Susan's Place Transgender Resources

Community Conversation => Transitioning => Hormone replacement therapy => Topic started by: JennJenn on August 07, 2017, 07:25:34 PM

Title: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on August 07, 2017, 07:25:34 PM
I am taking oral estradiol now for 10 years.  Actually switched to sublingual as of late and it's working much better for me.  Getting some good development now after like 10 years of post menopausal levels -- breasts are really taking off.

Anyways, I was considering bio-identical estradiol implants because I heard there is a good ratio of estrone to estradiol and it has lower risk of complications.

What's your take on it ?   I could afford $1000 a year or so on it if having lower estrone levels is really beneficial.

If you use it, which brand do you use?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: AnonyMs on August 07, 2017, 09:03:48 PM
I'm not sure there's really a brand for implants. Mine are compounded.

Price would also depend on where you are.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on August 07, 2017, 09:17:21 PM
One brand I have heard of is SottoPelle.  Don't know much about it.  I am in Oklahoma, USA.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: AnonyMs on August 07, 2017, 09:36:01 PM
I expect your main problem will be finding a doctor who will give you implants at all.

Here's a place that makes them

http://www.collegepharmacy.com/index.php?/bhrt_fused_pellet_implant/
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on August 07, 2017, 10:15:32 PM
Why change things if you are doing well at the moment? Bio-identical estradiol seems to be relatively safe according to studies, even when taken orally.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: LizK on August 08, 2017, 05:00:07 AM
I am on Implants, I have these replaced about the 5-6 month mark. These are compounded and the cost for the entire consult and procedure it about $300 Aus. My Dr gets them compounded and inserts them herself.

My Last Levels were way too high and were in the 600's  but I have to say I am getting good results. The spike could have been dues to my implant finally disintegrating, apparently this can skew the numbers. I don't think so because my breasts are sore and I guess I need oestrogen to make them grow.

Prior to this I seem to have a very stable level in the upper normal female range.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on August 08, 2017, 10:31:42 AM
Quote from: ElizabethK on August 08, 2017, 05:00:07 AMMy Last Levels were way too high and were in the 600's  but I have to say I am getting good results. The spike could have been dues to my implant finally disintegrating, apparently this can skew the numbers. I don't think so because my breasts are sore and I guess I need oestrogen to make them grow.

Prior to this I seem to have a very stable level in the upper normal female range.


600 pmol/L would appear to not be such a high level. Significantly higher levels have been recorded in post-menopausal women (as old as 66 years old), men with cancer of an advanced age (as old as 91 yrs old) in several studies, some of these individuals having been at these levels for as much as 28 years without serious side-effects. Levels recorded ranged from 78-3,000 pmol/L +.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: AnonyMs on August 08, 2017, 12:38:34 PM
I'd not be happy at all on 600pmol/L. I get new ones when I'm down around 800, and feel a whole lot better for it.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: StacyRenee on August 08, 2017, 02:32:37 PM
My pellets are called BioTE. I'm paying $350 and that includes the office visit and procedure. My NP likes to do new pellets every 3 months,  so that's $1400/ year. This is in Texas,  BTW.

Sent from my SM-G930V using Tapatalk

Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: AnonyMs on August 08, 2017, 02:44:55 PM
Quote from: StacyRenee on August 08, 2017, 02:32:37 PM
My pellets are called BioTE. I'm paying $350 and that includes the office visit and procedure. My NP likes to do new pellets every 3 months,  so that's $1400/ year. This is in Texas,  BTW.

That seems very frequent. My first ones lasted only 6 months or so, but the longer you are on them the longer they last. My endo also told me that if you take progesterone, which I do, it increases the interval further. I'm at 15 months interval now.

Maybe for 3 months they are tiny little ones?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: LizK on August 08, 2017, 04:07:36 PM
I don't know about the levels quoted by others because I am not an expert but I am having some reasonable results and as far as I can see most of the other Girls I hang out with are somewhere between 3-400 which my understanding is that this level is upper normal for average female...

I am getting a second opinion on my current regime so will be interested to see what the second Dr will have to say especially as far as levels go.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: jentay1367 on August 08, 2017, 05:05:22 PM
Quote from: ElizabethK on August 08, 2017, 04:07:36 PM
I don't know about the levels quoted by others because I am not an expert but I am having some reasonable results and as far as I can see most of the other Girls I hang out with are somewhere between 3-400 which my understanding is that this level is upper normal for average female...

I am getting a second opinion on my current regime so will be interested to see what the second Dr will have to say especially as far as levels go.

