After my last visit to my (very good) GP, she wants me to change from pills to patches. Latest blood screen was fine, but she wants to try it as a long term fix. Was on low dose for months before a short stint on transitional doses.
Anyone have experience/thoughts of oral vs transdermal patches.
Many thanks!
I have no experience with pills. I am 53, and my endo offered me a choice of pills, injections or patches. I chose patches because of a lower risk of blood clots and liver damage.
Even at my advanced age, and having been on patches for only two months, feminization has been pretty rapid. My skin is a lot smoother, my body is growing curves in all the right places, and even my face looks more feminine than it did when I started.
Thoughts only as I have always been on the pill. For me the pill is easy to do but getting the proper levels out of it are difficult. I am on a half transition dosage but my estradiol runs about 50 pg/ml and estrone which isn't very useful runs about 700 pg/ml. Patches if they work for you can provide much better estradiol levels without all the estrone as long as you don't have skin issues or problems with them sticking. Many people swear by the patch on this site but it comes down to what works best for you.
I was on implants, which were marvellous, but had to swap to patches. They have been fine. I prefer the smaller estradot patches rather than the larger estraderm. The smaller ones stick a lot better.
But effect wise they have been great.
My problem is I'm allergic to the adhesive used on them. Less than one day with a patch and my skin is bright red with little blisters.
This is how old I am though. My first thought seeing the title was the old Dickey Lee song "Patches."
I've been on low dose patches and find them to be fairly easy. I ended up splitting them (not officially sanctioned by the manufacturer, but my Dr approved) because of slightly uneven dosing at 2x per week. This probably has to do with the low dose honestly (my theory), but otherwise they are pretty easy and covered by insurance (though I will have a problem if I go above .1mg as insurance will only pay for 8 per month)!
Quote from: BreeD on August 06, 2016, 01:02:14 PM
I've been on low dose patches and find them to be fairly easy. I ended up splitting them (not officially sanctioned by the manufacturer, but my Dr approved) because of slightly uneven dosing at 2x per week. This probably has to do with the low dose honestly (my theory), but otherwise they are pretty easy and covered by insurance (though I will have a problem if I go above .1mg as insurance will only pay for 8 per month)!
What do you mean "splitting them"? Like cutting the patch, a different schedule or something else?
First thoughts:
Well I feel fantastic! No peaks or troughs, constant delivery....brilliant.
Very convenient, once every 3 1/2 days. This I can live with!
Only downside is the marks they leave, but hey that is insignificant in the big picture of life.
And so far they are reducing the dysphoria. Next step is the 28 day blood count, and adjust. Aim is to get the best mental results vs minimal physical change. Outing at work would not be easy or wanted.
Does anyone here have experience with once weekly patches vs the 2x/weekly in terms of efficacy, peeks/troughs etc.
Apparently the once weekly patch is on my formulary, whereas the 2x/weekly is not.
Any feedback would be appreciated.
Thanks!
Sent from my iPhone using Tapatalk
patches, estradots. they are harder to get off, than get on.
downside, they are essentially a little tattoo that says, "Trans".
I have irritation after each use of a patch. I have found that removing the in the shower and washing with soap helps a little. Once dry, I use clean the area I will apply the next patch on and then clean the area I removed a patch from to clean off the last bit of adhesive. No problems. Cleaning the new area gives a more reproducible dose and cleaning the old area minimizes the allergic reaction.
Jen
I remove the old patch in the shower, like Jen, and clean well. I also shave the new patch site just to make sure there aren't any little vellus hairs there. Post-shower I wipe the area with a little rubbing alcohol (pure, no glycerin or 'moisturizer'), let that air dry while i take care of other things, and slap on the new patch.
I've identified three locations wide enough to take the patch, that don't have wrinkles running through them when i sit or bend. (I popped off a patch that way.)
So far, so good...
i like the patches better... and my doc says its safer than the pills..
Mr doctor also recently switched me from oral to patches, saying they would be a safer option for me. I've used them about 3 weeks now and they seem to work fine. I am a bit confused about the doctor's instructions that say to apply them twice a week. According to the manufacture's instructions, they are designed to deliver an even dose of E for an entire week and should be changed weekly. That is what I have been doing and seem to feel fine. If I applied them twice a week, it seems I would be replacing one before it was "used up."
