My Doctor, after consultation with Trans Care BC doctors, switched me to patches instead of pills for estrogen. The reason is that both doctors were of the increased risk of stroke and or cardiac issues for someone my age. I was told that the new form of transmission should also be more effective. I have been on pills from the start of HRT, and my doctor thought that my levels very not where they should be. I guess we will seen.

I would like to hear how others found using patches, especially those over 60.

Hi Islandgirl,

We are still on the same path although you are further ahead than I am.

I started about 4 months ago taking the estradiol sublingually  instead of swallowing and it finally raised my E level, I will have a second lab test done again in a few weeks and my Endo said that if the E level was still not enough she was thinking of in addition to the pills to give me patches.   She had previously mentioned that she could not switch me to patches as it would required too many at the same time and she does not like shots for our age.

Keep in touch and PM if you need any additional info.

Remember 2 and half years ago when we both started on the low dosage thread on the same day???


Emily R

Today, we have many choices. The problems of the past years were with non bio-identical hormones. Many studies have shown the safety and effectiveness of bio-identical Estradiol. By using a non oral route, we eliminate the first pass effect. Estradiol taken by the oral route gets absorbed in the stomach and that blood goes straight to the liver, where much of the Estradiol is metabolized to mostly non-active metabolites.

Estradiol taken by a non-oral route goes directly into the circulating blood system. The choices we have are sublingual, topical in either patches or gel and of course, injectable as Estradiol Valerate. Take your pick. What ever you are comfortable with is just fine as all these routes are safe and effective.

Topicals and injectables do give a more steady blood level than sublingual. However, blood levels can fluctuate without being detrimental to the feminization process. Just keep taking the Estradiol and make sure your blood levels are somewhere in the normal female range.

Thanks Dani! Yes, I seem to be not absorbing at the rate expected when I took the pills. I will have to see how effective the the patches are.

Good to hear from you Emily! Glad that you are on your way! I do have more than one patch. My doctor told me that I have the 'Cadillac' model! Hopefully my blood levels will improve. All going well physically post op and I feel great! One of my biggest issues is breast development. I call mine my 'baby B's'. I may get what I got, as the saying goes.

Take care, Hugs!

Quote from: islandgirl on October 02, 2017, 07:10:09 PM
My Doctor, after consultation with Trans Care BC doctors, switched me to patches instead of pills for estrogen. The reason is that both doctors were of the increased risk of stroke and or cardiac issues for someone my age.

In a large long-term randomized controlled trial study, post-menopausal and hysterectomized women taking estradiol ORALLY were found to have a reduced risk of "mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke." (https://www.ncbi.nlm.nih.gov/pubmed/23048011)

Also, another study found that on ORAL estradiol, blood pressure dropped. See https://www.ncbi.nlm.nih.gov/pubmed/6367617

Finally, even in the famous WHI study, oral conjugated equine estrogens, taken alone, actually decreased the risk of coronary heart disease and did not significantly affect the risk of stroke.

QuoteI was told that the new form of transmission should also be more effective.

As far as breast growth, I had better results on oral estradiol vs. gel, patches or injections. More effective for what? I do feel better on non-oral, for some odd reason.

QuoteI have been on pills from the start of HRT, and my doctor thought that my levels very not where they should be.

Levels fluctuate in time. Does your doctor know your sensitivity to hormones? How was that measured by them? The right level for one might not be the right level for another.

QuoteI would like to hear how others found using patches

Didn't like them, as they left red marks.

Quote from: Emily R on October 02, 2017, 09:08:37 PMshe does not like shots for our age.

Why? Is there any study showing detrimental effects of E shots on older aged women? One study found that a high dose of estradiol injected weekly (far above the recommended doses for transgender women) had "virtually no side-effects" in women between the ages of 55-65.

Quote from: Emily R on October 02, 2017, 09:08:37 PM
Hi Islandgirl,

We are still on the same path although you are further ahead than I am.

I started about 4 months ago taking the estradiol sublingually  instead of swallowing and it finally raised my E level, I will have a second lab test done again in a few weeks and my Endo said that if the E level was still not enough she was thinking of in addition to the pills to give me patches.   She had previously mentioned that she could not switch me to patches as it would required too many at the same time and she does not like shots for our age.

Keep in touch and PM if you need any additional info.

Remember 2 and half years ago when we both started on the low dosage thread on the same day???


Emily R

I tried the sublingual (divided daily dose into 8 four hour doses).  Same amount of estrogen I took orally each day but did it sublingual.

Baseline (oral):  101 pg/mL
Sublingual 1 hour: 203 pg/mL
Sublingual 3rd hour: 136 pg mL.

So basically every four hours I was going from like 100 to 200 and back down.  Started to feel a bit weird doing it that way, after a couple months and just went back to oral.  Last blood test for oral dosage was 117 pg/mL.

What I felt that was different when doing this sublingually vs. oral:  My breasts swelled up immediately, just exactly like they have the past 3 days off adding progesterone creme along with oral dose of estradiol, due to water retention -- although they have had some permanent growth of the fat and breast tissue.  My skin got shinier and I had extreme increase in libido, which was relatively low the past few years. After a couple months on that libido decreased and skin wasn't as shiny -- still taking the same sublingual dose.   I can only think it eventually the E receptors become more insensitive over time.  Again I started this progesterone creme and getting same results, with HALF of the oral dose I took of E before.

I'm only 41 and have been on patches for two months.  It takes some getting used to.  Mine are changed out once a week.  It took me a while to find the right spot to put them.  Most people change locations up each time but I can't really do that.  I have one good area on my left hip that works well for me.  I've tried the same spot on the right side but it peels off since I sleep on my right side all the time.  Then there is the issue of panties.  Some cuts rub the area of the patch and the residue will stick to the panty. 

As for changing of the patch I take it off on Saturday morning.  Take a good shower and go most of the day without the patch.  Sometime in the afternoon or evening I put a new one on.  I haven't had any issues doing it this way.  Plus I keep a few Tegaderms on hand in case the patch starts to come off before it's supposed to.

Thanks! I will be changing my patches tomorrow. I will be trying the alternating spot method ( rib cage just below  my bra. I had a problem with one of my two patches, coming partly off. I just pressed it back on and it stayed for two days.

Quote from: islandgirl on October 04, 2017, 07:36:10 PM
Thanks! I will be changing my patches tomorrow. I will be trying the alternating spot method ( rib cage just below  my bra. I had a problem with one of my two patches, coming partly off. I just pressed it back on and it stayed for two days.

Is the estradiol gel as effective as the patches?  Seems like it'd be easier to use.

Because the patches are marketed to post-menopausal women, they tend to be dosed in such a manner that the user may have difficulty in reaching the sort of levels we typical aim for with feminization.  I have decided to inject for 5 years to max out whatever feminization I can achieve.  After that, I may try patches for the convenience, although once you get used to the shot, you really can't beat the convenience of injections.  I still plan to aim for lower levels after 5 years regardless of what vehicle I choose.  If I were cis-I would be likely be peri-menapausal at that point anyway.

Never a girl, but always a woman,

Renae