Susan's Place Transgender Resources

I had my appointment with my new hrt doctor. The appointment went very well. I asked to be moved from oral estradiol to a patch. The doctor didn't object, and sent it the pharmacy. Will I notice a difference being on a patch vs taking it orally?

Quote from: Alana Ashleigh on July 28, 2025, 04:37:26 PMWill I notice a difference being on a patch vs taking it orally?

I believe you will. Oral tablets must first pass through the liver, so the doses are typically higher to achieve the same effects. The patches bypass the liver and slowly absorb into your bloodstream. This means that you dose can be lower and still do the same job. It may take a week or two before you notice, but you should feel much better.

With tablets, my hormone levels would rise and fall every day. It was miserable. The patch lasts for 3 - 5 days, so the rollercoaster effect evens out. I only had the hot flashes, night sweats, and moodiness when it was time to change patches. Then my endo changed to twice-a-week patches. That smoothed things out a bit more.

The only problems I had were keeping the patches on. The generic (Mylan brand) would come loose from sweating. My doctor added Tegaderm to put over the patches to hold them on. The problem was that the Tegaderm wasn't big enough to cover the patches. The pharmacist changed it from Tegaerm to an IV cover. The film is very thin, covered the patch, and was ventilated so the skin could breathe beneath it. That was a HUGE improvement!

Then the problem was that the generic patches did not raise my hormone levels enough. We switched from the Mylan brand to the Grove brand. The patches (mini-dot) were so much better. But we later figured out that my metabolism is too fast for patches, and I got switched to injections.

Everyone's metabolism is different, so hopefully, the patches will work well for you. If you have problems with them staying stuck on, ask about covering them with IV film. The brand is Smith & Nephew IV3000. They are just under 3 inches by 3 inches square.

Let us know how the patches are working for you. Good luck!

Most patches adhere to skin much better than pills, even with duct tape.

Lori covered it pretty well. Some people develop rashes related to the patch adhesive, switching brands may help. The only issue I had with patches was around the edges of the patch, where the adhesive seems to attract debris. After only a day or two, you may notice a debris ring around the patch. When you replace the patch, use some baby oil on the old adhesive. After a few minutes, the old adhesive will become much easier to remove. Try to place the patch on an area that doesn't typically have a lot of friction with clothing. I typically placed patches a few inches below my belly button, slightly off-center, so I could alternate sides.

The parches did work very well for me, but after a few years I switched to injections. It took me a month or two to get used to doing it, but I find it more convenient now.

Love always -- Jessica Rose

I do sublingual and avoid the liver issues of swallowing the tablets.
At $4 a month or 30 pills this is also inexpensive for me.

I have been on patches from day one, due to being old.  My doctor wanted to take it easy on my liver.  Fine by me.

There is a huge variation among brands, especially between generic and name-brand patches.  I have used generic (Sandoz) and Estradot brand (also Sandoz), and there was no comparison.  The generic patches were enormous, limiting the available sites on my body, and requiring me to re-use the same patch of skin too frequently.  The adhesive was an irritant, causing nasty rashes.  And the adhesive was water-soluble, so they would come off in the shower.  The Estradot patches are much smaller, so I can go a full month without re-using the same bit of skin.  They are less irritating to my skin.  And the adhesive is oil-soluble, meaning that they stick in the shower.  It means that I need a bit of bath oil to remove the remaining adhesive when I remove them, but that only takes a minute.

I had to plead with our drug plan to let me use the more expensive name brand patches, but they agreed that the skin rashes from the generic were sufficient justification to do so.

Quote from: KathyLauren on July 29, 2025, 06:39:26 AMThe generic patches were enormous, limiting the available sites on my body, and requiring me to re-use the same patch of skin too frequently. 

I had the same issue with the large generic (Mylan brand) and the small Grove minidot brand.  :)

@Lori Dee I started the patches last night. I definitely feel more stable, and balanced. Interestingly, my boobs are more sore than usual.

Quote from: Alana Ashleigh on July 30, 2025, 10:56:20 AM@Lori Dee I started the patches last night. I definitely feel more stable, and balanced. Interestingly, my boobs are more sore than usual.

Good deal! Pay attention to your mood. If you start feeling down, notice if it is right before the day to change patches. I usually noticed it on Mondays (I changed on Tuesdays), and it bothered me at first. Then I realized that it only meant the patch was worn out, and it was time to start a new one. If you notice that is what is happening, don't panic. Just stick to your schedule and you'll be fine.

Congrats on starting the next step!

I started with the Sandoz patches, I really liked them. Then I switched to sublingual tablets, then compounded capsules.

The patches were trouble free, I changed it out on Sunday evenings and Thursday mornings.

When I switched to pills, I got one of those old person pill boxes with the days on the little doors. Well... colour me shocked at how many times I went to get my pills only to discover I hadn't taken them the day before.  :o

My peak seems higher than it should be and my trough lower. I think I have a similar issue to Lori: I "burn" through the patch medication quickly. But I've had excellent development so I'm staying where I'm at.

I'd been dealing with the dark rings from leftover adhesive until recently. I figured out that putting a Tegaderm HP over the adhesive and leaving it on for a couple of hours is all that's needed to remove most of the adhesive.

This thread is a little older but I am also being switched from pills to patches. My hematologist is looking at lowering my Eliquis dose so my PA-C tells me I will have to start patches in that case.

I had blood clots in my heart in lungs two years ago. Apparently the patches are a lower risk for that.

Quote from: CosmicJoke on September 20, 2025, 10:48:28 AMThis thread is a little older but I am also being switched from pills to patches. My hematologist is looking at lowering my Eliquis dose so my PA-C tells me I will have to start patches in that case.

I had blood clots in my heart in lungs two years ago. Apparently the patches are a lower risk for that.

This is true. Patches bypass the liver's "first pass," which can affect coagulation. Hopefully, the adjustment will be smooth and effective.

Hi ladies,

I'm seeing my Dr on Friday as I'm getting lots of light-headedness at the moment. Had my hormones tested 10 days ago and the results are still not through.

