I was watching a show not too long ago on the Discovery Channel, I think it was titled "Changing Sexes."  The program interviewed several transgendered individuals, all at various stages of their transition, and the program even had Dr. Marcy Bowers on it (she's a top SRS surgeon in the mid-west).

One of the girls interviewed had been on high doses of HRT (administered orally) for so long that she ended up in the hospital because of health complications (her body was shutting down or something).  She had to stop HRT for several months before she was healthy enough for HRT again.  This time she recieved her hormones through a trans dermal patch.  The program said that orally administered hormones are rendered 90% ineffective once they pass through the liver, but with a trans dermal patch the hormones go right into the bloodstream and are much safer to take than pills.

Can anyone else verify this?  I am considering seeking this option if it is more cost-effective that oral hormones (effects are faster which means less patches, versus pills that are 90% ineffective once ingested). 

~Fae

Any time you don't put a load on your liver to remove what it considers foreign and therefor something it is designed to remove, you are better off.

Typically drugs are given orally with a slight overdose to help compensate for the "first-pass" scenario in the liver, and this is why it's also recommended to NOT ingest grapefruit in any form during medication administrations.

It seems that the liver gets a shut down or very diminished command to remove what it considers foreign in the blood stream. You would then get a serious overdose of the medication going against pharmaceutical design.

Yes..trans dermal admission is very liver-friendly and oral ingestions are not so nice to the liver.

Thankfully the liver is very self-repairing and can make tremendous inroads to better health if it's not asked to work so hard in the future. I don't advocate pushing it's buttons just "so far" to get what it is you want to achieve in gender issues..you only get ONE liver.

I was concerned about taking oral hormones as well, but my endocrinologist assured me that because I am so young and don't drink alcohol I would be fine.  I also tend to forget things I don't do daily, so the pills are just more convenient form me in that sense.  Although I might switch later 

Unless you've got liver damage prior to HRT, which is why its good to get a liver panel done, and you take very high doses of E orally of the wrong kind (ethinil estradiol is by far the worse offender), the liver risk is minimal.

Usually the risk from orals (in particular premarin and ethinilestradiol) is DVT, the liver produces by products with processing those E's that are not like biological E in females than increases the clotting risk (some with genetic predisposition are particularly at risk).

Orals, if your under 40, in good health, use biologically similar to natural estrogens, sublingually, and do not use more than a well known safe max limit, are very safe.

To compensate for the first pass through the liver reducing effectiveness when not taken sublingually, they usually boost the dose a lot.

The synthetic Ethinil estradiol is very very hardy and is not degraded easily by the liver, that's why its both potent (effective at low doses) and dangerous (easy to abuse and take 10 or 100x the safe dose ).

Quote from: Kat on August 02, 2007, 02:26:51 PM
I was concerned about taking oral hormones as well, but my endocrinologist assured me that because I am so young and don't drink alcohol I would be fine.  I also tend to forget things I don't do daily, so the pills are just more convenient form me in that sense.  Although I might switch later 

I used to drink socially one in a while, but stopped last year because I began anti-depressants (alcohol just made me feel tired and dizzy with the anti-depressants).  My endo said the same thing, since I don't drink, I'm young and healthy the risk of HRT is minimal.  My blood work has been coming back fine so I'll stick with the oral administration for now.

Was just curious what others thought. 

~Fae

Quote from: Fae on August 02, 2007, 12:26:23 AM
Can anyone else verify this?  I am considering seeking this option if it is more cost-effective that oral hormones (effects are faster which means less patches, versus pills that are 90% ineffective once ingested). 

Transdermal systems are more expensive than pills, but yes they are that much more effective.  This is true of all pills, not just estrogen.  The majority of the medicine is ether eliminated when you go to the bathroom or filtered out by the liver.

According to my doctor, the patches work better than swallowing, however, they are much more expensive. I hear injections also work well, but the cost and then having to stick a needle into you all the time.

As for my medication, Estrace (Estradiol), I dissolve it under my tongue. The estrogen is adsorbed into your blood stream, and your liver doesn't need to process it. You also retain a higher dose of estrogen because it isn't going through the digestive tract. The good news is that Estrace isn't very expensive, and as far as I know, similar to a trans-dermal patch in effectiveness and risks.

Premarin (horse pee) is designed to be swallowed and you can't dissolve it under your tongue (where estrace is designed to be disoloved under the tongue). The coating on Premarin is supposed to protect the estrogen until it passes your stomach and then into your digestive system. Estrace doesn't have a protective  coating.

I stopped taking Premarin because I got some side effects from it. Estrace, for me at least, hasn't given me any negative side effects.

I know a lot of people who take Estrace and just swallow it. It will work, but as far as I know I think with estrace under the tongue is the best way to take it. A lot of people don't know that the pill is designed for that (well, people I run into and who are taking it). I know a few people who started dissolving it and have mentioned to me that it worked better for them.

So, anyway, those are some options for you to talk to your doctor about.

Posted on: August 04, 2007, 02:18:25 AM

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BTW Ethinyl estradiol is usually found in birth control, and I believe that the estradiol in Estrace is different. I might be wrong, but I'm pretty sure it's different. I think Estrace has 17B Estradiol, which is the easiest for your system to use because it's identical to human estradiol, and puts your body through less stress with a low risk of clots.

Patches for me!

Currently I'm on Vivelle/Estradot, which require changing every 3 or 4 days.  I haven't missed a change yet.  I also do a daily low dose estrace sublingually to provide a 'cycle' over 24 hours.

Both routes of administration go around the liver first-pass problem.

