I know we are not suppose to discuss levels so maybe I can safely phrase it this way. How would 2 mg a day from patches compare in effectiveness to 2 mg a day from pills????
I changed a month ago from patches to pills & I just do not feel as good or the same. A new blood test is around $500 so I'd prefer not to do that all the time.
Thanks for any advise.
You could have a look here:
https://www.susans.org/forums/index.php/topic,190982.msg1703299.html#msg1703299
hugs
After recently being changed from pills to patches, I can say that, for me, patches appear to be doing better.. My level is a touch higher and I, overall, feel better and have had some further breast development - something that stalled about 2.5-3 years ago on pills.
Quote from: Laura_7 on July 12, 2015, 05:41:47 PM
You could have a look here:
https://www.susans.org/forums/index.php/topic,190982.msg1703299.html#msg1703299
hugs
Thanks but nothing there but talk. I know patches deliever drugs better than pills. I just wondered how much of a difference. Like pills are 90% as effective or 50% as effective??? No big deal, I'll ask my doc later.
I started with pills almost 20 yrs. ago. (stopped after 5 yrs. due to life's issues) They worked fine no side effects reasonable success. I am now in my late 60's and started 'mones again for the long haul. This time with patches. Pills are not absorbed directly into the bloodstream and after passing through the digestive system lose some of their efficacy. Patches are the recommended method of delivery for us older gals, as they do not put any added stress on the liver & kidneys. For some, they can be a skin irritant. The adhesive can fail at times when showering or bathing and they require careful placement (which comes with experience). Also, if you are working out, excessive sweating can be an issue. Always keep extras on hand just in case you need to replace one before its time to change it. Hope this helps.
Hugz,
Joi
Quote from: FrancisAnn on July 12, 2015, 07:08:37 PM
Thanks but nothing there but talk. I know patches deliever drugs better than pills. I just wondered how much of a difference. Like pills are 90% as effective or 50% as effective??? No big deal, I'll ask my doc later.
Based on levels, I'd say that patches are about 25% more effective for me - assuming the same dose, which they aren't. Patches have a lower dose and give me a higher serum estrogen level..
Which method is most effective varies by person.
However, a 0.1 mg patch (that is, 1/10th of a milligram) is roughly equivalent in terms of average blood estrogen levels achieved to 2 mg of estrogen. Which means, if my math is correct, that a patch delivers about the same punch per milligram as 20 1 mg pills. That's not the same as saying it's 20X more *effective* in terms of feminization, though, because the patch doses are titrated for that effectiveness - a fancy way of saying that doctors prescribe patches in tenths of mg and pills in whole mg. They don't prescribe 2 mg per day in patches, as that would be 20 freaking patches. :)
(THIS IS NOT DOSAGE ADVICE. These numbers are included for illustration only, using one of several commonly found patch dosages, and is not a recommendation of any kind.)
Thanks Jenna Marie for clarifying that difference between the 0.1 mg. patch & the 1 mg. pill. Helped me understand my patch therapy better.
Quote from: FrancisAnn on July 12, 2015, 07:08:37 PM
Thanks but nothing there but talk. I know patches deliever drugs better than pills. I just wondered how much of a difference. Like pills are 90% as effective or 50% as effective??? No big deal, I'll ask my doc later.
Everyones skin is different. So there is no definite comparison.
Patches deliver a steady dose , usually not that high. Delivery is supposed to be more safe due to delivery into the blood stream which is supposed to be connected with less clotting factors.
With pills there is a slight seesaw pattern, which can be seen in the graphics in the link above.
Sublingual use instead of directly swallowing is also supposed to avoid some strain on the liver and some clotting factors, and its supposed to be a bit more effective. All shown in the graphics above.
To keep levels more steady spreading the daily dose over lower doses a few times a day instead of one or two higher doses might help.
The seesaw pattern might affect mood, like a slight pms syndrome a few times a day. As said, spreading the dose for more steady levels might help.
Concerning levels, many docs meanwhile not only look at levels but ask how the patient feels.
If you feel your levels are lower you might talk to your doc.
Quote
Which means, if my math is correct, that a patch delivers about the same punch per milligram as 20 1 mg pills.
You mean 2 1mg pills.
All in theory because it depends on the individual skin, absorption can be different from individual to individual.