I'm thinking of asking the Dr and my Endo if I could be switched from gels to either patches or injections. I tried injections twice before: once in the bad days of self-medication (huge no-no if anyone is reading this thread) and then once properly supervised. I found towards the end of the allotted timeframe for the injection that the comedown was horrendous.

So I don't know. Maybe patches? I too have a fast metabolism. And I'm also prone to eczema which I'll need to monitor.

xx

p.s. a thread without the phrase 'YMMV' appearing. Yay!!! ;) xx

I never tried patches.  I continue with my tablets.
My nipples were very sensitive yesterday and this morning.
But I doubt my breasts will get any bigger.

Chrissy

Quote from: Tills on October 05, 2025, 05:05:33 AMI found towards the end of the allotted timeframe for the injection that the comedown was horrendous.

That was the problem I had with patches. With sub-Q injections, my levels stay high enough.

What I found (with me) is that when my levels drop to a certain point, I get the symptoms (hot flashes, night sweats, etc.). With pills, my levels were rollercoastering up and down wildly every day. With patches that smoothed it out over time, but I was still hitting those lows twice a week. With injections, my lows do not drop low enough to trigger the symptoms.

For a while, my doctors were relieved that we resolved the "lows" problem, but were concerned that my highs were too high. I am still training them so that they will listen to me. I have read the studies, and they haven't. We compromised and instead of injecting weekly, we extended it to every ten days. That smoothes out the highs over time, and the lows do not drop into my discomfort zone. It seems to be working out.

I'm just providing you with information so that if you have issues with patches or injectables, you will have an idea of what to try to get your levels to hit that sweet spot.

I know the misery of those horrendous crashes. I was PMSing for four years before we figured it out. Not fun.

The tablets seem to work for me throughout the month.

I heard that less estrogen the better to avoid cancer for at least some people.
Doctors who manage your meds I trust to make the right recommendations for me.

Quote from: Lori Dee on October 05, 2025, 11:13:09 AMThat was the problem I had with patches. With sub-Q injections, my levels stay high enough.

What I found (with me) is that when my levels drop to a certain point, I get the symptoms (hot flashes, night sweats, etc.). With pills, my levels were rollercoastering up and down wildly every day. With patches that smoothed it out over time, but I was still hitting those lows twice a week. With injections, my lows do not drop low enough to trigger the symptoms.

For a while, my doctors were relieved that we resolved the "lows" problem, but were concerned that my highs were too high. I am still training them so that they will listen to me. I have read the studies, and they haven't. We compromised and instead of injecting weekly, we extended it to every ten days. That smoothes out the highs over time, and the lows do not drop into my discomfort zone. It seems to be working out.

I'm just providing you with information so that if you have issues with patches or injectables, you will have an idea of what to try to get your levels to hit that sweet spot.

I know the misery of those horrendous crashes. I was PMSing for four years before we figured it out. Not fun.

This has been such a helpful post Lori, and the thread in general, so thank you.

Rather than derail it I'll start something specific about menopause.

xx

@ChrissyRyan if you have found a doctor you trust to know what they're doing with hormone regimes then you've done well. In my experience they are gold dust.

My saga continues. I got blood drawn at absolute trough and the numbers were upsetting:
T: 196 ng/dL
E: 39 pg/mL

I guess the E number isn't too bad for trough but the T number was a real disappointment. I hadn't realized it, either, but I put two and two together and figure this may have something to do with the feeling of unease/sadness I've been struggling with for a while.

My doc and I decided to:
Add spiro (50 mg) back into my regimen
Double progesterone (from 100 mg to 200 mg)
Stay at 4 patches 2x/week

This should help me keep my T down.

Quote from: Tills on October 05, 2025, 05:05:33 AMSo I don't know. Maybe patches? I too have a fast metabolism. And I'm also prone to eczema which I'll need to monitor.

I think I'm burning up the medication but I'm sure there's also some loss, as the patches can lift a little during showers, perspiration, etc. I use 3M Tegaderm patches to remove adhesive (as I mentioned in another post, put them on for about an hour and they pull the adhesive off when you remove them) and I have used them over the patches on occasions when I knew I'd be swimming. I think the delivery and absorption of medication is a bit better with a Tegaderm and I wonder if longevity is affected.

So I'm using a Tegaderm twice a week, which covers all four of my patches. We'll see how I feel and also what the test results show. I'm pretty sure the Tegaderms will be covered by insurance.

I do wish we could wear a monitor for a couple of months that would allow us constant data about our levels. It would be so much easier to get dialed in that way!

Quote from: CosmicJoke on September 20, 2025, 10:48:28 AMI had blood clots in my heart in lungs two years ago. Apparently the patches are a lower risk for that.

Yup. I had a blood clot in my leg while taking phytoestrogens, so patches are the safest delivery method for me.

I have my annual Gender clinic appointment a week today and I think I've reached the point of wanting to ask if I can switch from gels to patches.

Previously I was going along with the idea that 'if it ain't broke don't fix it' but since my microdose of testosterone was adjusted back up slightly my estradiol level dropped. So this seems like a good time to get things set up for the longer term.

The gels are a bit of a faff and have had quite an impact on my life. Applying them twice daily is less than ideal. So I reckon patches will be less hassle. I do have sensitive skin though so I'm going to need to watch for site reaction.

In the UK I think it seems to be Evorel or Estradot.

xx

Quote from: Tills on November 23, 2025, 11:11:35 PMIn the UK I think it seems to be Evorel or Estradot.

I had problems with the generic patches I got from the VA Pharmacy. The brand was Mylan, and they had problems staying stuck on, and the formulation seemed to be inconsistent. I found some online reviews that showed that Mylan had changed its adhesive formulation a few years earlier, and the reviews were all bad after that.

After numerous complaints to my endocrinologist, she consulted with the lead pharmacist, and Estradot was available. By that time, I was up to three patches twice a week, and I was running out of real estate because you have to change the location with each application. The solution was a mini-dot, brand name Grove Pharmaceuticals. That was small and stayed on. It was thin and flexible. My only problem was that I needed a higher dose, and wearing four dots at a time was impractical. That was when they switched me to injectables.

I just did a quick search, and the Evorel patches have mixed reviews about staying stuck, especially on sweaty skin. The Estradot reviews claim the patches are small, thin, and stay stuck.