There are two ways of measurement, Liz. One is pmol/L and the other pg/ml.  Both are very different and where your 600 number is low in pmol/l   600 pg/ml is quite high. I'd suggest that if your Doctor thought you were high, you were being measured by the latter and not the former measurement.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: LizK on August 08, 2017, 05:28:39 PM
Quote from: jentay1367 on August 08, 2017, 05:05:22 PM
There are two ways of measurement, Liz. One is pmol/L and the other pg/ml.  Both are very different and where your 600 number is low in pmol/l   600 pg/ml is quite high. I'd suggest that if your Doctor thought you were high, you were being measured by the latter and not the former measurement.

Nice one...I think you are exactly right because some of the numbers quoted seemed way to high for what I am talking about. I also spoke with someone who I would trust to know the correct levels as she is a Dr, she also advised me that it was high. So I am seeking a second opinion. But I would still remain on implants despite this level as I saw it even out my moods really quickly  compared to straight tablets.

Thanks
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: jentay1367 on August 08, 2017, 05:50:56 PM
Quote from: ElizabethK on August 08, 2017, 05:28:39 PM
Nice one...I think you are exactly right because some of the numbers quoted seemed way to high for what I am talking about. I also spoke with someone who I would trust to know the correct levels as she is a Dr, she also advised me that it was high. So I am seeking a second opinion. But I would still remain on implants despite this level as I saw it even out my moods really quickly  compared to straight tablets.

Thanks

Well anecdotally speaking, I've seen more people get better results from injected pellets than any other protocol. All anecdotal mind you. But I've seen some astounding and outstanding results from the medium. I'd do it if it wasn't so ridiculously expensive over here.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on August 09, 2017, 10:53:30 AM
Quote from: AnonyMs on August 08, 2017, 02:44:55 PMMy endo also told me that if you take progesterone, which I do, it increases the interval further.

Strange as progesterone increases conversion of E2 (estradiol) to E1 (estrone), the weaker estrogen.

Quote from: ElizabethK on August 08, 2017, 04:07:36 PM
I don't know about the levels quoted by others because I am not an expert but I am having some reasonable results and as far as I can see most of the other Girls I hang out with are somewhere between 3-400 which my understanding is that this level is upper normal for average female...

I assume your levels are in pmol/L because you are from Australia. Typical levels seen in pre-menopausal women during a menstrual cycle are anywhere from 73 - 2,800 pmol/L, they can go as high as 275,000 pmol/L during pregnancy. Hence, 300-400 does not appear to be upper normal female range. Transsexual women may not respond the same as ciswomen to estradiol, in terms of feminization, for various reasons and thus comparison, in my opinion, is futile.

Quote from: jentay1367 on August 08, 2017, 05:05:22 PM
There are two ways of measurement, Liz. One is pmol/L and the other pg/ml.  Both are very different and where your 600 number is low in pmol/l   600 pg/ml is quite high. I'd suggest that if your Doctor thought you were high, you were being measured by the latter and not the former measurement.

I suspect it is the former because in Australia (in Europe, Canada), it's pmol/L, typically.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: AnonyMs on August 09, 2017, 11:02:06 AM
Quote from: KayXo on August 09, 2017, 10:53:30 AM
Strange as progesterone increases conversion of E2 (estradiol) to E1 (estrone), the weaker estrogen.

I expect he's correct. He's really good. I think he said something about it keeping blood levels down and it dissolving more slowly, but can't really recall.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on August 09, 2017, 11:07:57 AM
Quote from: AnonyMs on August 09, 2017, 11:02:06 AM
I expect he's correct. He's really good. I think he said something about it keeping blood levels down and it dissolving more slowly, but can't really recall.

It would be interesting to get the full explanation and details. Have studies confirmed this?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: AnonyMs on August 10, 2017, 01:05:10 AM
Quote from: KayXo on August 09, 2017, 11:07:57 AM
It would be interesting to get the full explanation and details. Have studies confirmed this?

I'm not seeing him again for another year and I'll probably have forgotten all about it by then.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: LizK on August 10, 2017, 05:29:28 AM
Quote from: KayXo on August 09, 2017, 10:53:30 AM


I assume your levels are in pmol/L because you are from Australia. Typical levels seen in pre-menopausal women during a menstrual cycle are anywhere from 73 - 2,800 pmol/L, they can go as high as 275,000 pmol/L during pregnancy. Hence, 300-400 does not appear to be upper normal female range. Transsexual women may not respond the same as ciswomen to estradiol, in terms of feminization, for various reasons and thus comparison, in my opinion, is futile.

I suspect it is the former because in Australia (in Europe, Canada), it's pmol/L, typically.

I checked with my Dr and it is pg/ml is the unit measure that is being used.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on August 10, 2017, 09:32:30 AM
Ok. Then I stand corrected about assuming it was in pmol/L. 600 is indeed upper range.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on August 23, 2017, 11:23:22 AM
Quote from: StacyRenee on August 08, 2017, 02:32:37 PM
My pellets are called BioTE. I'm paying $350 and that includes the office visit and procedure. My NP likes to do new pellets every 3 months,  so that's $1400/ year. This is in Texas,  BTW.