Karen

Quote from: gothique11 on August 04, 2007, 02:27:48 AM
According to my doctor, the patches work better than swallowing, however, they are much more expensive. I hear injections also work well, but the cost and then having to stick a needle into you all the time.

As for my medication, Estrace (Estradiol), I dissolve it under my tongue. The estrogen is adsorbed into your blood stream, and your liver doesn't need to process it. You also retain a higher dose of estrogen because it isn't going through the digestive tract. The good news is that Estrace isn't very expensive, and as far as I know, similar to a trans-dermal patch in effectiveness and risks.

Premarin (horse pee) is designed to be swallowed and you can't dissolve it under your tongue (where estrace is designed to be disoloved under the tongue). The coating on Premarin is supposed to protect the estrogen until it passes your stomach and then into your digestive system. Estrace doesn't have a protective  coating.

I stopped taking Premarin because I got some side effects from it. Estrace, for me at least, hasn't given me any negative side effects.

I know a lot of people who take Estrace and just swallow it. It will work, but as far as I know I think with estrace under the tongue is the best way to take it. A lot of people don't know that the pill is designed for that (well, people I run into and who are taking it). I know a few people who started dissolving it and have mentioned to me that it worked better for them.

So, anyway, those are some options for you to talk to your doctor about.

Posted on: August 04, 2007, 02:18:25 AM

---

BTW Ethinyl estradiol is usually found in birth control, and I believe that the estradiol in Estrace is different. I might be wrong, but I'm pretty sure it's different. I think Estrace has 17B Estradiol, which is the easiest for your system to use because it's identical to human estradiol, and puts your body through less stress with a low risk of clots.

Needles freak me out, so that's a no-go.

Premarin would never be an option, as my friend loves horses (Premarin comes from pregnant mares) and it would break her heart if I took it.  She asked me not to and I'm respecting her wishes.

I am going to start dissolving Estradiol under my tongue.  I brought this up with my endo a while back and she said I could try it and see if it makes a difference, though she mentioned it might taste like chalk.  We'll see if it does because it feels like my boobs have stopped growing. 

~Fae

The Estrace is kind of sweat to me, but a bit chalky -- it doesn't take long to dissolve. Try not to talk when doing it (I'm bad for that, then it gets all over my mouth... You'd think that I could stop talking for one minute! )

Posted on: August 07, 2007, 04:20:55 PM

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oh yeah, and after it dissolves, which isn't long, just drink some water and any chalkiness that is there will go away quickly.

I'm in the transdermal camp.

Pros:  less to remember, constant dose of estrogen in the blood stream, better for your liver, good idea if you smoke or are over 40.
Cons:  more expensive, patches can fall off, can leave an adhesive outline that takes some effort to remove.

If you are going with the patch, spend the extra money and get Vivelle Dot (or ask your doctor).  They are smaller than the other patches and they do not fall off.

If you take higher doses of E, transdermal are way too expensive.
Maybe as maintenance doses after 10 year of devellopment doses they would be cost effective.

Quote from: gothique11 on August 04, 2007, 02:27:48 AM
BTW Ethinyl estradiol is usually found in birth control, and I believe that the estradiol in Estrace is different. I might be wrong, but I'm pretty sure it's different. I think Estrace has 17B Estradiol, which is the easiest for your system to use because it's identical to human estradiol, and puts your body through less stress with a low risk of clots.

From what I have read the difference is they added ethyl to the molecule so that your liver cant break it down. Thats why you always see that it is issued in very small doses  mcg vrs mg.  It is the same 17B Estradiol but much more powerful milligram for milligram.

Just a note I thought I should edit in: its my understanding that Ethyl Estradiol for some reason has a reputation for causing deep vein thrombosis when used in high doses need for transsexuals.


Kristina

I'm on patches and the only problem is you need about 3 to 4 of them to equal an acceptable dose of orals. I use Estraderm but was on orals before. The one thing to watch is that the Estradiol in the patches can give you a headache and or a stomach ache.

Sara.

I have had no problem with side effects.

Sadly, the pharmacutical companies don't make anything larger than 0.1 patches.  I guess they don't see the market.  But at least after battling with my insurance company, they are covered.

Quote from: Sara on August 26, 2007, 08:37:20 PM
I'm on patches and the only problem is you need about 3 to 4 of them to equal an acceptable dose of orals. I use Estraderm but was on orals before.

Sara.

I found the opposite to be true.

From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

Quote from: Ashley Michelle on September 01, 2007, 12:03:20 PM

Quote from: lisagurl on September 01, 2007, 11:22:07 AM
From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

i have heard to change them every 3-4 days?

Different brands have different directions. Mine are changed every 7 days.

Quote from: Ashley Michelle on September 01, 2007, 12:03:20 PM

Quote from: lisagurl on September 01, 2007, 11:22:07 AM
From the drug data sheet and lab tests, one weekly .1 patch is about equal to 2mg of estradiol taken every day. Over the week the patch varies 50% in how much drug gets into the blood.

i have heard to change them every 3-4 days?

There are three different kinds of patches: once a week, twice a week, and once a day.  I started out on the once a week version and found that the change in hormone levels from the start of the week to the end of the week was too much.  It was causing me to take over the menstrual cycles of the women in my house.  Now I'm on the twice a week version, and they have control of their bodies back.

Quote from: Ashley Michelle on September 02, 2007, 03:53:41 PM
i'm using the vivelle dots myself

Vivelle-Dots are so much better than the Mylan ones I was using before.  If anyone did a class action suit against Mylan, I would join it.