Susan's Place Transgender Resources

    K guys as the topic says - What method do you think is the most effective and why? I'd like to hear peoples responses cuz there is alot of debate on what method is best for maximum feminization. 


      My opinion is that injectable estrogen is the way to go. Injectables bypass the liver thus giving you the most EV2 out of your dosage, also using this method gives you a nice steady estrogen lvl & has less harmful side affects that orals are known for. I've also heard that using injectables gives you better results faster then orals and from my own experience i can vouch for that claim. When i first started hrt at 19 my endo at the time had me on orals (premarin) and althou i did see great results from it i experienced terrible side affects from it as well. I should add that even thou i saw great results from orals it DID take alot longer for me to notice them. Now at 25 i've been using injectables for 8 months and i'm seeing way better results then i ever did using orals and i was alot younger then too!  :o

   
     Only bad thing about using injectables is getting over the fear of needles but once you do it's like nothing.  :D  Oh and transdermals would be my second choice cuz of the bypassing liver deal but from what i hear they come off easy and can irritate your skin.  :P 

If you can check out injectibles, do it. I do sublingual estradiol myself, no muss, no fuss, and I'm post op anyway.

I think injectables are great for all the reasons you listed. My doctor feels the same way, too. And using a needle does kind of suck, but it's only once a week and it really isn't the worst thing in the world.

Quote from: NikkiJ on September 12, 2011, 09:31:16 PM
If you can check out injectibles, do it. I do sublingual estradiol myself, no muss, no fuss, and I'm post op anyway.

  Yeah alot of people do that with orals but i just didn't like putting a pill under my tongue every day...it tastes nasty!

Quote from: Sunnynight on September 12, 2011, 09:32:41 PM
And using a needle does kind of suck, but it's only once a week and it really isn't the worst thing in the world.

   Yeah 4realz, my injections are once every two weeks so twice a month is better then having to remember to take a pill every single day. Just my opinion lol.  :)

I do oral/sublingual. No worries with needles, and no spikes/drops in E2 levels like with injectables. You get the most constant E2 level on a daily basis. Oral/sublingual also will make getting you on the proper dosage easier because your doc will be able to get the most accurate E2 blood serum levels this way due to the constant and level daily administration.

Needles suck, plus I'd probably forget the schedule. >.< I guess I have to get over it. :3

Quote from: ~RoadToTrista~ on September 12, 2011, 09:41:02 PM
Are injectables more effective? Needles suck, plus I'd probably forget the schedule. >.<

  From my own exp....yes, but that is my opinion & there has been no study done to prove this.

Quote from: Sunnynight on September 12, 2011, 09:32:41 PM
I think injectables are great for all the reasons you listed. My doctor feels the same way, too.

Wish my doc felt that way... she won't prescribe anything but pills.

Quote from: Zoë Natasha on September 12, 2011, 09:50:31 PM
Wish my doc felt that way... she won't prescribe anything but pills.

What's sad is that estrogen is such a non-dangerous drug. It's not rocket science to prescribe it and keep someone's levels in check, regardless of the route of administration.

Quote from: Laura91 on September 12, 2011, 10:04:06 PM
It's not that bad. Try chomping on a finasteride or spiro pill because you can not swallow pills. Those pills taste truly awful.

Yuck... I don't even like the aftertaste from Spiro when I swallow it. Nasty, chalky mint flavor. Nasty.  :icon_omfg: :icon_blah:

Using theory only...

Intramuscular:

Effectiveness:
-Slightly faster effects
-Hormones only go through the liver once
-Makes your hormone levels spike up and down a lot, possibly resulting in non-maximum results.

Practical side:
-Moderate price
-A huge hassle to take
-Hurts
-The easiest to forget

Oral:

Effectiveness:
-Hormone levels do not fluctuate as much
-Hormones go through the liver twice and put a lot of pressure on it, resulting in higher risks

Practical side:
-The cheapest
-The simplest to take

Transdermal:

Effectiveness:
-Hormones only go through the liver once
-Hormone level are very stable, possibly resulting in maximum results

Practical side:
-Irritates skin depending on the individual
-Can come off
-The most expensive

In my opinion, transdermal is by far the best, since it's very gradual and slow. But it is yet unknown whether the big fluctuations in levels with injectable hormones affect the overall results all that much. Some claim that whilst injections give faster results, it may also be the smallest overall effects. It's controversal.

