Susan's Place Transgender Resources

So as the title of this topic says I'm wondering if anybody has come up with ways to increase the speed on which the estrogen pill patch or shot actually works I myself take the pill it is a lot slower than the patch and the shot but I would like to help it speed up preferably without self-medicating other than vitamins and creams

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Arianna Valentine on December 10, 2018, 06:21:05 PM
So as the title of this topic says I'm wondering if anybody has come up with ways to increase the speed on which the estrogen pill patch or shot actually works I myself take the pill it is a lot slower than the patch and the shot but I would like to help it speed up preferably without self-medicating other than vitamins and creams

If you can't accept yourself,  how can you expect others to accept you?

Some ladies here have posted to put the patch on your rear, where you want fat to accumulate.

Also, some have said to get an orchiectomy or otherwise drop your T levels.

Stay in good health.  No smoking, no bad drugs, and curtail alcohol consumption.

Has your physician given you any advice on this?

Results may not come by quickly for a lot of trans-women though.  This might just be a case where nature has to take its course, and your doctor maybe changing dosages.  Cis girls develop over years, not months.

Chrissy

Quote from: ChrissyRyan on December 10, 2018, 06:32:51 PM

Some ladies here have posted to put the patch on your rear, where you want fat to accumulate.

Also, some have said to get an orchiectomy or otherwise drop your T levels.

Stay in good health.  No smoking, no bad drugs, and curtail alcohol consumption.

Has your physician given you any advice on this?

Results may not come by quickly for a lot of trans-women though.  This might just be a case where nature has to take its course, and your doctor maybe changing dosages.  Cis girls develop over years, not months.

Chrissy

Other than that not smoking not really I can't use the patch because I'm allergic to the adhesive so I'm stuck using the pills and I don't know what that procedure was that you mentioned is

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Arianna Valentine on December 10, 2018, 06:34:10 PM
Other than that not smoking not really I can't use the patch because I'm allergic to the adhesive so I'm stuck using the pills and I don't know what that procedure was that you mentioned is

If you can't accept yourself,  how can you expect others to accept you?

An orchiectomy or orchi is when your testicles are removed.  I do not think that a lot of trans-women do that shortly after starting mtf HRT, some will likley post to say when they did that.

I think someone said here that the shots were more potent than the pills for her.

Linde (Dietlind) has made some posts about the adhesive.  Maybe you can get an alternative adhesive patch.  She will likley post soon here.

Chrissy

My thoughts on this is, your physician prescribed medication that if taken as directed will be the optimal way to achieve your own personal needs.  If you deviate from that it could actually slow up your progress.  It's always safest and best to do what the doctor ordered.
Never combine any otc substance that may interfere with it either.  If in question, ask your doctor..

Hugs, Jessica

Quote from: Arianna Valentine on December 10, 2018, 06:21:05 PM
So as the title of this topic says I'm wondering if anybody has come up with ways to increase the speed on which the estrogen pill patch or shot actually works I myself take the pill it is a lot slower than the patch and the shot but I would like to help it speed up preferably without self-medicating other than vitamins and creams

If you can't accept yourself,  how can you expect others to accept you?

Quote from: ChrissyRyan on December 10, 2018, 06:39:53 PM

An orchiectomy or orchi is when your testicles are removed.  I do not think that a lot of trans-women do that shortly after starting mtf HRT, some will likley post to say when they did that.

I think someone said here that the shots were more potent than the pills for her.

Linde (Dietlind) has made some posts about the adhesive.  Maybe you can get an alternative adhesive patch.  She will likley post soon here.

Chrissy

I do know that the shots are more effective than the pills but my insurance won't pay for the shots my insurance fully pays for the pills

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Jessica on December 10, 2018, 06:42:31 PM
My thoughts on this is, your physician prescribed medication that if taken as directed will be the optimal way to achieve your own personal needs.  If you deviate from that it could actually slow up your progress.  It's always safest and best to do what the doctor ordered.
Never combine any otc substance that may interfere with it either.  If in question, ask your doctor..

Hugs, Jessica

Thank you very much Jessica I'm trying not to take anything other than I do take prenatal vitamins and biotin which were both okay by my doctor and now I am considering the orchiectomy because honestly I don't care if I have my testicles or not I don't plan on using them I've got two kids I did my part to the world and my family

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Arianna Valentine on December 10, 2018, 06:43:24 PM
I do know that the shots are more effective than the pills but my insurance won't pay for the shots my insurance fully pays for the pills

If you can't accept yourself,  how can you expect others to accept you?

I think just being patient makes sense.  You should talk with your doctor and just do what she or he says.  You can ask your doctor to consider some other medicines but I would not deviate from your medicines as prescribed, that is, no addition or subtractions. 

You can ask when the orchi would be allowed. 

No doctor is likely tell you to not stop smoking.
Staying healthy is not going to be objected to either.

Chrissy

OK, here comes my patch experience.  The best location for a patch is over fatty tissue, it seems that the transfer rate into the blood stream is the best in those locations.
My employer makes almost any of the patches out there, which means, we make the base material and adhesive, and pharmaceutical companies add their medication.  Transdermal patches are used for almost a million different medications as the vehicles to get the medication into the blood stream without undo burden on the stomach.

