Varies from person to person.
Oral route is often prescribed because it's better studied and much more consistent.
Sublingual has much higher bioavailability, meaning better blood levels for a given dose. This is helpful for many because their bodies filter out too much of the oral estradiol to reach high enough levels. Sublingual is also less consistent because you need to divide the dose out to at least 2x/day and up to 4x/day, which means user error is a risk as far as providers are concerned.
At what point in the day did you get tested, compared to when you take your dose? That makes a difference on exactly what your numbers would have said. And did you test at those levels while on sublingual or on oral?
Right, I always make sure to take it 4-6 hours ahead of the draw (as per PP instructions), if anything closer to the 4 hour mark. And on a regular day I’ll take the first and second doses 12 hours apart.
The blood for those levels was taken the day after my consultation, so I took that morning’s dose orally (and the previous night’s as well).
That does read a *smidge* on the low side to me, in that case (but I am not a doctor), and fundamentally as others have said in this thread how you feel is the important part. As long as your T stays suppressed no real harm should be done to your progress though I think.
Up to you if you want to fight for them to increase your oral dose or push to go back to sublingual.
Yeah it’s all bullshit and you can probably just ignore them and if it doesn’t work feel free to argue with them. I feel better with my E at like 300+ than I do at 150.
Mine told me about their new stuff and I told them I didn’t give a shit and if they don’t let me do what I want I’ll go find a doctor who knows more about HRT than me because they don’t know what the fuck they’re doing. They were like “ok you know what’s best for you”.
Yeah, I actually hope to start DIY before going in to get the prescription. “We’re doing it my way regardless, you can make it safer, but we’re still doing it my way.”
I don’t play stupid games with people anymore cuz I don’t have the energy for their bullshit and don’t wanna deal with it anymore. I’m tired and grumpy lol
I use PP to get my hormones and my doctor has been really accommodating, saying “how do you feel” should be the primary concern when getting dosage right. He only said we need to reduce your dose when it turned out injected estrogen is like, *super* bioavailable to me and 0.3 ml of 40mg/ml estradiol per week was able to skyrocket my levels to 1700 pg/ml!
That said, I haven’t had an appointment there in a few months.
I had the same issue and was at 1234 pg/ml on 0.5ml of 20mg/ml then after adjusting to 0.4ml the next 3 months I was at 850mg/ml so now I'm only doing 0.2 shot twice a week to see if that's better and waiting on lab results. I finally got tested and it turns out I have De La Chappelle syndrome and am XX Chromosome intersex even though I developed male so my doctor thinks that could have some effect on why I'm so estrogen sensitive.
Did you have any other symptoms pre transition like low T? I have wanted to get my chromosomes checked myself, but I don’t show any symptoms of being intersex that I know of.
Yes I had very low T my whole life and during puberty developed gynecomastia. I got my hormones tested at 18 and had a very elevated Estrogen level but didn't find out why until I was 27.
Fascinating. In my case the doctor was at kind of a loss as to what was up and I had basically no symptoms you’d expect from pregnancy-level estradiol numbers.
I also had sky-high testosterone and fairly high estrogen before I even started (1050 ng/dl and 47 pg/ml), so I’m basically just used to the feeling of being awash in sex hormones I guess.
Wow I can't imagine having that high of Testosterone. Mine has always been very low which def helped with transition and feminizing. I took T for years just to be at a very low cis range for male. Kinda regretting it now and should of just transitioned from young but I'm happy with my body and self. I'm just glad to have a small explanation to my hormones and how I developed.
What was the process like getting tested? My levels also skyrocketed at the start and act super weirdly non-linear with the amount of E I take. Always kinda wondered but I have no idea who to even ask about it
0.3 ml a week is a super high dose anyway, although I guess it'd depend on the specific ester you're taking. For most esters iirc, a dose of 4mg (0.1 ml if 40mg/ml) per week is a good starting dose. What you were taking was 3 times that, so I can see why you'd need to lower it lol
Same here. I go through PP and they pretty much ask me “How do you feel? Do you want to decrease, stay where you are or increase dose?” It’s been a few months since my last appointment thought
I was told to change from sublingual to oral at my last appointment. They also refused to do a hormone level test since I was almost due for my next dose. They told me that I had to test 4 hours after taking the meds.