If it's true, then transdermals really are better. If not, both are equivalent in terms of effectiveness, but injectable wins because it's cheaper.

I started out doing oral and sublingual.  And have continued for the last 3 years.  When you place the pills sublingual, you by-pass the first pass through the liver, thus reducing risk.

I have thought about going to injectables, but I am so use to take pills.  I think I will just continue taking them.

Quote from: Forever21Chic on September 12, 2011, 09:28:37 PM

    K guys as the topic says - What method do you think is the most effective and why? I'd like to hear peoples responses cuz there is alot of debate on what method is best for maximum feminization. 


      My opinion is that injectable estrogen is the way to go. Injectables bypass the liver thus giving you the most EV2 out of your dosage, also using this method gives you a nice steady estrogen lvl & has less harmful side affects that orals are known for. I've also heard that using injectables gives you better results faster then orals and from my own experience i can vouch for that claim. When i first started hrt at 19 my endo at the time had me on orals (premarin) and althou i did see great results from it i experienced terrible side affects from it as well. I should add that even thou i saw great results from orals it DID take alot longer for me to notice them. Now at 25 i've been using injectables for 8 months and i'm seeing way better results then i ever did using orals and i was alot younger then too!  :o

   
     Only bad thing about using injectables is getting over the fear of needles but once you do it's like nothing.  :D  Oh and transdermals would be my second choice cuz of the bypassing liver deal but from what i hear they come off easy and can irritate your skin.  :P

I get so angry sometimes as I've fought with the U.K authorities for years trying to prove injectables are better than Pills and Patches. But the U.K still won't license injectables and they are not legally available or licensed in the U.K. So after over a decade on HRT I am still not able to get injections here in the U.K. Unfortunitely over here there is no freedom of choice with the 'out of touch' NHS and I have never had the opportunity to try injectables.

You don't know how lucky you are in America where medications are readily available over there and you don't have all the red tape we have over here to  try and get medications of treatment for gender dysphoria.

If anyone on this forum is also from the U.K and knows how to get injectables legally in the U.K please let me know?

Quote from: Laura91 on September 12, 2011, 10:04:06 PM
It's not that bad. Try chomping on a finasteride or spiro pill because you can not swallow pills. Those pills taste truly awful.

Yea. tried keeping one of those under my tongue today.... I ended up swallowing it after 5 minutes and had the nastiest taste in my mouth for an hour after. Estradiol doesn't bother me. its small and dissolves pretty fast under the tongue. its nasty, but not as bad as Spiro.

Quote from: A on September 13, 2011, 09:12:02 PM
Using theory only...

Intramuscular:

Effectiveness:
-Slightly faster effects
-Hormones only go through the liver once
-Makes your hormone levels spike up and down a lot, possibly resulting in non-maximum results.

Practical side:
-Moderate price
-A huge hassle to take
-Hurts
-The easiest to forget

Oral:

Effectiveness:
-Hormone levels do not fluctuate as much
-Hormones go through the liver twice and put a lot of pressure on it, resulting in higher risks

Practical side:
-The cheapest
-The simplest to take

Transdermal:

Effectiveness:
-Hormones only go through the liver once
-Hormone level are very stable, possibly resulting in maximum results

Practical side:
-Irritates skin depending on the individual
-Can come off
-The most expensive

In my opinion, transdermal is by far the best, since it's very gradual and slow. But it is yet unknown whether the big fluctuations in levels with injectable hormones affect the overall results all that much. Some claim that whilst injections give faster results, it may also be the smallest overall effects. It's controversal.

If it's true, then transdermals really are better. If not, both are equivalent in terms of effectiveness, but injectable wins because it's cheaper.

I am on patches and I find them super easy to use. The Vivelle-dot patch it is great.  It does not ever accidentally come off and luckily it doesn't irritate my skin and it's easy to apply.  Luckily I am responding very well to the dosage too which at first I worried would be too low. Only downside is the cost.

Spiro SUBLINGUAL.... you gotta be joking!!!

Never tried Fin though. EstroPause and EstroFem are OK.

But Spiro is the most bitter taste I EVER recall I had in my mouth EVER. Eh!