I placed my first patch on my lower belly, just a little higher than the pubic hair.  This is probably one of the more sensitive skin areas of the body.  I got a pretty bad skin reaction after a few days, with a lot of blistering.  It took over a week for the skin to heal again.  I applied the next patch to the inside of my upper thigh, this resulted in a mild skin reaction.  I worked with the manufacturer of the patches (the pharmaceutical company), because I had the suspicion that some faulty adhesive was used.  We established a way that I could receive patches from a different manufacturing lot, and mine went back for QA testing.
I applied the new patches to my back just above the buttocks, and I did not have an adverse skin reaction.  But the skin is not as sensitive in this area either.
I would strongly recommend to any patch user, to apply the patches in the are over the buttocks, to avoid any nasty skin reactions!

Now I have a question.  As of today i am on the estrogen pills (because I don't want to bother my poor skin anymore).
I read somewhere here that some ladies her put them under their tongue and let them dissolve there.  What is the purpose of this exercise.
Why is this rather uncomfortable route of ingesting the pills undertaken?

To answer the original

Quote from: Arianna Valentine on December 10, 2018, 06:21:05 PM
... I'm wondering if anybody has come up with ways to increase the speed on which the estrogen pill patch or shot actually works...

The only safe and effective way to speed feminization is to see your Endocrinologist regularly to make sure your hormone blood levels are in the proper range. Excessively high blood levels will not speed things up and may increase your chances of an adverse side effect. Some people do respond to one route better than another method. Other people add Progesterone. Whatever works for you and with the consent of your Endocrinologist is just fine. You cannot expect any better.

My results are just average for someone my age. I experienced some feminization within one year and after three years I was fully transitioned. Faster results may be experienced by someone who started HRT much younger than me. Those who started as a teenager have exhibited complete transition after 6 to 8 months of HRT in some cases.

Losing weight and facial hair is also feminizing and gives the appearance of a faster transition.

In short, you cannot speed up the Estradiol. Just keep your hormones blood levels in the proper range and do all the other things you need to do in order to feminize yourself and let the magic of the hormones happen. It will be here before you know it.

Since you are taking the pill you can take it sublingual.  Put it under the tong.  It's safer also then swallowing it.  When one swallows the pill you have a higher risk of clotting.  This is because your system is detecting estrogen in you digestive system and is trying to stop it.

You want to put the pill under your tong.  The goal is to NOT taste it.  It will take a while for the pill to dissolve.

There was a good study done on this that has chart comparing estrogen levels.  One group swallowed the pill every 6 hours and the other group dissolved it under their tong every 6 hours.  They would then draw blood and test the e levels.  There was a very big difference between the two groups.

A lot doctors do recommend the sublingual method now.


Yes you should talk with your doctor.

Also there are threads here about this and elsewhere on the internet.

Quote from: Dani on December 10, 2018, 07:11:46 PM
To answer the original
The only safe and effective way to speed feminization is to see your Endocrinologist regularly to make sure your hormone blood levels are in the proper range. Excessively high blood levels will not speed things up and may increase your chances of an adverse side effect. Some people do respond to one route better than another method. Other people add Progesterone. Whatever works for you and with the consent of your Endocrinologist is just fine. You cannot expect any better.

My results are just average for someone my age. I experienced some feminization within one year and after three years I was fully transitioned. Faster results may be experienced by someone who started HRT much younger than me. Those who started as a teenager have exhibited complete transition after 6 to 8 months of HRT in some cases.

Losing weight and facial hair is also feminizing and gives the appearance of a faster transition.

In short, you cannot speed up the Estradiol. Just keep your hormones blood levels in the proper range and do all the other things you need to do in order to feminize yourself and let the magic of the hormones happen. It will be here before you know it.

I thank you very much for the information Dani I am following my in those orders to a T it's just I guess frustrating that is taking so long I am getting my signs that it's working but I don't know I guess I'm just getting antsy

If you can't accept yourself,  how can you expect others to accept you?

Quote from: CindyLouFromDBQ on December 10, 2018, 07:18:01 PM
Since you are taking the pill you can take it sublingual.  Put it under the tong.  It's safer also then swallowing it.  When one swallows the pill you have a higher risk of clotting.  This is because your system is detecting estrogen in you digestive system and is trying to stop it.

You want to put the pill under your tong.  The goal is to NOT taste it.  It will take a while for the pill to dissolve.

There was a good study done on this that has chart comparing estrogen levels.  One group swallowed the pill every 6 hours and the other group dissolved it under their tong every 6 hours.  They would then draw blood and test the e levels.  There was a very big difference between the two groups.

A lot doctors do recommend the sublingual method now.


Yes you should talk with your doctor.

Also there are threads here about this and elsewhere on the internet.

I thank you very much Cindy Lou I do believe I will talk to my doctor about letting it dissolve under my tongue rather than swallowing it and see what she says about it but that does sound very interesting that putting it under your tongue would be more effective although it also makes sense because by the time the pill hits your stomach and dissolves the acid would destroy most of the estrogen anyways I would think

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Dietlind on December 10, 2018, 07:05:35 PM
Now I have a question.  As of today i am on the estrogen pills (because I don't want to bother my poor skin anymore).
I read somewhere here that some ladies her put them under their tongue and let them dissolve there.  What is the purpose of this exercise.
Why is this rather uncomfortable route of ingesting the pills undertaken?

Sublingual is used by many of us, myself included, to give us a higher blood level and to avoid the first pass through the liver where the Estradiol is metabolized to less active or completely inactive compounds.

Sublingual is not uncomfortable for me. I take a drink of water to moisten my mouth first. Then place the uncoated tablet under the tongue and let it sit there until fully dissolved, about 10 to 15 minutes. Try not to swallow during that time. When the tablet is fully dissolved, you can spread the liquid, which has a sweet taste, to other areas in your mouth, such as the area between your jaw and cheek. As long as the liquid is in contact with the moist inner surface of your mouth, the Estradiol will be absorbed directly into your blood system.