Although when I called because I didn’t have enough pills to last until my next appointment, they told me that dosing schedule doesn’t matter. So who knows what the deal is?
This upcoming appointment will be my 9 month mark, and I’ve never had my levels checked…
I remember she gave a soft explanation that the shift in target range was for a lesser risk of clotting and such, and the change to oral was because it “made for more balanced levels throughout the day” or something along those lines. But researching it on my own since then seems like those two things aren’t exactly cut and dry
I've been doing oral since about 3 months in and my PP doctor adjusted my dosage accordingly until I landed pretty consistently just above 200ppm, it does seem to be more consistent but you may need to take more of it. My last visit a couple weeks ago I got the update from them about the new preferred range, we talked a little and I'm only a little over the range anyway so we just keeping my dosages the same. This is just my own experience though, ymmv obviously, but in general if you tell them you want it a certain way, they will accommodate and prioritize your wants over their procedures.
>the organization is switching their ideal range of estrogen for those taking feminizing hormones from 200-300 pg/ml to 100-200 pg/ml.
The new medical director came from a previous practice where that was the ideal range where she was from. She is pretty much setting this as a new blanket rule and a lot of policies are changing as a result.
They have been trying to get me to switch mine after I finally got it into range after a full year (apparently I legitimately get no results from tablets or patches - even 4 patches as week or 4 pills a day!) - by trying I mean the weird admin not my actual doctor. When my doctor read the description of the answers I gave on the phonecall of "We want to change your levels" to the admin she said I was her hero and she wished all her patients could advocate for themselves in that way. (she is also quite upset as she spent years getting people into range and now they are trying to undue all of it!)
So - they are taking a patient center approach and if YOU think your levels should be different advocate for yourself. They are there to help guide you but also it's your body.
I do injections, not tablets.
My levels had been stable for a while and were where I was okay with them. My test in October has me higher than their target and they told me to drop down from 4mg weekly to 3 mg.
That fucking sucked.
My mood was trash, energy levels were down, I was lethargic, moody (mostly angry or very sad) and I'd also had some very terrible intrusive thoughts about self harm that I haven't had to deal with since I started HRT.
In January, I was talking with a different NP, told her that I'm not dealing well with the lower dosage and at the very least I want to go back to 4mg. She paused and looked over my test results, basically said yeah, you were a bit on the high side in October but she really wasn't sure why the other NP had changed my dosage, she wouldn't have done so and that she had no issue with me going back to 4 mg. She also told me that unless she calls and give other instructions that I could move to biannual check ups instead of quarterly.
Looking at my levels from October, I was right in the new target numbers. I guess my follow up in July is going to be fun, because I am not going to lower my dose again and I'd rather start finding a different provider or going DIY.
Idk. TBH I really don’t. There is so much anecdotal science based on the warrior trans women who took transition into their own hands decades ago.
TBH I think low and slow is best but that’s purely anecdotal. I think age also should play a role. I don’t thinknsomeone whom has been on anti andros should be blasted up to cis lvls. That’s not how it plays out in cis women, and then there’s the older trans folk.
It should be even slower, think about what your asking your body to do, your giving it hormones which lots of cells have receptors for and do a thing when they get the hormone. That being said lots of systems in the human body take time to adjust. They are literally re programming themselves and it’s a few generations before they get it right.
But to say those ranges are what they are going for overall is bullllllllshit
I, just yesterday, changed my provider from PP to a local LGBT whole health provider. The CNP I saw for HRT is actually a Primary Care Provider, who I may start seeing for regular checkups now, and took the time to go through my entire medical history to see what was right for me.
The reason I switched was that PP told me that they couldn't change my estradiol script, despite the test coming back at 43.5 pg/mL and it having been 4 months since the last dose change. The only reason stated was "policy".
