If the pills go through the digestive tract, there the output does contain more of the weaker
estrogen. It has nothing with the pills themselves, more to do with their metabolism.
Some of this can be countered by higher dosages.

If you take them sublingually, you don't have this problem.

Sometimes, people remember information, but its trucated.

Quote from: Keira on January 07, 2008, 07:18:01 PM

If the pills go through the digestive tract, there the output does contain more of the weaker
estrogen. It has nothing with the pills themselves, more to do with their metabolism.
Some of this can be countered by higher dosages.

So in other words, the faster your metabolism, the better a candidate you are for transdermal/injectables?

QuoteIf you take them sublingually, you don't have this problem.

I've never seen any literature published by medical professionals stating that sublingual absortion was superior when taking estrogen pills, over just taking the pills themselves.  In theory and all it might work, but surely considering the big fuss about it, if it worked, then doctors would prescribe to take it that way.  the directions indicate to swallow the pills, not stick them in your mouth for an hour, that's all I'm saying.  If you have anything to shut me up, I'm easily humbled.

No I meant, going through the stomach is a different metabolism than direct injection in the blood of estradiol valerate. You got stomach acids, all sort of enzymes, etc. When you do it sublingually, its the same as injecting if your able to not swallow. There are actually studies, but I'm too lazy to get them .

Pills are also made to be used sublingually, if not they would be hard coated and the powder inside wouldn't micronised. Its just more convenient to swallow the pill instead of keeping the pill 10 minutes under your tongue.

Quote from: Keira on January 07, 2008, 07:30:49 PM

No I meant, going through the stomach is a different metabolism than direct injection in the blood of estradiol valerate. You got stomach acids, all sort of enzymes, etc. When you do it sublingually, its the same as injecting if your able to not swallow. There are actually studies, but I'm too lazy to get them .

Pills are also made to be used sublingually, if not they would be hard coated and the powder inside wouldn't micronised. Its just more convenient to swallow the pill instead of keeping the pill 10 minutes under your tongue.

I would appreciate it, and others would too I'm sure, if you'd find time sometime in the near future to find those studies:-)

Estrace when taken sub lingually essentially goes into the bloodstream directly. its the best method to take it as it does not get mucked up by the digestive track. 

Generally speaking nearly everybody I know on injections is on injections because pills did not work.  Injectibles did not work much better.  Why?  Because they were not as receptive to estrogen.  Plain and simple.  So as much as people think one works better then the other its really factors out of your control and it gets down to personal prefrence.  The only reason injections may have to be used is to get T to female range.  I was there very quickly with a low dosage of pills.  I know a few others on this board where that was also the case.   

Ya I am curious enough to want to know. I also wanted to inform you all of the price for injectables.

Wing Walker pays $135 for 20 ml of *prescribed,*  compounded injectables.  I will give you an idea of the costs for one person:

Dose = 1 ml every two weeks = 40 week supply = $135 USD or CAD.  = $135/40 wk = $3.38/wk.

The last time I bought the little blue estradiol pill here in Canada it cost me $75 for not even a full month because it was not on the Ontario formulary.  Prior to that I had been taking conjugated estrogens and I heard that they were pretty tough on a person, so I asked my doc to give me the blue pill.

Wing Walker did the rest.  BTW, a box of syringes and needles is also by prescription only and it varies between $6 and $12 for 100 each.

Cindy

Quote from: Amy T. on January 08, 2008, 03:10:11 AM
Estrace when taken sub lingually essentially goes into the bloodstream directly. its the best method to take it as it does not get mucked up by the digestive track. 

Generally speaking nearly everybody I know on injections is on injections because pills did not work.  Injectibles did not work much better.  Why?  Because they were not as receptive to estrogen.  Plain and simple.  So as much as people think one works better then the other its really factors out of your control and it gets down to personal prefrence.  The only reason injections may have to be used is to get T to female range.  I was there very quickly with a low dosage of pills.  I know a few others on this board where that was also the case.  

O, puh-leez!! 

That was quite a "loading of language." "Because they weren't as receptive to estrogen...." What's unspoken there is ...? (That is sorta an 'I'm better than you' doncha think, Amy?)

Please! MY doctor had reasons for beginning and continuing on IM that had nothing to do with anything like that, Amy. When someone begins prescribing a drug they NEVER know before-hand that " they were not as receptive to estrogen." That becomes an ad hominem argument from the git-go. But, you're a smart girl and knew that, didn't you?

Where is this alleged test that your doctor did to determine 'estrogen-receptivity' prior to any hrt at all? Please cite references for such tests being available and used within the profession. Most docs start with a mix of oral, skin-absorbed and IM unless there are other physical (medical) reasons that might interfere: i.e. liver-damage possibly most-frequent.

Certainly there is no "estrogen-receptivity" test!!! 

