Susan's Place Transgender Resources

So I had my appointment with the doc today, and he prescribed estrogen for me, but on the prescription he wrote sub lingual (under the tongue), because he said he's found that putting it under the tongue helps bypass some of the problems with it building up in the liver (or something like that).

However when I went to the pharmacy (in my supermarket), they said that it doesn't actually come in sub-lingual form, so they would have to call the doctor to ask about that, but by that point it was 7:20pm so they're going to call tomorrow and then call me back.

So I was wondering if anyone else's doctor has had them take their E under the tongue, and if so did you have the same pills as normal E or special sub-lingual pills?

Quote from: Ketsy on May 19, 2010, 06:46:00 PM
So I was wondering if anyone else's doctor has had them take their E under the tongue, and if so did you have the same pills as normal E or special sub-lingual pills?

subling. is done with plain uncoated tablets

The standard estrogen pill can be taken sublingual.  Sublingual is the method of delivery.  The pills are nothing special.  Go get your pills.  ;D

Quote from: Ketsy on May 19, 2010, 06:46:00 PM
So I had my appointment with the doc today, and he prescribed estrogen for me, but on the prescription he wrote sub lingual (under the tongue), because he said he's found that putting it under the tongue helps bypass some of the problems with it building up in the liver (or something like that).

However when I went to the pharmacy (in my supermarket), they said that it doesn't actually come in sub-lingual form, so they would have to call the doctor to ask about that, but by that point it was 7:20pm so they're going to call tomorrow and then call me back.

So I was wondering if anyone else's doctor has had them take their E under the tongue, and if so did you have the same pills as normal E or special sub-lingual pills?

I've never seen a special formula for sublingual estradiol.  My doctor told me the same thing, but I've often wondered how much gets dissolved sublingually and how much actually slides down my esophagus into the stomach.  Another doctor friend told me that the pills need to be specially formulated in order to be sublingual.

That's what I thought... well, what's one more day in the scheme of things :).

QuoteSo I had my appointment with the doc today, and he prescribed estrogen for me, but on the prescription he wrote sub lingual (under the tongue), because he said he's found that putting it under the tongue helps bypass some of the problems with it building up in the liver (or something like that).

I think the specific reason is so the estrogen only passes through the liver once.  There's potentially more risk involved when you simply swallow and get multiple passes.

Edit: Oh yeah, and for what it's worth I take mine sublingual as well.  They're just plain old estradiol tablets.

Congrats on your prescription by the way :)

normal little blue E tabs uncoated, kinda sweet. I also wonder how much goes down tne esophogus. Cause some days I feel I have more E in my than other days.

Quote from: cynthialee on May 19, 2010, 08:04:06 PM
I also wonder how much goes down tne esophogus.

I understand that the "hard on the liver" justification does not apply to modern bio-identicals, but I still try to take mine when I can let it dissolve over several hours under my tongue. The absorption directly into the bloodstream via diffusion through the capilaries is supposed to be much higher than if it goes through the digestive system. If you taste it you waste it.

Quote from: Valeriedances on May 20, 2010, 03:25:22 PM
It's great that your doctor was clear about how he wants you to take them and the prescription is marked that way.

After reading posts of others taking theirs sublingually, I asked my endo and she said no, take them orally. So it looks like it depends on the doctor. Maybe the dosages would be different depending on how it was taken. It's good to be clear.

Yep Subbing you need only between 1/2 and 1/4 of the dose to get the same blood serum levels so taking an oral dosage sublingual could be dangerous.

Oh yes - and Ketsy - the ones containing Estradiol-Hemihydrate can be taken sublingual - the Uk brand name is Elleste-solo but they are exactly the same formulation as the Estrace that the USA girls use for their sublingual meds.

Well it turns out they do make ones specific for sub-lingual, which they did have at the pharmacy, so it was all just a big mixup.  So I just got back with them and the bottle is sitting on my desk, temptingly.  I'm curious -- is it better to take after a meal? before a meal?  Some time later?  Or does it not really matter?  I'm eating dinner first because I have a birthday party to go to.

I take mine in the morning. Sub of course.  If I miss the morning I take them when I remember.  And seeing I don't do breakfast, it would be before a meal.

Quote from: Ketsy on May 20, 2010, 06:37:51 PM
Well it turns out they do make ones specific for sub-lingual, which they did have at the pharmacy, so it was all just a big mixup.  So I just got back with them and the bottle is sitting on my desk, temptingly.  I'm curious -- is it better to take after a meal? before a meal?  Some time later?  Or does it not really matter?  I'm eating dinner first because I have a birthday party to go to.