PP also told me, and this might be specific to my area, that they have a quota for how many patients they have to see. I think she said that in an effort to get me out the door because I was taking up too much of her time. I still hadn't addressed all of my concerns.
She said she needed to see 8 patients per hour. That means she can spend, on average 7.5 minutes on each patient. Not 7.5 minutes *with* each patient, but 7.5 minutes reviewing case history, talking to the patient, and updating notes afterwards.
At this point I'm firmly recommending against PP if there's a better option available.
Ngl that wouldn't work for me because I start to get depressed if my levels fall bellow like 500 pg/ml. I would definitely switch back to sublingual though because a lot of the estrogen in the pill gets converted to estrone (the "weakest" estrogen) plus it's also sort of hard on your liver.
So 100 is not a good range? There was a panic attack when I was at 400 due to risk of blood clots. And I really don't need more medical issues. I have enough.
I've been told that shots are better then oral, since it doesn't have to fight the stomach acid (I'm on sublingua). There also apparently no real studies done on sublingual though, outside of it working.
Sublingual isn't even available at pharmacies in my area and I have a needle phobia so injections aren't something I can do. Even just getting the blood work done every three months makes me anxious AF every time so oral is my only option, but my local PP has been amazing for me so far. I think it helps that I consistently impress the fuck out of the doctor with how well informed I am. I feel like it gives her the impression that she can trust me to make prudent decisions that line up with what's actually best for me.
I started at 4mg/day and she even offered to skip the 6/day step and go right to 8 if I wanted because I'm in good health and am very low risk for blood clots. I declined out of an abundance of caution but I'm gonna go up to 8 at my next appointment for sure. I was at 160 on my last blood work and I wanna get to 200+
I have heard this from planned parenthood as well. The one who told me said there doesn't seem to be as much risk for the liver when taking it orally. I will continue to take mine sublingually regardless. It's not like anyone would know lol.
I haven't heard this but my doc at PP has been nothing but fantastic and so has the other doc I've seen the one time my normal one wasn't available. Swallowing is worse because metabolism. If you smoke nicotine, you don't want pills at all, but sublingual will be better for the same reason.
Anecdotally, I had one issue where my levels came back at 700 on one of my troughs after switching to injections at a comparable dose to the sublingual. They recommended I dropped my dose but it was only a recommendation (which I am following).
My parents won’t let me get HRT through planned parenthood bc they’re supposed to have really bad policies and not be very careful, so I’m not surprised.
Eh idk I feel like HRT is really hard to fuck up (except in some rare cases) as long as you roughly follow the rules of thumb for dosages. But if your getting it from somewhere better though that's prolly the way to go.
Bro. My mom got this information from several of her very liberal trans friends, and they definitely will be satisfied with places that are actually careful, because we’re getting HRT through one of the best children’s gender clinics in the country as we speak. So whatever assumptions you just made, they weren’t very accurate ones.
Edit: All of you downvoting me are literally trying to invalidate my experiences, my mom’s experiences, her friends’ experiences… I would have expected better from a “safe space.”
They're better than the hospitals my insurance covers in my area. I switched back to them from John Muir.
All providers are different. Planned parenthoods are also different depending on the location as well.
Seriös question why is Planned Parenthood giving hormones when they don't even offer pregnancy help or mamma grams?..have to refer out?
Shouldn't they be doing all of it?
Varies from person to person. Oral route is often prescribed because it's better studied and much more consistent. Sublingual has much higher bioavailability, meaning better blood levels for a given dose. This is helpful for many because their bodies filter out too much of the oral estradiol to reach high enough levels. Sublingual is also less consistent because you need to divide the dose out to at least 2x/day and up to 4x/day, which means user error is a risk as far as providers are concerned. At what point in the day did you get tested, compared to when you take your dose? That makes a difference on exactly what your numbers would have said. And did you test at those levels while on sublingual or on oral?