Depending on skin sensitivity, the Estradot sounds like the way to go if you have a choice. When I had problems keeping patches on, my doctor recommended applying Tegaderm over the patches. That was an epic fail. The Tegaderm was too thick and only compounded the problem. When it started to peel off, it would pull the patch off with it.

We went back to the Head Pharmacist with this problem. She suggested an IV film. It is thin, flexible, and waterproof, yet perforated so the skin can breathe when worn for several days. It worked great! They are also available in different sizes, so I could use one IV cover to hold two patches on at a time. You would need to see what brand they might have available. Mine was Smith & Nephew IV3000.
https://www.amazon.com/Dressing-IV3000-Standard-Inch-Square/dp/B002YKHE9O

Hope this helps.

Hugs!

Oh wow, thanks Lori-Dee. That's all extremely helpful information.

As well as the issue about adhesion, I hadn't considered the idea that the patches wouldn't deliver sufficient dosage. I think they're available in four different strengths in the UK so it will be interesting to see what my Gender Clinic advocate.

I have a cis female friend who has no problems with Evorel patch adhesion but I guess it's going to be a case of trying them out, with regular hormone level monitoring in the early stages.

I have reached the point where the gels are pretty invasive. My morning dose is the higher of the two and applied to my thigh. This means I have got into an ingrained habit of waking early (3.30 or 4 am) to apply the dose, waiting an hour or more for it to dry, and then going back to sleep. This has been going on for more than two years and it's a bad sleep pattern. Then the afternoon dose involves hitching up a sleeve and spreading it over my arm: hardly ideal if you are out and about. And both doses require careful planning with baths or showers.

xx

I think you might be happier with the patches. The adhesion could be a factor of skin moisture and maybe even acidity. Just watch for sensitivity. If one leaves a rash, switch to the other brand. If adhesion becomes the only issue, try an IV cover to keep it in place. It can't deliver its dose if it isn't stuck in place.

😀

I should really move to patches as they don't really recommend oral after age 40 due to risk of blood clots. But patches are extremely expensive!

Hopefully will be ok as only on 4mg oral so it's not too high.

Does sound from this thread patches have their issues too though. There is a spray Lenzetto available on prescription now in uk giving about 1.5mg per spray. Being DIY though I can't get it 😕

Charlotte 😻

Quote from: Charlotte_Ringwood on November 24, 2025, 01:53:53 AMI should really move to patches as they don't really recommend oral after age 40 due to risk of blood clots. But patches are extremely expensive!

Hopefully will be ok as only on 4mg oral so it's not too high.

The biggest problem with oral tablets (not sublingual) is the first-pass through the liver. The metabolites (leftovers) can affect blood coagulation. Hence, the blood clot/stroke warnings. The other problem is that, because of being processed in the liver, the effective dose must be higher so that enough makes it into the bloodstream to be effective. Higher dose = higher risk.

Other methods bypass the liver, such as sublingual drops, sprays, gels, patches, and injectables. They all have their pros and cons, but for some, one method works better than others or is more convenient, as Tills pointed out. Although I would never recommend DIY, I do understand your situation with the availability of a provider.

Quick update from me.

A few weeks ago my blood results showed, after a long period of stability, an Estradiol E2 dip from 500 pnmol/L to 200 pmol/L. This was probably caused by me slightly upping my micro-dose of testosterone. My T level had gone from 'undetectable' to 0.5 nmol/L. It's a long story but I seem to need a micro-dose of T. If I don't I go into the most awful spaced-out world with brain fog and extreme light-headedness. I had tried to strip out my T micro-dose entirely but the results were horrendous. So that little daily pea-sized amount of T does the trick for me. Now my energy has returned and I'm working out loads again every day. I've got my mojo back.

At Lori Dee's suggestion a slight upward adjustment of Estrogen dose seems to have done the trick, as well as I suspect my body settling back. Bloods were re-taken yesterday:

Estradiol E2 453 pmol/L
Testosterone <0.5 nmol/L

I'm putting all this into this thread because on Monday I have my Gender Clinic appointment and I'm still going to ask them if I can switch from the estrogen gels to patches. It's about practicalities. Here I am awake at 4 am UK time typing this. That's because every morning I now wake up early like clockwork to apply the gels and then wait for it to dry which can take at least an hour. Then in the afternoon I have another application.

I don't mind routine or discipline, it's just that the gels are so disruptive, especially to my sleep patterns.

So I'm going to ask to go onto patches. I'll just need to keep an eye on levels and also site irritation and adhesion.

xx

I have my appointment with the Centre for Transgender Health today at 1pm.

Curious situation though. My GP surgery are happy to go ahead and change me without reference to the Trans Clinic. Their position appears to be that because I have a GRC they treat me as a woman not as a transgender woman. In fact, the protected status of the GRC seems to mean that they've deleted references to me being 'trans' from the system.

xx

I'm approved for the switch to patches.

I know we can't discuss doses but my GP was trying to work out the equivalent patch dose from my Sandrena gel.
 
It's looking like she's going to start me on Evorel. Anyway, for complicated reasons to do with holidays at the medical practice it may take a few weeks to get this properly prescribed.

(Apologies Alana Ashleigh for slightly hijacking this thread but it is about patches)

xx

Quote from: Tills on December 02, 2025, 10:40:00 PMI know we can't discuss doses

Tills,

First, congrats!

On dosage, we have relaxed the rules on that.

It is okay to discuss your dosage and describe your experiences. What we don't want to see are recommendations for dosages for others, because everyone's biochemistry is different, and we don't want to give unlicensed medical advice.

😀

Quote from: Lori Dee on December 02, 2025, 11:01:38 PMTills,

First, congrats!

On dosage, we have relaxed the rules on that.

It is okay to discuss your dosage and describe your experiences. What we don't want to see are recommendations for dosages for others, because everyone's biochemistry is different, and we don't want to give unlicensed medical advice.

😀

Oh wow, that's great Lori Dee. Thank you for telling me.

Well I'm currently on 2.25 mg Sandrena gel per day, split into morning and afternoon.

My GP was trying to work out what patch strength to match to that. She says Evorel 75 is the equivalent of 2mg Sandrena, whereas Evorel 100 would be 3 mg Sandrena.

