Switching to transdermal patches

[Courtney G]

PS: I learned, over time, the best location to put the patches and the methods for maximum adhesion but using the Tegaderms has been a bit of a game-changer for me. Long, hot showers or swimming are a non-issue now.

[KathyLauren]

The women's health GP, who seemed to speak a lot of sense, suggested Evorel 75 and I think that sounds right to me

That sounds like a conservative first guess.  My dose is 150 micrograms per day (0.15 mg), which has kept my levels stable for several years.  I apply the patches twice a week (Saturdays and Wednesdays) on my abdomen, below the navel.  My Estradot patches are small enough that I can change them 8 times (4 weeks) before re-using the same spot.  They also stay stuck in the shower without any covering.

[Tills]

Right, I can finally start on the patches tomorrow mid-morning. My Gender clinic have instructed requested my GP surgery to start me on Evorel 75. The surgery have issued the prescription.

Blood tests in 6-8 weeks time.

I will in fact switch the patches every 3 days, not 3,4,3,4 ... days because it's easy with the Health App alert on my watch. That will prevent the day 4 dip and build the level just a tad higher and more consistently. I'll use three alternating application sites: right thigh, left thigh, left buttock. I don't want to use my right buttock because I have, ahem, a saucy tattoo there 😜

All good. I'm expecting an estradiol dip for a few weeks whilst the depot starts to take hold but I'm going to have to live with that.

xx

[Tills]

Good morning gals.

I had bloods taken yesterday, to check levels seven weeks after switching from gels to transdermal patches. I'm on Evorel 75 which I change every 3 days rather than two in seven days, which they advise so that people always change them on the same day. Instead of that my Apple Watch is set with a medication alert every 3 days and that is working really well. So the Evorel 75 should give a slightly higher dose by taking 2 patches every 6 days rather than 7 days. Hope that makes some sort of sense?

We'll see how my levels look but in terms of lifestyle the switch has been the best move ever: life changing. Instead of the incredibly invasive and disruptive process of twice-daily gel smearing it's now just a morning patch applied every 3 days. Takes less than a minute. I've not had any issues with the Evorel patches coming off.

On the very first day I did get an aural migraine but it passed very quickly and it may have had more to do with dehydration, and lack of food, following an 8-mile hike. No recurrences since then and, besides, I've had migraines all my adult life: roughly one every two months and always when I'm overdoing it.

So we'll see how the levels pan out but in terms of lifestyle, the patches are fantastic. I wouldn't do anything else now.

xx

[Tills]

Well ... results are back and Estradiol is a dip

Estradiol 131 pmol/L
Testosternone <0.5 nmol/L
Serum Sex Hormone Binding Glob 48.8 nmol/L

The estradiol reading was on Day 3 of my patch, just before application of the new one, but even so I think that's a bit suppressed.

I'm going to propose upping from Evorel 75 to Evorel 100 which I think some of you may have suggested all along?!!! Sigh.

xx

[Charlotte_Ringwood]

Oh wow that's very low. This being the main issue with patches in my mind. Really I think that E needs to be tripled to get on lower end of WPATH recommendations.

T looks low, though within range...are you on blockers too?

I'm sure you're doctor can sort this all with you soon hopefully.

Charlotte 😻

[Lori Dee ✅]

Yes, the E level is a little low, but keep in mind that it is a trough reading, not a peak. This was at the lowest point between doses. I prefer mine higher, too. When I get that low, I get hot flashes and night sweats. Are you having any symptoms at the bottom like that? If not, your provider might not want to increase to the 100s. But if you are, then a higher dose patch might be in order.

Also, just FYI, that E will accumulate in the fatty tissues below the patch. As it leeches out, it never gets to zero. Over time, that reserve builds up. With me, I didn't notice it until I started packing boxes and getting ready to move. That increase in activity caused me to lose weight, specifically belly fat. That released some of those reserves, which caused an increase in my serum levels.

My doctor freaked out at first, but then we figured out what had happened, and she relaxed. Nothing to worry about. Just FYI.

[Tills]

Yes, the E level is a little low, but keep in mind that it is a trough reading, not a peak. This was at the lowest point between doses. I prefer mine higher, too. When I get that low, I get hot flashes and night sweats. Are you having any symptoms at the bottom like that? If not, your provider might not want to increase to the 100s. But if you are, then a higher dose patch might be in order.

Also, just FYI, that E will accumulate in the fatty tissues below the patch. As it leeches out, it never gets to zero. Over time, that reserve builds up. With me, I didn't notice it until I started packing boxes and getting ready to move. That increase in activity caused me to lose weight, specifically belly fat. That released some of those reserves, which caused an increase in my serum levels.

My doctor freaked out at first, but then we figured out what had happened, and she relaxed. Nothing to worry about. Just FYI.

Thanks Lori-Dee. That's really helpful.

I'm not getting any symptoms, no. Feeling good actually with bags of energy, I'm exercising loads and losing weight. I'm not really light-headed at the moment either which is a major improvement.

My GRC clinic did want me to take the tests on Day 2 but there wasn't an available appointment so it had to be Day 3.

@Charlotte_Ringwood I had an orchidectomy about 10 yrs ago so I have no naturally occurring testosterone. In fact I take a micro dose of T each day (0.2ml) for energy. If I don't I go totally spaced.

xx

[Tills]

Also, I do sometimes wonder about what it is I'm now wanting to achieve hormonally? I'm 62 in about a week and I transitioned over a decade ago. Boobs are 42 DD and I don't think I've any body hair to speak of. I don't have any naturally occurring testosterone at all.

Do I really need to be in so-called 'therapeutic' range which in the UK is considered roughly 400-600 pmol/L?

Or is there a case for letting my body wind down gradually into post-menopausal range?

