Choosing the form of HRT

[2.B.Dana]

My therapist approved me for HRT at the end of February. Through a long series of frustrating missteps I am still in the waiting game to receive my first prescription.

Yesterday I received a call from one of the nurses who works with my endocrinologist. He had finally reviewed my HRT letter and had ordered Premarin for me.  I was in the middle of work and really didn't have my brain tuned into these matters but my heart sank. I wasn't expecting that at all but didn't feel good about it. I told her the vast majority of girls I had read about were on estradiol and could that be considered. She said she would speak to the dr and call me back.

He reviewed his options for prescriptions in their system and the only estradiol they offered was in patch form. I didn't feel good about that but she said they could request the pharmacy get the pills but that would have to be approved. I am going through the VA and while pills are available nationally, they were not stocked at my main VA in the state.

I told her that I don't react well to surgical tape etc and didn't want to deal with the patches and skin irritation. I may still have to accept them if the pills aren't approved but it is a step in the right direction I guess. There is so much controversy or lack of specifics for doctors to go by in this realm. I'm finding that estrogen is as debated in the endocrine world as testosterone is when it comes to dosage and delivery.

I have read numerous posts about patches being both good and bad. Some brands working better or the patches themselves have good and bad properties. One of the down sides of the VA drugs is they can be changing brands by the month. The have estradiol patches, but a different brand may be shipped each month based on contracts etc. So if you like a particular patch, you may not get that one again. I had this on other pills I take and it's frustrating, but just part of the low bidder system.  I was hoping that the pills would be more standardized with less differences between vendors.

I was wondering if any of you ladies specifically told your providers what you would or would not take? Is there a method of delivery that limits the emotional roller coaster ride or do they all have bitchy periods built in?

thanks for any info you can share on your preferred method of HRT.

[Devlyn]

I'm on the  patch due to age, liver concerns and a needle phobia . I'm prescribed Vivelle Dot but they've given me an equivalent Sandoz patch from the beginning. My doctor says the transdermal delivery is very steady. I get a slight pinkening of the skin that was covered for 3 1/2 days. It looks like a shingler was working on me. Laurie, get your mind out of the gutter.    I decided early on that little pink rectangles were a side effect that I'd gladly accept.   

Hugs, Devlyn

[Colleen_definitely]

Another option to consider if you really want pills is to try to get them to write a prescription and get it filled at Walmart.  Generic 2mg estradiol tablets are covered under the $4 for a 30 day supply price plan.  It's not as nice as getting the VA to cover it completely, but it's still really cheap.

I went with tablets initially since my skin doesn't like adhesives (and REALLY doesn't now that I've started HRT), and am not a huge fan of needles either.  The pills are cheap, easy, and seem to be effective for others so I didn't really see a down side.  Sure I have to take them every day, but I'm already taking spiro every day so it's not a huge deal.

[KayXo]

Another option is gel. Brand name Estrogel, usually in the US.

Liver concerns with pills for people over the age of 40 are based on studies in transwomen who were taking a high dose of ethinyl estradiol (and cyproterone acetate, also known to adversely affect liver). Having nothing to do with estradiol pills (often taken with a lower dose of cyproterone acetate or none at all) that contain a natural, bio-identical form known to affect clotting and liver to a much lesser degree and at doses significantly lower if you calculate equivalences. It's unfortunate that people over 40 are denied pills for this reason as sometimes it's cheaper, more convenient and effective for feminization.

[Devlyn]

I have cirrhosis.

Hugs, Devlyn

[jentay1367]

Is this Endo used to working with Trans Women? Premarin seems like a pretty archaic choice. It's much more inclined to be associated with DVT episodic problems. Are these people through an Insurance carrier? If not, it's my humble opinion that I'd find someone else to deal with. You really seem to be off on a rocky footing with these people. Might be better to cut your loses and move on before you have to much of your precious time wrapped up here.

[2.B.Dana]

Hats off to Colleen for her suggestion of Walmart! I forgot I had done that on another med with the VA. I called the nurse and she had the doc do a prescription through them and it's already waiting for me. I may out grow the dose they do on the $4 plan but this certainly gets me started. I have a follow up scheduled for Aug 1 so I can discuss a dose change then.

The dr is older, chief of the department, but has done trans women in the past. He is the best the VA has to offer at the moment in my locale. This is a decent start I guess and I can discuss the plan better in person than through the nurse.

Thanks everyone,

[Colleen_definitely]

Glad I could help!  Looks like it's $4 per 30 tablets, so even at higher doses you're looking at a pretty affordable prescription.  Or if you can get a 90 day prescription written, it's $10 per 90 tablets and you save a couple bucks.