That is just wishful-thinking and speaks not at all to what the thread is discussing. It may be good for 'ego-points' but certainly doesn't have any viable chemistry or medicine behind it. We're back to "this is what I use so it must be the best."

Cindy is correct on costs and cost-efficiency. $44.56 for 10cc 40mg/ml solution of estradiol valerate w/ syringes mailed by a compounding pharmacy. There is at least one that is about $5 less than that.

N~

I'm starting to get upset at all these unsupported, dogmatic claims.

Please people on these forums, discontinue talking about how sublingual absorption of estrogen, "goes directly to your bloodstream" and all that until there is literature by a medical professional posted on these forums and studies to support such a claim.

I edited the poll, making distinctions now between oral and sublingual, since it's becoming a pretty big issue.

Right now I'm on Estradiol Valerate injections plus progesterone been on it for 4 months it seems to work. I only been on premarin sporadically so I can't really make a call on whats best. I read some where that injectable give you faster results in the beginning than pills but things even out after a time period. Tonight I'll look for that article and really don't know much about sublingually.

Later,
Anna

Kalt, that's what sublingual does and means, going into the bloodstream, how on earth do you think the estrogen gets into the body there!! That does not need a study, that's the mode of action of sublingual, micronised estradiol valerate gets absorbed there because there because the area is so vascularized and the blood vessels are so close to the surface of the skin. There are few areas like that, the lower intestinal tract is another one, and that's why its used for suppositories. The medication of suppositories is not digested, its absorbed into the bloodstream directly. That's why progeterone capsule are more efficient as suppositories than swallowed. Its the swallowed thing that's less effective.

If you're so upset about it, go get the info yourself.

I'm upset by the fact that you do not distinguish things that need full scientific
scrutiny from things that do not.

Things that would need a study is finding out how much people swallow when using sublinguals.
That's now known specifically, but its higher than 0%;.

This gives a little summary of each method. For women who had a hysterectomy but information is still good.
http://menopausehysterectomy.com/methods.htm

Later,
Anna

Quote from: Keira on January 08, 2008, 09:32:53 AM

Things that would need a study is finding out how much people swallow when using sublinguals.
That's now known specifically, but its higher than 0%;.

That's exactly what I've wondered. 

Kristi

Quote from: Nichole W. on January 08, 2008, 05:14:49 AM

Quote from: Amy T. on January 08, 2008, 03:10:11 AM
Estrace when taken sub lingually essentially goes into the bloodstream directly. its the best method to take it as it does not get mucked up by the digestive track. 

Generally speaking nearly everybody I know on injections is on injections because pills did not work.  Injectibles did not work much better.  Why?  Because they were not as receptive to estrogen.  Plain and simple. So as much as people think one works better then the other its really factors out of your control and it gets down to personal prefrence.  The only reason injections may have to be used is to get T to female range.  I was there very quickly with a low dosage of pills. I know a few others on this board where that was also the case.   

O, puh-leez!! 

That was quite a "loading of language." "Because they weren't as receptive to estrogen...." What's unspoken there is ...? (That is sorta an 'I'm better than you' doncha think, Amy?)

Please! MY doctor had reasons for beginning and continuing on IM that had nothing to do with anything like that, Amy. When someone begins prescribing a drug they NEVER know before-hand that " they were not as receptive to estrogen." That becomes an ad hominem argument from the git-go. But, you're a smart girl and knew that, didn't you?

Where is this alleged test that your doctor did to determine 'estrogen-receptivity' prior to any hrt at all? Please cite references for such tests being available and used within the profession. Most docs start with a mix of oral, skin-absorbed and IM unless there are other physical (medical) reasons that might interfere: i.e. liver-damage possibly most-frequent.

Certainly there is no "estrogen-receptivity" test!!! 

That is just wishful-thinking and speaks not at all to what the thread is discussing. It may be good for 'ego-points' but certainly doesn't have any viable chemistry or medicine behind it. We're back to "this is what I use so it must be the best."

Cindy is correct on costs and cost-efficiency. $44.56 for 10cc 40mg/ml solution of estradiol valerate w/ syringes mailed by a compounding pharmacy. There is at least one that is about $5 less than that.

N~

Like I said, this is not from the people I know who started out on Injections, this is from women who started out on orals and who had to go to injections. 

This is from people I know.

I know there are doctors out there who only do injections and start you on them, I also know there are doctors out there who will start on orals and will only switch to injections if it is necessary. 

Generally speaking, pretty much every women I know personally on injections with regards to how receptive their bodies are to estrogen.  If your body is more receptive, it just is.  Plain and simple.  You probably would not know if you would have done just as well on orals, which may have acted a little bit slower, but still probably would have worked just as well.

By the way most doctors do not start out on a mix of methods.  They all seem to have their own crazy idea as to what works. 