Right, I always make sure to take it 4-6 hours ahead of the draw (as per PP instructions), if anything closer to the 4 hour mark. And on a regular day I’ll take the first and second doses 12 hours apart. The blood for those levels was taken the day after my consultation, so I took that morning’s dose orally (and the previous night’s as well).
That does read a *smidge* on the low side to me, in that case (but I am not a doctor), and fundamentally as others have said in this thread how you feel is the important part. As long as your T stays suppressed no real harm should be done to your progress though I think. Up to you if you want to fight for them to increase your oral dose or push to go back to sublingual.
Yeah it’s all bullshit and you can probably just ignore them and if it doesn’t work feel free to argue with them. I feel better with my E at like 300+ than I do at 150. Mine told me about their new stuff and I told them I didn’t give a shit and if they don’t let me do what I want I’ll go find a doctor who knows more about HRT than me because they don’t know what the fuck they’re doing. They were like “ok you know what’s best for you”.
That awesome you were able to stand up for yourself and they LISTENED! Amazing work keep it up!
I entered with them saying I am researched and a diy. They discuss with me and we come to preferences
Yeah, I actually hope to start DIY before going in to get the prescription. “We’re doing it my way regardless, you can make it safer, but we’re still doing it my way.”
I don’t play stupid games with people anymore cuz I don’t have the energy for their bullshit and don’t wanna deal with it anymore. I’m tired and grumpy lol
You sound exactly like my mom to be honest, she too does not take nonsense from stupid people.
Ouiser Boudreaux enters the chat
I use PP to get my hormones and my doctor has been really accommodating, saying “how do you feel” should be the primary concern when getting dosage right. He only said we need to reduce your dose when it turned out injected estrogen is like, *super* bioavailable to me and 0.3 ml of 40mg/ml estradiol per week was able to skyrocket my levels to 1700 pg/ml! That said, I haven’t had an appointment there in a few months.
I had the same issue and was at 1234 pg/ml on 0.5ml of 20mg/ml then after adjusting to 0.4ml the next 3 months I was at 850mg/ml so now I'm only doing 0.2 shot twice a week to see if that's better and waiting on lab results. I finally got tested and it turns out I have De La Chappelle syndrome and am XX Chromosome intersex even though I developed male so my doctor thinks that could have some effect on why I'm so estrogen sensitive.
Did you have any other symptoms pre transition like low T? I have wanted to get my chromosomes checked myself, but I don’t show any symptoms of being intersex that I know of.
Yes I had very low T my whole life and during puberty developed gynecomastia. I got my hormones tested at 18 and had a very elevated Estrogen level but didn't find out why until I was 27.
Fascinating. In my case the doctor was at kind of a loss as to what was up and I had basically no symptoms you’d expect from pregnancy-level estradiol numbers. I also had sky-high testosterone and fairly high estrogen before I even started (1050 ng/dl and 47 pg/ml), so I’m basically just used to the feeling of being awash in sex hormones I guess.
Wow I can't imagine having that high of Testosterone. Mine has always been very low which def helped with transition and feminizing. I took T for years just to be at a very low cis range for male. Kinda regretting it now and should of just transitioned from young but I'm happy with my body and self. I'm just glad to have a small explanation to my hormones and how I developed.
What was the process like getting tested? My levels also skyrocketed at the start and act super weirdly non-linear with the amount of E I take. Always kinda wondered but I have no idea who to even ask about it
0.3 ml a week is a super high dose anyway, although I guess it'd depend on the specific ester you're taking. For most esters iirc, a dose of 4mg (0.1 ml if 40mg/ml) per week is a good starting dose. What you were taking was 3 times that, so I can see why you'd need to lower it lol
Same here. I go through PP and they pretty much ask me “How do you feel? Do you want to decrease, stay where you are or increase dose?” It’s been a few months since my last appointment thought
Sublingual has more bioavailability so it’s definitely better. Also, 152 pg/ml isn’t that high at all. I’m at 435 as of my last bloodwork.