You might think about adding bioidentical progesterone, which also might help with mood, even out some side effects of estro and might help with breast development.
hugs
I've found patches to be much better as a hormone delivery system as I had to change over to them from pills due to health problems. My breasts woke up and grew a bit more, my skin is nicer and no issues with GI side effects. The only downside to patches is trying to find the best way to get the left behind black circles off my skin whenever I remove one.
THanks so much. I used patches for about a year with not too much irriation however I started to itch so much it drove me crazy so a month or so I switched back to pills. I know patches are safer & seem more effective so maybe I'll try again soon. 7 larger days patches were easy if they did not itch so much. I could only stand them for 2-3 days then a red rash. I have sensitive skin. Other 3.5 day smaller patches worked OK but such a pain changing every 3 & 1/2 days but they might be the best solution & safer. Maybe I should ask my doc more about a pellet implant. That might be the best solution. Thanks so much & good luck to us all.
I've been on & off E since my early 20's. I tried hard to correct my gender long ago but I had to stop. Now in my late 50's, in good health & look very good. I started back full time with pills 2 years ago then changed to patches to try & be safer. I want a nice long life. I take care of myself, eat right, on the Atkins diet for 6 months, MBI of 26.5. I look good after all my plastic surgery. Anyway I stiched to patches about a year ago with little 3.5 day patches & they did not itch too much, then tried the climara 7 days patches & they worked OK for a while then itched so much I would have to take them off in 2-3 days, such a waste of money. So now back to pills. Ugggg, so frustrated. I want to live long & be safe so maybe I'll try patches again. Maybe an implant is right but I hear a lot of bad stories about pellet implants. I do not need more trouble. I've had a plenty healing up from surgeries.
Oh me, it's so frustrating if only some safe simple way to receive the right hormone. Good luck to us all.
Laura : No, I mean 20. I referred to 1/10th milligram patch. So 1 mg of patch is 10x as much as a tenth of a mg, meaning the 2 mg pill dose also would get multiplied by 10 = 20. There actually are studies out there making the comparison in average blood levels, as well. I actually picked 0.1 mg just to make the math easier for me!
Joi : Glad to help. :)
Haven't had pills, but patches were fine. Never experienced the roller coaster of emotions that some people on pills describe, and had very good breast growth.
Oh, yeah, patches are annoying in a practical sense. I rotated patch locations, but they still left my skin with minor irritation and itching. I do have pale, sensitive skin, though. I burn easily and glow in the dark... @_@
I'm going to rotate locations more. That might have caused the problem, I kinda used the same areas over & over. 7 day patches were nice, kinda forget them. Thanks.
If I remember correctly, you are supposed to rotate locations because each location can become irritated from the adhesive and not absorb it as well as a result.
Mariah
Quote from: FrancisAnn on July 13, 2015, 06:12:28 AM
I'm going to rotate locations more. That might have caused the problem, I kinda used the same areas over & over. 7 day patches were nice, kinda forget them. Thanks.
I so wish there were some better way. I see my doc Thursday. I'm going to ask about implants again. I do not want to go through life dealing with patches or pills if I can help it. Patches gave me fits itching, red areas, know pills are not safe in the long run. Yuck. Good luck to us all.
My completion has surely changed in the past few weeks, ugggg. I'm gonna stick a patch on my butt & hope for the best. I just cannot take life without estrogen. Thanks to all.
The patches can be extremely effective. However, for some like me, I was sensitive to the adhesive and had to change. Pills were not an option due to metabolism difficulties. That left shots or cream. I use the cream. I use a low dose twice a day with no real problems and it is very effective. I have not tried shots.
There are companies in the US that will do estrogen testing on-demand. It's $150.00 US and was cheaper than the lab that my doctor was sending me to use.
Hugs,
Jen
Patches never worked for me, irritation and loss of adhesion :-\
Went on Oral... next stop implants/pellets
Katy xx
Thanks, I got hit for $520 for my last simple blood test, yuck. Maybe these patches will not itch, I sure hope so. Before I use the same locations pretty much, maybe that's what caused the trouble. I still want an implant so it's just not something to deal with every day. Maybe soon.
Quote from: FrancisAnn on July 13, 2015, 06:30:27 AM
I so wish there were some better way. I see my doc Thursday. I'm going to ask about implants again. I do not want to go through life dealing with patches or pills if I can help it. Patches gave me fits itching, red areas, know pills are not safe in the long run. Yuck. Good luck to us all.