I think one way around that will be to change the patch every 3 days instead of 2 per week which is one of 3 days and another of 4 days. They do that so that people keep the same days and don't forget to change them but with Apple watch Health App I can set a recurring medication reminder for every 3 days (72 hours). Taking two patches in 6 days rather than 7 days should yield a slightly higher strength over time.

As ever though it will come down to blood tests to get the right dosage with patches.

For those of you on patches, does any of this resonate or make sense?!

xx

On the blood work, one of the things they are watching for is "saturation". The patch delivers the medicine into the fatty layer below the skin, where it sits as a "depot". The system leeches out what it needs over time. That tissue can become saturated to where it will not absorb more. This is why changing the application site at each change is important, plus avoiding skin irritation. Spacing the change date by an extra day can also help.

Good luck!

Quote from: Lori Dee on December 04, 2025, 09:57:22 AMOn the blood work, one of the things they are watching for is "saturation". The patch delivers the medicine into the fatty layer below the skin, where it sits as a "depot". The system leeches out what it needs over time. That tissue can become saturated to where it will not absorb more. This is why changing the application site at each change is important, plus avoiding skin irritation. Spacing the change date by an extra day can also help.

Good luck!

That's really helpful Lori Dee: thank you. My GiC have said to take the blood tests 2 days after applying the patch which means a trough reading. But that's very interesting about saturation. I might alternate 3 or even 4 sites then (two thighs, one or two buttocks).

Someone else at the surgery has calculated the equivalent dose from my gel would be Evorel 112.5 not Evorel 75.

I don't know? I think a case of just trying and testing.

xx

More head scratching at my GP surgery. They are a bit flummoxed that my GiC have left the surgery to decide on my dose. This was all worked out by one of the women's health doctors there on Monday at Evorel 75 but she's then gone on holiday for 3 weeks and no one else seems to believe me when I tell them the dose she and I had agreed.

Sigh. This is very typical of the NHS these days, across almost all services. It's opaque at best, downright obstructive at worst, and patients and their carers have to keep at it and keep at it and keep at it.

I'm determined about this switch to patches because I find the gels very disruptive to normal life and they have certainly contributed to broken sleep.

To keep this on thread topic, the one thing no medical professional will countenance is a return to oral estradiol. At the age of 61 this would be considered a big no-no here.

xx

Quote from: Tills on December 04, 2025, 10:41:05 AMI think a case of just trying and testing.

That won't hurt. Read the literature that comes with the prescription. They have done studies and found the abdomen to be more effective than other areas. Just be aware of how you feel. It is possible that the other areas' "slowness" will compensate for the abdomen's "effectiveness" if that makes sense.

Checking the levels at the trough is the smart way to do it. You can't overdose on estrogen, so the important metric is if you are getting enough. After a month or two, you will know what is working and what is not.

So latest impasse

A clinical pharmacist at the surgery has said that the equivalent of Sandrena 2mg a day is Evorel 50. Having researched this I think they are wrong and are confusing Sandrena and Estrogel.

The main thing though is that three different people at the same surgery have suggested Evorel 100, Evorel 75, and Evorel 50. Little wonder, then, that this afternoon they wrote back to my Transgender Clinic asking for guidance.

The women's health GP, who seemed to speak a lot of sense, suggested Evorel 75 and I think that sounds right to me, with bloods taken in a few weeks.

As ever in this area of hormone therapy we are sometimes dealing with limited professional expertise, at least from mainstream practitioners i.e. non gender specialists.

Any thoughts and insights from any of you gratefully received.

xx

Hi Tills,

Part of the problem with equivalent conversion is that gel formulation differs from patch formulation. The gel is designed to be absorbed quickly for more frequent doses, while patches are designed for slow release over a longer period.

So it isn't a specific ratio but more of an educated guesstimate. Whatever they decide is ok, because they can always adjust (titrate) the dose upward depending on what your labs show. More importantly, your symptoms score higher in relevance than blood tests. If you have issues with hot flashes, night sweats, moodiness, then that is a sign that your body needs a higher dose, regardless of what the blood levels show.

If you are feeling good, they may try to adjust to get the levels they want to see on your labs. But how your body responds should be more important than the numbers.

Let them figure out the initial dose and see how it goes for a month.

Hugs!

The method of administration makes a huge difference to the dosage. For example, oral doses are measured in milligrams, whereas transdermal patch doses are measured in micrograms, for the same blood level.  And individual responses are different too.  When switching methods, you will need to start with a best guess, then adjust with monitoring.

Thanks ladies.

I think I'm going to take the middle path. It appeals to the slight Buddhist tendencies in me :)

Seriously though, the only one who talked this through properly with me was the women's health specialist and she suggested Evorel 75 to start with.

My last estradiol E2 blood tests were, in the words of my clinic, 'a little on the low side' so I don't think it will do harm to up things and I sense coming from the short-fuse gels it might be better if the Evorel is slightly higher than slightly lower.

I did once spike with my estradiol level about 3 years ago for reasons which no one could quite work out. I went up to 1250 pmol/L. I had slightly tender breasts and nausea but my then brilliant GP (a different one) said it wouldn't be doing me any harm as such and we nudged down my dose.

One thing I have to report that they have all said at my surgery is not to apply it to the abdomen, but waist-down? @Lori Dee

Wow it gets confusing 🤔

Another thing which is interesting is that seemingly no one there wants to take responsibility. But if I try to do so that becomes a big no-no. Not being funny but those of you on here probably have more knowledge about these things than they do: when it comes to gender care I mean. There's a balancing act and that can add to the sense that we're flying solo. For newbies on this journey, or those with mental health issues, this can all add to the fear factor.

I'll also add that that once over a decade ago I self-prescribed and self-sourced and that was a massive no-no. I made myself very ill with the anti-androgens.