After about 30 minutes, I can no longer taste the Estradiol. At that time, I will resume eating and drinking.

The disadvantage of sublingual administration is that you will get a very high peak blood level for a very short time. This does not matter. What does matter is your average blood level over a long time period. Patches and Injections give a more steady blood level and they avoid the first pass through the liver as well. Swallowing the tablet causes the tablet to dissolve in the stomach. From there the Estradiol goes straight to the liver for metabolism. The blood levels are much lower than sublingual for the same sized tablet, but the blood levels are more steady, similar to patches or injections.

After all is said and done, Just keep your blood levels in the normal female range and do this for at least 3 years.

Quote from: Dani on December 10, 2018, 07:28:23 PM

Quote from: Dietlind on December 10, 2018, 07:05:35 PM
Now I have a question.  As of today i am on the estrogen pills (because I don't want to bother my poor skin anymore).
I read somewhere here that some ladies her put them under their tongue and let them dissolve there.  What is the purpose of this exercise.
Why is this rather uncomfortable route of ingesting the pills undertaken?

Sublingual is used by many of us, myself included, to give us a higher blood level and to avoid the first pass through the liver where the Estradiol is metabolized to less active or completely inactive compounds.

Sublingual is not uncomfortable for me. I take a drink of water to moisten my mouth first. Then place the uncoated tablet under the tongue and let it sit there until fully dissolved, about 10 to 15 minutes. Try not to swallow during that time. When the tablet is fully dissolved, you can spread the liquid, which has a sweet taste, to other areas in your mouth, such as the area between your jaw and cheek. As long as the liquid is in contact with the moist inner surface of your mouth, the Estradiol will be absorbed directly into your blood system.

After about 30 minutes, I can no longer taste the Estradiol. At that time, I will resume eating and drinking.

The disadvantage of sublingual administration is that you will get a very high peak blood level for a very short time. This does not matter. What does matter is your average blood level over a long time period. Patches and Injections give a more steady blood level and they avoid the first pass through the liver as well. Swallowing the tablet causes the tablet to dissolve in the stomach. From there the Estradiol goes straight to the liver for metabolism. The blood levels are much lower than sublingual for the same sized tablet, but the blood levels are more steady, similar to patches or injections.

After all is said and done, Just keep your blood levels in the normal female range and do this for at least 3 years.

Dani, I know that you are a professional in this area. Do you have a reference for this method? I was asked by health professionals in the area as they get requests from their patients about using sublingual absorption and there is a feeling that it may be an 'urban myth'. There are medications designed for sublingual absorption but if the medication is not designed for it is there any clinical evidence that there is any benefit? I'm talking about a reference to a controlled study.

Thanks
Cindy

Quote from: Arianna Valentine on December 10, 2018, 07:22:04 PM
I thank you very much Cindy Lou I do believe I will talk to my doctor about letting it dissolve under my tongue rather than swallowing it and see what she says about it but that does sound very interesting that putting it under your tongue would be more effective although it also makes sense because by the time the pill hits your stomach and dissolves the acid would destroy most of the estrogen anyways I would think

I don't know how well the mouth absorbe estrogen.  Presumably it does so moderately well or people wouldn't do it.  Any route that avoids the stomach will likely improve absorption, because the stomach will break down most of the dose before it even gets to the bloodstream. 

My patches contain a small fraction of the estrogen that is in pills, yet we end up with similar blood levels.  It is because 90% of the estrogen going via the stomach gets destroyed before it is absorbed.

Quote from: KathyLauren on December 10, 2018, 08:00:47 PM
I don't know how well the mouth absorbe estrogen.  Presumably it does so moderately well or people wouldn't do it.  Any route that avoids the stomach will likely improve absorption, because the stomach will break down most of the dose before it even gets to the bloodstream. 

My patches contain a small fraction of the estrogen that is in pills, yet we end up with similar blood levels.  It is because 90% of the estrogen going via the stomach gets destroyed before it is absorbed.

It does makes some sense if the patch with a lower amount of estrogen than the pills but gives the same average blood level results, that the daily estrogen dosage would be lower in the patch as compared with the pill.

So this makes me think, if sublingual for the same dose of pill puts more estrogen in the blood, including on an average estrogen blood level basis, should you not take a lower estrogen dose sublingually as compared to swallowing?

This leads me to think that everyone should talk with her endocrinologist before switching to sublingual to make sure it is safe to do so.  Too much estrogen might be a problem for you.


Chrissy

Quote from: Dani on December 10, 2018, 07:28:23 PM
Sublingual is used by many of us, myself included, to give us a higher blood level and to avoid the first pass through the liver where the Estradiol is metabolized to less active or completely inactive compounds.

Sublingual is not uncomfortable for me. I take a drink of water to moisten my mouth first. Then place the uncoated tablet under the tongue and let it sit there until fully dissolved, about 10 to 15 minutes. Try not to swallow during that time. When the tablet is fully dissolved, you can spread the liquid, which has a sweet taste, to other areas in your mouth, such as the area between your jaw and cheek. As long as the liquid is in contact with the moist inner surface of your mouth, the Estradiol will be absorbed directly into your blood system.

After about 30 minutes, I can no longer taste the Estradiol. At that time, I will resume eating and drinking.