Best delivery method? Ovaries I would say, yeah --- call me stupid :-)

As far as patches go they WAY expensive for pre- and non-op E loads.
Post-op --- worth a try for sure.

Axelle

I use transdermals, patches if I'm with a partner and gel if I'm not. Gel can cause problems to the other person.

Started on pills but got stomach problems, tried needles but they freak me out and then went back to pills but got the usual problem and so ended up on transdermals.

Anti androgens don't come in transdermal form as far as I know so we're stuck with the ultra foul tasting Spiro. What it costs them to sort Spiro out with some coating is beyond me, surely that would be very easy?

the needle would be better for the liver for sure, but you got to work with what you got. :-\

I think I would prefer injections but my doctor is about 1 1/2 hours away from where I live. So, I'll stick with my pills. Besides, they've been working well.

the best information on hormone delivery is best given by your DR.

well i'm not on hormones yet but i would guess injections would be best, not causing as much pressure on the liver :)

Luckily my doctor said you can get anti-androgen's in injection form as well. YESSSSS i am happy about that because i don't like pills.

(here's a secret i have never swallowed a pill in my life and i'm 18, how sad am i :P)

Salisha x x

FYI...My doc says that there is no evidence that hormone pills cause any damage to the liver.

Good because this is all new to me. >.<

Quote from: Keaira on September 14, 2011, 02:35:44 AM
Yea. tried keeping one of those under my tongue today.... I ended up swallowing it after 5 minutes and had the nastiest taste in my mouth for an hour after. Estradiol doesn't bother me. its small and dissolves pretty fast under the tongue. its nasty, but not as bad as Spiro.

  Lol i don't think you're supposed to take spiro sublingual, it will dissolve the nerves under your tongue. xD


 

Quote from: JenJen2011 on September 14, 2011, 08:50:21 AM
I think I would prefer injections but my doctor is about 1 1/2 hours away from where I live. So, I'll stick with my pills. Besides, they've been working well.

  You don't need a doctor to give you injections it's actually pretty easy to do by yourself. Getting over the fear of needles is hard thou, my hand still shakes right before i jab myself.  :( 

Best hormone delivery method?  A small hollow needle attached to a tube with a plunger on the end of it.  Orals are processed through the liver, et al.  Transdermals aren't completely absorbed but that tiny needle stabbed deep into the muscle ensures you get all the doctor ordered.

But that damned brain with all its little thought processes that turns that little needle into a harpoon...  That's a problem.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Ft3.gstatic.com%2Fimages%3Fq%3Dtbn%3AANd9GcTjjqwxMmmzSG4kr60zoI70yMj3UaetQDkpQgNyo7T-21IuNF-vBodNP5t-&hash=d0a3b0f36388ea433e0fd44d38147afa0a973771)

Quote from: Forever21Chic on September 14, 2011, 03:50:38 PMYou don't need a doctor to give you injections it's actually pretty easy to do by yourself. Getting over the fear of needles is hard thou, my hand still shakes right before i jab myself.  :(

Ouch! I don't think I could.

Quote from: Forever21Chic on September 12, 2011, 09:38:55 PM

  Yeah alot of people do that with orals but i just didn't like putting a pill under my tongue every day...it tastes nasty!




   Yeah 4realz, my injections are once every two weeks so twice a month is better then having to remember to take a pill every single day. Just my opinion lol.  :)

I don't understand that, I don't taste mine at all, they're pretty small to begin with.

Watch out for the ups and downs with injectibles, one of the worst people I ever met in this scene boasted constantly about how superior she was doing injectibles, and was a total trainwreck of a person.

Quote from: NikkiJ on September 14, 2011, 09:46:53 PM
I don't understand that, I don't taste mine at all, they're pretty small to begin with.

Watch out for the ups and downs with injectibles, one of the worst people I ever met in this scene boasted constantly about how superior she was doing injectibles, and was a total trainwreck of a person.

    Well with any form of estrogen you have up's and downs that is unavoidable. There really hasn't been any actual study done to prove which method is best for trans women, from my own exp with pills vs injections i've had much better success with the injections and that is my opinion.

Quote from: JenJen2011 on September 14, 2011, 12:35:30 PM
FYI...My doc says that there is no evidence that hormone pills cause any damage to the liver.

