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Katie

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Dec 10, 2019
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I was on oral estradiol pills for about two years. A couple of weeks ago I had a blood panel during my checkup and my doctor discovered that my liver function was elevated. Out of concern due to knowing that there is increased risk of liver damage on oral estradiol pills, I decided to request that I be prescribed injectable estradiol instead. I am not a doctor, so I won't try to explain why the liver can be damaged by the pills.

I had my first injection today. Back when I first taking oral estradiol, I remember how I could feel it kick in. There was a distinct feeling of calm and almost euphoria when it would kick in. Over time, as the dosage was increased and my body adjusted, I stopped experiencing this. I experienced that feeling today with the injection. The initial boost of hormone level was quick, maybe 10 or 15 seconds after injection. It was strange to feel that again.

The injection process is pretty uneventful. Nothing difficult about it. Grab some flab, stab, and pump it in. I was a little bit surprised by how viscous the solution is. It is very thick, almost like motor oil.
 

Dylan J

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May 31, 2020
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20
I've never heard of oral pills for trans guys. The most common form of hrt for guys is shots, but there's also patches and gel, which I believe are taken daily, but I've also heard that some guys can have a reaction to the patches.
 

Katie

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I've never heard of oral pills for trans guys. The most common form of hrt for guys is shots, but there's also patches and gel, which I believe are taken daily, but I've also heard that some guys can have a reaction to the patches.
Ah! I put this in Female to Male. Good catch, @Dylan J . I'll move it.
 

Maddie

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Feb 9, 2020
Messages
297
I am currently injecting.
One of the reasons I do so is to bypass the liver.
Also have read threads, posts and videos sent to me by forum people that suggested injecting for development porpoises;)
Dr Powers too, but I did not start with his method.

My E levels seem quite good and high, while not taking huge doses.

Watch out for mood swings and distorted thinking! Both are more associated with this method of administration. I have experienced these.

Good luck Katie!
 

Kenna

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Jan 26, 2020
Messages
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My understanding is that blood flows straight from the stomach to the liver and this allows for what is called "first-pass" metabolism by the liver. I've no knowledge of the precise process, but this first-pass metabolism of E is somehow linked to the increased risk in blood clots, especially in older people. It also results in different levels of E1 and E2 compared to other methods, and it may have other consequences.

There are a number of methods of avoiding this first-pass metabolism and injecting is clearly one. Injections or implants are not readily available in Australia, so many of us here use patches or gel for a trans-dermal method of getting our E. There is also the sub-lingual approach (letting a tablet dissolve and get absorbed through the membranes under the tongue), but my limited reading and personal experience suggests that this can lead to wildly variable E levels, and some inevitably gets swallowed as well.

In terms of feminising transgender women, they clearly all work, but we are all unique and finding the best method and dose for each of us is why we utilise doctors and regular blood tests.

-Kenna
 

TonyaJanelle

Two more days
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Dec 23, 2019
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@Kenna

You described the first pass effect accurately.

I've been taking sublingually for over 3 years. I figured that its no worse than swallowed so why not.
A little disappointed in breast growth. I got a small dose bump in January. I'll see if that's done anything level wise next week. I think there's been a tad of growth.

My thoughts are that if the levels are improved, I'll keep using sublingually until December at my usual 6 month med check appointment. See if removal of the testosterone factories and not taking spiro helps any. I'll ask about injectable either then depending on results. I'll ask about it for whrn I start back up after surgery of the levels are still pretty low at next weeks test.
 

Kenna

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Jan 26, 2020
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@TonyaJanelle
There is a Wikipedia article on the Pharmacodynamics of Estradiol that has a lot of info on various modes of administration, including numerous graphs that seem reasonably well referenced. In relation to sublingual estradiol it describes a rapid high peak then a quick return to base levels. This seems consistent with my experience taking it sublingually together with a patch, where my blood tests ranged from 200 to 1700 (int'l). In Australia we don't have the option of injections so I've changed to a couple of gels daily and am getting much more stable results that have ranged from 530 to 707 (int'l) which my Dr says is a safe range. Neither my Dr nor I were happy with the variability of sublingual.
 

OzGirl

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Kenna, I have been offered injections by my current Endo, and it is a definite possibility if I continue to require pills to keep my levels up. While injections ae not encouraged, they are definitely available in Australia.

Hugs,

Allie
 

TonyaJanelle

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Dec 23, 2019
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@Kenna

My guess would be that the spike is the part that would be lost to first pass effects. It eventually goes through the liver either way, which would be why it then drops back down.

No idea if the spike is helpful or doesn't stay around long enough to have any effect.

I'm hopefully still in development mode for a whold yet, and will switch to patches when I get to maintenance mode.
 