The disadvantage of sublingual administration is that you will get a very high peak blood level for a very short time. This does not matter. What does matter is your average blood level over a long time period. Patches and Injections give a more steady blood level and they avoid the first pass through the liver as well. Swallowing the tablet causes the tablet to dissolve in the stomach. From there the Estradiol goes straight to the liver for metabolism. The blood levels are much lower than sublingual for the same sized tablet, but the blood levels are more steady, similar to patches or injections.

After all is said and done, Just keep your blood levels in the normal female range and do this for at least 3 years.

What you are telling me is to use the pill for a subversion of transdermal delivery, kind of trans mucous membrane.  That is basically the same idea my coworkers had, when they developed the transdermal delivery systems.

I will give it a try, and see how self controlled I am!

Thank you for sharing your knowledge with us!
Linde

Quote from: Arianna Valentine on December 10, 2018, 06:21:05 PM
So as the title of this topic says I'm wondering if anybody has come up with ways to increase the speed on which the estrogen pill patch or shot actually works I myself take the pill it is a lot slower than the patch and the shot but I would like to help it speed up preferably without self-medicating other than vitamins and creams

If you can't accept yourself,  how can you expect others to accept you?

For pills don't swallow them. Put them under your tongue and allow the estrogen to absorb through the skin. The swallow what is left.

I am so happy that I posted this topic I as well as a bunch of other ladies I am sure have been wondering about this like DietLind and have gotten wonderful answers from all of you thank you my sister's for all of your wonderful advice as usual

If you can't accept yourself,  how can you expect others to accept you?

As I am on a half transition dosage, I wasn't seeing progress happen very fast. After over a year and discussing it with my provider, I started sticking in my cheek. For the first time ever in my life, my breast became sensitive and after all these years I grew at least another cup size. For me anyway, avoiding the stomach made the pills more effective. I don't expect much more development because years of hormones probably have resulted in most of the possible changes. Though I was surprised after all these years that there was some potential left.

In Oz a number of us use pellets which are implanted in the buttock, and combine this with conjugated or compounded progesterone and Spiro. Seems to have worked better for me than E pills, whether taken sub lingually or not
Safe travels
Gerri


Sent from my iPad using Tapatalk

I go sublingual under the tongue, seems to have worked well for me 

Quote from: Arianna Valentine on December 10, 2018, 06:21:05 PM
So as the title of this topic says I'm wondering if anybody has come up with ways to increase the speed on which the estrogen pill patch or shot actually works I myself take the pill it is a lot slower than the patch and the shot but I would like to help it speed up preferably without self-medicating other than vitamins and creams

If you can't accept yourself,  how can you expect others to accept you?

I have tried pills & E gel. I would highly recommend gel. Contrary to popular belief gel is potent and puts me above the normal female range. I follow doctors recommendation

E gel is low risk for blood clots and bypasses the liver for better effect and less liver stress.

Only for your consideration though. Whatever works for you!

Kind regards, Kirsten.

Sent from my SM-G930F using Tapatalk




*No Dosages Please*

Puberty is a natural process that takes years. You're basically asking "How can I get older faster?" Trust me, if there was a way, you'd regret it sooner than you think.  ;)

Hugs, Devlyn

Quote from: Kirsteneklund7 on December 11, 2018, 01:52:18 AM
I have tried pills & E gel. I would highly recommend gel. Contrary to popular belief gel is potent and 4mg day puts me above the normal female range. I follow doctors recommendation at 3mg per day

E gel is low risk for blood clots and bypasses the liver for better effect and less liver stress.

Only for your consideration though. Whatever works for you!

Kind regards, Kirsten.

Sent from my SM-G930F using Tapatalk

Thank you very much Kirsten my doctor I don't believe offers that gel as far as I know she only offers the shots patches and pills but I have an appointment with her January so I will be sure to ask about that

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Devlyn on December 11, 2018, 02:00:00 AM
Puberty is a natural process that takes years. You're basically asking "How can I get older faster?" Trust me, if there was a way, you'd regret it sooner than you think.  ;)

Hugs, Devlyn

I'm not trying to get older faster I'm trying to get features faster LOL

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Arianna Valentine on December 11, 2018, 02:02:51 AM
Thank you very much Kirsten my doctor I don't believe offers that gel as far as I know she only offers the shots patches and pills but I have an appointment with her January so I will be sure to ask about that

If you can't accept yourself,  how can you expect others to accept you?

To satisfy the question of the options open to you - make enquires at pharmacies to see what products they will supply under a prescription. Oestrogel or Sandrena should be readily available. Then ask your doctor for a prescription. It is low risk medication from a doctors perspective.

Drive the agenda yourself. Any regimen you prefer is out there.

Pills, injections,patches,gel, pellets.

Kind regards, Kirsten.

Sent from my SM-G930F using Tapatalk

For all taking bioidenticle estradiol tablets

If you swallow the pill, it will mostly be converted to estrone in the liver. This raises liver protein levels and estrone / estrone sulfate do increase the blood playlet clotting factor. Blood from the intestin s passes by the liver before going anywhere else.

Sublingual, under the tongue. Dissolved in the mouth, most of the estradiol is absorbed into the blood stream dodging the liver conversion. The estradiol can directly activate cells and a much smaller amount is initially converted to estrone. The sweetness of the pill will trigger a lot of saliva to be produced so you may end up swallowing more than you realize.

Buccal absorption is when you place it in the upper cheek. There is a bit of a ridge that your upper gum forms. You can put the pill there and it will dissolve much slower as this does not trigger production of much more saliva.

Ideally you want estradiol in your bloodstream not estrone. Large amounts of estrone don't do much good. Estrone is a storable form that can be converted back to estradiol as the body wants it but barely activates cell receptors.