Your doctor is likely right.

Personally I think this liver paranoia is likely a trans community myth.

There 'may' be a slightly reduced overall risk with injections (and by overall I mean risk of strokes and other complications, not liver damage) for people already unhealthy or older trans people. But in general I've never seen any scientific argument for why injections are so much better.

None of the commonly used medications for transition have warnings to watch for liver damage except for cyprotone actate.

None of the doctors I've ever gone too have done liver function tests on me with regards to HRT medications (they have however for other medications I'm no unrelated to being transgender)

Honestly I kinda think the transgender community (in particular the anti-self medication side) overhype the dangers of HRT medications.

By contrast to other commonly prescribed medications, they're very safe.

Quote from: Sunnynight on September 12, 2011, 09:32:41 PM
I think injectables are great for all the reasons you listed. My doctor feels the same way, too. And using a needle does kind of suck, but it's only once a week and it really isn't the worst thing in the world.

Injections arent the worst thing in the world?? Speak for yourself. I've heard that needles are the best way forward but i'm terrified that i'll be put on them, i've gotten over my fear enough to inject my dog but because of his fur I don't see the needle go in.
When I have a blood test or an injection at the dentist I end up crawling up the chair to get away from the needle & I can't even watch injections on tv.

Even if I wouldn't mind to have my booty jabbed and perforated like a colander, - injectables in my world are in NO WAY cheaper then pills.
28x 2mg Estropause are ~ 10.00 US$

Every GP jab is $35, just to say hello to the dude. That's before I paid for the E, his needle and what not.

No one seems to recall that cost. Doctor's visits do cost as well, not so?

Musing...
Axelle

Quote from: Axélle on September 15, 2011, 08:53:36 AM
Even if I wouldn't mind to have my booty jabbed and perforated like a colander, - injectables in my world are in NO WAY cheaper then pills.
28x 2mg Estropause are ~ 10.00 US$

Every GP jab is $35, just to hello to the dude. That's before I paid for the E, his needle and what not.

No one seems to recall that cost. Doctor's visits do cost as well, not so?

Musing...
Axelle

You are correct, indeed! Good observation. Imagine those with no medical insurance. :o

  Injections if there are difficulties with the other methods.  I choose the orals, they worked so well with me.  The orals are more convenient.  Sublingual on E & P. 
  Joelene

@asf

I am so glad you said those things. Sometimes I think I'm the only person in the world who thinks there are more dangerous meds out there than HRT. Just today I gave out a medication to a patient that is way dangerous IMO than ours

I get my blood drawn a lot, so I have no problem with the needles. I think if you go on injectibles, you can often get a nurse to inject you and maybe avoid a costly dr visit. It's always good to learn how to do it yourself. I think a lot of people fetishize the idea of the injectible. It's dramatic and symbolic, I can understand that completely.

As for my estradiol, I do it sublingually, so it's gone in a minute.

Quote from: Jane on September 15, 2011, 07:25:51 AM
Injections arent the worst thing in the world?? Speak for yourself. I've heard that needles are the best way forward but i'm terrified that i'll be put on them, i've gotten over my fear enough to inject my dog but because of his fur I don't see the needle go in.
When I have a blood test or an injection at the dentist I end up crawling up the chair to get away from the needle & I can't even watch injections on tv.

I can sooo relate to you there... anyone remember that needle pit scene in Saw !!

Saw II Needle Pit (http://www.youtube.com/watch?v=xbviirWLCQg&feature=fvsr#)

ARRRRRRRGHGGGHGHHHHHHH!!!!!!!!   >:-)

Quote from: Axélle on September 14, 2011, 06:01:51 AM
Best delivery method? Ovaries I would say, yeah --- call me stupid :-)

Axelle

...and it's Axelle for the win !!!

Quote from: Bird on September 16, 2011, 09:27:46 AM
Sometimes I think I'm the only person in the world who thinks there are more dangerous meds out there than HRT.

Maybe, but spiro has been responsible for people nearly losing their kidneys.
Cypro has the potential for destroying your liver.
YMMV.

QuoteHonestly I kinda think the transgender community (in particular the anti-self medication side) overhype the dangers of HRT medications.

