Hi everyone!

I'm wondering about the relative effects of estradiol injections rather than pills, and whether I should fight for a prescription for injections against a Dr. who seems to be dragging his feet.

So, I've had a frustrating experience with HRT. I started taking estradiol & spiro in June of 2017, and for several months saw some nice albeit subtle changes. Some facial changes, some breast growth, maybe a tiny bit of overall fat redistribution. As my Dr. steadily raised my estradiol dose, I expected to see more changes and higher levels, but this has hardly been the case.

After maybe 6-8 months HRT, everything seemed to have stagnated, and I have not seen any substantial changes over the whole of 2018. My levels for estradiol and testosterone have hardly left the normal "male" range, and have shown no steady growth.

Each time I saw my Dr., he made some changes in my medications. My estradiol dose has repeatedly been raised 1 mg/day and now sits 1 mg below the dose that my doctor says is the highest he will prescribe. He added progesterone, and most recently, about 6 months ago I switched from spironolactone to bicalutamide, and was led to believe this would significantly inhibit my testosterone.

3 months after that switch, I once again got poor results from the lab. When I saw those results, I emailed my doctor asking about switching to injections. I had heard from other girls online that they saw marked improvement on injections, and was even told that, for some girls, pills just aren't very effective no matter what the dose. My Dr. agreed that I could make this switch pending another round of tests 3 months later.

When I saw him last week, however, he seemed to be walking back on his word, mentioning that we could still raise my E dose 1 more milligram, or that there is still yet another anti-androgen we could try. Needless to say, I'm starting to lose faith in the changes he has suggested and feeling like I'm losing a lot of time not having the proper hormone levels.

Now, I've just gotten my latest test results back, the ones which were to decide whether I should begin injections, and they're hardly comparable to my previous results. Instead of the estradiol tests that my doctor has consistently ordered, I now see that they ran a total estrogen test. The levels do seem improved, and my total estrogen sits comfortably within the normal female range during the luteal phase, but I am unable to compare this value to my previous levels, and I am worried I thus have little ground to stand on for asserting my desire to switch to injections.

I've been feeling more and more that maybe I shouldn't trust my doctor's plan for my care, but I don't feel informed enough to confidently advocate for myself if we disagree.

Any advice on how I might proceed--whether it would be worth it to fight for injections or whether I should continue listening to my Dr.'s advice--would be much appreciated.

Thank you.

And if you don't see the same results that the other girls told you they saw on injections, then what? We should know going in that there are no guarantees with HRT, it allows your body to adapt to its feminine form. Not all girls are extremely femme.

Of course you should advocate for the treatment you want, but you really can't advocate for the changes you want, it varies from person to person.

Good luck!

Hugs, Devlyn

Quote from: Devlyn on August 31, 2018, 08:50:35 AM
And if you don't see the same results that the other girls told you they saw on injections, then what? We should know going in that there are no guarantees with HRT, it allows your body to adapt to its feminine form. Not all girls are extremely femme.

Of course you should advocate for the treatment you want, but you really can't advocate for the changes you want, it varies from person to person.

Good luck!

Hugs, Devlyn

Thanks for you response.

I understand that I can't control the results I get, but it's not that I'm displeased with a lack of results from proper hormone levels. The problem is that I have not reached the right hormone levels, and thus I have not even reached my own potential for results.

So I'm looking for information specifically about whether injections have shown to be more effective on estrogen levels.

Quote from: halah june on August 31, 2018, 09:19:12 AM
Thanks for you response.

I understand that I can't control the results I get, but it's not that I'm displeased with a lack of results from proper hormone levels. The problem is that I have not reached the right hormone levels, and thus I have not even reached my own potential for results.

So I'm looking for information specifically about whether injections have shown to be more effective on estrogen levels.

No, they haven't. Injections give peaks and valleys in your levels, patches provide a steady level that protects the liver, and tablets are super duper convenient. Your provider uses the various methods of delivery based on your medical status. In my case, needle phobia and potential liver damage made patches the initial recommendation of my doctor. She has subsequently deemed my liver strong enough and switched me to tablets. In any event, due to the unsteady supply of injectables, she isn't putting any new patients on injectable estradiol.

Hugs, Devlyn

Quote from: Devlyn on August 31, 2018, 09:33:18 AM
In any event, due to the unsteady supply of injectables, she isn't putting any new patients on injectable estradiol.

Hugs, Devlyn

There was never a problem with supply of the brand name product, Delestrogen - just most inusrance co's wouldn't pay for it.. Perrigo, the manufacturer of the generic, has announced a full return to supply this month.

I've been experiencing anxiety over the same issue. I've been on HRT for over year, and development has been, shall we say, problematic. I raised the option of injections with my new endocrinologist almost a year ago, and he told me that, while he was willing to go that route, there wasn't an FDA-approved source on the market and that some people had contracted meningitis using what was available. I subsequently learned that this was simply not true. However, he has also told me that he has no experience using injectable estrogen for trans women.

Although it looks like I'm going to get my prescription, I do not yet know if the concentration will be what I want. I fear he will start me at the bottom of the range and re-evaluate in 3 months. I'm 61, and I don't have to time to monkey around spending a year nailing down my dosage. We'll see what happens.

There is one other endocrinologist in the area and she does treat trans women. But changing doctors takes time, too. It's so aggravating.

Injections are much better for me. Delestrogen is widely available if the generic is still on back order.


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So first thing is you need a new doctor. The method of delivery is your choice, it is your body and if you are not comfortable that your provider is listening to you and working with you for your overall well being, then find someone else.

I switched to injections in November 2017, at that point I had been on oral estradiol for four months and was just at the bottom edge of female range at 208, and had decent but not wonderful breast growth. In January, my estrogen level was 540. Pretty high as my dr wants to see me right around 260 on the midpoint of my cycle. She warned about potential health issues of it being so high and now I am on what is essentially a 20% of normal transition dose because for whatever reason the injectable has been far more effective at keeping my e level high.

However, at the 13 mo the Mark, like you my breast growth is no different than at the six month mark. My dr says it's because my estrogen was so high but maybe not.

This is the whole YMMV part right

I have also been on Progesterone since November and switched to micronized in June. I really can't say it has helped but I am sure it has not hurt. I started to see obvious fat redistribution at around month 8 or so, though recently wonder if that's going backwards. But I look at my belly and it has a female shape now.

I am on Delestrogen now due to the supply issues with the generic that have been going on since November let year. I am fortunate that when I brought this issue up to my employer, they forced coverage until the generic becomes available, and they revisit that every 90 days. For me that's the difference between $10 a vial and $183 a vial. It is always worth asking. Same thing with the pharmacy, wegmens got me finesteride for $18 a month, instead of the $78 it would cost as a not covered drug.

Oh by the way, sticking yourself with a 2" needle in the thigh every week (or whatever frequency you choose) is not fun, but you do get used to it. But it's still time you need to find to prepare the syringe (I use a different draw needle and inject needle), do the injection and then safely clean up.

Good luck with your physician, but remember it's your body and if there's not a medical reason not to do it, the delivery mechanism should be your choice. But I would not want you to expect that miracles in transition will happen just because you are injecting, that is not the case and you will also get to experience pms symptoms and in my case an increase in frequency and intensity of migraines due to the hormone cycle. Things to look forward to