Quote from: josie76 on December 11, 2018, 07:03:13 AM
For all taking bioidenticle estradiol tablets

If you swallow the pill, it will mostly be converted to estrone in the liver. This raises liver protein levels and estrone / estrone sulfate do increase the blood playlet clotting factor. Blood from the intestin s passes by the liver before going anywhere else.

Sublingual, under the tongue. Dissolved in the mouth, most of the estradiol is absorbed into the blood stream dodging the liver conversion. The estradiol can directly activate cells and a much smaller amount is initially converted to estrone. The sweetness of the pill will trigger a lot of saliva to be produced so you may end up swallowing more than you realize.

Buccal absorption is when you place it in the upper cheek. There is a bit of a ridge that your upper gum forms. You can put the pill there and it will dissolve much slower as this does not trigger production of much more saliva.

Ideally you want estradiol in your bloodstream not estrone. Large amounts of estrone don't do much good. Estrone is a storable form that can be converted back to estradiol as the body wants it but barely activates cell receptors.

Hi everyone!

I am curious.  If there are some apparent benefits of dissolving in the mouth the non-coated estrogen pills as compared to swallowing the estrogen pills, unless there is a medical reason for a patient to swallow as noted by the doctor, why do not most physicians simply instruct on the prescription for the estrogen pills to be taken sublingually?

Maybe because the physician realizes that the effective dose might be lower if swallowed and she or he wants you to start mtf HRT on a lower estrogen dose and later have you go sublingual for a higher effective dose?

Maybe the doctor does not understand the different estrogen blood level impacts, if any exist?

If sublingual administration is going to give you a higher average blood estrogen level, that may impact your next prescription dosage, up, down, or constant.

So ask if sublingual is okay instead of taken by mouth (swallowed) and keep your physician informed.

Note that you can often leave a message with a physician or her or his nurse, then you should get a reply.  You should not necessarily have to setup another appointment simply to ask if sublingual is okay for you.

Chrissy

Quote from: Kirsteneklund7 on December 11, 2018, 01:52:18 AM
I have tried pills & E gel. I would highly recommend gel. Contrary to popular belief gel is potent and puts me above the normal female range. I follow doctors recommendation

E gel is low risk for blood clots and bypasses the liver for better effect and less liver stress.

Only for your consideration though. Whatever works for you!

Kind regards, Kirsten.

Sent from my SM-G930F using Tapatalk




*No Dosages Please*

It is very often a question of insurance.  My insurance pays for patches (with a very high copay), and pills with a rather low copay.  They do not pay for gels or injections!

Any transdermal delivery (and gel is transdermal) or injection would have similar effects on the liver.  Having the pills dissolve under the tongue, would be trans mucous membrane, which would promise to be even faster introduction into the bloodstream caused by the structure of the membrane, than transdermal would do.

Quote from: ChrissyRyan on December 11, 2018, 07:45:11 AM

Hi everyone!

I am curious.  If there are some apparent benefits of dissolving in the mouth the non-coated estrogen pills as compared to swallowing the estrogen pills, unless there is a medical reason for a patient to swallow as noted by the doctor, why do not most physicians simply instruct on the prescription for the estrogen pills to be taken sublingually?

Maybe because the physician realizes that the effective dose might be lower if swallowed and she or he wants you to start mtf HRT on a lower estrogen dose and later have you go sublingual for a higher effective dose?

Maybe the doctor does not understand the different estrogen blood level impacts, if any exist?

If sublingual administration is going to give you a higher average blood estrogen level, that may impact your next prescription dosage, up, down, or constant.

So ask if sublingual is okay instead of taken by mouth (swallowed) and keep your physician informed.

Note that you can often leave a message with a physician or her or his nurse, then you should get a reply.  You should not necessarily have to setup another appointment simply to ask if sublingual is okay for you.

Chrissy

I almost have the feeling that most physicians don't even think about the delivery form, or don't know the difference (never thought about it).
The new endocrinologist I am seeing admitted that he does not know anything about trans people, and just prescribed what my psycho recommended.  He wants me to see a specialist endo for transgender issues, who he  cooperates with ,to make detailed adjustments.

In reality, I did not know about the dissolving of oral pills, even though I am pretty familiar with transdermal delivery.  The better decission makers concerning delivery of medications are pharmacists because they the ones who are way better educated about stuff like this than physicians are.

I sent a private message to my doctor and she okayed me to stick it under my tongue it take it that way she said the pill is absorbed by your body either way so I want to do it that way she has no problem with it they will just want to check my blood levels when I come in which they're going to do anyway so I got the go-ahead and it's a good thing cuz I did it last night anyways LOL

If you can't accept yourself,  how can you expect others to accept you?

@Gerri

Quote from: Gerri on December 11, 2018, 01:13:59 AM
In Oz a number of us use pellets which are implanted in the buttock, and combine this with conjugated or compounded progesterone and Spiro. Seems to have worked better for me than E pills, whether taken sub lingually or not
Safe travels
Gerri


Sent from my iPad using Tapatalk

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Just a few more comments about sublingual administration of Estradiol:

In the US all drugs that are for sale here are reviewed by the Food and Drug Administration (FDA). They require the drug manufacturers to provide safety and effectiveness data which includes recommended administration. There are also many  studies to examine other uses that the FDA has not put in the official recommendation. These are called Off Label Indications. Sublingual administration of Estradiol is one of these Off Label Indications. For reports of these studies, I just Google "sublingual estradiol". I only trust reports that have been published in well known medical journals.

