estraderm but was on orals before. The one thing to watch is that the Estradiol in the patches can give you a headache and or a stomach ache.

Sara.

I have had no problem with side effects.

Sadly, the pharmacutical companies don't make anything larger than 0.1 patches.  I guess they don't see the market.  But at least after battling with my insurance company, they are covered.

Quote from: Sara on August 26, 2007, 08:37:20 PM
I'm on patches and the only problem is you need about 3 to 4 of them to equal an acceptable dose of orals. I use Estraderm but was on orals before.

Sara.

I found the opposite to be true.

From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

Quote from: Ashley Michelle on September 01, 2007, 12:03:20 PM

Quote from: lisagurl on September 01, 2007, 11:22:07 AM
From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

i have heard to change them every 3-4 days?

Different brands have different directions. Mine are changed every 7 days.

Quote from: Ashley Michelle on September 01, 2007, 12:03:20 PM

Quote from: lisagurl on September 01, 2007, 11:22:07 AM
From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

i have heard to change them every 3-4 days?

There are three different kinds of patches: once a week, twice a week, and once a day.  I started out on the once a week version and found that the change in hormone levels from the start of the week to the end of the week was too much.  It was causing me to take over the menstrual cycles of the women in my house.  Now I'm on the twice a week version, and they have control of their bodies back.

Quote from: Ashley Michelle on September 02, 2007, 03:53:41 PM
i'm using the vivelle dots myself

Vivelle-Dots are so much better than the Mylan ones I was using before.  If anyone did a class action suit against Mylan, I would join it.

Has anyone tried the Estrogel?  http://www.estrogel.com/ (http://www.estrogel.com/)

Seems since this is transdermal it has the advantages of the patch...  with out worrying about the falling off or the adhesive residue left behind.

Yes I have, and it works great. I have had the same results on the patch as gel . Doc put me on pills at first, but I didn't like taking all those things, and worried about my liver. Then I switched to the patch. Better than pills as far as ease of use. They did give me a rash, and dried out my skin where the patch was. Moved to the gel same blood tests results as the patch, and easier to use.

No one has mentioned the Estrodial 17b in gel form. I have been using it for about a year and find it to be the best for me. I can't use the pill and the patches kept falling off. Yes it is more expensive but to me the expense is worth it. Jolene

Quote from: Fae on August 02, 2007, 12:26:23 AM
I was watching a show not too long ago on the Discovery Channel, I think it was titled "Changing Sexes."  The program interviewed several transgendered individuals, all at various stages of their transition, and the program even had Dr. Marcy Bowers on it (she's a top SRS surgeon in the mid-west).

One of the girls interviewed had been on high doses of HRT (administered orally) for so long that she ended up in the hospital because of health complications (her body was shutting down or something).  She had to stop HRT for several months before she was healthy enough for HRT again.  This time she recieved her hormones through a trans dermal patch.  The program said that orally administered hormones are rendered 90% ineffective once they pass through the liver, but with a trans dermal patch the hormones go right into the bloodstream and are much safer to take than pills.

Can anyone else verify this?  I am considering seeking this option if it is more cost-effective that oral hormones (effects are faster which means less patches, versus pills that are 90% ineffective once ingested). 

~Fae

Fae, I think that's a cert....I've been on oral hormones for 7 years and they haven't worked. I haven't got any fat re-distribution, no hips and very little breast tissue. I am now trying different things and patches is one of them. You are right when you say the liver breaks them down and makes them 90% ineffective....

In the U.K injectable hormones are sometimes illegal but Might also be much better than oral pills....how can I get them? 

Also can someone give me advice on what HRT patches are available, especially in the U.K?

Effectiveness depends on comparing the blood tests not the results. Mileage can very depending on your physical makeup. No matter what the delivery system you should have a target hormone level you want in the blood. Doctors very on this amount. The same level can have profound different effect on the individual. For a preop typically one patch will not give the levels you need for transition. Just like one 2mg estradiol pill will not. 4 or 5 pills deliver in the blood as much as 4 or 5 patches. However that many patches become difficult to manage. Yes the pills have much more of hormone that is lost in the liver but in the end, it is about the same added to the blood. If you take the pill sublingually the amount in the blood will be much greater.

Quote from: Ashley Michelle on September 01, 2007, 12:03:20 PM

Quote from: lisagurl on September 01, 2007, 11:22:07 AM
From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

i have heard to change them every 3-4 days?

According to the TS Roadmap web site, once per week. My doctor agrees.

I have problems with them falling off after a couple of days.  I have found the Johnson & Johnson Paper Tape to be a cheap and effective solution to keep the patches in place.

Dora

Quote from: Dora on September 08, 2007, 12:22:40 PM

Quote from: Ashley Michelle on September 01, 2007, 12:03:20 PM

Quote from: lisagurl on September 01, 2007, 11:22:07 AM
From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

i have heard to change them every 3-4 days?