Concerning patches, you might have a look here:
https://www.susans.org/forums/index.php/topic,189624.msg1688205.html#msg1688205
QuoteMaybe an implant is right but I hear a lot of bad stories about pellet implants. I do not need more trouble. I've had a plenty healing up from surgeries.
Well what kind of stories did you hear ?
Pellet implants of bioidentical estrogen are considered one of the best methods of delivery.
They deliver a steady dose, no seesaw pattern, over a longer time without further hassle.
Available are bioidentical estrogen, bioidentical progesterone and a low dose of t after srs.
There is even one form of hrt where bioidentical estrogen alone is enough to drive e well into the female range and t down into the female range as well, without further anti androgens. This usually works only with implants and injections.
You can look up experiences of others on susans, many are very happy.
Many stories people hear might be due to non bioidentical forms, both estrogen and progesterone. Side effects on liver etc are much different in synthetic forms, bioidentical ones are supposed to be safer. This is shown by studies.
hugs
Thanks, I only have one good friend that had implants for E, she had some trouble & stopped. I'll ask my doc on my next visit. The patches worked for a long time then started itching. I think it was from me using the same areas. Thank you so much for your time, you are more knowledgable than me, I just want some E that works & is safe.
I've used estradot & climara for well over a year, like the dot ones, small, last well. I just got tired of every 3-4 days swapping, tried big climara, they worked ok for a while but I used the same areas, bet that was the problem, thanks again. Climara are on now, maybe no trouble for a while, that will be a refief, I have a big supply.
Quote from: FrancisAnn on July 13, 2015, 10:51:01 AM
Thanks, I only have one good friend that had implants for E, she had some trouble & stopped. I'll ask my doc on my next visit. The patches worked for a long time then started itching. I think it was from me using the same areas. Thank you so much for your time, you are more knowledgable than me, I just want some E that works & is safe.
Imo implants are one of the best solutions. You might ask for bioidentical estrogen.
An implant lasts about 4-6 months usually.
They dissolve on their own.
hugs
Laura, thank you & everyone so much. I was so rattled. I hope for better E & implants soon so I can just relax a while. I had liposuction & tummy tuck surgery 6 weeks ago. That hurt & was a challenge healing up from. I just do not need any more stress for now including the risk of pills or itching.........TC GF
Climara patches. If you are going to try them do not buy many. Just 6 hours on an entirely new area & already burning my skin, uggggg. What a waste of $ & effort.
Well their manual says lower belly below navel...
or upper buttocks...
you might try a spot in the front for a change...
here is a picture of the prrocedure:
hemingways.org/GIDinfo/drugdata/ClimaraPI.pdf
hugs
I have around eight sites on my body where I rotate the patches around in turn. I've found if I overuse a particular spot or leave a patch on too long I get some redness and irritation. Aloe gel is good to sooth the irritation, but it sounds like your skin must be really sensitive if you're getting irritation after only 6 hours.
Quote from: Laura_7 on July 13, 2015, 06:33:08 PM
Well their manual says lower belly below navel...
or upper buttocks...
you might try a spot in the front for a change...
here is a picture of the prrocedure:
hemingways.org/GIDinfo/drugdata/ClimaraPI.pdf
hugs
Tummy tuck surgery: Incision from one side of your body to the other + ............You don't want to know all the details for a flat stomach so no, not putting anything on lower stomach, still healing up. No idea what's in climara patches but it gives me fits..... Back to little dot 3-4 day patches I guess until implant. Thanks
Quote from: FrancisAnn on July 14, 2015, 12:24:03 AM
Tummy tuck surgery: Incision from one side of your body to the other + ............You don't want to know all the details for a flat stomach so no, not putting anything on lower stomach, still healing up. No idea what's in climara patches but it gives me fits..... Back to little dot 3-4 day patches I guess until implant. Thanks
You could look up he manual for the little dots.... some manufacturers give a few more spots, like on the arm.
Upper buttocks are supposed to be most effective, but if for example upper arm is a bit less effective yet does not itch it should be better.
Just look into the manuals or ask your doc.
The manuals all say to stay away from the breasts.
hugs
I've used my upper arms as patch sites and subjectively speaking I don't think they were as effective, but putting them there is better than nothing. No irritation though, which I suppose is the point of the exercise.
Tried patches,got a rash and they always came off in the shower.It's a whole lot easier to swallow a pill when I get up
Quote from: Laura_7 on July 14, 2015, 02:08:37 AM
You could look up he manual for the little dots.... some manufacturers give a few more spots, like on the arm.