The biggest disadvantage for sublingual administration is the blood levels go extremely high for about an hour or two right after putting the tablet under the tongue. There is no reported problems with this except for the need to get accurate blood levels. For this reason, it is recommended to get your blood levels drawn right before your daily dose of Estradiol. This is called the trough (lowest point) of the blood level during the daily highs and lows. If your doctor wants to see the peak blood level, he or she can order another blood level about one hour after you put a tablet under your tongue. If you take your Estradiol at your usual time and then get your blood drawn several hours later, your measured blood level will be somewhere between the peak and trough. The exact blood level reported will mostly depend on how many hours between administration and blood draw and can be quite variable, yielding useless data.

If all this sounds too complicated, you can get more steady blood levels with patches, gels or injection.

Quote from: Dani on December 13, 2018, 02:37:54 AM
Just a few more comments about sublingual administration of Estradiol:

In the US all drugs that are for sale here are reviewed by the Food and Drug Administration (FDA). They require the drug manufacturers to provide safety and effectiveness data which includes recommended administration. There are also many  studies to examine other uses that the FDA has not put in the official recommendation. These are called Off Label Indications. Sublingual administration of Estradiol is one of these Off Label Indications. For reports of these studies, I just Google "sublingual estradiol". I only trust reports that have been published in well known medical journals.

The biggest disadvantage for sublingual administration is the blood levels go extremely high for about an hour or two right after putting the tablet under the tongue. There is no reported problems with this except for the need to get accurate blood levels. For this reason, it is recommended to get your blood levels drawn right before your daily dose of Estradiol. This is called the trough (lowest point) of the blood level during the daily highs and lows. If your doctor wants to see the peak blood level, he or she can order another blood level about one hour after you put a tablet under your tongue. If you take your Estradiol at your usual time and then get your blood drawn several hours later, your measured blood level will be somewhere between the peak and trough. The exact blood level reported will mostly depend on how many hours between administration and blood draw and can be quite variable, yielding useless data.

If all this sounds too complicated, you can get more steady blood levels with patches, gels or injection.

I think the sublingual administration comes closest to injections.  The entrance of the medication into the blood stream is much faster than through transdermal patches.  We know from transfer rates of bacteria that mucous membrane is not a real barrier to them (if we would not have our saliva wich is pretty good as a bactericidal agent, we would be sick quite a bit).  I belief that estrogen can pass through the mucous membrane as well as bacteria, and thus can enter the bloodstream immediately.

I'll add my 2 cents worth.  I've tried pills, patches and injections.  Injections are my preferred delivery method.

After being on pills for a while, I decided to let them dissolve under my tongue.  When I went back for my followup lab work, as I recall I either skipped my morning pill, or just took half of it.  My blood was drawn just an hour or two before I was due for my next pill.  The lab results showed the E level in my blood to be very high (can't remember how high, but higher than most women see, I think) and my doctor was going to cut my dosage by 2/3.  I explained how I was taking them under my tongue and promised not to do that again.  Soon after that I was given the option for injections, and that is what I still do. 

While I know everyone is a bit different, for me, it appears that taking the E pills under my tongue elevated my E level to perhaps an unhealthy level.  Something to be aware of.  Please be safe and take care of yourself.

Quote from: Phlox1 on December 13, 2018, 01:06:09 PM
I'll add my 2 cents worth.  I've tried pills, patches and injections.  Injections are my preferred delivery method.

After being on pills for a while, I decided to let them dissolve under my tongue.  When I went back for my followup lab work, as I recall I either skipped my morning pill, or just took half of it.  My blood was drawn just an hour or two before I was due for my next pill.  The lab results showed the E level in my blood to be very high (can't remember how high, but higher than most women see, I think) and my doctor was going to cut my dosage by 2/3.  I explained how I was taking them under my tongue and promised not to do that again.  Soon after that I was given the option for injections, and that is what I still do. 

While I know everyone is a bit different, for me, it appears that taking the E pills under my tongue elevated my E level to perhaps an unhealthy level.  Something to be aware of.  Please be safe and take care of yourself.

I don't think I will have that issue because I take my medicine before bed

If you can't accept yourself,  how can you expect others to accept you?

Any method with the exception of possibly patches is going to make your estradiol level spike right after taking it. So having a really high blood level right after taking a pill is completely normal.

I like injections because it's a once a week thing instead of daily.

Quote from: Arianna Valentine on December 13, 2018, 01:11:48 PM
I don't think I will have that issue because I take my medicine before bed

If you can't accept yourself,  how can you expect others to accept you?

I would spread the E out through the day.  I do injections now, but when I did do pills I spread them out to keep a constant E level.

You can google puberty level estrogen, post puberty level estrogen, and pregnancy estrogen levels. Pregnant level estrogen can go very high! 

The goal is to stay in the high end of the puberty level of estrogen for a good 7 years. 

That's why I switched to injections.

Of course I'm not a doctor and this is my own opinion based off of my experience, doctors recommend dosages, and others experiences.  Consult with your doctor.  🙂

Pills have worked very well for me. I take one pill buccally three times per day with at least 6 hours between each dose.  This way of taking my pill was discussed thoroughly with my doctor and my provider's on-staff pharmacist, who gave me the okay. Placement is between cheek & upper gum, as far up as possible. If I don't have to talk or smile a lot the pill stays in place  and dissolves slowly for at least an hour, often up to 3 hours.  I look at it as having all the benefits of taking it sublingually, but with a much longer contact with mucous membranes in the mouth.