My primary complaint about the patches is the price. If I use 2 per week according to the doctor's instructions, the cost is about 8 times more expensive than oral. I have crummy insurance coverage on medications, so everything is mostly out of pocket for me. To go through 2 patches per week, or 8 per month, is more than I can afford and I will need to find a cheaper option.
chemically speaking if you have two sources and they are renewed on alternating cycles, it just has to provide a more even supply. that said, I change both on the same day because I'll get confused which is new and which is old; and its easier for me to remember, because the universe has always been so:
Tuesday is patch day!
I've always used patches, and I've gotten great results. I did, however, definitely have to switch to the twice weekly - the once a week ones were giving me terrible PMS for the last 2-3 days of each week. (That may have been the manufacturer rather than the nature of a weekly patch; I was using the Mylan generics for Climara, and those have since been tested to show that they deliver more estrogen in the first couple days and then it tapers off. Which defeats the purpose of a patch for the sake of steady delivery! Now I'm using Vivelle [that's Estradot in Britain] and loving it.) I'm actually within the range of doses provided to menopausal cis women, too, so the few times I've had to explain it to a doctor, I just say I'm in surgical menopause relatively young... which is absolutely true, as far as it goes.
Jenna Marie, I know exactly what you mean. I'm on 'low dose', and get a biweekly Mylan patch once a week. Monday (patch day) is great, and by Friday I'm dragging a bit. Sunday I'm cranky. Ah, then it's Monday again!
I've pretty much decided my path forward won't be low dose stealthy. Endocrinologist! Transition dose, engage!
Quote from: Michelle_P on August 19, 2016, 03:04:50 PM
I'm on 'low dose', and get a biweekly Mylan patch once a week.
That sounds strange. IMO a biweekly patch should be changed twice a week and a weekly one should be changed once a week. If you are on low dose the dosage of each patch should be lower, not the frequency with which they are renewed...
Quote from: Lucie on August 20, 2016, 08:41:48 AM
That sounds strange. IMO a biweekly patch should be changed twice a week and a weekly one should be changed once a week. If you are on low dose the dosage of each patch should be lower, not the frequency with which they are renewed...
Yeah. The pharmacist also questioned that and called the endocrinologist to verify. That's what she wanted! (I'm definitely not her first MtF, by the way.) I do my first quarterly check in a few weeks, and I expect this to be boosted to a normal transition level once we have the numbers on how well the current prescription is working. I'd like to end the current roller coaster ride and get things a little smoother.
Michelle: Yeah, that's really not how it's supposed to work. I was using a *weekly* Mylan patch that started to run out near the end of the week; it was supposed to last 7 days, but even laboratory testing suggested that it tapered down from the full dose after day 4 or so.
Using one that was meant for biweekly only once a week would mean that was effective for, at most, 3.5 days out of 7. And that's if it's delivering the dosage it's intended to - it's entirely possible that another biweekly generic from Mylan actually works for only 1-2 days. It's just like taking antidepressants or some other daily drug only 4 days out of 7 and expecting it to work.
I have no idea why your endo suggested this, but I'd be dubious if I were in your shoes. I started on a super low dose (think half or less of what menopausal cis women get) and I still was told to simply use a patch that was the appropriate dose, not to use one half as often as recommended. You're suffering the "roller coaster" because she deliberately chose to give you medication for only half a week at a time, which really does defeat the purpose of the patches' offering regular and steady levels.
Michelle, what is unacceptable is that she (the endo) does not want (or is not able perhaps) to explain to you the reason for applying patches in such an odd way...
Actually, I sat there with the endocrinologist while she looked through the online pharmacopeia for the HMO, and what they had both listed as in-plan and in-stock in one of the regional pharmacies. I could tell that she was getting annoyed as she kept picking things and getting "Discontinued" or "Out of stock; no estimate for arrival" messages. What I'm on is the best we could find after about 30 minutes of searching and phone calls.
The pharmacist thought the instructions (one bi-weekly patch per week) were odd, and called up the endocrinologist to verify. The instructions were what I had expected from talking with the doctor. It was a sort of 'make-do' situation.
There's apparently some form of supply shortage for 17-beta-Estrodiol right now in injectable and patch form, at least with the suppliers the HMO contracts with. We didn't want to do pills or synthetic non-bioidentical because of my age and family history.
I'm hoping to get a better result when we tinker with the numbers next month.