Sent from my SM-G930V using Tapatalk

Just curious, what level of estradiol in the blood does your doctor target. (My endo is happy if my estradiol is in the 125 to 200 range, for me personally.) And since on the pellets, do you notice a  lot lower levels of estrone compared to estradiol tablets?  Ever have your estrone checked?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: StacyRenee on August 24, 2017, 06:44:33 AM
 I've only been on the pellets. She hasn't told me what my levels were. She checked it at 1 month and said that my levels were ideal. She never gave me the exact numbers.

Sent from my SM-G930V using Tapatalk

Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: OU812 on August 24, 2017, 01:23:04 PM
I definitely consider any kind of trans-/sub-dermal absorption a superior form of HRT over oral methods, even if just for avoiding the liver first-pass, which on rare occasions can cause tumors.

I'm going to start advocating for people to get as much information from their doctors as possible. Specific levels are worth having, and I sometimes have to pressure mine for that. 20+ years of doctors and the only time I was ever even given my blood type was in Thailand where they took it and told me for some reason.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: yuna on August 24, 2017, 01:40:00 PM
I got my implant about 5 weeks ago. The recent lab shows my estradiol is at 52 pg/ml. When I was on sublingual estradiol my E level was 48. Sigh, I guess I just have really fast metabolism or something. Hopefully my doctor can increase the implant dosage next time in October. Does low estradiol level mean slow feminization?


Sent from my iPhone using Tapatalk
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: Toni on August 24, 2017, 05:58:03 PM
Hello girls.  I just started BioTE in Texas like StacyRenee.  We're shooting for numbers of about 50 to start with and will ramp up considerably at 6 weeks if blood work looks good.  I've read a couple of things about HRT that, in spite of my enthusiasm, make me want to be patient.  One is that starting a bit slower may actually be better for breast growth in the long term because it allows breast buds and underlying connective tissues and ducts to form without being rushed, a better foundation if you will.  The other thing that seems to be as important as the estradiol level is how low can you get the testosterone.  If you can't get T down, then even high doses of E will be hampered.  I went with the pellet because I had read that others who tried it seem to have been pleased with the results and the convenience of not having to travel with pills or keep remembering to take something when I'm having fun on vacation.  I will say that my butt was a bit more sore than I expected, felt like I got kicked in the butt and bruised, but became pretty normal after a week.  It was difficult to veg for three days after the insertion (mandatory) as I exercise daily. 
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on August 24, 2017, 07:19:40 PM
Quote from: OU812 on August 24, 2017, 01:23:04 PM
I definitely consider any kind of trans-/sub-dermal absorption a superior form of HRT over oral methods, even if just for avoiding the liver first-pass, which on rare occasions can cause tumors.

Latter part of your sentence not proven to be causal relationship and only perhaps in the case of non bio-identical forms of estrogen. It's important to mention this.

QuoteSpecific levels are worth having

Levels of estradiol and testosterone aren't useful to measure, IMHO. I explained the reasons why several times before and went into detail.

Quote from: yuna on August 24, 2017, 01:40:00 PM
I got my implant about 5 weeks ago. The recent lab shows my estradiol is at 52 pg/ml. When I was on sublingual estradiol my E level was 48. Sigh, I guess I just have really fast metabolism or something.

Levels fluctuate, especially on sublingual, one reason measuring them is not very useful. Had you measured the levels on sublingual at 1-2 hours, they would have been strikingly different while on implants, less likely but perhaps higher and even so, how do you know what level is IDEAL for you? You don't.

QuoteDoes low estradiol level mean slow feminization?

Not necessarily and as I explained, your levels could have been higher at a different time so really average level could be higher. Everyone has a different response and sensitivity. Some might do quite well on lower levels, some needing higher. Doctors are unable to assess beforehand what levels will be best for a given individual. They estimate (guesswork) based on average levels in ciswomen but ciswomen developed at much lower levels and most of us would probably not do well at those levels; this indicates that for various reasons, we cannot use ciswomen as a reference in this context.

Quote from: Toni on August 24, 2017, 05:58:03 PM
how low can you get the testosterone.  If you can't get T down, then even high doses of E will be hampered.

High doses of E will naturally significantly reduce testes' production of testosterone through pituitary gland negative feedback. The higher the levels get, the weaker the signal from the pituitary gland to the testicles to secrete testosterone. You can't have both high E and high T unless you also take T exogenously.

Measuring T has its own problems as total T is inaccurate since part of it is inactive due to being bound to SHBG. Some anti-androgens block T so that the level measured only tells part of the story. One study in transsexual women found feminization was similar despite higher or lower levels of T. Each individual responds differently and is unique so the right T is not the same for all. Etc.

Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: Nora Kayte on September 07, 2017, 11:50:01 AM
Quote from: KayXo on August 24, 2017, 07:19:40 PM


Levels of estradiol and testosterone aren't useful to measure, IMHO. I explained the reasons why several times before and went into detail.

High doses of E will naturally significantly reduce testes' production of testosterone through pituitary gland negative feedback. The higher the levels get, the weaker the signal from the pituitary gland to the testicles to secrete testosterone. You can't have both high E and high T unless you also take T exogenously.

Measuring T has its own problems as total T is inaccurate since part of it is inactive due to being bound to SHBG. Some anti-androgens block T so that the level measured only tells part of the story. One study in transsexual women found feminization was similar despite higher or lower levels of T. Each individual responds differently and is unique so the right T is not the same for all. Etc.


Wow Kay that's some good info. It pretty much how my doctor explained a lot of it to me.

My doctor was just telling me that I don't need spiro anymore as after a while the Progesterone and Estradiol will keep my t levels down. So if I am reading the last part of your post right. That confirms it?

Oh and I never care what my levels are. Because basically what you and my doctor say. They fluctuate and I have no way of knowing what's good for me level wise. So my doctor reads results asks how I feel at different times and adjusts from there.
She has been pretty right on so far. I get new pellets about every 4 months and I am on Progesterone so it does not work with me. Still every 4 months. Never known anybody that got better results from anything other than pellets.
I always thought in order of how well it worked was pellets, injections, patches creams and under the tongue. Then pills. But what do I know. That's why I don't think to much. Lol


Sent from my iPhone using Tapatalk
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: OU812 on September 08, 2017, 06:30:40 AM
Quote from: KayXo on August 24, 2017, 07:19:40 PM
Latter part of your sentence not proven to be causal relationship and only perhaps in the case of non bio-identical forms of estrogen. It's important to mention this.

Yes, it is important, because otherwise somebody might make the terrible mistake of choosing a delivery method that's actually superior to the oral dosages that must filter through the liver before circulating throughout the body. In a pragmatic perspective, you have to assume a large portion of the oral estrogen available, especially for those who are taking it as their only option, is not bioidentical, or they would likely have better delivery methods available to begin with. If no other option exists, it's probably tolerable in the short-term, but even in a bioidentical form, the combination of liver first-pass with a spike makes it inferior to virtually every other form of HRT. And your insistence that "it doesn't cause tumors" just completely misses the forest for the trees.

Quote from: KayXo on August 24, 2017, 07:19:40 PM
Levels of estradiol and testosterone aren't useful to measure, IMHO. I explained the reasons why several times before and went into detail.

Levels fluctuate, especially on sublingual, one reason measuring them is not very useful. Had you measured the levels on sublingual at 1-2 hours, they would have been strikingly different while on implants, less likely but perhaps higher and even so, how do you know what level is IDEAL for you? You don't.

Compounded with the above, it astounds me that you're truly suggesting it's irrelevant to know your levels. If you're testing levels responsibly you're going to anticipate where the spikes or ebbs will occur in the same way you fast before a wide variety of blood tests, and you're not going to just trust a physician (who perhaps knew less about transition-related HRT than you when you came to them with a need) to just tell you what's okay and what's not. What if they're secretly throwing shade your way? What if you change doctors? Several times?

Appropriate level is based on how well it's working and whether you're having too much in the way of side-effects. It's laughable, yes, that anyone in the world would just "know" some abstract number that is ideal, but you absolutely should have data available on yourself that points one way or the other over time. Your extent of feminization changes. Metabolisms change. Delivery methods change. Two points of data on a scatterplot won't help you - but a large data set compiled over the long-term will let you know if you enter outlier territory on the high or low end. This is what you want.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on September 08, 2017, 10:48:41 AM
Quote from: OU812 on September 08, 2017, 06:30:40 AM
you have to assume a large portion of the oral estrogen available, especially for those who are taking it as their only option, is not bioidentical

Today, most transwomen worldwide get prescribed bio-identical estradiol, whether orally or not, so the oral form is, most of the times, bio-identical as that is what's recommended unanimously for us due to risks associated with other forms of estrogen.

Quoteeven in a bioidentical form, the combination of liver first-pass with a spike makes it inferior to virtually every other form of HRT.

Studies suggest bio-identical estradiol, even taken orally, and especially at the doses prescribed to transwomen, is quite safe and even as or more effective than if it were taken non-orally, in some people.

QuoteAppropriate level is based on how well it's working and whether you're having too much in the way of side-effects.

IMO, appropriate DOSE. Levels will be all over the map and aren't reliable.

Quotea large data set compiled over the long-term will let you know if you enter outlier territory on the high or low end. This is what you want.