Lab results have shown a really high spike if the blood draw happens one to two hours after placing the pill. At around five hours my estrogen level is typically in the 200s. If only there were really good peer-reviewed studies and data on the efficacy of the various ways of taking estrogen for transition!

Quote from: Phlox1 on December 13, 2018, 01:06:09 PM

While I know everyone is a bit different, for me, it appears that taking the E pills under my tongue elevated my E level to perhaps an unhealthy level.  Something to be aware of.  Please be safe and take care of yourself.

It also depends very much on the dosage.  If your physician prescribed a rather high dosage, considering that not that much will reach your blood when taken orally, doing the same dosage sublingual will allow almost all of the active ingredients to reach your blood stream and have a high initial hormone level.
Any injection would cause a similar high level, if that is not the case, the injection may have a lower amount of active ingredients.
But of importance with the intake of Estrogen is not the initial level, but the average level over time,  I don't know if there is something existing like the A1c test for diabetes.  This test measures the blood sugar over a 3 month period, and gives a pretty accurate information on the average blood sugar level.  Something like this test would be ideal to give a reliable information on the average estrogen level

Quote from: RoryL on December 13, 2018, 01:41:25 PM

Lab results have shown a really high spike if the blood draw happens one to two hours after placing the pill. At around five hours my estrogen level is typically in the 200s. If only there were really good peer-reviewed studies and data on the efficacy of the various ways of taking estrogen for transition!

The problem here is that any standard lab test is only a single shot at a certain moment, and may not reflect your average estrogen level properly.
I think there are not studies, because the population of trans women is way to small  One would need a test group for each of the different levels to take estrogen, and a control group.  It should be at least a few 100 persons in every group to have a reliable sample size.
I don't think that any epidemiologist or related specialty is really hot about starting such a study.  And who would finance it?  Who would do the logistics?

Quote from: Dietlind on December 13, 2018, 01:41:31 PM
It also depends very much on the dosage.  If your physician prescribed a rather high dosage, considering that not that much will reach your blood when taken orally, doing the same dosage sublingual will allow almost all of the active ingredients to reach your blood stream and have a high initial hormone level.
Any injection would cause a similar high level, if that is not the case, the injection may have a lower amount of active ingredients.
But of importance with the intake of Estrogen is not the initial level, but the average level over time,  I don't know if there is something existing like the A1c test for diabetes.  This test measures the blood sugar over a 3 month period, and gives a pretty accurate information on the average blood sugar level.  Something like this test would be ideal to give a reliable information on the average estrogen level

Yeah, I think the best thing to do is take the test 4 to 6 hours after taking the pill.  Or a few days after one has their injection.

Then maybe have another test in a week or two, followed up by another test.

I never inject before my blood tests.  The last thing I want is my endo seeing my E levels in the 600 to 800 levels.

I'm pretty sure they do reach that high within 24 hours after my injection then drop to around 200 before my next injection.

I try to keep my E between 200 and 400.  It keeps my T in the 30's which is healthy for a female my age without taking spiro.  I quit taking spiro two years ago.  I don't need it anymore thank goodness.

Quote from: CindyLouFromCO on December 13, 2018, 01:37:08 PM
I would spread the E out through the day.  I do injections now, but when I did do pills I spread them out to keep a constant E level.

You can google puberty level estrogen, post puberty level estrogen, and pregnancy estrogen levels. Pregnant level estrogen can go very high! 

The goal is to stay in the high end of the puberty level of estrogen for a good 7 years. 

That's why I switched to injections.

Of course I'm not a doctor and this is my own opinion based off of my experience, doctors recommend dosages, and others experiences.  Consult with your doctor.  [emoji846]

Unfortunately I only get a 30 day supply and I'm supposed to take them once a day for now I do have a feeling that next month when I see my endocrinologist this will change but for now I follow her instructions except I have went from swallowing them to putting them under my tongue and I contacted her before I did that and she was okay with that

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Arianna Valentine on December 13, 2018, 02:00:59 PM
Unfortunately I only get a 30 day supply and I'm supposed to take them once a day for now I do have a feeling that next month when I see my endocrinologist this will change but for now I follow her instructions except I have went from swallowing them to putting them under my tongue and I contacted her before I did that and she was okay with that

If you can't accept yourself,  how can you expect others to accept you?

How much estrogen do your pills contain? I have a 90 days supply of xx mg each and are supposed to take them once a day until I have my big blood test done next month.  I take the pills sublingual, but I have no idea what my blood level is.
I could take two of those a day to end up with xx mg, but I don't know what the results of that would be.  I do not want to have big boobs and a blood clot in my veins!  I rather stay with smaller bobs and no clots!
I assume that my testosterone level is pretty low, because of my long term ingestion of finasteride and now in addition spiro.  Spiro seems to wok, measuring with the increased number of trips to the bathroom!

Quote from: Dietlind on December 13, 2018, 01:51:27 PM
The problem here is that any standard lab test is only a single shot at a certain moment, and may not reflect your average estrogen level properly.
I think there are not studies, because the population of trans women is way to small  One would need a test group for each of the different levels to take estrogen, and a control group.  It should be at least a few 100 persons in every group to have a reliable sample size.
I don't think that any epidemiologist or related specialty is really hot about starting such a study.  And who would finance it?  Who would do the logistics?

The only somewhat related data I could find was from an NIH study in 1997 (might have the year wrong). It compared blood levels of estradiol & estrone over time for cisgender women who either swallowed the pill or took it sublingually.  S/L definitely showed a much higher spike, with about the same levels as swallowing five hours from administration.

