Switching to transdermal patches

[Tills]

I'd just like to reiterate though, staying on topic, that generally I think the patches are fantastic. Compared to the gels I was smearing on twice a day, the patches have transformed my life and quality of life.

xx

[Charlotte_Ringwood ✅]

I'd love to go on to patches myself. They are just very expensive. I think I'll move to them when I'm not having to spend on laser removal, surgery and such. Or I'll jus wait a few years until I can get through NHS.

Good to know that you rate them so highly. I love the idea of them

[Tills]

Today was changeover day so I've switched up to Evorel 100. In the extremely unlikely event that I feel off colour I'll peel off the extra mini patch.

But I'm expecting my transgender clinic and GP surgery to approve this in a few weeks time.

Bear in mind that my trough reading on gels was 400 pmol/L so 131 pmol/L really is a dip.

xx

[Courtney G]

I did lots of stuff to manipulate my dosage while using patches. Early on, I cut them in halves or quarters in order to microdose and later I left some patches on for a couple of extra days after I added new ones, creating an "overlap" to increase my effective dose. It was also a means to allow me to stockpile patches.

[Tills]

Thanks @Courtney G : that's helpful to know. I hadn't thought about leaving the previous one on to create an overlap.

[Tills]

In terms of stockpiling, I have some extra patches as whilst I awaited the GP surgery to connect with my clinic I ordered a private prescription through the post. Nothing dodgy about that: a bona fide UK pharmacy who checked that my clinic had approved it. It's useful to have the extras as I hate running low.

@Charlotte_Ringwood I bought 16 x Evorel 75 for £25. I suppose that is quite pricey but if you're doing 2 a week (mine is 2 in 6 days) then it's roughly £13 a month. Not too bad?

xx

[Charlotte_Ringwood ✅]

@Charlotte_Ringwood I bought 16 x Evorel 75 for £25. I suppose that is quite pricey but if you're doing 2 a week (mine is 2 in 6 days) then it's roughly £13 a month. Not too bad?

xx

Doesn't sound so bad...just not sure of equivalent dose as I'm on 6mg oral per day to get my levels. Might need two patches to get it. I'll have a look again. Thanks 😊

[Courtney G]

Thanks @Courtney G : that's helpful to know. I hadn't thought about leaving the previous one on to create an overlap.

You're welcome. I'll add that near the end of my time with patches just a month ago, I decided to stagger them to create a shallower trough. I was using four .100 mg patches twice a week and I think my peak was ok but my trough too low, so I did something like this:

Monday night: 3 patches (instead of 4). Maybe leave one patch on from the previous dosing, creating a four patch dose (effectively)
Wednesday evening or Thursday morning. Add one patch. Remove the "overlap" patch if used
Friday morning: 3 patches, same as Monday

[Tills]

Sure enough, my clinic have requested to my GP an increase from Evorel 75 to Evorel 100.

The covering letter says this, which I found interesting: this is the first time I've seen my clinic or anyone within the NHS pick up on the idea mentioned upthread by others about application to the trunk. I may well go for that as one of my alternating sites I think.

I'm copying most of the letter because I think the context is important:

'Thank you for forwarding on a copy of the latest blood investigations which show a lower than ideal oestradiol level of 131pmol/L.

Treatment plan

We would be most grateful if you would amend treatment as below:

•   Please increase Evorel twice weekly patches from Evorel 75 to Evorel 100mcg/24hr
Patches should be applied to clean unbroken skin to the trunk below the belly button or the top of the thighs.

•   10 weeks after increasing this dose of Estradiol patches please carry out the following blood investigations:

Oestradiol, Testosterone, LFT's, LH, FSH, SHBG and Prolactin
It is important that blood investigations are carried out approximately 48 hours after patch application.

We are aiming for an Oestradiol level in the range of 400-600pmol/L.'


I still love the patches in terms of their ease of application and lack of intrusion, a marked contrast to the gels.

xx

[Tills]

I'm getting increasingly tired of NHS England and the bullying and anti-trans note of this Labour Gov't.

So after my Transgender Clinic requested my GP to increase my dose from Evorel 75 to Evorel 100, the GP Surgery insisted on an appointment and put this on my notes:

'11 February 2026 12:14 pm
SURGERY -
Comment
• Patient requesting Evorel 100. Recommended by Nottingham Centre for Transgender Health.
• Amber on Surrey Pad.
• Shared care agreement required.
• 06 Dec 23 - Surrey Heartlands Integrated Care System Area Prescribing Committee (APC); After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for ostrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults.;; Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.;; A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC.;; The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.
• A+G sent to clinic today requesting SCA.'

This is all very Gatekeepery but above all it's just a giant waste of time. I've been under Nottingham GiC for 14 years. I've also requested them to take this unnecessary addition off my notes, citing my GRC. My GP already knows this is Amber status but that because it comes from the GiC that is covered, and actually irrelevant in my case.

I think it's partly because this GP surgery, which is a new one for me, aren't familiar with care for people like me.

Sigh.

Sorry. Just annoyed. I could continue this rant into the diabolical state of how to get an appointment and 'online triage' brought in by that slimy anti-trans slug Wes Streeting.

Meantime I've ordered 3 months supply from a private pharmacy online as I like having a stock for precisely this sort of NHS faffery and bureaucracy.