[Laurie]

Glad I could help!  Looks like it's $4 per 30 tablets, so even at higher doses you're looking at a pretty affordable prescription.  Or if you can get a 90 day prescription written, it's $10 per 90 tablets and you save a couple bucks.

Another note: With the 2mg pills it makes splitting the dose very easy when you get increases they are usually done in that increment.

  I am with the VA in Oregon and get generic estradiol pills though them.

Hugs,
  Laurie

[KayXo]

I have cirrhosis.

Bio-identical estradiol taken orally has never been shown to precipitate/cause or worsen cirrhosis, AFAIK. Perhaps, other forms. Liver enzymes in studies where oral estradiol was given to transwomen remained normal. Even where high levels are attained with non-oral estradiol and there is substantial uptake by the liver, in studies with ciswomen of a certain age and younger, liver function/enzymes remained normal.

The only thing that could result from cirrhosis is that estradiol is metabolized differently, is not broken down to the same degree so that higher levels of estradiol end up circulating in the blood.

I'm not a doctor. I'm sharing my own findings, nothing else.

[Devlyn]

"I'm not a Doctor"

Ya. The first rule of medicine is do no harm. I have a sick liver. My doctor is avoiding anything that might harm me. You don't poke bears with sticks. 

Hugs, Devlyn

[jentay1367]

"I'm not a Doctor"

Ya. The first rule of medicine is do no harm. I have a sick liver. My doctor is avoiding anything that might harm me. You don't poke bears with sticks. 

Hugs, Devlyn

So what's up Dev? Hep C? Too much adult beverage? Lousy genes? You seem too smart and centered to have done something to yourself. How's a woman like you end up With Cirrhosis?? God knows I tried to get it. Drank and drugged myself into many stupors. My family gene pool apparently has weak minds and strong bodies. My father drank like a fish and killed himself at 73. Autopsy showed the liver of a 30 year old. Life is so unfair and so damned weird. Anyways, girl....my heart breaks for you to have such a crappy problem to live with. Be well, Hon.

[Devlyn]

"I'm not a Doctor"

Ya. The first rule of medicine is do no harm. I have a sick liver. My doctor is avoiding anything that might harm me. You don't poke bears with sticks. 

Hugs, Devlyn

So what's up Dev? Hep C? Too much adult beverage? Lousy genes? You seem too smart and centered to have done something to yourself. How's a woman like you end up With Cirrhosis?? God knows I tried to get it. Drank and drugged myself into many stupors. My family gene pool apparently has weak minds and strong bodies. My father drank like a fish and killed himself at 73. Autopsy showed the liver of a 30 year old. Life is so unfair and so damned weird. Anyways, girl....my heart breaks for you to have such a crappy problem to live with. Be well, Hon.

Way way way too much adult beverages when I wasn't even close to being an adult. Thanks for caring. 

Hugs, Devlyn

[Dena]

Walmart had a little difficulty filling my last prescription because they didn't have it in stock but I got 180 tablets for $20. The last time I filled a prescription for Premarin, the tablet was about half that strong and it cost over $80. In addition, after being on both tablets, I have had far better results on estradiol and even after years on Premarin I seem to be getting additional development from estradiol. For me, it's worth paying it out of pocket to get away from Premarin.

[KathyLauren]

I am on the patch due to my age (62).  Not that there's anything wrong with my liver, but the doc isn't taking any chances. 

The clinic I go to does not work with an endo.  They offer transition services because they saw a need and had a concern about long waiting lists at the endo.  Not being specialists, they only take low-risk patients and proceed conservatively.  I don't have a problem with that, and it is working fine for me.

My doctor told me that if I had concerns about what they prescribe, I could take my chances on the endo's waiting list.

[jentay1367]

So what's up Dev? Hep C? Too much adult beverage? Lousy genes? You seem too smart and centered to have done something to yourself. How's a woman like you end up With Cirrhosis?? God knows I tried to get it. Drank and drugged myself into many stupors. My family gene pool apparently has weak minds and strong bodies. My father drank like a fish and killed himself at 73. Autopsy showed the liver of a 30 year old. Life is so unfair and so damned weird. Anyways, girl....my heart breaks for you to have such a crappy problem to live with. Be well, Hon.


Way way way too much adult beverages when I wasn't even close to being an adult. Thanks for caring. 

Hugs, Devlyn

Well...you look happy, beautiful and healthy now, so you slayed your demons girl. More than many can say. Glad you're here to keep us from getting out of hand

[kelly_aus]

"I'm not a Doctor"

Ya. The first rule of medicine is do no harm. I have a sick liver. My doctor is avoiding anything that might harm me. You don't poke bears with sticks. 

Hugs, Devlyn

I'm going to assume your Doc is a Hufflepuff, so 10 points to Hufflepuff. There are many here who dispense "wisdom" that lack proper knowledge and training in the field.