You are unlikely to be outside of the female range as it is VERY wide, from as a little as 20 pg/ml to up to 75,000 pg/ml. On 1,000-4000 pg/ml, for several years, under the supervision of 3 doctors. Never had any health problems, blood test results came back fine.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: LizK on September 08, 2017, 08:22:07 PM
I am currently experiencing one of the downsides to implanted pellets

I have one about 5 months old and had a blood test awhile ago that showed I had very high levels of Oestrogen and nil levels of Testosterone. I was tested 2 weeks ago and the levels have fallen off 600 to 432. That drop occurred over an  8 week period, however I was also up until 2 weeks ago taking an oral dosage as well.

The last time my pellet stopped working I had a couple of weeks that were just horrible. I did not know if it was just me or there was a problem with my levels. I got really dysphoric and stressed out for that period of time. I didn't even think about it being my E levels until the nurse told me the day I got the pellet replaced, that if I didn't feel right, to call and they would send out a blood form. I had already been through one phase of this pellet breakup, where you get as spike in the oestrogen levels before they begin to decline and I didn't really want to have to go through it again.

Overall though, I am incredibly happy with the results I have had and will definitely be continuing with them. I have a new Dr who is more proactive with keeping an eye on levels so I may have an even better experience.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: Pisces228 on September 09, 2017, 03:32:00 PM
Quote from: JennJenn on August 07, 2017, 07:25:34 PM
I am taking oral estradiol now for 10 years.  Actually switched to sublingual as of late and it's working much better for me.  Getting some good development now after like 10 years of post menopausal levels -- breasts are really taking off.

Anyways, I was considering bio-identical estradiol implants because I heard there is a good ratio of estrone to estradiol and it has lower risk of complications.

What's your take on it ?   I could afford $1000 a year or so on it if having lower estrone levels is really beneficial.

If you use it, which brand do you use?

Just curious, but if you are having good development, why worry about the estrone/ estradiol ratio?  Are you pleased with the changes?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: OU812 on September 10, 2017, 02:10:54 PM
Quote from: KayXo on September 08, 2017, 10:48:41 AM
Today, most transwomen worldwide get prescribed bio-identical estradiol, whether orally or not, so the oral form is, most of the times, bio-identical as that is what's recommended unanimously for us due to risks associated with other forms of estrogen.

Specious argument. This was one of the key points from my last post, that standards and recommendations often don't pan out in a practical sense. The "bio-identical" form I was getting turned out to actually not be such (only upon investigation with the pharmacy) and it was prescribed by a physician specializing in care of trans people.

This is what bothers me about insistently defending oral methods - it's all theory. If I had not come down with an unrelated illness, that only by exploratory diagnostics revealed the asymptomatic tumor I referenced, I very likely could have seen my tumor continue to grow over the years until one day it ruptured and put me at (at least) a 10-20% risk of hemorrhaging to death. Not cool. I don't see why this anecdote constitutes a good reason to put a carte blanche approval on oral methods and assume everyone using it has access to the highest quality ingredients, when they may well be simply taking whatever they have access to. There are more reliably-safe ways to take hormones.

Quote from: KayXo on September 08, 2017, 10:48:41 AM
Studies suggest bio-identical estradiol, even taken orally, and especially at the doses prescribed to transwomen, is quite safe and even as or more effective than if it were taken non-orally, in some people.

Even if it were, which we do not know, I'm not convinced it would even be worth the gamble. Delayed absorption is much better aligned with typical female physiology, even given the fluctuations of the menstrual cycle, than the constant spikes and ebbs characteristic of male-pattern daily hormone levels. Besides, one more pill to take... ugh...

Quote from: KayXo on September 08, 2017, 10:48:41 AM
IMO, appropriate DOSE. Levels will be all over the map and aren't reliable.

Dose is what creates levels. The same dose and administration method can create different levels at different times in your life, which is why your levels are what actually matter. Levels are only "all over the place" if you're not thorough with keeping records on yourself and you're basing it on a handful of blood workups.

Quote from: KayXo on September 08, 2017, 10:48:41 AM
You are unlikely to be outside of the female range as it is VERY wide, from as a little as 20 pg/ml to up to 75,000 pg/ml. On 1,000-4000 pg/ml, for several years, under the supervision of 3 doctors. Never had any health problems, blood test results came back fine.

I said nothing about outlier territory being based on the female range; in fact, I didn't say anything about the female range at all, which obviously is incredibly wide depending on age, pregnancy status, etc. I said you'll have a sense of what levels are normal or abnormal for you, and that this is based on how well your feminization is setting in or being maintained, along with any side effects you may or may not experience at higher levels (again, higher being relative to your own biology and subjective experience.)