This is not a "I'm better then you" scenario.  It is something that I have experienced with people I know in real life.  I know about half a dozen women on injections...in which nothing happened.  Whether you like to admit it or not some peoples bodies are more receptive to certain types of hormones.  This is common knowledge with regards to HRT.  Thats why some people like Gothique do great with low doses of orals, while others like my friends who go on injections have absolutely no breast development after a year.  Its hormone receptivity, which is by in large...genetic. 

Quote from: Amy T. on January 08, 2008, 11:53:21 AM
By the way most doctors do not start out on a mix of methods.  They all seem to have their own crazy idea as to what works. 

A personal theory of mine from what I've seen... and yes, pure IMHO and speculation... is that dosage changes are what cause bursts in development. Someone goes to their doc and complains nothing is happening anymore, the doc switches them from pills to shots, they start developing again, and HEY! INJECTIONS ARE BETTER! When in fact it's not the method, but rather the dosage change that "shocks" the body back into motion.

And vice-versa, from injections to patches or pills.

Pure speculation though.

~Kate~

I think you're on the right track there Kate.

Its very rare when people switch from pills to injections that the serum level will
be exactly the same, so saying one is better than the other is like comparing
apples and oranges.

Doctors tend to rarely prescribe high enough dosages
of pills because of the misguided notion (in my opinion) that its hard on the liver.
They seem to confound non-bio identical estrogens like premarin and ethinilestradiol,
with those that are bio identical.

They seem to also totally forget that they can be used sublingually.

There is a correspondence table between pills and injections,but this is an
area which has not been studied at all and I don't even know where those
tables come from!

So, when they prescribe injections which are more liver friendly, they might
boost the doses. But, since we're not comparing actual numbers here I can't say
for sure what doctors prescribe here, just what I know from TS acquaintances on
my side.

And yes, everything has a baseline genetic sensitivity to E.
This sensitivity even varies with the amount of T and P and the level of E in the body,
plus a few other feedback mechanisms. How much tissue growth or fat transfer
you get from this sensitivity is influenced by multiple metabolic factors (insulin and human growth hormone
levels for example).

So, it is impossible at first hand to know how sensitive you are and what results you'll get
from this sensitivity, though its possible to guess
from familly genetics and your own body.

If you're at a normal weight and
you've got very little fat in the gynoid areas, thigh and legs,  prior to HRT, your response
to estrogen is likely lower (not zero, so nobody jumps on me)
than someone who's got a good cover of fat there even if skinny.

I've seen both versions at a party this summer, there were some with years of HRT
who had muscles well defined on their legs with little fat on them (and they were not that athletic or skinny) and others with no visible muscle definition because of fat coverage who were athletic (one was an university athlete).

The patches work better with a hot iron.

LO

Quote from: lisagurl on January 08, 2008, 01:48:02 PM
The patches work better with a hot iron.

LOL, I'm sure that they do, Lisa!!! Did you get those patches on your jeans when you were a kid too!!!?

Sweetie, I think these patches are meant to come off sooner than those were. LOL!!

Yes, I know that there are levels of receptivity -- some do better, some worse, some not much visibly at all except maybe skin softening. And lotsa women are fooling themselves to think that pills, patches, sublingual or swallowed or IM will affect that.

Keira & Kate are definitely right about dosages changing and I suspect Keira is also correct that most endos are way too conservative -- although we should be aware that E, like some vitamins and minerals, will simply be flushed outta the system when the level reached is higher than the receptivity level at any particular time. So there is a level beyond which some one is wasting her money. However, that old saw about E 'turning' into T is not true. It just gets evacuated.

Low doses are particularly problematic, imo, for post-ops who are taken to post-menopausal levels. They often complain of feeling tired, generally crappy, etc. I imagine that there's a perfectly good reason for that: too little E. Of course, finding physicians stats on THAT is impossible -- there are none.

N~

Hi I never said or suggest anyone take this or that over this and that I only listed what worked for me. I started on conjugated estrogen  then I went to estradiol pill then went to injectables and I found that (for me) the injectables worked best. A 62 year old with the body of a fourty year old woman's body, I say that's darn satisfying results for me. Well except the pot needs to go. I can only say I have nothing to complain about.

Ya'll have a wonderful day. 

Cindy

Cindy, it goes back to my argument. Injections were better, but
where you in fact getting the same dose. Very doubtful since you
went from something that's known bad for DVT and the liver, to
something with a very slight impact.

Its probable the doctor
pushed the dosage when you went through this change.
Did you swallow the pills or use them sublingually? (this would have
a major impact on effectiveness)

Well I agree with you that the dosage wouldn't be consistent with all. I am smaller then the average woman so I would be taking less then anyone bigger the me I suppose. Ya I swallowed the pills, tried the under the tongue thing but there never seemed to be sufficient time where I wasn't talking to someone and it doesn't work to well talking. I like talking to people out there as well as my friends in here.

Cindy