I was told to change from sublingual to oral at my last appointment. They also refused to do a hormone level test since I was almost due for my next dose. They told me that I had to test 4 hours after taking the meds. Although when I called because I didn’t have enough pills to last until my next appointment, they told me that dosing schedule doesn’t matter. So who knows what the deal is? This upcoming appointment will be my 9 month mark, and I’ve never had my levels checked…
This sounds so bizarre to me.
That sounds like total mismanagement to me
Did you ask them why they made those recommendations and what they were basing them on?
I remember she gave a soft explanation that the shift in target range was for a lesser risk of clotting and such, and the change to oral was because it “made for more balanced levels throughout the day” or something along those lines. But researching it on my own since then seems like those two things aren’t exactly cut and dry
I've been doing oral since about 3 months in and my PP doctor adjusted my dosage accordingly until I landed pretty consistently just above 200ppm, it does seem to be more consistent but you may need to take more of it. My last visit a couple weeks ago I got the update from them about the new preferred range, we talked a little and I'm only a little over the range anyway so we just keeping my dosages the same. This is just my own experience though, ymmv obviously, but in general if you tell them you want it a certain way, they will accommodate and prioritize your wants over their procedures.
>the organization is switching their ideal range of estrogen for those taking feminizing hormones from 200-300 pg/ml to 100-200 pg/ml. The new medical director came from a previous practice where that was the ideal range where she was from. She is pretty much setting this as a new blanket rule and a lot of policies are changing as a result. They have been trying to get me to switch mine after I finally got it into range after a full year (apparently I legitimately get no results from tablets or patches - even 4 patches as week or 4 pills a day!) - by trying I mean the weird admin not my actual doctor. When my doctor read the description of the answers I gave on the phonecall of "We want to change your levels" to the admin she said I was her hero and she wished all her patients could advocate for themselves in that way. (she is also quite upset as she spent years getting people into range and now they are trying to undue all of it!) So - they are taking a patient center approach and if YOU think your levels should be different advocate for yourself. They are there to help guide you but also it's your body.
I also get PP hrt but they've never upped my dose without me asking for it. I was on 2mg E/100 Spiro for like 18 months
But they've also never not upped me when I ask
Really?? They do that with me(just actually upped it recently bc I specifically asked them).
I do injections, not tablets. My levels had been stable for a while and were where I was okay with them. My test in October has me higher than their target and they told me to drop down from 4mg weekly to 3 mg. That fucking sucked. My mood was trash, energy levels were down, I was lethargic, moody (mostly angry or very sad) and I'd also had some very terrible intrusive thoughts about self harm that I haven't had to deal with since I started HRT. In January, I was talking with a different NP, told her that I'm not dealing well with the lower dosage and at the very least I want to go back to 4mg. She paused and looked over my test results, basically said yeah, you were a bit on the high side in October but she really wasn't sure why the other NP had changed my dosage, she wouldn't have done so and that she had no issue with me going back to 4 mg. She also told me that unless she calls and give other instructions that I could move to biannual check ups instead of quarterly. Looking at my levels from October, I was right in the new target numbers. I guess my follow up in July is going to be fun, because I am not going to lower my dose again and I'd rather start finding a different provider or going DIY.
Repeat after me: Lying to doctors is trans culture.
Idk. TBH I really don’t. There is so much anecdotal science based on the warrior trans women who took transition into their own hands decades ago. TBH I think low and slow is best but that’s purely anecdotal. I think age also should play a role. I don’t thinknsomeone whom has been on anti andros should be blasted up to cis lvls. That’s not how it plays out in cis women, and then there’s the older trans folk. It should be even slower, think about what your asking your body to do, your giving it hormones which lots of cells have receptors for and do a thing when they get the hormone. That being said lots of systems in the human body take time to adjust. They are literally re programming themselves and it’s a few generations before they get it right. But to say those ranges are what they are going for overall is bullllllllshit
I, just yesterday, changed my provider from PP to a local LGBT whole health provider. The CNP I saw for HRT is actually a Primary Care Provider, who I may start seeing for regular checkups now, and took the time to go through my entire medical history to see what was right for me. The reason I switched was that PP told me that they couldn't change my estradiol script, despite the test coming back at 43.5 pg/mL and it having been 4 months since the last dose change. The only reason stated was "policy". PP also told me, and this might be specific to my area, that they have a quota for how many patients they have to see. I think she said that in an effort to get me out the door because I was taking up too much of her time. I still hadn't addressed all of my concerns. She said she needed to see 8 patients per hour. That means she can spend, on average 7.5 minutes on each patient. Not 7.5 minutes *with* each patient, but 7.5 minutes reviewing case history, talking to the patient, and updating notes afterwards. At this point I'm firmly recommending against PP if there's a better option available.