I guarantee the current roller-coaster ride lows are still vastly better than what I was seeing before HRT, and my body is definitely responding.
Quote from: Michelle_P on August 20, 2016, 04:01:37 PM
There's apparently some form of supply shortage for 17-beta-Estrodiol right now in injectable and patch form, at least with the suppliers the HMO contracts with.
That's true. It seems it's a world wide shortage. However in my country it's easier to get low dosage patches than high dosage ones (unfortunately for me :( ).
As far as I know, there's no shortage for patches, but obviously I can't speak to a specific HMO's choices. :) (Basically all patches use 17-beta-estradiol, which is one of the safest forms of estrogen, and so if there is a shortage, it's a localized one and/or limited to the higher-dose patches. Otherwise, menopausal women the world over would be frantic right now.) That does make sense of why the endo would choose the best of a bad set of options, though it's frustrating as heck that the HMO refuses adequate coverage. I wonder if it was actually that it was only possible to get them to cover half of a prescription for biweekly patches, and so she's having you use them twice as long? When I was on weekly patches, the endo had to specifically contact my insurance company with a request to "double the normal dose" [she wanted me doing the reverse of what you are, using 1 weekly patch at a time but changing it every 3.5 instead of 7 days, so I'd use up twice as many in a month as my HMO expected]. Before she called to yell at them, however, the HMO only issued me half as many as I needed. But *biweekly* patches are usually packaged specifically for that purpose - that is, 8 to a box - so it's still baffling why the HMO wouldn't cover a box a month as is typical.
Anyway I'm sorry you're having to deal with this hassle. It doesn't sound like going up to a transitioning dose is going to be covered by the HMO either, if you must do patches or injectables and they're claiming a shortage of both...
Quote from: Jenna Marie on August 20, 2016, 07:05:29 PM
Anyway I'm sorry you're having to deal with this hassle. It doesn't sound like going up to a transitioning dose is going to be covered by the HMO either, if you must do patches or injectables and they're claiming a shortage of both...
I'm not worried. The HMO is the insurance company, Kaiser. There's lots of gals in the group I'm in who are on full dosage. They just didn't have available the range of dosages the endocrinologist needs for starting, from what I could tell. (She's a little conservative with us late bloomers, I think.) Eight a month of what I'm on would be fine. ;D
The pharmacy is currently splitting boxes and giving me 4 in a little baggie with the prescription label tacked on. I suspect they do this a lot. When I went in to first pick these up the pharmacy said they only had 3 patches in stock (!), but another pharmacy in the medical complex had more, so they sent me over there.
Honest girls, it's not that big a deal. I still feel better than I did a few months ago, by a ridiculous amount. Heck, I feel like my senses are turned up to 11 now. The wife and I were out at dinner at a Ruth's Chris steak house last night. Now, I've been on a severely restricted sodium diet until I started spironolactone. Now, I can eat anything. I was happy and posted the other day about eating a spinach salad and bagels, which I though was wonderful. Last night I had a strawberry salad, filet mignon, and their 'Thanksgiving pie" sweet potato with pecan crust side. Oh... My... Goddess... I thought that was so good, and kept tasting the steak and the sweet potatoes, while trying to explain to my wife why I felt so very good, and was enjoying the meal. I'm pretty sure the patch was still delivering E. My nipples got hard, my tiny breastlets were aching, and I thought I was going to explode, from a darn steak and side dish!
When I was done, I felt like maybe I should roll over and have a cigarette... >:-)
I can't wait for my adjustment next month. ;)
Quote from: Jenna Marie on August 20, 2016, 07:05:29 PM
As far as I know, there's no shortage for patches, but obviously I can't speak to a specific HMO's choices. :) (Basically all patches use 17-beta-estradiol, which is one of the safest forms of estrogen, and so if there is a shortage, it's a localized one and/or limited to the higher-dose patches. Otherwise, menopausal women the world over would be frantic right now.)
AFAIK
there is a shortage for transdermal estradiol, either patches or gels, at least in my country. Trans women are impacted, as are a lot more of cis women (either pre or post-menopausal) who also need HRT.
I'd heard that patches were pretty good and talked to the Endo but unfortunately am also allergic to adhesives and even get rashes from simple band aids :P Also, sublingual tabs were the only thing my ins. would cover and that was a bit of a wrestling match to get done in itself