For those TG individuals with some experience, I have a question (or to those with the appropriate medical knowledge).
When I began estrogen several years ago, I started with oral (pills). My doc switched me to an injectable form, which I am still on. Because of rising costs and my new insurance not covering the IM form of estrogen, I was considering asking my doc about switching to the transdermal form, which is covered by my insurance (at the lowest co-pay as well).
Does anyone have any experience with both of these that can give me an idea of how they worked for them?
Thanks,
Stephanie
Comments
Medications
Stephanie,
Having read many posts on many message boards about TG medications, I can only shake my head at how hard some MTF people seem to make their medication experience.
Many of the posters have been from the US, and I don't fully understand the medical system over there but some go to quite extroardinary lengths to build their superstructure.
It seems that many find it difficult to just go to a GP and get properly supervised medication regimes and resort to self medication buying various forms of oestrogens on-line and putting their bodies at risk because of dubious information.
You describe having been on oral oestrogen early on and do not say why you switched to the injectable form. I can only speculate a number of quite valid reasons for doing so.
My personal experience has been oral oestrogen in a med called Microgynon 50 ED. This contains 50 micrograms of ethinyloestradiol and 125 micrograms of Levonnogestrel, a progesterone. One tablet daily skipping the lactose tablets that natal women have to prompt menstruation.
I was referred by a GP to an endocrinologist who prescribed the meds and my GP has continued to rewrite scripts for me with no problems at all. This started in 2003 and I am still on them. SRS was three years ago. I have noticed a maturing shape change from masculine to more feminine over that time and my breasts are a DD.
I know that individual responses to oestrogen vary considerably and I have friends who take their "girly juice" via injection. Their preference, as they believe they can manage their mood better. Their breasts after six years are still only a small A.
There is much said about "the first pass effect" reducing the efficacy of the meds taken which may have some validity, but pharmaceutical companies take this into account when developing oral meds to be absorbed by the liver via the bowel.
My own experience and that of my partner, Rachel, is one of great satisfaction with the oral meds we are prescribed.
Microgynon 50 is a contraceptive taken by women all over the world, is widely available, convenient and relatively cheap when comparing other delivery systems.
I hope that my experience can be of help to your decision making.
Robyn B
Sydney
Robyn B
Sydney
Clarifications
Hi Robyn!
I guess that I should clarify a few things...
1. I have NEVER self-medicated, nor would I.
2. My doc is the one who started me on the oral, then switched me to the injectable. I believe that the reason he did so was because of the bio-availability of the injectable over the oral.
3. I am not sure why, but I have not yet begun any type of progesterone. At one point, my doc mentioned that he would not let me start it until I lost some weight (I am somewhat overweight). I am not sure if there is a health issue, or if it was his way of bribing me to lose weight.
My whole point in asking this question was to try and get some information before discussing it with my doc.
Thank you for your input.
Stephanie
My doc gave me the choice...
Shot or patch... Said they're GENERALLY equally effective. Though, there are some folks that don't tollerate the adhesive in the patch and/or don't absorb through the skin at a normal rate. She actually does both, herself. Patch in the Winter/injection in the summer (Doesn't want the patch to show with swim suit, she said).
Oh - and in response to why Shot/patch over oral... My doc said she prefers that route for anyone 40 or over, due to reduced stress on the kidneys/liver among other things.
Annette
That is what I was getting at with my question...
I take several meds, and am always looking for ways to reduce that. I am not always as disciplined with the pills as I should be.
With my injectable estrogen, it has become rather expensive ($65 per vial, 5 weekly doses per vial). In addition, I am starting with my new insurance coverage on 6/1/09, and the injectable is not covered. The transdermal IS covered, and at tier 1 (a US$10 co-pay per month). With my size and my sensitivity to the sun, the swimsuit argument does not really hold water with me (pun intended). The other issue on the injectable is that I cannot bring myself to "shoot" myself, so I have my spouse do it for me. With the patch, I can obviously do that myself.
Thank you for your input.
Stephanie
I Am On Estradiol Valerate
I have been on Estradiol Valerate Injectable from the beginning of my transition and I did a lot of research before I went into to see my Endocrinologist for the first time. I was concerned about the longterm damage to my liver from taking the oral form. He explained that it was more economical and aesthetically more successful on injectables. I can get a 20 ml vial that lasts me five months at half a cc every two weeks for a little over $100. The patches would actually cost more for me, because here in KY, I have never been able to get an insurance company to even cover it. Wherever you live and work must be pretty forward thinking. Down here it is like pulling teeth to get them to cover very much that is TG/TS related without the provider listing something else like Depression as a Primary Diagnosis.
Hugs,
Jen
I take depo-estradiol
Hi Jen!
Since I have been on the injectable, I have been on 1ml per week of Depo-Estradiol. It comes in 5ml vials for about $65 each.