Upper buttocks are supposed to be most effective, but if for example upper arm is a bit less effective yet does not itch it should be better.
Just look into the manuals or ask your doc.
The manuals all say to stay away from the breasts.
hugs
Thanks, no idea what's going on with my skin, I used dots for almost a year with no trouble at all on lower stomach but since my surgery my skin is so sensitive. I'll try dots on my butt & see. Doc appt for Thursday anyway so maybe I can finally get an implant. I've wanted a nice implant for a year or more anyway. Thanks for everyone's help & advise.
Oh if anyone reading this is considering liposuction & tummy tuck surgery it is amazing how nice your waist line will look & how more of a hour glass figure you will have but it is very painful for the first 2 weeks, then just uncomfortable for a while. You will have to wear a tight corset 24/7 for almost 2 months. However it is amazing how much nicer your midsection will look. Good luck to us all for a happier life.
Quote from: Lady Smith on July 13, 2015, 03:36:00 AM
I've found patches to be much better as a hormone delivery system as I had to change over to them from pills due to health problems. My breasts woke up and grew a bit more, my skin is nicer and no issues with GI side effects. The only downside to patches is trying to find the best way to get the left behind black circles off my skin whenever I remove one.
Kendall makes a product called "preppies" that some clinics use to remove adhesives, works well for me for getting the ring off:-)
Quote from: Tessa James on July 14, 2015, 02:04:15 PM
Kendall makes a product called "preppies" that some clinics use to remove adhesives, works well for me for getting the ring off:-)
Thanks, - I'll check that out. I've been using aloe wipes, but I don't like having to scrub too hard at my skin.
I initially tried patches as well and could not stand them. I have sensitive skin as well and they would just itch and then I would get a rash. Then I went to sublingual pills which were ok and worked. With much reluctance I went to injections and have not looked back. I was not thrilled about giving myself a shot but once I was trained I have not looked back. I am hesitant to use pellets because if there is a negative reaction what do you do - go dig it out?
At the end of the day you just need to find what works for you. Keep searching you will find it.
Quote from: angiegurl on July 14, 2015, 03:56:07 PM
I am hesitant to use pellets because if there is a negative reaction what do you do - go dig it out?
They are about the size of a grain of rice, maybe a bit bigger.
The site of application should be well known so it should be possible..
And reactions are rare imo.
You could see it the other way... what about if reactions are good ?
No hassle... no seesaw pattern... no handling of meds... one procedure every 4-6 months and that is all...
availabale are bioidentical estrogen and bioidentical progesterone...
hugs
I started on patches. My Elevels were up around 120. 6 months ago i changed to pills and it dropped down to 70. So going back on the patches when i meet my endo on thursday
I have been on the patches for 4 weeks, first one came off after a couple of days and left a residue ring on me. I started putting a product called tegaderm over it and they stay on for the full week and it comes off with no ring. Tegaderm is a breathable film bandage I have seen some people say not to cover the patch and others say the tegaderm is ok.
I'm sure looking forward to a nice pellet so I can relax & not have to deal with this pill/patch stuff any more. Luckily my electrolysis lady that I've used for 2 years uses pellets for her hormone/HRT. She will know the best doc in my area for that. My doc is OK but just a GP doc & will prescribe anything I need but I do not think he has any experience with actually doing pellet implants.
Quote from: FrancisAnn on July 15, 2015, 04:48:19 AM
I'm sure looking forward to a nice pellet so I can relax & not have to deal with this pill/patch stuff any more. Luckily my electrolysis lady that I've used for 2 years uses pellets for her hormone/HRT. She will know the best doc in my area for that. My doc is OK but just a GP doc & will prescribe anything I need but I do not think he has any experience with actually doing pellet implants.
You might ask for bioidentical estrogen.
They might use enough pellets to drive the e well into the female range, its possible you need no further anti androgen then.
Anti androgens also have side effects. If t is driven down to female levels with estro alone you would need no further medication.
( works usually only with implants and injections because bioidentical estrogen applied internally is considered safe).
And you might ask for bioidentical progesterone as implant.
It might help with some side effects of estrogen, even out mood, and help with breast development.
hugs
Laura, thank you so much, I was just ready to send you a PM thank you.
Since I have no experience with pellets any knowledge is appreciated so I can talk more intelligently with this doc. First question is does each pellet release a certain amount of drug per day? How do they know? Are there standard pellets? Who makes the best ones?