According to the TS Roadmap web site, once per week. My doctor agrees.

Once again, there are three different kinds of patches: once a week, twice a week, and once a day.

I have been doing patches for over 3 years and haven't missed one yet. I do vivelle/estrodot. I have the strongest one they have and that is all I use. It seems to be all right. I have high cholesterol and have to take medications for my fatty blood so I wanted to releave some of the pressure off my liver by doing the patch. I was taking prometrium but stopped just 2 weeks ago. Dr. want to see what that will do, she seems to think I don't need it.
Sheila

Its two a week, one after 3 days then another after 4 days. On the 4th day, I'm a little cranky. That is day would be wednesday.
Sheila

Pills never worked on me in 7 or 8 years so now I'm trying patches.......the first one I put on the other week I started to lactate which I've never done before, so my guess is they are miles better...

So is there any specific better way for the intake of estrogen?  From what it sounds like patches are better than everything is what people are saying.  Well patches and injections over pills any day.  Is my doctor doing it the obsolete way by giving me pills?

Quote from: shanetastic on September 18, 2007, 12:25:35 AM
So is there any specific better way for the intake of estrogen?  From what it sounds like patches are better than everything is what people are saying.  Well patches and injections over pills any day.  Is my doctor doing it the obsolete way by giving me pills?

I'm no authority on this, but I believe precribing transdermal patches is the preferred option for older people or for anyone with an increased risk of clotting or with a family history of cardovascular problems, because the medication gets into the bloodstream without passing through other organs. Someone far more knowledgeable than me will be able to explain it better - where's Keira?!  :)

Its preferred in older patients because of doctor conservatism more than anything else, because most people under 60, don't have significant risks using sublingual orals at at the lower dosage often prescribed to older TS patients (again conservatism).

Of course, if you have a conditions favorable to a stroke, have smoked a long time, liver problems, genetic predisposition to clotting (like leyden), injection or transdermals are preferred.

Injections are much cheaper than transdermals and in theorie have the same advantages, but tend to lead to spiking in the serum level of E, so even though it goes to the blood, its not used in older individuals (over 50) generally.

Quote from: Kiera on September 19, 2007, 04:08:27 PM
LOL! Well, I'm over 50 and I vote the estrofem dial pack (for all reasons stated above). Been taking for almost 11 months now and I keep open "click" packs at home, in my luggage as well as in my car but definitely not on my person! I work a very active, strenuous  . . . ok, ok, sweaty job and 1) I cannot have a patch on me to fall off or worse yet 2) somebody asking me "what's that for"? The dosing is very level because I have yet to skip a beat (I like the daily routine/reminder of who I truly am with no mood swings) and combined with a powerful anti antigen "this 'ole lady" is very happy with her results so far . . . 

Can't tell ya how many times SO has accusingly asked "have you taken your meds today?" & threatened to "pitch em" but she hasn't actually done so yet!  ;)

Can I have that money you promised for electrolysis dear?  ::)

:icon_bunch:

hormones don't work on everyone no matter how many you've tried. Both myself and my friend who is the same age as me has been on them and anti - androgens for 13 years and she hasn't got any female fat distribution either.....

I too started on Estrofem in 1998 and then onto ethinyestrodial, premarin, progynova, Zoladex, androcur etc.....nothing works on me no matter what doses or hormones. I have no hip size or changes whatsoever. I believe this is common in transsexuals and I have met many who seem to be the same and have no female fat distribution even though some think they do. I'd love to see body picture's of anyone who has proper female fat distribution? 

My endocrinologist gave up on both myself and my friend and more or less said 'you are both over 40 now and to be honest we've tried everything and nothing else is going to work'.....not what we wanted to hear but probably as truthful as someone could get...

Quote from: Berliegh on September 19, 2007, 05:58:47 PM
I have no hip size or changes whatsoever. I believe this is common in transsexuals...

As far as I know, women's hips come mostly from wider pelvic bones for giving birth, and NOT fat. Although, the upper thighs get fatter which gives a similar effect.

Yes, my rear, thighs and breasts gained fat. I'm not imagining it. My arms are different. My face is different.

QuoteMy endocrinologist gave up on both myself and my friend and more or less said 'you are both over 40 now...

I think the age thing is a bit of an urban myth. The women in my support group all started HRT in their late 40s or 50s, and all of them look great... meaning female.

It's curious that both you and your friend are seeing no changes, and you're both seeing the same endo. Maybe try someone new?