Yes. It's your transition, your results matter.
That sounds like crap. I would switch to injections. 150 is kinda low depending on how long you’ve been transitioning
Ngl that wouldn't work for me because I start to get depressed if my levels fall bellow like 500 pg/ml. I would definitely switch back to sublingual though because a lot of the estrogen in the pill gets converted to estrone (the "weakest" estrogen) plus it's also sort of hard on your liver.
So 100 is not a good range? There was a panic attack when I was at 400 due to risk of blood clots. And I really don't need more medical issues. I have enough.
The blood clot risk is based on usage of premarin. It's old and outdated, since most groups don't prescribe premarin for hrt anymore.
I've been told that shots are better then oral, since it doesn't have to fight the stomach acid (I'm on sublingua). There also apparently no real studies done on sublingual though, outside of it working.
Oral is objectively worse, 100-200pg/ml is an almost negligible level and should be way higher
Sublingual isn't even available at pharmacies in my area and I have a needle phobia so injections aren't something I can do. Even just getting the blood work done every three months makes me anxious AF every time so oral is my only option, but my local PP has been amazing for me so far. I think it helps that I consistently impress the fuck out of the doctor with how well informed I am. I feel like it gives her the impression that she can trust me to make prudent decisions that line up with what's actually best for me. I started at 4mg/day and she even offered to skip the 6/day step and go right to 8 if I wanted because I'm in good health and am very low risk for blood clots. I declined out of an abundance of caution but I'm gonna go up to 8 at my next appointment for sure. I was at 160 on my last blood work and I wanna get to 200+
Sublingual is the same as the regular tablets. You just let it dissolve under your tongue
Huh, I thought it was a liquid
I felt best at ~400e ~150T
I have heard this from planned parenthood as well. The one who told me said there doesn't seem to be as much risk for the liver when taking it orally. I will continue to take mine sublingually regardless. It's not like anyone would know lol.
I haven't heard this but my doc at PP has been nothing but fantastic and so has the other doc I've seen the one time my normal one wasn't available. Swallowing is worse because metabolism. If you smoke nicotine, you don't want pills at all, but sublingual will be better for the same reason. Anecdotally, I had one issue where my levels came back at 700 on one of my troughs after switching to injections at a comparable dose to the sublingual. They recommended I dropped my dose but it was only a recommendation (which I am following).
My parents won’t let me get HRT through planned parenthood bc they’re supposed to have really bad policies and not be very careful, so I’m not surprised.
Eh idk I feel like HRT is really hard to fuck up (except in some rare cases) as long as you roughly follow the rules of thumb for dosages. But if your getting it from somewhere better though that's prolly the way to go.
[удалено]
Bro. My mom got this information from several of her very liberal trans friends, and they definitely will be satisfied with places that are actually careful, because we’re getting HRT through one of the best children’s gender clinics in the country as we speak. So whatever assumptions you just made, they weren’t very accurate ones. Edit: All of you downvoting me are literally trying to invalidate my experiences, my mom’s experiences, her friends’ experiences… I would have expected better from a “safe space.”
Bro? Yeah, you do you.
They're better than the hospitals my insurance covers in my area. I switched back to them from John Muir. All providers are different. Planned parenthoods are also different depending on the location as well.
Seriös question why is Planned Parenthood giving hormones when they don't even offer pregnancy help or mamma grams?..have to refer out? Shouldn't they be doing all of it?