What is the brand name of those please - just out of curiousity... I take mine sub with my doctors approval - but if there is a special formulation I'll ask him to switch it next time. Please PM me if you don't want to post brandname details...

I can't see a brand name, it just says Estradiol on the bottle.  They're little blue-green oval pills -- on one side it says 887|2, and the other side has either a b or a q.

Quote from: Ketsy on May 20, 2010, 06:47:05 PM
I can't see a brand name, it just says Estradiol on the bottle.  They're little blue-green oval pills -- on one side it says 887|2, and the other side has either a b or a q.

Hey, that's what I take!  It's a generic form of Estrace:  http://www.drugs.com/imprints/b-887-2-1098.html (http://www.drugs.com/imprints/b-887-2-1098.html) 

My doctors have never prescribed specifically sublingual preparations before.  I'm not entirely convinced it comes in a different tablet form than this. 

But to answer your other questions about when to take it, I was never told when.  I take mine after meals with my other pills.  But if it's entering your bloodstream via sublingual method, I wouldn't think it would matter.  I take multiple e pills a day and space them out to keep me girly all day long  ;)

Interesting.  Well I just took the first one... not really sure what to expect at this point :).  It's a little unreal that this is even happening.

In about 5 minutes you will begin tripping like on acid.  Then you will begin to have hot flashes.












jk
I feel only peace form the first one.

I take mine at bedtime

Quote from: Ketsy on May 20, 2010, 07:34:47 PM
Interesting.  Well I just took the first one... not really sure what to expect at this point :).  It's a little unreal that this is even happening.

Wow, that's exciting!  Your first HRT pill?  I remember my first one too, not knowing what to expect.  It takes a while, at least a few weeks for me until I felt some breast tenderness.

Quote from: Ketsy on May 20, 2010, 07:34:47 PM
Interesting.  Well I just took the first one... not really sure what to expect at this point :).  It's a little unreal that this is even happening.

OMG! That is so cool. It wasnt that long ago I took mt first HRT.
Just relax. In a few days your brain will notice it has E in it and the changes will start .
I was so excited the first dose I was shaking so bad I almost spilled my pills.

I never understood the way a medication builds up in your system or the effect of dosage and half life until I tried to figure out how I was supposed to take four hormone tablets a day. My doctor put me on a conservative dosage for the first two weeks to make sure I didn't have any negative effects and increased it to a full transition level after two weeks. Rather than giving me a new prescription, he just told me to double things up. Given the 12 hour half life, taking my prescriptions every six hours keeps my estrogen level extremely level. I'm sure taking it sublingually, I must have more hormones pumping through me than a squad of teenage cheerleaders :)

It's been about 5 hours... not feeling anything particular yet, but I can be patient.  I'm going to be on twice a day, but the doc told me to take once a day for the first few days just to be safe.  I guess I must have good health insurance because it only cost me $8 for the month.

that is good, no reaction.  But funny too.  it will be a bit for the feelings some thing

Yeah the normal amount of time it takes for the HRT to mellow the mind is 3-7 days. Don't expect instant results, just ain't gonna happen.
Your brain has to recognise it has E in  the body befor it starts changing things.

Quote from: ƃuıxǝʌ on May 21, 2010, 07:31:37 PM
Where did you get that stat from?

Ya know I didnt know I was being held to thesis level of justifications for my arguments and opinions. Clearly I am wrong on so many things with you it seems.
I can not be bothered to remember the source every silly little statistic and piece of trivia I have read.

But I can see clearly from anectotal evidence, (which probably does not meet your stringent acedemic requirements) that is indeed a matter of a few days to a week before most people I have known that have started HRT to feel a diferance.
Have a wonderful day.

I had dizzy spells, hot flushes and a bitching temper within 24 hours of starting to take anti-androgens and estrogen   :P    Soon settled down though and then I had about 3 months of feeling utterly blissful.
About a month in, I started filling up with tears at anything and nothing.   Weird, to be unable to stop tears seeping out although not actually particularly upset or unhappy - I couldn't even relate any slightly sad news, like "The neighbours dog died last week" without getting weepy ....... then giggling at myself and the ridiculousness of it all..... whilst still crying.   ;D
By then my skin was softer and the large pores less visible and much less greasy, as was my hair.

By the fifth week, my nipples looked like they each had half a golf-ball under them and felt like it too.

Now, a couple of years later the blissfulness and the tearfulness are still there, but less than a quarter what they were during that first period.

i've always had a problem trying to figure out whether im supposed to swallow or put it under my tongue.... i've been swallowing. i just hope when i go see my endo in September he doesn't tell me i've been taking it wrong......