So I guess we need to go through the professionals but balance this with awareness that they may not always 'know best'?

xx

Quote from: Tills on December 05, 2025, 09:34:27 PMOne thing I have to report that they have all said at my surgery is not to apply it to the abdomen, but waist-down? @Lori Dee (https://www.susans.org/index.php?action=profile;u=68936)

Wow it gets confusing 🤔

I can't find the article I had that explained this. The best place is the abdomen below the navel. The article was in-depth, but the explanation was concerning the lymphatic system and included a chart. The lymphatic system works like the waste collector. Because of the way the lymph flows, placing patches, gels, or whatever too high puts it closer to major lymph nodes (waste collection points). So the medicine gets absorbed, and the waste collector grabs it before it can do its work. By applying below the umbilicus, the medicine absorbs into the fatty tissue there, then gets transported through the bloodstream, so it can get to where it needs to go.

This is an extremely simplified version of it, but that is how I understood it.

You are correct that most of us here have more knowledge and experience than the healthcare professionals because we are in it every day. They may treat a transgender patient once a week or a month? One of the first things I ask a new provider is how much knowledge and experience they have, and whether they are willing to listen to someone with six years of real-life experience and a lot of research behind them. If not, like a certain VA Regional Center, I stop going to them.

The ones who are willing to listen and learn from us will be the best care providers. When something isn't working for a patient, they have our knowledge and experience to refer to. Maybe we can help the next patient. We must train them because Donald Trump will not.

Thanks so much @Lori Dee That's very interesting about the navel down.

With my gels my morning one has been applied to my thigh - always the same thigh because of the side of bed I'm on so I keep that leg out of the bed whilst it dries (up to 90 minutes). My afternoon dose always goes on my left upper arm because, very simply, I can't drop my skirt or trousers in public :D

I've not noticed any ill effects with the upper arm application. Also, curiously, the instructions on my micro dose of testosterone specifically say to apply it to the upper arm.

But this is the kind of reason why I have gone off gels. They can be very invasive and impractical over a long term. There have been three principle problems for me: 1. A bad habit of waking very early in order to apply the gels; 2. Applying a gel to your arm at 5pm if you are out and about is very intrusive and can lead to all kinds of looks and questions, plus you need to be careful not to rub it on people; 3. Gels cause problems with bathing or showering: everything has to fit around when you can and can't wash.

xx

I alternate thighs twice a week, left on Monday night, right on Friday morning.

I think there might be some confusion about the dose. My "100" patches deliver .100 mg/day. .100 is considering a "full starting dose" by my doctor, with less than that more a microdose. The maximum standard dosage for this type of therapy is .400 mg/day. That's the dose I'm on.

Over the last four years of HRT, I've come to the conclusion that my body absorbs the medication more quickly than most. I made a spreadsheet of blood test results and found that my estradiol levels are pretty high at peak and pretty low at trough. My fast metabolism seems to burn through the medication quickly. It can cause some mood swings, but that's more manageable than a blood clot!

I'll be interested to see if my use of  Tegaderm over the patches affects levels, as I haven't been tested since starting that.

PS: I learned, over time, the best location to put the patches and the methods for maximum adhesion but using the Tegaderms has been a bit of a game-changer for me. Long, hot showers or swimming are a non-issue now.

Quote from: Tills on December 05, 2025, 12:17:33 PMThe women's health GP, who seemed to speak a lot of sense, suggested Evorel 75 and I think that sounds right to me

That sounds like a conservative first guess.  My dose is 150 micrograms per day (0.15 mg), which has kept my levels stable for several years.  I apply the patches twice a week (Saturdays and Wednesdays) on my abdomen, below the navel.  My Estradot patches are small enough that I can change them 8 times (4 weeks) before re-using the same spot.  They also stay stuck in the shower without any covering.

Right, I can finally start on the patches tomorrow mid-morning. My Gender clinic have instructed requested my GP surgery to start me on Evorel 75. The surgery have issued the prescription.

Blood tests in 6-8 weeks time.

I will in fact switch the patches every 3 days, not 3,4,3,4 ... days because it's easy with the Health App alert on my watch. That will prevent the day 4 dip and build the level just a tad higher and more consistently. I'll use three alternating application sites: right thigh, left thigh, left buttock. I don't want to use my right buttock because I have, ahem, a saucy tattoo there 😜

All good. I'm expecting an estradiol dip for a few weeks whilst the depot starts to take hold but I'm going to have to live with that.

xx

Good morning gals.

I had bloods taken yesterday, to check levels seven weeks after switching from gels to transdermal patches. I'm on Evorel 75 which I change every 3 days rather than two in seven days, which they advise so that people always change them on the same day. Instead of that my Apple Watch is set with a medication alert every 3 days and that is working really well. So the Evorel 75 should give a slightly higher dose by taking 2 patches every 6 days rather than 7 days. Hope that makes some sort of sense? :)

We'll see how my levels look but in terms of lifestyle the switch has been the best move ever: life changing. Instead of the incredibly invasive and disruptive process of twice-daily gel smearing it's now just a morning patch applied every 3 days. Takes less than a minute. I've not had any issues with the Evorel patches coming off.

On the very first day I did get an aural migraine but it passed very quickly and it may have had more to do with dehydration, and lack of food, following an 8-mile hike. No recurrences since then and, besides, I've had migraines all my adult life: roughly one every two months and always when I'm overdoing it.

So we'll see how the levels pan out but in terms of lifestyle, the patches are fantastic. I wouldn't do anything else now.

xx

Well ... results are back and Estradiol is a dip

Estradiol 131 pmol/L
Testosternone <0.5 nmol/L
Serum Sex Hormone Binding Glob 48.8 nmol/L

The estradiol reading was on Day 3 of my patch, just before application of the new one, but even so I think that's a bit suppressed.

I'm going to propose upping from Evorel 75 to Evorel 100 which I think some of you may have suggested all along?!!! Sigh.

xx

Oh wow that's very low. This being the main issue with patches in my mind. Really I think that E needs to be tripled to get on lower end of WPATH recommendations.

T looks low, though within range...are you on blockers too?

I'm sure you're doctor can sort this all with you soon hopefully.

Charlotte 😻

Yes, the E level is a little low, but keep in mind that it is a trough reading, not a peak. This was at the lowest point between doses. I prefer mine higher, too. When I get that low, I get hot flashes and night sweats. Are you having any symptoms at the bottom like that? If not, your provider might not want to increase to the 100s. But if you are, then a higher dose patch might be in order.

