Just looking at all of my options for estrogen therapy.

Torn between pellets and Premarin.

Just thoughts on how they worked for you in regards to your regime (if you used them).

Did Premarin work in softening the vagina post op?

Alternatives for Premarin...as its not ideally made.

Here are infos on pellets :

https://www.susans.org/forums/index.php/topic,200276.0.html


Imo non bioidentical sources of estrogen have no advantage but the risk of additional side effects.


*hugs*

Quote from: journey1 on March 30, 2016, 10:34:21 AM
Torn between pellets and Premarin.

Premarin is not a safe option as it contains equine (horse) estrogens that increase the risk of clots to a far greater degree than bio-identical estradiol, available in pills, patches, gels or injectables. And pellets!

Pellets may deliver too steady levels that may desensitize body to estrogen over time.

Pharmacology of estrogens and progestogens: influence of different routes of administration, CLIMACTERIC 2005;8(Suppl 1):3–63

"the administration of estradiol pellets was associated with relatively small fluctuations during the 6 months after implantation"

"There are reports on recurrence of hot flushes within 3–16 weeks after implantation of (...) estradiol, although (or because?) the estradiol levels were measured in these women to be extremely high (between 400 and 1000 pg/ml)149. The underlying mechanism is unknown; perhaps the symptoms are due to a desensitization phenomenon by extremely high estrogen levels causing the recurrence of estrogen deficiency symptoms."

If indeed it was extremely high levels that caused these symptoms and desensitization, then why do pregnant women who have MUCH higher levels of E (up to 75,000 pg/ml) don't experience this and why does the body produce so much if it proves ineffective? Why do transwomen such as myself have very high levels (up to 4,000 pg/ml) on injectables and experience no such symptoms or breast shrinkage or any other symptom associated with lack of E?

The answer is likely too steady levels.

QuoteDid Premarin work in softening the vagina post op?

When I switched to injectable bio-identical estradiol, my vagina softened, become more pliable and elastic. I also self-lubricate, sometimes a lot! I'm also taking bio-identical progesterone.

Quote from: KayXo on March 30, 2016, 04:09:36 PM
Premarin is not a safe option as it contains equine (horse) estrogens that increase the risk of clots to a far greater degree than bio-identical estradiol, available in pills, patches, gels or injectables. And pellets!

Pellets may deliver too steady levels that may desensitize body to estrogen over time.

Pharmacology of estrogens and progestogens: influence of different routes of administration, CLIMACTERIC 2005;8(Suppl 1):3–63

"the administration of estradiol pellets was associated with relatively small fluctuations during the 6 months after implantation"

"There are reports on recurrence of hot flushes within 3–16 weeks after implantation of (...) estradiol, although (or because?) the estradiol levels were measured in these women to be extremely high (between 400 and 1000 pg/ml)149. The underlying mechanism is unknown; perhaps the symptoms are due to a desensitization phenomenon by extremely high estrogen levels causing the recurrence of estrogen deficiency symptoms."

If indeed it was extremely high levels that caused these symptoms and desensitization, then why do pregnant women who have MUCH higher levels of E (up to 75,000 pg/ml) don't experience this and why does the body produce so much if it proves ineffective? Why do transwomen such as myself have very high levels (up to 4,000 pg/ml) on injectables and experience no such symptoms or breast shrinkage or any other symptom associated with lack of E?

The answer is likely too steady levels.

When I switched to injectable bio-identical estradiol, my vagina softened, become more pliable and elastic. I also self-lubricate, sometimes a lot! I'm also taking bio-identical progesterone.

I appreciate your input. I am currently on bio-identical estrogen via injection and bio-identical progesterone. Great kidney and liver function, perhaps I'll just stay on what I am now and I'll be ok.

I presently use a  Estrogel which is a generic Premarin product. I only use a very small amounts to soften the labia minora after my dilations It is working well and getting softer after 1 month use. The amount I use is minimal and recommended by the surgeon. Don't have any side effects ...maybe because of the small quantity used.

Quote from: KayXo on March 30, 2016, 04:09:36 PM
Pellets may deliver too steady levels that may desensitize body to estrogen over time.

My endo replaces implants when they go below 800 pmol/L, and won't do it above that (I asked when it was round 1000). He says it risks desensitization.

On another occasion I asked about the safety at much higher levels and he said no problem, with the pregnant women up to 70K being the example.

He's not said anything about constant levels being a problem, and I can't say I've noticed it. I'm getting much better effects on implants than years of gel/patches, but my levels are also 4 to 5 times higher. I also notice the mental effects.

I'm sure looking forward to pellets. So tired of pills & patches. Not yet post op however maybe later this summer, trying to save some $, sell off some things. Good luck ladies.

Quote from: FrancisAnn on April 03, 2016, 06:46:05 AM
I'm sure looking forward to pellets. So tired of pills & patches. Not yet post op however maybe later this summer, trying to save some $, sell off some things. Good luck ladies.

You can have SRS while using implants. No need to stop.

Quote from: AnonyMs on April 03, 2016, 06:53:08 AM
You can have SRS while using implants. No need to stop.

That's good to know. I've had a facelift & tummy tuck surgery. Both times my doc wanted me to stop estrogen for a while before surgery. My body felt funny & strange & wrong but I did what he said.

Quote from: AnonyMs on April 03, 2016, 06:25:31 AM
My endo replaces implants when they go below 800 pmol/L, and won't do it above that (I asked when it was round 1000). He says it risks desensitization.