Back when I was on the oral estradiol, my insurance covered it, and nothing was ever asked or said about it. At that time, all my paperwork showed me as male, with my male name. I never made a fuss about anything because they never gave me any trouble. I have been without insurance for almost six years, and begin my new coverage on 6/1. The new insurance has me listed as female, so I don't think I should have a problem.
My PCP is the doc prescribing my meds (he is one of 2 in St. Louis that cater to TG patients). His records show nothing of my GID or treatment. One of the ICD codes he lists is "hormonal imbalance" for TG patients. He says that this usually suffices.
My psychologist shows only my GAD (anxiety) and MDD (depression) diagnoses. With all of that, my fingers are crossed that I won't have any problems.
Thanks for the input!
Stephanie
Are you in the US?
There are just lots of ways to approach this and different Docs seem to do it differently.
This whole discussion seems to come to the board about every three months.
I started off stealing Estrodial pills (2mg) and took them for a couple months with no visible results. I was quite disappointed. After everyone found out what I was doing and I got thrown out, the Doc gave me my very own Estrodial pills and some Spironolactone too. I was quite vocal and non compliant at first, so I badgered a Doc into a Castration within about a month of coming out. After that the Spiro was no longer necessary. At that time many of the T folk around me were taking other stuff to make them more feminine, but my Doc said no and HELL no; they being too hard on my internals.
There were also various stories circulating about dosages of Estrogen. Lots of self medication and other stupidity going on. I heard as high as 20 Mg for Estrogen. I was on 2 Mg and tried to increase it a couple times but literally went NUTS, bawling all the time.
Well, after I got back from Thailand, I saw my first Endocrinologist, and she put me on Vivelle Dot Patch. She said that the Estrogen going through my gut, liver and all that was not very effective. She said the patch went right into my blood. I find them very agreeable. My breast size doubled in about two months. A couple other girls and I wound up in this long discussion, because they were changing their patches twice a week and my prescription said every day. As it turned out, I was wrong.
As far as injections go, I am far too frightened by needles to do that. Anyone who injects themselves, well you are far braver than I am.
Yes, I am in the US
Hi Gwen!
The one thing I have learned over the past 10 years is that there are so many factors that go in to hormone regimens for T folk...
1. The patient's health conditions,
2. The baseline hormone levels,
3. The reaction of the body to the hormones administered,
4. The doctor's education/experience/biases,
and on and on and on...
I have NEVER self-medicated, and have always been under a doctor's care regarding my hormone regimen. Unfortunately, with no insurance, I have not been monitored as frequently as either I or my doc would like, but everything has remained steady and under control.
In addition to the depo-estradiol I mentioned above, I am also on spironolactone. My doc has mentioned an orchiectomy, but seeing as how that would not be covered under insurance coverage, it has not happened yet due to financial limitations. Soon, though, as I am tired of taking so many meds, and it is also one step closer to my end goal.
I have heard too many horror stories about how mismanaged estrogen can cause serious damage to the body and even death if you are not careful. I have had decent results with what I take, and never had any problems.
Unfortunately, my op is a long way off for two reasons, my weight and money.
As for the injections... I don't like, but can handle needles O.K., but I could never bring myself to administer the injection myself. Fortunately, my spouse has been willing to handle that for me.
Thanks for your input!
Stephanie
Funny Hormone Stories
Depending on who it is happening to, and who is hurt, there are some really strange and often humorous stories about T folk. People who are quite heavy can often still pass if they decide to, I think. I was in a meeting with a woman who was over 6" I think and perhaps 250lbs. Her voice was well within the range, but like many Twomen, she kept outing herself. She was one of the spokes women for T folk too!
I had that fatal flaw for a long time, but lately I have stopped doing that. I am old enough that I would no longer be considered "Hot" and I am told that most men my age aren't looking.
Yes, well we can get into the discussion about honesty and all that, but I have decided that if they aren't going to bed you then they probably don't need to know.
Many Blessings
Gwendolyn
My meds, FWIW
Hi Stephanie, I thought I'd chip in my experience, though I'm not sure how much it adds to what's already been said here.
My doctor started me on spironolactone last July, then added finasteride in October because of a slightly enlarged prostate that the spironolactone, surprisingly, hadn't taken care of. Two months ago I started on the transdermal estradiol she prescribed for me; she'd have been willing to prescribe pills if I'd insisted, since they're considerably less expensive, but I'd done some research and knew that patches or injections are preferred for those of us over 40, due to the dramatically reduced risk of blood clots and liver problems. The steady release of meds means you don't get the daily spikes of blood estrogen concentrations that you get from a pill, which are what cause a lot of the problems and side-effects.
I'd been using the Vivelle Dot samples she'd given me to start out with, but when I took in the prescription I discovered they cost something like $110 for a four weeks' supply, even with the state drug program discount (my insurance doesn't cover prescriptions), and there isn't an exact generic equivalent. The generic patches are much, much larger and more conspicuous, though they only have to be changed once a week instead of twice. They cost $65 for a four weeks' supply through the state discount program.