I completely agree. But it's actually self-medicators that will steer you toward injectables rather than pills for safety and will argue how dangerous spiro can be.

Quote from: NikkiJ on September 18, 2011, 10:50:36 AM

As for my estradiol, I do it sublingually, so it's gone in a minute.

I agree.  And with sublingual you don't have to worry about possible liver damage.  I take a number of other meds, so one less thing going there is good to me. 

Now Spiro is a different matter.  I can't for the life of me imagine Spiro (or even Finasteride) sublingually.  Just swallowing Spiro is horrible IMHO.   Estradiol kinda has a sweet taste, really no trouble. 

It was kind of easy in my case.  Since my body didn't respond to spiro, I got put on depo provera.  So instead of testosterone eating my body alive, I get to be suicidal!  Joy!  And yet, I prefer that to the testosterone.  Is that crazy or what?  Still, I started antidepressants last Friday and I'm hopeful that they'll work. :)  Maybe, in the very near future, I get to have lowered T and a desire to live.

Quote from: Zoë Natasha on September 20, 2011, 10:38:41 PM
Maybe, in the very near future, I get to have lowered T and a desire to live.

Your humour always cracks me up, Zoe.

It's like they say... When life pulls the rug from underneath you... learn to dance on the go.

I wish I had the opportunity to try shots! but over here in the United Kingdom they are not legally licensed which is a real bummer!

i say Injections. if i can start back in Jan i will do them

   I've been looking into estrogen pellets. I guess they surgically implant them into your bum and they dissolve over a few months. Anyone tried this method yet?  :-\

i have not but also think that could be a very good way to go

Quote from: Forever21Chic on September 27, 2011, 07:57:22 PM

   I've been looking into estrogen pellets. I guess they surgically implant them into your bum and they dissolve over a few months. Anyone tried this method yet?  :-\

Yes, I have tried them. I went on them because it was nearest thing I could get to shots over here in the U.K.  I thought the implants were working well but the implant never dissolved and I still have it in my butt a year later! I now need to get it surgically removed. I've now found out the implants have been discontinued by the manufacturer. 

Sorry for necro'ing this thread,  but I have a few ideas or whatever.

I have questions or whatnot for all of these delivery methods. \

First of all, I've only ever done pills. From what I understand about pills, it is prone to being processed by the liver before ever hitting the blood stream if some of the chalkyness slips out from your tongue. That would render a certain dose not quite that dose, right?

With injectables, you have to buy needles, dispose of the needles, be careful with them, prick yourself, and on top of it all, at the end of the week, you're low on estrogen, right? I would think the lack of consistent estrogen would hurt. On the other hand, upon initial injection you get a spike in levels. Maybe on day 6, one could support their waning estrogen with a pill or 2?

With transdermal patches, they're visible and can come off in a shower! I wouldn't want to worry about somebody seeing the patch on me for whatever reason. With cream / gel, doesn't that stuff rub off on your clothes?

What if money wasn't an issue? Let's say my insurance covers every penny of my HRT. What would be the best delivery method then? I am honestly thinking about asking my doctor if she could switch me to gel / cream, because I think some of the estradiol she's prescribed me is escaping from under my tongue (I can feel it in my teeth) and I don't want to stick myself with a needle and deal with safely disposing them. IDK, I think I may inject myself but only if I was allowed to supplement a small bit at the end of the week with some oral or cream.

Thoughts?

I consider Hormone creams dangerous as their is a substantial risk of affecting others around you personally. They can get in your bed clothes, adversely effect loved ones and pets. Triggering hormone problems in them.
Spayed pets going into heat, Kids experiencing premature puberty, (or incorrect puberty) unintentional feminization of male partners unintentional masculinization of female partners ect.

Patches... yeah they arn't bad expensive in my experience so if cost wasn't a factor I'd go with those. They can be messy. what with the adheasive but they work and are safe.

Injections I use these they are moderately safe (Barring hazards accociated with needles), highly effective and very cheap for what you get whitch makes it ideal for me where the NHS still drags it's heels and ignores me years after I asked them for help.

Pills the Ethynl-Estrogens are the ones that are the particularly dangerous ones whitch cause blood clots and liver damage these arn't seen so much their are native human estrogen pills these days however they are often digested by the body before begin absorbed. They can cause anywhere from good to bad feminization depending on the indivduals digestive tract.