Also, just FYI, that E will accumulate in the fatty tissues below the patch. As it leeches out, it never gets to zero. Over time, that reserve builds up. With me, I didn't notice it until I started packing boxes and getting ready to move. That increase in activity caused me to lose weight, specifically belly fat. That released some of those reserves, which caused an increase in my serum levels.

My doctor freaked out at first, but then we figured out what had happened, and she relaxed. Nothing to worry about. Just FYI.

Quote from: Lori Dee on January 28, 2026, 02:59:02 PMYes, the E level is a little low, but keep in mind that it is a trough reading, not a peak. This was at the lowest point between doses. I prefer mine higher, too. When I get that low, I get hot flashes and night sweats. Are you having any symptoms at the bottom like that? If not, your provider might not want to increase to the 100s. But if you are, then a higher dose patch might be in order.

Also, just FYI, that E will accumulate in the fatty tissues below the patch. As it leeches out, it never gets to zero. Over time, that reserve builds up. With me, I didn't notice it until I started packing boxes and getting ready to move. That increase in activity caused me to lose weight, specifically belly fat. That released some of those reserves, which caused an increase in my serum levels.

My doctor freaked out at first, but then we figured out what had happened, and she relaxed. Nothing to worry about. Just FYI.

Thanks Lori-Dee. That's really helpful.

I'm not getting any symptoms, no. Feeling good actually with bags of energy, I'm exercising loads and losing weight. I'm not really light-headed at the moment either which is a major improvement.

My GRC clinic did want me to take the tests on Day 2 but there wasn't an available appointment so it had to be Day 3.

@Charlotte_Ringwood I had an orchidectomy about 10 yrs ago so I have no naturally occurring testosterone. In fact I take a micro dose of T each day (0.2ml) for energy. If I don't I go totally spaced.

xx

Also, I do sometimes wonder about what it is I'm now wanting to achieve hormonally? I'm 62 in about a week and I transitioned over a decade ago. Boobs are 42 DD and I don't think I've any body hair to speak of. I don't have any naturally occurring testosterone at all.

Do I really need to be in so-called 'therapeutic' range which in the UK is considered roughly 400-600 pmol/L?

Or is there a case for letting my body wind down gradually into post-menopausal range?

I'm not meaning to be controversial here. Just asking. A good friend of mine in her 70's who transitioned decades ago is no longer prescribed any hormones at all. She takes calcium and that's all.

xx

Quote from: Tills on January 28, 2026, 10:32:07 PMDo I really need to be in so-called 'therapeutic' range which in the UK is considered roughly 400-600 pmol/L?

Or is there a case for letting my body wind down gradually into post-menopausal range?

That is a good question.

For transitioning, we want our range to be in the puberty range, so we get curves and boobs. Once we have that, the maintenance range is typical for women of reproductive age. I'm 68 and still trying to hit puberty!

However, "therapeutic" could mean anti-menopause. I would ask the doctor if that is correct. You don't want the hot flashes and unpleasantness of menopause.

My thinking is different. I know that hormones regulate a lot of stuff in the body, from bone density to body temperature. So, in theory, if I keep my hormones targeted for a young person, maybe I can fool my body into believing it is not 68 years old. Live long and prosper. That's my story, and I'm sticking to it.

😁

Remember, the medical community 'practices' medicine. In addition to all of their studies and tests, sometimes the answer comes down to 'how do you feel?'. While there are guides to 'normal' ranges of blood chemistry, there is probably no one number that is right for everyone. For many women, the 'right' level of hormones is somewhere between hot flashes and 'are you pregnant?' If you are comfortable at lower levels and all of your other blood chemistry numbers are within norms, then it sounds like you are in a good place.

Love always -- Jessica Rose

Quote from: Tills on January 28, 2026, 10:32:07 PMOr is there a case for letting my body wind down gradually into post-menopausal range?

It is pretty much personal preference.  I figure that cis women get about 40 years on estrogen, so that's what I am aiming for.  I'll stop when I am 102.  :D  On the other hand, cis women my age have lost their estrogen long ago, so there could be a case made for not continuing.  In between those extremes, there is room for a whole range of personal preferences.

Quote from: KathyLauren on January 29, 2026, 07:16:17 AMIt is pretty much personal preference.  I figure that cis women get about 40 years on estrogen, so that's what I am aiming for.  I'll stop when I am 102.  :D  On the other hand, cis women my age have lost their estrogen long ago, so there could be a case made for not continuing.  In between those extremes, there is room for a whole range of personal preferences.

I'm with you, sis. I waited decades to run on estrogen. I'm in no rush to cut back on levels unless someone tells me I have to for health reasons.

As an aside, I switched from patches to injections about 4 weeks ago, after 4 years on patches. I got amazing breast development, soft skin, lost body hair, body and face shape changes and significant scalp hair regrowth on patches despite the fact that my estradiol levels were not great at trough and my T levels have been difficult to suppress. Due to the last bit, and due to the fact that I'd really like to discontinue spironolactone, I made the switch.

I feel pretty good overall, but not noticeably "better." I do have a sense that my estradiol remains higher for the duration of my (1 week) cycle than when using patches. I have to admit that I'm enjoying the single weekly shot over twice-weekly replacement of four (!) patches, and I'm quite enjoying the lack of patch adhesive all over my thighs.

Having said that, I liked patches. They did great things for me and I have confidence in the low level of health risk they afford.

A bit off topic, but related: during the few months I was on transdermal patches, my A1C dropped significantly without any other changes to medication or diet. Just coincidence?

Quote from: Dances With Trees on January 29, 2026, 10:28:58 AMA bit off topic, but related: during the few months I was on transdermal patches, my A1C dropped significantly without any other changes to medication or diet. Just coincidence?

That happened to a friend of mine. She happens to be intersex, so she figured that had something to do with it. But it prompted me to suggest to my GP that I cut my statin dose in half. I did, and my cholesterol levels are right where they should be.

I now have to wait 4 weeks for the transgender clinic and my GP surgery to communicate all in order to authorise what I've suggested, which is an increase from Evorel 75 to Evorel 100.