Thanks for any knowledge.
Laura, My last blood test was a year ago, E of 186 & no t really, 12. I guess the doc will want new tests which will be OK. My breasts are maybe a B cup, nothing exciting yet, growing too slow it seems. But lots of other nice changes from HRT, body hair almost gone, completion is smoother,......, I'm pretty steady & do not have to high or low mood swings but I will cry sometimes a little but that feels OK. My friends tell me they can tell if I'm having an estrogen rush. Thanks
Depending on where you are there are different sources for pellets.
One source are compounding pharmacies, they even deliver worldwide to med personnel.
For example
collegepharmacy.com/images/download/CollegePharmacy_Fused_Pellet_General.pdf
They provide further infos concerning application.
They even provide a list of endos working with their products if asked.
According to one of their sheets, pellets with their highest estro dose might produce serum levels of nearly 80-120pg/ml .
Of course reactions might be individual, so have it checked by an endo.
But this is something that can be discussed with a doctor/endo.
(This info is NOT usable for other forms of medication. Like with patches, there is a multiple in efficiency. Patches being in principle more effective, but applied dosage per patch can be thus much lower).
After six months there might be a rest of the pellet remaining, still dissolving slowly. So a new implant dose might possibly be adapted.
Or it might be good to know, so there is no surprise if values are a bit higher.
hugs
That's funny one of the largest compounding pharamist in my city is right down the hall from my GP doc's office. My GP doc maybe able to handle implants. I know & trust him. Thanks so much.
I vote for implant as well!
I was on sublingual E, and got tired of waiting for the stupid thing to dissolve.
With implants, it boils down to how they have been compounded. The first one I had left a small scar which faded over 6 months (no worse than a bad scrape). The second pellet was inserted in the same site, but with a different coating and it agreed much better with me - at 6 months other than a small discolouration, I wouldn't know it was there unless I feel around carefully.
I was on the Dot-patches for 6 months or so and comperate to pills, they were really better and more effective.
I stopped after i got an allergic reaction to them so i switched to gel. They are as effective as patches and are easier to dose. The only downside is that you have to apply them every day. Im always applying them before i go to sleep.
You could try that if you want.
Good luck to all of us to find a safe way for simple estrogen, it should not be so hard. It's tough enough having facial hair zapped, that should be enough pain! We don't deserve any more.
It really pisses me off that we have to hide, use fake names, jump thought hoops for therapist....wiggle our way to find some estrogen that works. Just yesterday I kinda unloaded on my plastic surgeon. I told him we are just nice people, why do so many docs avoid us like the plague......He agreed but so many docs do not.......................Ugggg for us all.
After reading all the positive experiences people have had with implants, I felt the need to post my experience with them. Before I start, I will not blame the doctor for what happened, her professionalism is not in question.
I had an implant after about a year on oral. It caused my E levels to drop back to 'acceptable' male ranges and all estrogen-based changes stopped, including breast development. My levels were so bad that after a couple of months my doctor put me back on an oral administration route. It's taken me 3 years and a change to patches to restart my breast development. Was it a bad implant? Unlikely, as my gyno had never had one from that implant supplier. Was it that I simply didn't react well to the implant? Possibly, but as I have no plans to try them again, I guess we'll never know.
Quote from: kelly_aus on July 15, 2015, 05:47:25 PM
After reading all the positive experiences people have had with implants, I felt the need to post my experience with them. Before I start, I will not blame the doctor for what happened, her professionalism is not in question.
I had an implant after about a year on oral. It caused my E levels to drop back to 'acceptable' male ranges and all estrogen-based changes stopped, including breast development. My levels were so bad that after a couple of months my doctor put me back on an oral administration route. It's taken me 3 years and a change to patches to restart my breast development. Was it a bad implant? Unlikely, as my gyno had never had one from that implant supplier. Was it that I simply didn't react well to the implant? Possibly, but as I have no plans to try them again, I guess we'll never know.
There is no rule that only one implant should be used. Yet some endos seem to see it that way.
If blood levels are too low dosage is upped with other forms of application as well.
Transgender people are not menopausal cis people in this regard, for whom implants are used as well. They need different doses.
hugs
Quote from: Laura_7 on July 15, 2015, 06:17:48 PM
There is no rule that only one implant should be used. Yet some endos seem to see it that way.