The sublingual ones are better than the regular pills and are safer too but they have to be especially formulated making them rather expensive.

I've. been using transdermal patches for years and I've tried the US brands. I currently use the Vivelle Dot. It adheres to my skin the best and it doesn't irritate my skin. The only thing I don't like is changing it bi weekly. Climara doesn't adhere as well as Vivelle but the patch lasts the whole week. Generics suck! They're thick and don't stick. If it comes.off in the shower it's toast. Vivelle & Climara you can reapply.

Injectables sound great but for one problem. My insurance has a 50% share of cost on injectable meds. They pay 100% of the patches :-)

Normally USPS...

But can't go wrong with FedEx

There is also a nose spray.
One spray in the nose every morning, a deep breath trough the nose and you're done.
The Estrogene will go to the blood trough the mucosa of the nose.
Easy and with excellent blood levels.

Don't know or it's available in the US.

I have been on HRT for almost a month now, and have been taking estradiol sublingually - but swallowing the rest of the pills (finasteride and spiro). I developed sore and puffy nipples right away within 2 weeks, so I think it is working pretty well.

Estradiol doesn't taste awful sublingually in my opinion.... actually, a lil sweet as matter of fact

Quote from: MsDazzler on November 16, 2011, 10:17:54 PM
I have been on HRT for almost a month now, and have been taking estradiol sublingually - but swallowing the rest of the pills (finasteride and spiro). I developed sore and puffy nipples right away within 2 weeks, so I think it is working pretty well.

Estradiol doesn't taste awful sublingually in my opinion.... actually, a lil sweet as matter of fact

OMG I think it tastes like ice cream. I find myself wanting to snack on them like tic tacs... but I don't...

I only worry about it dissolving and moving thru the teeth and eating pieces of  it, then the liver gets it and breaks it down to less effective levels. The generic is what I have this problem with. However I just kinda cap it tight under my tongue and I've found it to be effective.

My results were like yours when I started. Then I was actually prescribed them and took them at a different scheduling arrangement. I thought HRT was losing effectiveness because of my theory about breaking away, but I've since switched back to taking exactly half my dosage in the morning, and half after work, and I'm back to sore, slightly uncomfortable nipples.

Quote from: Alainaluvsu on November 16, 2011, 10:55:32 PM
OMG I think it tastes like ice cream. I find myself wanting to snack on them like tic tacs... but I don't...

I think they taste like children's tylenol.

Estradiol does taste pretty sweet.

I took it for a month regularly(swallowing...lol swallowing)
But then I started doing it sublingually ever since and I started feeling better.

Quote from: JoeyD on November 17, 2011, 12:24:31 AM
Estradiol does taste pretty sweet.

I took it for a month regularly(swallowing...lol swallowing)
But then I started doing it sublingually ever since and I started feeling better.

Sweet as femininity on a springs day.

Quote from: JoeyD on November 17, 2011, 12:24:31 AM
Estradiol does taste pretty sweet.

I took it for a month regularly(swallowing...lol swallowing)
But then I started doing it sublingually ever since and I started feeling better.

I did the sublingual with the regular estrodiol at the start.  Physical relief after 2 1/2 weeks, mental, two months.  Fast, compared to the 50+ years suffering.  Estrodiol amount is in a small percentage in that tiny pill.  Fillers and a sweetener make up most of that pill.  Estrodiol gets absorbed by the lower palate but not the sweeteners nor the fillers.  Don't worry about that getting swallowed.  There will be more than enough estrogen that gets absorbed anyway in most cases. 
  Joelene

Quote from: annette on November 14, 2011, 03:53:33 AM
There is also a nose spray.
One spray in the nose every morning, a deep breath trough the nose and you're done.
The Estrogene will go to the blood trough the mucosa of the nose.
Easy and with excellent blood levels.

Don't know or it's available in the US.

That sounds super cool.

If you take oral estrogen, make sure you get the micronized, and take it sub-lingual.  If your dr prescribes them, they will give you them automatically at Walgreens, but injectable is much more potient, as like said above, it goes right into your bloodstream, bypassing the liver.  The thing you have to watch for is that is you take too often or too much, it can cause acute depression.  So make sure you or your drs knows and has experience with MTF HRT.