Also, and I mean this as no critique because you claim to be doing alright on your current dosage, but levels of 1,000-4,000 pg/mL sound exceptionally high when compared with reference ranges ranges that are typical of pre-menopausal, non-pregnant women (generally less than 500 pg/mL even at the peak of cycle) and standard practice for transitioning, which in practicality favors keeping levels at the lower end of the spectrum particularly after GRS.

http://emedicine.medscape.com/article/2089003-overview?pa=Hr8nVvDPfSiufkOezSTYzKZO%2B0VV59DLatJyEZLdU3lPzaOUVbwOwCfopLOQzkgRU6AjIeeL3uJ4ryUHXc%2Bz%2FF%2FDMAtBBAsM6eN9kpLn%2Fas%3D
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on September 26, 2017, 06:25:31 PM
Quote from: yuna on August 24, 2017, 01:40:00 PM
I got my implant about 5 weeks ago. The recent lab shows my estradiol is at 52 pg/ml. When I was on sublingual estradiol my E level was 48. Sigh, I guess I just have really fast metabolism or something. Hopefully my doctor can increase the implant dosage next time in October. Does low estradiol level mean slow feminization?


Sent from my iPhone using Tapatalk

Does a faster metabolism generally mean you get less estradiol levels in blood the faster it is?  If so, that'd explain why with a pretty high dose I barely get over 100 pg/mL.  I have a very fast metabolism since I am obese and active.  I burn about 4800 calories per day.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: yuna on September 26, 2017, 10:14:48 PM
Quote from: JennJenn on September 26, 2017, 06:25:31 PM
Does a faster metabolism generally mean you get less estradiol levels in blood the faster it is?  If so, that'd explain why with a pretty high dose I barely get over 100 pg/mL.  I have a very fast metabolism since I am obese and active.  I burn about 4800 calories per day.

I am relatively skinny( 5'7'' 116lbs) and have always had trouble gaining weight and muscles. My body fat is at 5%. I heard it from somewhere that body fat helps the body absorb estradiol or something. I don't remember where I read it and I could be totally wrong though. Girl you are at 100 pg/mL, which is twice as much as me! I am so jealous ; )
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: kelly_aus on September 27, 2017, 02:46:55 AM
Quote from: OU812 on September 10, 2017, 02:10:54 PM
Dose is what creates levels. The same dose and administration method can create different levels at different times in your life, which is why your levels are what actually matter. Levels are only "all over the place" if you're not thorough with keeping records on yourself and you're basing it on a handful of blood workups.

Is it worthwhile to check levels occasionally? Probably, but it shouldn't be the controlling factor in dose. I find that results are the key.

Dose does not create levels on it's own. Dose + metabolism = level. And given that I can dose 2 people the same, via the same delivery method, at the time and get quite different results, you have to wonder. Also, some people react better/differently at different levels. I ran for 6 years on levels that were "accepted best practice" and had little in the way of results. My solution? In consultation with a specialist, I upped my dose until I started seeing results. Yes, I've had my levels checked simply to answer my specialists curiosity..

I do have regular blood done and check a variety of other things, but rarely bother with E or T levels - they don't really provide me with usable data.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: Jessica Lynne on September 27, 2017, 11:18:09 AM
Hi Kelly, I'm always interested in your opinions since you always bring something intersting and educational to any converstation. I have recently done just what you said and had my endo literally double my IM injections after q5 months of very so so results. Just recently, I'm noticing some substantial breast growth. That seems positve, particularly since I feel fine. I'm 59 years old and as such have tempered my  hope for mezningful results but am still hopeful. Might you have any opinion as to what I might anticipate or look for regarding real results? I feel I'm toclose to the forest to see the trees and wonder how I might objectively make the ascertain that results are actually occuring. Since you've been doing this substantially longer and you yourself are closer to my age than say 20 :) I was wondering if you might offer any anecdotal info I can use or may be helpful.  Thanks and all my best! Jess
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on October 03, 2017, 12:04:05 PM
Quote from: AnonyMs on August 08, 2017, 02:44:55 PM
That seems very frequent. My first ones lasted only 6 months or so, but the longer you are on them the longer they last. My endo also told me that if you take progesterone, which I do, it increases the interval further. I'm at 15 months interval now.

This is interesting.  I wonder how.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on October 03, 2017, 12:06:56 PM
Quote from: Jessica Lynne on August 08, 2017, 05:50:56 PM
Well anecdotally speaking, I've seen more people get better results from injected pellets than any other protocol. All anecdotal mind you. But I've seen some astounding and outstanding results from the medium. I'd do it if it wasn't so ridiculously expensive over here.

Do you think this might be due to the fact of that mass amount of estrones produced via oral estrogen, competing with the estradiol for the estrogen receptors?