If blood levels are too low dosage is upped with other forms of application as well.
Transgender people are not menopausal cis people in this regard, for whom implants are used as well. They need different doses.
hugs
Other patients of hers, including one of the Admins here, have no problems with her implants, which I was told were nonstandard doses. Even the gyno was surprised by it's lack of efficacy.
And I love how people here will always blame the doctors when something doesn't go quite right, whether it was deserved or not. In this case, the doctor cannot be blamed, as evidenced by her other patients. I believe that doctor uses similar implants herself - as a post-op..
My post was simply a warning that the implants may not be as great for everyone as some people here seem to think. If they've worked for you, great.. But there is a chance it won't work.
Quote from: kelly_aus on July 15, 2015, 06:33:18 PM
Other patients of hers, including one of the Admins here, have no problems with her implants, which I was told were nonstandard doses. Even the gyno was surprised by it's lack of efficacy.
And I love how people here will always blame the doctors when something doesn't go quite right, whether it was deserved or not. In this case, the doctor cannot be blamed, as evidenced by her other patients. I believe that doctor uses similar implants herself - as a post-op..
My post was simply a warning that the implants may not be as great for everyone as some people here seem to think. If they've worked for you, great.. But there is a chance it won't work.
Well there is for example the possibility of an encapsulation...
but there are ways to work around that...
and for example using a few smaller ones instead of one big one... for more surface...
Well it was not meant to blame but to look for a solution...
hugs
Quote from: Laura_7 on July 15, 2015, 06:41:00 PM
Well there is for example the possibility of an encapsulation...
but there are ways to work around that...
and for example using a few smaller ones instead of one big one... for more surface...
Well it was not meant to blame but to look for a solution...
hugs
You don't think this was discussed and the possibility of encapsulation explored? Imaging revealed no encapsulation. For whatever reason, implants were not the solution for me, despite the fact they worked just fine in many of her other patients. Dose wasn't an issue - it was the same as her many of her other patients.
You know what? This is the last time I share any of my personal experiences here. Because they sometimes fall outside of the 'groupthink' realm of reality, either I get treated like an idiot or my medical professionals are made to seem questionable. The gyno in question is not incompetent, far from it.. And as a trans woman herself, I suspect she might have even paid a little more attention to what she was doing.
(Kelly : For what it's worth, I hear you. One of my own experiences - that I had documented liver damage after only a couple months on a dose of E [only] so low that most people swear it wouldn't have any effect at all even for feminization - is frequently taken as up for debate when I mention it. And yes, I trust my doctors and the tests they ran, and I believe it really happened. I'm sorry you feel similarly questioned.)
Good luck to all of us. I'm back on pills until I can find for me a much better soultion which is a pellet it seems. One thing is for sure is that going without my normal hormone of estrogen is not just an option. A nice little pellet that last 4-6 months will be so nice.
:police:
Hi all, just a little caution on choice of wording, what may seem fine to you may not read the same to others, we all have different stories and reactions to any discussion in progress
thanks xx
Quote from: kelly_aus on July 15, 2015, 07:29:45 PM
You don't think this was discussed and the possibility of encapsulation explored? Imaging revealed no encapsulation. For whatever reason, implants were not the solution for me, despite the fact they worked just fine in many of her other patients. Dose wasn't an issue - it was the same as her many of her other patients.
You know what? This is the last time I share any of my personal experiences here. Because they sometimes fall outside of the 'groupthink' realm of reality, either I get treated like an idiot or my medical professionals are made to seem questionable. The gyno in question is not incompetent, far from it.. And as a trans woman herself, I suspect she might have even paid a little more attention to what she was doing.
This was all in no way meant to be an allegation but a point for discussion...
Descriptions of personal experiences are valuable.
Its simply that concerning implants, there is both not much literature and not too much experience since its unfortunately not a standard medication for many docs.
From a purely technical point of view, things that might be tested:
-a few small implants instead of one big one. Smaller implants have bigger surface, so absorption might be larger.
-simply trying another place
Well imo its difficult to say how reliable imaging is... sometimes it might be favourable to simply try another location, because there might be so many reasons it did not work out in one place...
But this is all theory.
Its completely understandable you are done for now with trying. Important thing is you have a solution that works for you now, which you seem to have.
Wish you a good time :)
I'm going to lock this thread for awhile. I think it has run it's course anyway, and I think a rest I'd needed.
Thank you