Vent over. For now.

xx

[Tills]

I hope Scotland's better because I feel like moving to another country right now

[Charlotte_Ringwood ✅]

The state of the NHS is dire to be honest. They've left with me with no mental health support and waiting lists for gender related care. So not surprised to hear your story. I get your frustration!

I'm just glad I'm totally DIY and doing everything else privately. Just leaves in thousands of debt!

I hope you get everything sorted soon x

[Tills]

Well there has been a fairly gobsmacking update on this situation which, I feel, warranted a new thread:

https://www.susans.org/index.php?topic=253232.msg2326695#msg2326695

As it happens I have obtained a private prescription of Evorel 100 for 3 months and my GP wants to try and go through the traffic light as she doesn't agree with it either.

Utterly ridiculous. I'm fuming.

xx

[Tills]

It's now 2.5 months since I switched from gels to patches. I began on Evorel 75 but following a slightly low estradiol reading of 133 pmol/L, albeit taken on day 3 trough, I commenced Evorel 100 a month ago today. That had to come from a private prescription thanks to some gatekeeping bureaucracy which I've written about elsewhere.

What I'd say is that in and of myself I feel good. Loads of energy. The patches have also transformed my life. Instead of waking up and thinking, 'I have to apply gels' I now drift back to sleep. I also don't have to worry about when I can shower or bath which was a massive hassle with gels. And just as important as the change to the mornings is the end of the very invasive afternoon gel. Having to apply a gel at 5pm when I'm often out and about and with people was an embarrassment and a pain in the proverbial. Embarrassment because there's nothing quite like signalling you are trans than slathering gel over your body and having to wait 30 minutes for it to dry

I'd say that gels were brilliant for my levels but terrible for my lifestyle.

I'm 62 and in lots of ways the convenience of the patches far, far, outweighs consideration about levels. I suspect that on this Evorel 100 my day 2 level will be absolutely fine, within tx range, and I feel good.

I've certainly not had any issues with adhesion. In fact quite the opposite: the patches do leave a stubborn line around the edge which I've tried various methods to rub off when I switch to the next location.

But that minor issue aside the patches are great. They have transformed my quality of life.

xx

[Charlotte_Ringwood ✅]

Glad that you are finally going to get the 100 patches officially and get that level increased. Seems it's making a very good improvement for your life which is great to hear. Hopefully even easier once you make your move!

I've decided to move to spray in a few months time. I would only need two sprays a day to probably do monotherapy and no rubbing in needed. Unfortunately it's "unofficial" so not available through healthcare.

Charlotte 😻

[Tills]

Glad that you are finally going to get the 100 patches officially and get that level increased. Seems it's making a very good improvement for your life which is great to hear. Hopefully even easier once you make your move!

I've decided to move to spray in a few months time. I would only need two sprays a day to probably do monotherapy and no rubbing in needed. Unfortunately it's "unofficial" so not available through healthcare.

Charlotte 😻

Yeah I'm not too fazed about my level to be honest. If a day 3 trough reading was 133 pmol/L on Evorel 75 then I'm confident that on Evorel 100 I'm just fine. My body has completed all the actual transitioning it needs and I'm into long-term maintenance these days.

That spray does look really good, compared to gels. Still a few things to watch out for I see:

'Although it dries within around 2 minutes and leaves no residue, women should wait a few minutes before dressing and avoid swimming or bathing within the first few hours of using it. If using sun cream, this must be applied at least an hour before using Lenzetto.'

https://www.menopausecare.co.uk/medication-lenzetto 🔗

That's still a lot less invasive than the gels. Good luck with it Charlotte. I'll be fascinated to see how you go with it and I expect your levels to be excellent.

[Charlotte_Ringwood ✅]

Thanks I'll keep you posted.  I'm a fan of following what nature does, so I'll be elevating my levels to what they'd be naturally into tanner 4. This is about 500 pmol/l from the 330pmol/l I am now. Like you say later it doesn't matter too much. As long as you're healthy with your levels it's all good! X

[Lori Dee ✅]

I've certainly not had any issues with adhesion. In fact quite the opposite: the patches do leave a stubborn line around the edge which I've tried various methods to rub off when I switch to the next location.

That is great to hear that the patches are working for you. The adhesive edge can be removed by rubbing with a bit of oil. I found that lint and dust collect along the edges and leave residue behind. When I had issues with adhesion, I covered the patch with an IV cover (Tegaderm didn't work well). That not only kept the edges from peeling off prematurely but also prevented lint and dust from collecting, eliminating the residue line.

The brand I used was Smith & Nephew IV 3000, and it worked great.

[Tills]

That's really helpful @Lori Dee - thank you.

As I get older I find the concept of what's natural to have changed. 14 years ago my my body went through big transition changes. Now into my 60's I'm more conscious that 'natural' may mean levels more commensurate with cis females and I'm comfortable and cool with that. I have a friend in her 70's who transitioned years ago and no longer needs to take any estrogen as such, although personally I think she might have continued with a low dose.

My breasts went up to Tanner 5 DD and won't go down and without any natural testosterone I won't grow body hair. So I'm mainly interested now in what 1. gives me energy and 2. maintains bone and body health.

I did try to express some of my reflecting over here:

https://www.susans.org/index.php?topic=252160.0

xx