I'm not meaning to be controversial here. Just asking. A good friend of mine in her 70's who transitioned decades ago is no longer prescribed any hormones at all. She takes calcium and that's all.

xx

[Lori Dee ✅]

Do I really need to be in so-called 'therapeutic' range which in the UK is considered roughly 400-600 pmol/L?

Or is there a case for letting my body wind down gradually into post-menopausal range?

That is a good question.

For transitioning, we want our range to be in the puberty range, so we get curves and boobs. Once we have that, the maintenance range is typical for women of reproductive age. I'm 68 and still trying to hit puberty!

However, "therapeutic" could mean anti-menopause. I would ask the doctor if that is correct. You don't want the hot flashes and unpleasantness of menopause.

My thinking is different. I know that hormones regulate a lot of stuff in the body, from bone density to body temperature. So, in theory, if I keep my hormones targeted for a young person, maybe I can fool my body into believing it is not 68 years old. Live long and prosper. That's my story, and I'm sticking to it.

😁

[Jessica_Rose ✅]

Remember, the medical community 'practices' medicine. In addition to all of their studies and tests, sometimes the answer comes down to 'how do you feel?'. While there are guides to 'normal' ranges of blood chemistry, there is probably no one number that is right for everyone. For many women, the 'right' level of hormones is somewhere between hot flashes and 'are you pregnant?' If you are comfortable at lower levels and all of your other blood chemistry numbers are within norms, then it sounds like you are in a good place.

Love always -- Jessica Rose

[KathyLauren]

Or is there a case for letting my body wind down gradually into post-menopausal range?

It is pretty much personal preference.  I figure that cis women get about 40 years on estrogen, so that's what I am aiming for.  I'll stop when I am 102.    On the other hand, cis women my age have lost their estrogen long ago, so there could be a case made for not continuing.  In between those extremes, there is room for a whole range of personal preferences.

[Courtney G]

It is pretty much personal preference.  I figure that cis women get about 40 years on estrogen, so that's what I am aiming for.  I'll stop when I am 102.    On the other hand, cis women my age have lost their estrogen long ago, so there could be a case made for not continuing.  In between those extremes, there is room for a whole range of personal preferences.

I'm with you, sis. I waited decades to run on estrogen. I'm in no rush to cut back on levels unless someone tells me I have to for health reasons.

As an aside, I switched from patches to injections about 4 weeks ago, after 4 years on patches. I got amazing breast development, soft skin, lost body hair, body and face shape changes and significant scalp hair regrowth on patches despite the fact that my estradiol levels were not great at trough and my T levels have been difficult to suppress. Due to the last bit, and due to the fact that I'd really like to discontinue spironolactone, I made the switch.

I feel pretty good overall, but not noticeably "better." I do have a sense that my estradiol remains higher for the duration of my (1 week) cycle than when using patches. I have to admit that I'm enjoying the single weekly shot over twice-weekly replacement of four (!) patches, and I'm quite enjoying the lack of patch adhesive all over my thighs.

Having said that, I liked patches. They did great things for me and I have confidence in the low level of health risk they afford.

[Dances With Trees]

A bit off topic, but related: during the few months I was on transdermal patches, my A1C dropped significantly without any other changes to medication or diet. Just coincidence?

[Courtney G]

A bit off topic, but related: during the few months I was on transdermal patches, my A1C dropped significantly without any other changes to medication or diet. Just coincidence?

That happened to a friend of mine. She happens to be intersex, so she figured that had something to do with it. But it prompted me to suggest to my GP that I cut my statin dose in half. I did, and my cholesterol levels are right where they should be.

[Tills]

I now have to wait 4 weeks for the transgender clinic and my GP surgery to communicate all in order to authorise what I've suggested, which is an increase from Evorel 75 to Evorel 100.

I wouldn't normally advocate this to anyone as a point of principle but I am mightily tempted just to get on and make the change myself now.

You can cut the patches to produce different doses so cutting a patch in 1/3rds would make it easy to hit c.100. This is something described in the patient leaflet so there's nothing radical about that. But I would effectively be jumping the gun into a temporary period of self dosing.

Not ideal. On the other hand I learned a long time ago that on trans matters doctor doesn't always know best.

Any thoughts ladies?

xx

[Lori Dee ✅]

How does cutting 75 get you to 100? I can see cutting 100 down to 75 or 50.

I suppose I am assuming the number correlates to mg dosage.

[Charlotte_Ringwood]

Your E seemed low but if you're not feeling any effects I wouldn't worry. As far as I'm aware E dosage doesn't affect anything as much as you may think. Possible menopause symptoms maybe. Lack of T is most important. You do need E for bone health but 1 month isn't going to affect it much.

I'm DIY myself and even I'd advise to just wait in this case.

[Tills]

How does cutting 75 get you to 100? I can see cutting 100 down to 75 or 50.

I suppose I am assuming the number correlates to mg dosage.

Sorry yes I didn't explain myself very well

1 x 75 patch
+
1/3rd of another 75 patch

Thus making 100 give or take.

The number is micrograms so 100 delivers 100 micrograms per day. Evorel 100 is a pretty standard dose in transgender care.

xx

[Tills]

That sounds like a conservative first guess.  My dose is 150 micrograms per day (0.15 mg), which has kept my levels stable for several years.  I apply the patches twice a week (Saturdays and Wednesdays) on my abdomen, below the navel.  My Estradot patches are small enough that I can change them 8 times (4 weeks) before re-using the same spot.  They also stay stuck in the shower without any covering.

As you will see from @KathyLauren's post here, Evorel 75 is 'conservative'. She's on 150 twice a week.

I think I may just switch up now to 100 every 3 days on the assumption that in about 4 weeks that's precisely what my clinic will advise anyway.

xx