I work in an academic medical center and often my visits with providers includes me promoting the idea of a study (ANY kind of trans-specific medical care study) since they're always looking to publish. Generally, there's not much of a response other than agreement that actual data would be nice to have.

At a guess, perhaps one of the Centers for Excellence for Transgender Healthcare would have the connections & awareness of funding opportunities to conduct or sponsor such research. They certainly would have access to an IRB and academics who specialize in designing research studies.

[EDIT] - corrected "estradiol & estrace" to "estradiol & estrone" 

Quote from: Arianna Valentine on December 13, 2018, 02:00:59 PM
Unfortunately I only get a 30 day supply and I'm supposed to take them once a day for now I do have a feeling that next month when I see my endocrinologist this will change but for now I follow her instructions except I have went from swallowing them to putting them under my tongue and I contacted her before I did that and she was okay with that

If you can't accept yourself,  how can you expect others to accept you?

I hope you get the results that you want, you seem to making good progress.
Enjoy your wonderful changes as they arrive.   :)

Chrissy

Quote from: RoryL on December 13, 2018, 03:19:09 PM

At a guess, perhaps one of the Centers for Excellence for Transgender Healthcare would have the connections & awareness of funding opportunities to conduct or sponsor such research. They certainly would have access to an IRB and academics who specialize in designing research studies.

As always with medical studies, one has to have an opinion leader who is willing to run with it and take ownership.  I almost feel that us transgender women are not exciting enough to find somebody to run with a study idea.
When we needed to publish data on one of the new developments of our lab, we could always find a leading surgeon to take control, but we also made all the money available for this opinion leader to be excited to run such a study.  It was always a win/win situation, the leader could publish, and we had our data!

But with us transgender women, who would be exited?  We don't take enough of medications to knock a pharma business of their stool.  I would need to be done by academia, but again, how much fame can be had from it?

Quote from: Arianna Valentine on December 13, 2018, 05:05:23 PM
1mg

If you can't accept yourself,  how can you expect others to accept you?

That is rather low.  My patches had  mg per day delivery, and as I told the endo that I do not feel any results of them, he increased it to xx mg.  He said we can go up to xx mg per day.

Are you taking anything else along with it.  As I said, I take the highest dose of finasteride for many years now (has nothing to do with being trans, but it helps a lot), and now spiro.  My testosterone levels should now be about as high as my basement here, and I have to see if I see any effects from estrogen now.
But again, I have that wired body configuration.  My body does not metabolize opioides, and the heck, it might not metabolize Estradiol either!  Who knows?

Quote from: Dietlind on December 13, 2018, 05:26:31 PM
That is rather low.  My patches had  mg per day delivery, and as I told the endo that I do not feel any results of them, he increased it to xx mg.  He said we can go up to xx mg per day.

Are you taking anything else along with it.  As I said, I take the highest dose of finasteride for many years now (has nothing to do with being trans, but it helps a lot), and now spiro.  My testosterone levels should now be about as high as my basement here, and I have to see if I see any effects from estrogen now.
But again, I have that wired body configuration.  My body does not metabolize opioides, and the heck, it might not metabolize Estradiol either!  Who knows?

My doctor started me out on a low-dose because she wants my breast and body growth to be more natural so it starts out as a low dose and gradually increases every 3 to 6 months so I'm guessing my next visit which is next month it'll probably increase again

If you can't accept yourself,  how can you expect others to accept you?

Quote from: Arianna Valentine on December 13, 2018, 05:38:11 PM
My doctor started me out on a low-dose because she wants my breast and body growth to be more natural so it starts out as a low dose and gradually increases every 3 to 6 months so I'm guessing my next visit which is next month it'll probably increase again

If you can't accept yourself,  how can you expect others to accept you?

This makes sense, the skin would not be stretched to much all of a sudden.  It took me well over 3 years to grow to my currently smallish B cup size,  That is the reason why I never had, and still don't have any pain in my breasts, just the nipples hurt once in a while, but that is not bad, the need a pretty hard contact to hurt.

Quote from: Dietlind on December 13, 2018, 07:19:56 PM
This makes sense, the skin would not be stretched to much all of a sudden.  It took me well over 3 years to grow to my currently smallish B cup size,  That is the reason why I never had, and still don't have any pain in my breasts, just the nipples hurt once in a while, but that is not bad, the need a pretty hard contact to hurt.

Oh my God I know all about nipple pain I was taking a tree limb off of my tree earlier today with both of my nephews and I went nipple first into the truck walking into it oh my God hurt so bad

If you can't accept yourself,  how can you expect others to accept you?

Ladies, please!

We are not allowed to mention dosages here on Susan's Place. We do not want to encourage self medication.

What you can see from all of this discussion is that the prescribed dose, schedule and route of administration all determine our blood levels. It is much safer for a trained professional to determine your dose. We are not all identical and we all have our own preferences, so discuss this with your Endocrinologist or other prescriber who is familiar with transgender issues.

Would one of the moderators please be so kind and remove the dosages from my last few posts?  While you ladies do this, I will spread ashes over my head and feel very guilty!

 :police: Dani is correct in saying that TOS 8 prohibits discussing dosages. You may discuss most medications and you may even discuss pill strength as long as you don't provide enough information that it could be used to self medicate with. The thread has been corrected and is unlocked for discussion.   :police:

My doc adding a T-blocker to the estrogen works for me. Our bodies are all different, so there's really no pat answer for everyone. A healthy diet and exercise are definitely important, so that the body can respond with maximum efficiency and without interference of the effects of bad foods and poor health.