At my last visit for bloodwork, she asked about whether I'd consider IM injectable estradiol, as an alternative to the patches. I haven't looked into the cost of that. We also discussed implantable estradiol, which seems to work out to be less expensive if you're paying out-of-pocket, but there are only a few doctors in the US who currently do that (the nearest to me is in Portland, OR, a three-hour drive--Gwen, have you looked into this option?). I realize you're looking at switching so it'll be covered by insurance, so this pricing information isn't as useful to you, but I thought I'd include it in case someone else reading this is interested.
My doctor's take on it is that implants, injectables, and patches all have similar safety and efficacy benefits over oral forms, but generally cost more. The main reasons to choose one over another include sensitivity to the patch adhesive, aversion to needles or incisions, or how they fit your lifestyle. I run out of Vivelle Dot and will start using the generic patches today. If (as I suspect) their larger size makes them too conspicuous with the clothing styles I prefer, which due to my height tend to expose a little skin at the midriff now and then, I may be switching to injectables when this batch runs out, or looking more seriously into implantable estradiol.
As far as progesterone, we've discussed that and she hasn't prescribed it yet, but is willing to if I request it. I'm holding off for now because I seem to be getting good results from estradiol already after only two months, and she says that progesterone does have some androgenic effects.
We don't need no stinkin' patches!
Sorry about the subject line. I just watched Blazing Saddles a few nights ago (LOL). My Endo started me out on Patches with spiro, as I was over 40, and had a history of high blood pressure that has mysteriously disappeared with the removal of the stress of self denial. When the adhesive proved to be very annoying to my skin, she switched me to oral estrodial 6 mg in split 2 mg doses, then cut me back to 4 mg when that was too effective on the estrogen levels (though I felt great). My testosterone was really low to start with, and one tab of daily Spiro was enough to make it non-existent. I really like the patches for convenience, but I had the large generic ones (covered by my insurance) and they only make them in .100 mg and below doses. I was therefore wearing 2 of them to get the estrogen up, and that covered too much area and irritated just too much. I should mention this was preop, not post op. Postop one patch does well on the levels, but I still have problems with the skin irritation, espec. in the summer, but have more room with one to switch areas each week. I have not tried injectibles, though I have had friends who do that route. They had a lot of cycle problems pre-op, with a PMS like depressive crash just before the time for the shot, and then for a few days after they cry at the drop of a hat at anything -- a cute kitty cat, a baby bird, a baby anything, but the post shot effects have been better since surgery for them. However, your milage may vary.
CaroL
CaroL
Injections for medications
I grew up fearing hypodermic needles. I would get faint or wobbly just seeing one being filled with whatever it was they were filling it with.
In 1997 I was put on insulin as a diabetic. I had a short ten minute course on how to fill the syringe and then give myself an injection. that was twelve years ago.
I still cringe when I see medical professionals fill syringes. I pray before each shot I give myself.
It is a necessary evil, I do it twice a day and each day I tell myself its not going to hurt.
I can if I have to administer other meds that require a syringe to myself. I may not be happy about doing it , but I do know that it will imporve my lifestyle.
Most people practice on an orange as an orange peel closely resembles the human skin. the positive side of that is if you imbibe alcohol you can shoot it into the orange and then peel the orange and have a nice good feeling while eating the orange
Jill Micayla
May you have a wonderful today and a better tomorrow
Jill Micayla
Be kinder than necessary,Because everyone you meet
Is fighting some kind of battle.
Ouch!
Long time ago I used injectable estrogen and progesterone, mostly because my ADD prevented me from remembering when OR IF I took the stinking pills so I'd either go days before remembering and wondering why I was such a raging bitch or take several pills in one day and wondering why I was such a raging crying bitch. I'd usually get the first and fifteenth of the month thing right with the injections keeping to a nice even bitch :)
Sticking an inch and a half long needle into your butt while looking over your shoulder is like Annie Oakley. Trying to remember where that vein was you hit last time or where that nerve is.. oh yes you will know when you hit that freaking nerve!, no guesswork involved ;-) I finally got so gun-shy from hitting veins and nerves I'd start crying and have to call a girlfriend who was so good at it and I never minded bearing my butt to her but thats a 'nuther subject. Thankfully post-op I dropped off all of that for a very minimal 2mg tablet a day and it keeps me very happy. I have a housemate who dispenses my vites, asprin and girly pills each morning so no worries on forgetting either.
If you have to inject, get the pharmacy to give you wo sets of needles, one set is short very large bore for drawing the meds, cap and remove that needle and install a small gauge needle for the injection. I found that just the act of drawing the meds can easily dull the tip of the needle and make it very painful to poke yourself. If you find it painful this may help. Also placing the syring with the drawn meds in it in a warm place and using the nxt gauge down needle will thin the oily goo down and allow it to pass through a finer needle that might hurt less. Draw and X on your butt with a sharpie or have the doc do it so you can remember the ideal spot..sounds silly but I am serious.
I've known other girls to use a short needle and do several shots just under the skin in their thighs, it seemed to be working for them.