I wouldn't normally advocate this to anyone as a point of principle but I am mightily tempted just to get on and make the change myself now.

You can cut the patches to produce different doses so cutting a patch in 1/3rds would make it easy to hit c.100. This is something described in the patient leaflet so there's nothing radical about that. But I would effectively be jumping the gun into a temporary period of self dosing.

Not ideal. On the other hand I learned a long time ago that on trans matters doctor doesn't always know best.

Any thoughts ladies?

xx

How does cutting 75 get you to 100? I can see cutting 100 down to 75 or 50.

I suppose I am assuming the number correlates to mg dosage.

Your E seemed low but if you're not feeling any effects I wouldn't worry. As far as I'm aware E dosage doesn't affect anything as much as you may think. Possible menopause symptoms maybe. Lack of T is most important. You do need E for bone health but 1 month isn't going to affect it much.

I'm DIY myself and even I'd advise to just wait in this case.

Quote from: Lori Dee on January 29, 2026, 11:46:24 PMHow does cutting 75 get you to 100? I can see cutting 100 down to 75 or 50.

I suppose I am assuming the number correlates to mg dosage.

Sorry yes I didn't explain myself very well :)

1 x 75 patch
+
1/3rd of another 75 patch

Thus making 100 give or take.

The number is micrograms so 100 delivers 100 micrograms per day. Evorel 100 is a pretty standard dose in transgender care.

xx

Quote from: KathyLauren on December 06, 2025, 09:21:44 AMThat sounds like a conservative first guess.  My dose is 150 micrograms per day (0.15 mg), which has kept my levels stable for several years.  I apply the patches twice a week (Saturdays and Wednesdays) on my abdomen, below the navel.  My Estradot patches are small enough that I can change them 8 times (4 weeks) before re-using the same spot.  They also stay stuck in the shower without any covering.

As you will see from @KathyLauren's post here, Evorel 75 is 'conservative'. She's on 150 twice a week.

I think I may just switch up now to 100 every 3 days on the assumption that in about 4 weeks that's precisely what my clinic will advise anyway.

xx

I'd just like to reiterate though, staying on topic, that generally I think the patches are fantastic. Compared to the gels I was smearing on twice a day, the patches have transformed my life and quality of life.

xx

I'd love to go on to patches myself. They are just very expensive. I think I'll move to them when I'm not having to spend on laser removal, surgery and such. Or I'll jus wait a few years until I can get through NHS.

Good to know that you rate them so highly. I love the idea of them

Today was changeover day so I've switched up to Evorel 100. In the extremely unlikely event that I feel off colour I'll peel off the extra mini patch.

But I'm expecting my transgender clinic and GP surgery to approve this in a few weeks time.

Bear in mind that my trough reading on gels was 400 pmol/L so 131 pmol/L really is a dip.

xx

I did lots of stuff to manipulate my dosage while using patches. Early on, I cut them in halves or quarters in order to microdose and later I left some patches on for a couple of extra days after I added new ones, creating an "overlap" to increase my effective dose. It was also a means to allow me to stockpile patches.

Thanks @Courtney G : that's helpful to know. I hadn't thought about leaving the previous one on to create an overlap.

In terms of stockpiling, I have some extra patches as whilst I awaited the GP surgery to connect with my clinic I ordered a private prescription through the post. Nothing dodgy about that: a bona fide UK pharmacy who checked that my clinic had approved it. It's useful to have the extras as I hate running low.

@Charlotte_Ringwood I bought 16 x Evorel 75 for £25. I suppose that is quite pricey but if you're doing 2 a week (mine is 2 in 6 days) then it's roughly £13 a month. Not too bad?

xx

Quote from: Tills on January 30, 2026, 07:28:53 AM@Charlotte_Ringwood I bought 16 x Evorel 75 for £25. I suppose that is quite pricey but if you're doing 2 a week (mine is 2 in 6 days) then it's roughly £13 a month. Not too bad?

xx

Doesn't sound so bad...just not sure of equivalent dose as I'm on 6mg oral per day to get my levels. Might need two patches to get it. I'll have a look again. Thanks 😊

Quote from: Tills on January 30, 2026, 07:22:35 AMThanks @Courtney G : that's helpful to know. I hadn't thought about leaving the previous one on to create an overlap.

You're welcome. I'll add that near the end of my time with patches just a month ago, I decided to stagger them to create a shallower trough. I was using four .100 mg patches twice a week and I think my peak was ok but my trough too low, so I did something like this:

Monday night: 3 patches (instead of 4). Maybe leave one patch on from the previous dosing, creating a four patch dose (effectively)
Wednesday evening or Thursday morning. Add one patch. Remove the "overlap" patch if used
Friday morning: 3 patches, same as Monday

Sure enough, my clinic have requested to my GP an increase from Evorel 75 to Evorel 100.

The covering letter says this, which I found interesting: this is the first time I've seen my clinic or anyone within the NHS pick up on the idea mentioned upthread by others about application to the trunk. I may well go for that as one of my alternating sites I think.

I'm copying most of the letter because I think the context is important:

'Thank you for forwarding on a copy of the latest blood investigations which show a lower than ideal oestradiol level of 131pmol/L.

Treatment plan

We would be most grateful if you would amend treatment as below:

•   Please increase Evorel twice weekly patches from Evorel 75 to Evorel 100mcg/24hr
Patches should be applied to clean unbroken skin to the trunk below the belly button or the top of the thighs.

•   10 weeks after increasing this dose of Estradiol patches please carry out the following blood investigations:

Oestradiol, Testosterone, LFT's, LH, FSH, SHBG and Prolactin
It is important that blood investigations are carried out approximately 48 hours after patch application.

We are aiming for an Oestradiol level in the range of 400-600pmol/L.'


I still love the patches in terms of their ease of application and lack of intrusion, a marked contrast to the gels.

xx

I'm getting increasingly tired of NHS England and the bullying and anti-trans note of this Labour Gov't.

