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I'm five months in and my endo won't up my estradiol dose, and I'm only taking a single low dose of estradiol in the morning. After both checkups I've had thus far, my endo keeps saying that my E levels are higher than they should be.

After doing lots of research, I think what she's seeing is the initial spike from taking estradiol sublingually? She told me that there shouldn't be a difference in the way I take it, but the data tends to show otherwise. So I'm thinking I'll call her tomorrow and see if I can go in for another blood test, and go all next week taking estradiol orally to see if it changes the levels?

Are there any ramifications to doing this? I wasn't aware of estradiol's shortened half-life when taking sublingually, and since I'm only taking a very low dose of estradiol, I feel like after the initial morning "spike", it's throwing everything off? Is it better to take it orally at this point? This would keep my levels more steady, but overall lower.

Can anyone provide me with any insight into this?

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Welcome to Susan's Place. Sublingually can really spike your levels if your levels are check within a few hours of your dosage. In my case, I take my pill in the morning but I don't take it until after my blood draw. This give me a minimum of 24 hours for my levels to reach the lowest level before the test. This is how I was instructed to prepare for my blood draw. If you are taking your dose twice a day, then you would take your evening dose but skip the morning dose.

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I took the same dose of estradiol orally and sublingually and it didn't make an iota of a difference in terms of how I felt or how my body was responding (i.e. breast growth, overall feminization, etc.) except that it was more practical, less annoying to take it orally. :) Yes, levels will fluctuate more on sublingual and you may get higher levels of estradiol in the short-term, with smaller increases in estrone, the weaker estrogen and even a slight overall increase in estradiol levels but in my case, made no difference. YMMV.

Perhaps the time of the blood test could be timed such that it gives a more accurate of the average E level ( take E in morning and have blood test in evening). Are you on an ant androgen? What were your E and free E levels and T levels? If you are new to HRT then a lot of doctors ramp up slowly so as to not shock your system. I had 3 ramp ups.

Quote from: Rachel on August 27, 2017, 04:27:06 PM
Perhaps the time of the blood test could be timed such that it gives a more accurate of the average E level ( take E in morning and have blood test in evening). Are you on an ant androgen? What were your E and free E levels and T levels? If you are new to HRT then a lot of doctors ramp up slowly so as to not shock your system. I had 3 ramp ups.

That's what I'm figuring. I'm on spironalactone

My estrogen levels (presumably spiked from sublingual consumption) were "a little higher than they should have been, according to my endo, at 122. My testosterone was still in the low male range of 334. This was from my most recent check up, a couple weeks ago.

I am just over 5 months, and have only had a single "ramp up" of Spiro  back in May. Still only taking low dose Estradiol, however, and I feel that the spikes that show up on my blood tests make my endo think that I don't need additional estradiol.

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I asked told my new Dr that I was talking my oestrogen sublingually and she was really nice about it but she said all it will do is absorb much faster but will have no long term effects. I have stopped bothering and just swallow it now.

Quote from: ElizabethK on August 28, 2017, 01:21:07 AM
I asked told my new Dr that I was talking my oestrogen sublingually and she was really nice about it but she said all it will do is absorb much faster but will have no long term effects. I have stopped bothering and just swallow it now.

If taken sublingually, you'd take a load off your liver which would otherwise have to process the estrogen if you took it orally.

Quote from: Violets on August 28, 2017, 03:25:19 AM
If taken sublingually, you'd take a load off your liver which would otherwise have to process the estrogen if you took it orally.

She disagreed with this, saying to me that it made no difference and went on to talk about stuff that just lost me so I wasn't going to argue...she is a well respected expert in this area and not someone I am qualified to question.

Quote from: Violets on August 28, 2017, 03:25:19 AM
If taken sublingually, you'd take a load off your liver which would otherwise have to process the estrogen if you took it orally.

Bio-identical estrogen has never shown to be harmful to the liver, per say. The concern is how it impacts hepatic markers such as coagulation factors and proteins as well as renin substrate. Since this form is native, is quickly metabolized, the impact is low relative to other forms of estrogen. I've taken high doses orally without any problem. :)

My doctor told me to take it sublingually to avoid possible blood clotting. I agree that it would be much easier to just take it orally, though.