Susan's Place Transgender Resources

Hey everyone!  Since I may be starting my transition within a few months I have been thinking of a lot of questions regarding the process.  For these questions in particular, I was hoping on getting some opinions, and some facts on the delivery method for hormones.

I know that there are pills, patches, and injections (and possibly others?), but I wanted to know if anyone knew what the endocrinologist's preferred method for delivery is (the most effective)?  Is it the injection?

Also, if you had the choice, what did you choose, and why?

Thanks in advance, Ashley

I am on spironolactone tablets, progesterone capsules, and estradiol tablets.  Spiro and P are swallowed, E is disolved under my tongue.  My estradiol levels have never been super high, but both my T and E levels are in the normal female range.  Dont obsess about levels or think one method of delivery is better.  I have developed extemely well.  Some of my friends back home from a year ago didnt recognize me when i saw them in public last month.  I asked my dr about switching to shots and she said some people like shots, or patches, or tablets.  It just depends what gives you the right results that you want.

I'm on patches due to needle phobia and concerns for my liver. As Pisces said:

"Don't obsess about levels or think one method of delivery is better."

Your provider will select the delivery method that's best for you. Itdoesn't matter what's best for someone else.

Hugs, Devlyn

My new favorite is GEL. I tried oral/sublingual, patches, suppositories, injections. Injections is my second fave, oral/sublingual was my worst. The gel contains estradiol, I also use a dab of Androgel every day. In addition, I take progesterone capsules (Prometrium) daily.

To each their own...

Pills work pretty good for me however while it's not likely to happen, I would like to try pellets. My estradiol levels have never been out of the menopause range and I am a bit curious what having more normal levels is like.

Quote from: Dena on July 25, 2017, 10:20:34 PM
Pills work pretty good for me however while it's not likely to happen, I would like to try pellets. My estradiol levels have never been out of the menopause range and I am a bit curious what having more normal levels is like.

Dena, you've always offered sound advice to me that I've valued. Back to you, I'd say that a sharp increase prolly wouldn't make a lot of difference.

--AshleyP

I am on implanted pellets and they are great...they are supposed to last 6-12 months although from what I can tell from my own and those from the same Drs clinic they last about 4-6 months. Even still they kept my levels very steady and right up in the top female range when last checked 2 months ago.

Are injections harder on your liver than other methods?  This is one concern that I had when I made this thread.  Since I'm in the USAF I'm not sure if I'll have a choice on the method, I heard many others in my position were prescribed the injections.  I don't mind taking the shots, honestly, but I'd prefer to make sure it's safe and effective.

Thanks!
~Ashley

Quote from: KageNiko on July 26, 2017, 10:48:57 AM
Are injections harder on your liver than other methods?  This is one concern that I had when I made this thread.  Since I'm in the USAF I'm not sure if I'll have a choice on the method, I heard many others in my position were prescribed the injections.  I don't mind taking the shots, honestly, but I'd prefer to make sure it's safe and effective.

I am definitely curious about what the community think of this as well. As of right now, if I had the choice, I would prolly go with delestrogen IM. Additionally, I'll prolly talk about days 12 and 13 with my doctor since I have seen so many ladies reporting big mood swings on those two days.

Quote from: KageNiko on July 26, 2017, 10:48:57 AM
Are injections harder on your liver than other methods?  This is one concern that I had when I made this thread.  Since I'm in the USAF I'm not sure if I'll have a choice on the method, I heard many others in my position were prescribed the injections.  I don't mind taking the shots, honestly, but I'd prefer to make sure it's safe and effective.

Thanks!
~Ashley

The only form of Estradiol that is hard on the liver, is a tablet that is swallowed and absorbed in the stomach. From the stomach the Estradiol goes straight to the liver for the first pass at metabolism. All the other routes go directly to the circulating blood system where they do their magic, then eventually to the liver for metabolism. Even if you are prescribed tablets, most tablets in the US are micronized and just fine for sublingual administration, thus avoiding the first pass directly to the liver.

Indeed, injections are slightly safer as estradiol goes directly into the blood and does not need to circulate through the portal vein connecting the intestines to the liver where it triggers a host of changes that tends to increase coagulation. Injections, just like patches, gels, pellets have shown to affect hepatic (liver) markers to a much lesser extent and thus be more appropriate for older people (who are more prone to clotting) although bio-identical estradiol taken orally is still relatively safe, it seems.

In ciswomen, for instance OR even in transwomen, on high doses injections, it has been shown that high doses or levels do not, in general, lead to an increase in the risk of DVT (deep vein thrombosis) or other complications, even in those who are older. The rate of complications is either negligible or very low. 

With Delestrogen (estradiol valerate), half-life is around 4-5 days, with levels already significantly decreasing by day 7-8 so usually, individuals feel best injecting every 7 days (5-10 days), keeps things more stable.

For what it is worth I do injections for both E & P. I have found that every 5 days for E and 7 days for P work the best. We adjusted the dosages to maintain a set monthly amount. My GP had me try a couple different cycles if you will and this seems to work the best - for me. Each of us are different and there is no set formula that will define how our bodies will react. Again this is what works for me.

I picked the patch.  Change it out once a week for me.  I'm not a needle person and sometimes I have issues with pills. My gag reflex sometimes makes it hard to swallow a pill.

Quote from: freebird on July 27, 2017, 02:49:55 PM
For what it is worth I do injections for both E & P. I have found that every 5 days for E and 7 days for P work the best

What exactly is the P you are injecting as if you inject bio-identical progesterone, it needs to be injected daily due to quick elimination from the body. By day 2, levels have practically gone down back to baseline values.

Are you injecting 17-alpha hydroxyprogesterone caproate by any chance? This has a longer half-life and is usually injected weekly.

Yes it is 17-alpha hydroxyprogesterone caproate which I inject weekly. It has helped keep me even keeled and my breasts have become rounder and not pointy (lets not start the debate that I have read about).

Thanks all, I kind of hesitate with needles, but honestly I'm perfectly fine with them if that is the preferred method. Thanks for all the responses!