I read somewhere it's like 10:1 estrone to estradiol via oral.  Is this true? I can't recall the exact ratios.  But isn't a normal female ratio like 1:1 2:1 or 3:1 not 10:1?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on October 03, 2017, 12:13:27 PM
Quote from: Toni on August 24, 2017, 05:58:03 PM
Hello girls.  I just started BioTE in Texas like StacyRenee.  We're shooting for numbers of about 50 to start with and will ramp up considerably at 6 weeks if blood work looks good.  I've read a couple of things about HRT that, in spite of my enthusiasm, make me want to be patient.  One is that starting a bit slower may actually be better for breast growth in the long term because it allows breast buds and underlying connective tissues and ducts to form without being rushed, a better foundation if you will.  The other thing that seems to be as important as the estradiol level is how low can you get the testosterone.  If you can't get T down, then even high doses of E will be hampered.  I went with the pellet because I had read that others who tried it seem to have been pleased with the results and the convenience of not having to travel with pills or keep remembering to take something when I'm having fun on vacation.  I will say that my butt was a bit more sore than I expected, felt like I got kicked in the butt and bruised, but became pretty normal after a week.  It was difficult to veg for three days after the insertion (mandatory) as I exercise daily.

How low on the testosterone?  Do you mean in normal female range with respect to free testosterone?  My Free Testosterone, Direct tested at 0.4 and 3.6 recently.   Normal range is 0.8-4.2 pg/mL

The first blood test result at 0.4 pg/mL was with a higher dose of Spiro.  Having some problems with the diuretic aspect of the drug and tried ditching the evening dose, so my dose was cut by 1/3rd.  The result of the fasting AM free testosteorne was 3.6.   

Wondering if the progesterone I just started taking will make up for less spiro.  Wondering as long as I stay in the 0.8 to 4.2 range , I'll be okay.  So much to learn :)
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on October 03, 2017, 12:26:47 PM
Quote from: KayXo on September 08, 2017, 10:48:41 AM

You are unlikely to be outside of the female range as it is VERY wide, from as a little as 20 pg/ml to up to 75,000 pg/ml. On 1,000-4000 pg/ml, for several years, under the supervision of 3 doctors. Never had any health problems, blood test results came back fine.

Wow! Your E2 levels are that high?  Maybe that's why progesterone didn't work well for you because of the sensitizing of the receptors then BAM overload with estrogen dominance.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on October 03, 2017, 05:03:51 PM
Spoke to a local doctor's office that does the bieTE estrogen pellets.   They want like $150 for initial consult, $385 for the medicine/insertion.  They say it lasts 4 to 6 months.

I talked to the receptionist there and she explained that the body only pulls the estrogen from the pellet on an as needed basis-- and that there is variability in how long they last depending on diet, stress, exercise, etc. I find this very interesting.  Wonder how it does this; I need to research this.

It makes sense then if what above is true and if what Dr. John R. Lee says about progesterone sensitizing estrogen receptors is true, that the pellet might last as long as year.  (Dr. John R. Lee says this throughout his book --What Your Doctor May Not Tell You About Menopause -- and mentions a bunch of studies for each chapter, in an appendix.  I need to read all the study reports myself to see with my own eyes.  However he's treated thousands of women, collaborated with similar minded doctors, and has done years and years of research on this -- so I bet I will find what he says is true; we'll see.)

I also need to research more about the excess estrones produced by the liver when it metabolizes oral estrogen.  There is like a 7 to 10 ratio of estrone to estradiol in oral estrogen and more like a 1-3 to 1 ratio with pellet and transdermal.   I have a lot of questions about excess estrones.  Like do they compete with estradiol for estrogen receptors, similar to how lignans do it in flax seed?  Would that slow down development, body fat redistribution etc?  Lots of questions.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on October 06, 2017, 09:12:29 AM
Quote from: JennJenn on October 03, 2017, 05:03:51 PMIt makes sense then if what above is true and if what Dr. John R. Lee says about progesterone sensitizing estrogen receptors is true, that the pellet might last as long as year.  (Dr. John R. Lee says this throughout his book --What Your Doctor May Not Tell You About Menopause -- and mentions a bunch of studies for each chapter, in an appendix.  I need to read all the study reports myself to see with my own eyes.  However he's treated thousands of women, collaborated with similar minded doctors, and has done years and years of research on this -- so I bet I will find what he says is true; we'll see.

https://www.ncbi.nlm.nih.gov/pubmed/3297211

"Progesterone may also have an antagonistic activity against estradiol, mediated through a decrease in the replenishment of the estrogen receptor, and also through increased 17 beta-hydroxysteroid dehydrogenase which leads to accelerated metabolism of estradiol to estrone in the target organ."

Confirmed by several other sources and by the fact that progesterone opposes estrogenic effects on the uterus and breast.