On another occasion I asked about the safety at much higher levels and he said no problem, with the pregnant women up to 70K being the example.

He's not said anything about constant levels being a problem, and I can't say I've noticed it. I'm getting much better effects on implants than years of gel/patches, but my levels are also 4 to 5 times higher. I also notice the mental effects.

There are endos who try to balance out high levels of estrogen via implants with progesterone.
There are people who say they have good effects, only one person seemed to be not able to use it due to incompatibilities.


*hugs*

Quote from: Laura_7 on April 03, 2016, 09:19:04 AM
There are endos who try to balance out high levels of estrogen via implants with progesterone.
There are people who say they have good effects, only one person seemed to be not able to use it due to incompatibilities.

I tried a progesterone implant and it was rejected. Not fun. I now use Microgest instead.

Quote from: AnonyMs on April 03, 2016, 09:30:36 AM
I tried a progesterone implant and it was rejected. Not fun. I now use Microgest instead.

Bioidentical progesterone is available as capsules.
There is also a Proluton-Depot shot.

And the implants are often rejected if implanted traditionally.
Intramuscular implantation is a remedy.


*hugs*

Quote from: Laura_7 on April 03, 2016, 10:04:48 AM
Bioidentical progesterone is available as capsules.

aka Microgest

Quote from: Laura_7 on April 03, 2016, 10:04:48 AM
And the implants are often rejected if implanted traditionally.
Intramuscular implantation is a remedy.

I finally took the page from that book and gave it to my endo, but the appointment was so busy I forgot to get his opinion on it. Next time...

Quote from: AnonyMs on April 03, 2016, 10:10:15 AM
aka Microgest

Yes. just to mention.

Quote
I finally took the page from that book and gave it to my endo, but the appointment was so busy I forgot to get his opinion on it. Next time...

*hugs*
It were people having experience with it 


*hugs*

Quote from: warlockmaker on April 03, 2016, 03:12:56 AM
I presently use a  Estrogel which is a generic Premarin product.

Estrogel contains 17-beta estradiol. Premarin contains this as well but mostly estrone and other horse (equine) estrogens that affect clotting to a FAR greater degree due to the horse estrogen and the fact that it is taken orally. They aren't the same.

Quote from: AnonyMs on April 03, 2016, 06:53:08 AM
You can have SRS while using implants. No need to stop.

Then logically same should apply to all non-oral delivery of estradiol as implants, gels, patches, injections all deliver estradiol directly into the blood.

Quote from: Laura_7 on April 03, 2016, 10:04:48 AM
There is also a Proluton-Depot shot.

It's important to mention this is not bio-identical progesterone but 17-alpha hydroxyprogesterone caproate, which appears to be quite safe as well.

QuoteAnd the implants are often rejected if implanted traditionally.
Intramuscular implantation is a remedy.

Why would progesterone implants be rejected and not estradiol implants? This is what I don't understand. 

Quote from: KayXo on April 03, 2016, 11:01:50 AM
Then same goes for all non-oral delivery of estradiol as implants, gels, patches, injections all deliver estradiol directly into the blood.

I'm not sure sure about that. Its up to the surgeon, and I've only heard of it for implants. For example I know Suporn accepts implants but this is on his site:

Stop oral HR, gels and patches 7 days before you leave
Time last injectable HRT to have  expired by 7 days before you travel

Quote from: AnonyMs on April 03, 2016, 11:10:00 AM
I'm not sure sure about that. Its up to the surgeon, and I've only heard of it for implants. For example I know Suporn accepts implants but this is on his site:

Stop oral HR, gels and patches 7 days before you leave
Time last injectable HRT to have  expired by 7 days before you travel

It varies. Some us surgeons say to reduce doses but not stop.

Implants cannot be stopped.


*hugs*

Quote from: AnonyMs on April 03, 2016, 11:10:00 AM
I'm not sure sure about that. Its up to the surgeon, and I've only heard of it for implants. For example I know Suporn accepts implants but this is on his site:

Stop oral HR, gels and patches 7 days before you leave
Time last injectable HRT to have  expired by 7 days before you travel

Reread what I wrote...then LOGICALLY SAME should apply...(sorry, I rewrote it) because all these forms deliver the same type of estrogen, bio-identical estradiol and all, directly to the blood so mimic the way in which natal women naturally get it. Surgeons, doctors, for the most part, don't GET this but it's so easy to grasp even a 10 yr old could understand, lol. Fear gets in the way of sound judgment and transwomen end up paying for this, sadly.

My 2 cents...

Quote from: Laura_7 on April 03, 2016, 11:12:34 AM
Implants cannot be stopped.

They could, like 3-6 months before and be replaced with another form that would be stopped weeks to days before surgery. It could be done, if needed.

Quote from: Laura_7 on April 03, 2016, 11:12:34 AM
It varies. Some us surgeons say to reduce doses but not stop.
Implants cannot be stopped.

I asked my endo about this one too.

He said the implant should be timed so its running its low for SRS. He also said he can remove it, but has never done it. Given how it goes in I can't imagine taking it out.

He's got a lot of patients each year going for SRS, so I imagine they are going to a variety of surgeons.

Quote from: KayXo on April 03, 2016, 11:01:50 AM
Why would progesterone implants be rejected and not estradiol implants? This is what I don't understand. 

Its a different substance and possibly a different surface.
Its usually crystallized material.

Here is the reference:
https://www.susans.org/forums/index.php/topic,193313.msg1723640.html#msg1723640

Intramuscular implantation helped.


*hugs*