~Kate~

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi199.photobucket.com%2Falbums%2Faa85%2FKeirasthings%2FIMG_6148q.jpg&hash=181dcb459fff2692af35195db4a69d6c6fb4fafc)(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi199.photobucket.com%2Falbums%2Faa85%2FKeirasthings%2FIMG_6151A.jpg&hash=94b1340a8a26b19be9251c36003518d58fec8353)

Always had good hips (not fat, just my bones), and now my waist is down to 26.5, hips 38

Its the smaller waist, 32 -> 26.5 that makes me look more female, actually lost 2 inches around the hips. I've lost 25 pounds in the last 8 months. 185 -> 160.

I'm 40 (in 1 month).

Gosh, you look great Keira. I hope I look half as good at 40. Though now that I think about it I am not all that far away from 40 myself...

Keira, you have a very similar bodyshape to me.....but you look a bit fitter. Like me you also have a very small bust and larger upper body mass compared to lower body mass.....

I really appreciate you posting the pics. I'll also try and post mine as soon as I can........



Posted on: September 20, 2007, 11:53:35 AM

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Quote from: Kate on September 19, 2007, 07:52:48 PM
As far as I know, women's hips come mostly from wider pelvic bones for giving birth, and NOT fat. Although, the upper thighs get fatter which gives a similar effect.

Yes, my rear, thighs and breasts gained fat. I'm not imagining it. My arms are different. My face is different.

I think the age thing is a bit of an urban myth. The women in my support group all started HRT in their late 40s or 50s, and all of them look great... meaning female.

It's curious that both you and your friend are seeing no changes, and you're both seeing the same endo. Maybe try someone new?

~Kate~

Age is usually important as a 13 year old boy starting on HRT would develop hips and their pelvis would change as they would not have reached puberty.  Once past puberty it's very hard to eradicate male type fat distribution even after excessive hormone therapy. Obviously if you had an endomophic bodyshape as a male it will appear you have better fat distribution as a female but generally most transsexuals I've seen are thin and have a completely different bodyshape to women. My sister for instance is the same height (5' 7") and age as me yet she looks completely different. Her hips and butt are huge in comparison and I am completely aware of the differences at first hand.

Both my friend and I have seen different endicrinologists over the years and most come to the same concusions if they are honest and thruthful. 

Quote from: Berliegh on September 20, 2007, 12:02:23 PM
Keira, you have a very similar bodyshape to me.....

And me....and I'm fit too, but obviously no boobs....yet!

Yes, Keira You look great.  Congratulations on the weight loss. Well done.

The breasts are not that small, its just the straight on angle that makes it look that way, its a small 36C (meaning some 36C fit well, other do not). I'll show a side view and you'll see.
You have to remember that I'm 6 foot, so what looks small is not that small :-).


Berleigh, not sure if we are similar by your own description. I only got 33 inch under the bust and I wear a 10 coat (size 8 dress and tops, 6-8 for pants). Once I lose the muscles on the shoulders I'll probably wear a 8 coat. 

And if you truly have a 38 inch hip and a close to 26 inch waist l (I'm 6 foot tall, so that's slim), that's a better figure than 90% of female out there! So, not sure why you wouldn' be satisfied with that.

Quote from: Keira on September 20, 2007, 02:03:37 PM

The breasts are not that small, its just the straight on angle that makes it look that way, its a small 36C (meaning some 36C fit well, other do not). I'll show a side view and you'll see.
You have to remember that I'm 6 foot, so what looks small is not that small :-).


Berleigh, not sure if we are similar by your own description. I only got 33 inch under the bust and I wear a 10 coat (size 8 dress and tops, 6-8 for pants). Once I lose the muscles on the shoulders I'll probably wear a 8 coat. 

And if you truly have a 38 inch hip and a close to 26 inch waist l (I'm 6 foot tall, so that's slim), that's a better figure than 90% of female out there! So, not sure why you wouldn' be satisfied with that.

Keira, what am I thinking of...your shape is a million miles better than mine.....see pic

It's never easy to tell someone's shape from photographs and some genetic girls are quite thin. I want to personally have a more curvy shape, more like Bridget Jones with a reasonable size butt and hips.  I look at a lot of genetic females and they always seem to have a bigger bottom ratio to the top. I'm not saying every transsexual has a male body shape but I am aware of the very noticable differences.....

If I put on fat it goes on around my belly like male type fat distribution, I've tried diet and excercise but it doesn't work. When I did lose weight I just looked skinny and look like I'd got even less shape..

What about rectal intake?
Sounds far out and well, sick, but the walls of the rectum are very thin so perhaps crushing the pill and mixing it with vegatable oil and injecting it could work.

And as far as intaking it under the skin, alcohol is absorbed directly by the skin.  Perhaps mixing the pill with a small amount of liquor and holding it under the tongue until absorbed?

And just for theoretical purposes, how would sublingual absortion(sniffing) effect your liver?  I think that would get it directly into the bloodstream faster than anything else, but it might leave it just as fast too...