So after my Transgender Clinic requested my GP to increase my dose from Evorel 75 to Evorel 100, the GP Surgery insisted on an appointment and put this on my notes:

'11 February 2026 12:14 pm
SURGERY -
Comment
• Patient requesting Evorel 100. Recommended by Nottingham Centre for Transgender Health.
• Amber on Surrey Pad.
• Shared care agreement required.
• 06 Dec 23 - Surrey Heartlands Integrated Care System Area Prescribing Committee (APC); After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for ostrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults.;; Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.;; A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC.;; The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.
• A+G sent to clinic today requesting SCA.'

This is all very Gatekeepery but above all it's just a giant waste of time. I've been under Nottingham GiC for 14 years. I've also requested them to take this unnecessary addition off my notes, citing my GRC. My GP already knows this is Amber status but that because it comes from the GiC that is covered, and actually irrelevant in my case.

I think it's partly because this GP surgery, which is a new one for me, aren't familiar with care for people like me.

Sigh.

Sorry. Just annoyed. I could continue this rant into the diabolical state of how to get an appointment and 'online triage' brought in by that slimy anti-trans slug Wes Streeting.

Meantime I've ordered 3 months supply from a private pharmacy online as I like having a stock for precisely this sort of NHS faffery and bureaucracy.

Vent over. For now. ;)

xx

I hope Scotland's better because I feel like moving to another country right now

The state of the NHS is dire to be honest. They've left with me with no mental health support and waiting lists for gender related care. So not surprised to hear your story. I get your frustration!

I'm just glad I'm totally DIY and doing everything else privately. Just leaves in thousands of debt!

I hope you get everything sorted soon x

Well there has been a fairly gobsmacking update on this situation which, I feel, warranted a new thread:

https://www.susans.org/index.php?topic=253232.msg2326695#msg2326695

As it happens I have obtained a private prescription of Evorel 100 for 3 months and my GP wants to try and go through the traffic light as she doesn't agree with it either.

Utterly ridiculous. I'm fuming.

xx

It's now 2.5 months since I switched from gels to patches. I began on Evorel 75 but following a slightly low estradiol reading of 133 pmol/L, albeit taken on day 3 trough, I commenced Evorel 100 a month ago today. That had to come from a private prescription thanks to some gatekeeping bureaucracy which I've written about elsewhere.

What I'd say is that in and of myself I feel good. Loads of energy. The patches have also transformed my life. Instead of waking up and thinking, 'I have to apply gels' I now drift back to sleep. I also don't have to worry about when I can shower or bath which was a massive hassle with gels. And just as important as the change to the mornings is the end of the very invasive afternoon gel. Having to apply a gel at 5pm when I'm often out and about and with people was an embarrassment and a pain in the proverbial. Embarrassment because there's nothing quite like signalling you are trans than slathering gel over your body and having to wait 30 minutes for it to dry ;)

I'd say that gels were brilliant for my levels but terrible for my lifestyle.

I'm 62 and in lots of ways the convenience of the patches far, far, outweighs consideration about levels. I suspect that on this Evorel 100 my day 2 level will be absolutely fine, within tx range, and I feel good.

I've certainly not had any issues with adhesion. In fact quite the opposite: the patches do leave a stubborn line around the edge which I've tried various methods to rub off when I switch to the next location.

But that minor issue aside the patches are great. They have transformed my quality of life.

xx

Glad that you are finally going to get the 100 patches officially and get that level increased. Seems it's making a very good improvement for your life which is great to hear. Hopefully even easier once you make your move!

I've decided to move to spray in a few months time. I would only need two sprays a day to probably do monotherapy and no rubbing in needed. Unfortunately it's "unofficial" so not available through healthcare.

Charlotte 😻

Quote from: Charlotte_Ringwood on February 28, 2026, 03:17:11 AMGlad that you are finally going to get the 100 patches officially and get that level increased. Seems it's making a very good improvement for your life which is great to hear. Hopefully even easier once you make your move!

I've decided to move to spray in a few months time. I would only need two sprays a day to probably do monotherapy and no rubbing in needed. Unfortunately it's "unofficial" so not available through healthcare.

Charlotte 😻

Yeah I'm not too fazed about my level to be honest. If a day 3 trough reading was 133 pmol/L on Evorel 75 then I'm confident that on Evorel 100 I'm just fine. My body has completed all the actual transitioning it needs and I'm into long-term maintenance these days.

That spray does look really good, compared to gels. Still a few things to watch out for I see:

'Although it dries within around 2 minutes and leaves no residue, women should wait a few minutes before dressing and avoid swimming or bathing within the first few hours of using it. If using sun cream, this must be applied at least an hour before using Lenzetto.'

https://www.menopausecare.co.uk/medication-lenzetto

That's still a lot less invasive than the gels. Good luck with it Charlotte. I'll be fascinated to see how you go with it and I expect your levels to be excellent.

Thanks I'll keep you posted.  I'm a fan of following what nature does, so I'll be elevating my levels to what they'd be naturally into tanner 4. This is about 500 pmol/l from the 330pmol/l I am now. Like you say later it doesn't matter too much. As long as you're healthy with your levels it's all good! X

Quote from: Tills on February 28, 2026, 02:32:12 AMI've certainly not had any issues with adhesion. In fact quite the opposite: the patches do leave a stubborn line around the edge which I've tried various methods to rub off when I switch to the next location.

That is great to hear that the patches are working for you. The adhesive edge can be removed by rubbing with a bit of oil. I found that lint and dust collect along the edges and leave residue behind. When I had issues with adhesion, I covered the patch with an IV cover (Tegaderm didn't work well). That not only kept the edges from peeling off prematurely but also prevented lint and dust from collecting, eliminating the residue line.

The brand I used was Smith & Nephew IV 3000, and it worked great.

That's really helpful @Lori Dee - thank you.

As I get older I find the concept of what's natural to have changed. 14 years ago my my body went through big transition changes. Now into my 60's I'm more conscious that 'natural' may mean levels more commensurate with cis females and I'm comfortable and cool with that. I have a friend in her 70's who transitioned years ago and no longer needs to take any estrogen as such, although personally I think she might have continued with a low dose.

My breasts went up to Tanner 5 DD and won't go down and without any natural testosterone I won't grow body hair. So I'm mainly interested now in what 1. gives me energy and 2. maintains bone and body health.

I did try to express some of my reflecting over here:

https://www.susans.org/index.php?topic=252160.0

xx