QuoteI also need to research more about the excess estrones produced by the liver when it metabolizes oral estrogen.  There is like a 7 to 10 ratio of estrone to estradiol in oral estrogen and more like a 1-3 to 1 ratio with pellet and transdermal.   I have a lot of questions about excess estrones.  Like do they compete with estradiol for estrogen receptors, similar to how lignans do it in flax seed?  Would that slow down development, body fat redistribution etc?  Lots of questions.

On oral estradiol, I had lots of breast growth. On both gel and injections, where estradiol was at least as high as estrone or higher, I had no breast growth.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: Colleen_definitely on October 06, 2017, 09:29:01 AM
Quote from: JennJenn on October 03, 2017, 05:03:51 PM
I talked to the receptionist there and she explained that the body only pulls the estrogen from the pellet on an as needed basis-- and that there is variability in how long they last depending on diet, stress, exercise, etc. I find this very interesting.  Wonder how it does this; I need to research this.

I could totally see stress and such varying how rapidly they are dissolved, but the line about your body only going shopping for estradiol when it needs it is a load of hooey.  Figuring out a way to make that happen is one of those drug delivery holy grail things for researchers, and I haven't heard of anyone getting it right just yet.
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: JennJenn on October 06, 2017, 04:44:06 PM
Quote from: KayXo on October 06, 2017, 09:12:29 AM
https://www.ncbi.nlm.nih.gov/pubmed/3297211

"Progesterone may also have an antagonistic activity against estradiol, mediated through a decrease in the replenishment of the estrogen receptor, and also through increased 17 beta-hydroxysteroid dehydrogenase which leads to accelerated metabolism of estradiol to estrone in the target organ."

Confirmed by several other sources and by the fact that progesterone opposes estrogenic effects on the uterus and breast.

Even John R. Lee said progesterone in excess would do this.  Idea is to get them balanced.

It's interesting because I was taking a certain amount of estradiol per day orally for many years, then I took that same dose sublingual.  My breasts swelled up (along with substantial development) along with improvements to my skin. The swelling and development slowed down after about 2 months to where they were no longer swollen but definitely had more tissue.

Well when I started on progesterone cream (USP Progesterone), with 1/2 the dose of my oral estradiol, I had the same exact thing happen:  breasts are swollen and skin improvements.  And it feels like my breasts are developing all the same -- I'll let you know in month or two.  And now since I am on progesterone I should also get extra development since it'll be working on the lobules. Dr. John R. Lee also said the effects of the swelling are temporary and that they would wear off in about 2 months (interesting because that's how long extra dose of estradiol took to wear off, i presume due to resistance over time) and said it was the influence of estrogen due to sensitization of the receptors -- he said this can happen in women who were severely deficient in progesterone for a while.   

So this leads to me to believe if I was progesterone deficient (which I was since I didn't take it before), that the progesterone I rubbed on my skin absorbed immediately and started working, sensitizing estrogen receptors.   Making the 50% dose of oral estrogen work as well as 100% dose estradiol sublingual.

I've been reading on hystosysters forum that swelling and pms symptoms can happen if there is an imbalance of either hormone, not just too much progesterone, as I think you are lead to believe.

I haven't ruled out that, for the best development, cycling isn't a better method, since the two hormones would switch back and forth to balance each other out and not desensitize the receptors.  I need to look into this more.. just a thought I have.

Btw, I've read in other studies that excess doses of estradiol does in fact down regulate the receptors, makign the cells more resistant.  They do this for other hormones like insulin etc.. why not sex hormones as well?
Title: Re: Pellet Implants vs. Oral Estradiol (blue pills)
Post by: KayXo on October 07, 2017, 10:48:47 AM
Quote from: JennJenn on October 06, 2017, 04:44:06 PM
Even John R. Lee said progesterone in excess would do this.  Idea is to get them balanced.

Progesterone, not in excess, but progesterone, in any amount. The higher the dose, the stronger its anti-estrogenic effect.

QuoteWell when I started on progesterone cream (USP Progesterone), with 1/2 the dose of my oral estradiol, I had the same exact thing happen:  breasts are swollen and skin improvements.

Progesterone, like estrogen, swells up breasts because of progestogenic action.

Quotesaid it was the influence of estrogen due to sensitization of the receptors -- he said this can happen in women who were severely deficient in progesterone for a while.

The idea that progesterone sensitizes estrogen receptors is in contradiction with all the studies out there. It is absolutely not supported by any clinical evidence.

QuoteBtw, I've read in other studies that excess doses of estradiol does in fact down regulate the receptors, makign the cells more resistant.  They do this for other hormones like insulin etc.. why not sex hormones as well?

I had the same thought but I don't think it's so much the quantity of the hormone in the blood but perhaps more the **constant** secretion of the hormones that eventually causes desensitization of receptors such as is the case with LhRh agonists.