Moni

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Feb 1, 2020
Messages
831
Patches would seem like a pain. They can fall off especially for active folks. Skin irritation for some folks! I do sublingual but a fair amount gets swallowed. Been tempted to try shots. I don't want boob change but would welcome butt and arm changes. I do get concerned about blood clots. Endo's have a tendency to blow off a lot of patient concerns. Glad to see you adding your side to this Dylan.
 

Linde

Ready to sleep after a hard day
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Dec 10, 2019
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@Kenna

You described the first pass effect accurately.

I've been taking sublingually for over 3 years. I figured that its no worse than swallowed so why not.
A little disappointed in breast growth. I got a small dose bump in January. I'll see if that's done anything level wise next week. I think there's been a tad of growth.

My thoughts are that if the levels are improved, I'll keep using sublingually until December at my usual 6 month med check appointment. See if removal of the testosterone factories and not taking spiro helps any. I'll ask about injectable either then depending on results. I'll ask about it for whrn I start back up after surgery of the levels are still pretty low at next weeks test.
I did sublingual, too, and reached an estrogen level of about 127. Last October I was switched to injections, and the dose was increased early this year. My current estrogen level is around 170. I had my orchi over two years ago, and think that helped a little with breast development. I don't know if the injections did anything. What you see in my avatar picture, was mostly there prior to me starting HRT.


Hugs
Linde
 

Katie

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I had excellent breast development with oral estradiol, and a combination of spironolactone and finasteride. I just did my first estradiol injection yesterday, so I can't yet comment on how it effects breast development. I can't imagine it would give me any improvement over what I was seeing with pills.
 

TonyaJanelle

Two more days
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Dec 23, 2019
Messages
871
I did sublingual, too, and reached an estrogen level of about 127. Last October I was switched to injections, and the dose was increased early this year. My current estrogen level is around 170. I had my orchi over two years ago, and think that helped a little with breast development. I don't know if the injections did anything. What you see in my avatar picture, was mostly there prior to me starting HRT.


Hugs
Linde

I had a level of 162 in Feb 2018. December it was down to 58. March 2019 was still 56, December 2019 was 72. This is why I sought a higher dose. See what I get next week after a slight bump in dose.

@Moni Patches falling off id a possibility but I dont recall anyone complaining about it when I worked retail. Some of them are quite small and should be fine for maintenance doses

My concern using them for transition rather than maintenance is one of dose and cost. Multiple patches should be needed and they not cheap. Rather use injections if spending the money.
 
Last edited:

Linde

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Multiple patches should be needed and they not cheap. Rather use injections if spending the money.
I was on the patches for two month, and developed a very negative skin reaction (two different brands)
On the positive side, I got my new Depot stuff today, and my copay is down to $52.00 per vile.


Hugs
Linde
 

Kenna

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Jan 26, 2020
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320
Kenna, I have been offered injections by my current Endo, and it is a definite possibility if I continue to require pills to keep my levels up. While injections ae not encouraged, they are definitely available in Australia.
Hi Allie, as I mentioned during the zoom, my understanding is that they are not on the PBS, and consequently not imported. A person we know mentioned having to get them prepared by a compounding pharmacist. let us know if if you find out anything more.
Hugs,
-Kenna
 

Kenna

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Patches would seem like a pain. They can fall off especially for active folks. Skin irritation for some folks!
I used patches for several months and only ever had one come unstuck, but single patches didn't achieve an adequate level of E, so I ended up supplementing them with sublingual. Eventually I developed a bit of a reaction to the patches; they left pink marks that took a bit over a week to fade, although there was no sensation associated with it. I eventually changed to gels, which are working well and don't have any visible evidence.
 

Katie

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@Kenna thanks for posting this! I took a look at this over the weekend to get a better understanding of what the injections I am taking now will be doing and what to expect in terms of spike and taper.
 

Linde

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@Kenna thanks for posting this! I took a look at this over the weekend to get a better understanding of what the injections I am taking now will be doing and what to expect in terms of spike and taper.
I don't get any of these spike and taper experiences. Once in a while i am a date late with doing the injections, and I still don't feel any different. I am either on the almost perfect dose for me, or my body does not react like others do?

I do feel positive about the bit of testosterone I take now, I start to look at pretty females with different eyes these days!


Hugs
Linde
 

Donica

Just moving forward!
Joined
Dec 24, 2019
Messages
466
It depends on what type of injectible you are using as to how bad the highs and lows can be. I believe the most common injectable estradiols in the US are Valerate and Cypionate. Unlike Cypionate, Valerate tends to peek much higher but also drops off much faster, causing greater highs and lows. I've posted an article on the subject I found interesting. It's a good addition to the article Kenna provided.

 
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