I'm taking my estrogen pills sublingually aswell. Injections used to be offered in my country but for some reason not anymore.

I started my HRT with oral pills that you have to swallow and then my doctor prescribed me sublingual pills when my estrogen levels just refused to rise. She told me sublingual ones are more effective and at least for me she was right. My estrogen levels began to rise dramatically.  :)

I'm bumping this thread as I had the same question.  I just started HRT yesterday.  My endo told me sublingually is safer, but I would interpret the instructions I have as orally swallowing.

I swallowed my first pill but have dissolved the last 3 under my tounge.  I take tablets 3 times a day...I have been spacing them out at around 8-hour intervals.

I know this thread has some age.  Based on this thread, should I be concerned about the delivered dosage to the body? 

Basically, if you swallow then the drug enters your system via the liver.   It is this first pass through the liver which is most hazardous and likely to cause the formation of blood clots.
In passing through, the liver will filter out around two thirds of the estrogen.
Taking sublingually a much greater percentage of the estrogen will be absorbed directly, bypassing the liver.

Avoid grapefruit juice - it interferes with the liver's abilities and can lead to very high blood-estrogen levels.

One precaution you may need to have with sublingual administration is that your blood levels will be very high immediately after taking it, but it drops pretty quickly. Taking it sublingually, I would say it's better to split your doses into 2 a day so you remain high enough consistently to see effects. I do sublingual btw, and I have very little room to complain about the changes I've seen on HRT.

Take 3 pills a day for a couple of years and you will stop caring how it gets into your body (at least I did) I usually stick them under my tounge but like others have said I wonder how much I'm swallowing anyway some times I want to eat or drink something right after I put the little blue pill (why are they blue shouldn't they be pink?) under my tounge then I end up swallowing them anyway. I have even been known to chew them up on occasion. You will be taking estrogen for THE REST OF YOUR LIFE I don't think swallowing a few here and there is going to make a bit of difference in the grand scheam of things.

I never "felt" anything from E but gradually over a long period of time I noticed changes. Some of those changes were phyisical some were mental/emotional but none of them amounted to "feeling" like I was "on something". In fact I was pretty much majorly depressed when I started HRT and that continued unabated until I started taking antidepressants which helped. What really got rid of the depression for me was quiting the anti androgen I was on (Cyproterone). My T level is still pretty much zilch without any anti androgen and I no longer have week long crying fits.

Hi!
I was just prescribed estrogen sublingual too, but I'm not sure if I'm doing it right. I always salivate way too much, so I'm not sure how effective this could be. Is there a technique to do it?

I'm still not sure if I'm doing this right.
There always seems to be some sort of residue, but I'm not sure if that's what's left or if that is the entire pill, just dissolved.

I read in an older post to put the pill under your tongue and hold it flat against the bottom of your mouth until it dissolves. Times vary from a few minutes to forty five. If you salivate a lot it seems like it would go quicker. Hope this helps, hugs, Devlyn

Thanks!
I salivate way too much so that's worries me. But if it's helps things along, then it's good.

if you kinda seal the pills off with your tongue and don't move your tongue, then saliva won't get to them.

Hmm, I feel like if I consciously do that, I salivate a lot more.
And when I do, it builds up really quickly and mixes with what's left of the pill. After this, it's just really uncomfortable and there is no way I can hold it for more than five minutes. Even so, the rest is not absorbed.
So I usually swallow the rest. Is this a bad thing?

So I'm still failing at this and swallowing way too much because I just can't keep my tongue still, and if I pay any attention to it, I salivate too much which causes me to swallow. I've noticed that any other time I think I still salivate.
I've already tried sealing my tongue, but that still caused saliva to build up and I locked my jaw, that it hurt when I tried to eat later.
It really shouldn't be that hard, so what am I doing wrong?

I think the only problem is that you're worrying about it. You put it under your tongue, it dissolves, you're done! You can't control the amount of saliva, and I'm thinking the only issue would be a dry mouth that doesn't allow the pill to dissolve at all. Have a nice day, hon! Hugs, Devlyn

Without being rude as far as E is concerned it doesn't matter, on the doses we are on forget it.


I will crawl into my cave and let all the people who know better tell you.

It doesn't matter. Why do you tell a patient to do sub-lingual?

They have problems swallowing - suddenly it goes around the clinic

35 experience, dumb from birth.


CJ PhD FFs(RCPA)

I guess that it's true that I worry too much.

Thanks anyway!