So, I just got a phone call from my GP. Since starting oral estrogen my bilirubin levels have been creeping up to 2.1 - normal should be about 1.6 or so. Thankfully, I haven't turned yellow yet:P All the other liver enzyme stuff is fine. It's a known possible side effect of estrogen use to cause a pure cholestasis and should be reversible. Anyway, I was wondering if anyone knows if the transdermal/injections have less potential to cause cholestasis? I was able to find one reference in "Practical Gynecology" doing a Google Search that transdermal estrogens have less cholestasis effects. Anyway my follow-up appointment is on Thursday and he was going to review the endocrine societies recommendations and probably give me some patches... My estrogen levels were OK though.

Any thoughts?

Injections will definitely help since the estrogen doesn't have to pass through your liver to get into the blood stream. Transdermal will also help, but I think injections are much more effective than transdermal and especially pills. Inject once every two weeks and forget about it. People I've know with patches many didn't like them if you sweat or they just got in the way.

Thanks for the input. I would love to get injections. In the discussion I had with my GP he and I were on the same page of getting off the pills (I was having emotional swings about the time I took another pill anyway.) I know the bilirubin was a minor bump and I do agree with my GP that we need to keep a close eye on the numbers. Sadly, there isn't a whole bunch of literature on estrogen induced cholestasis. Part of this is to be able to bring to my GP resources that would help explain what to do next. I can find tons of stuff on cholestasis of pregnancy though.....