Swallowing Vs. Sublingual Administration

[Guest Nigh]

I recently (Monday) got my first prescription of hormones from my doctor and was wondering the most effective way to take the estrogen pills. I already asked him and he said you could do both, but didn't go into the benefits of either. So, I researched the subject a little and saw a couple people talking about a possible reduction of strain on the liver if taken sublingually. Is this true? Is there any difference, or is it just a different method?

Thanks.

[Paula ult]

I too take Estradiol pills, when i asked my Endo about sublingual vs swallowing he said there was no proof of it being easier on the liver, however one of the woman in my trans group who just recently graduated nursing school said yes indeed it does help reduce strain on the liver. I been taking them sublingually and so far my lab work has been normal. I think it's your choice how you want to take them and seems either way is ok.

Paula

[Guest angie]

I recently (Monday) got my first prescription of hormones from my doctor and was wondering the most effective way to take the estrogen pills. I already asked him and he said you could do both, but didn't go into the benefits of either. So, I researched the subject a little and saw a couple people talking about a possible reduction of strain on the liver if taken sublingually. Is this true? Is there any difference, or is it just a different method?

Thanks.

Sublingal goes straight to the blood stream,lessening the strain on your liver.

Swallowing,will do nothing but use up your estrogen quickly,peeing most of the milligrams ingested

daily out of your system.Besides,estradiol has a sweet taste,desolves pretty quickly.Soooo do yourself a favor,and put it under your tongue dear.

Angie

[Guest Elizabeth K]

Its a joy to put them under your tongue!

TRY IT - SWEET WOMAN TASTE LIKE ITS MAKING YOU OVER...

And it is.

Lizzy

[Guest AshleyRF]

I've been taking estrogen for about 7 months now and I've done sublingual the entire time. I dunno if it is any better but It can't hurt I guess.

[Guest Melanieshaman]

granted i haven't been on hormones long, but under the tongue is what my doc told me would work best and be best for my liver... she would know i think lol she is a fully transitioned mtf.

[Guest AllisonD]

I recently (Monday) got my first prescription of hormones from my doctor and was wondering the most effective way to take the estrogen pills. I already asked him and he said you could do both, but didn't go into the benefits of either. So, I researched the subject a little and saw a couple people talking about a possible reduction of strain on the liver if taken sublingually. Is this true? Is there any difference, or is it just a different method?

Thanks.

I cannot say from personal experience, but I recently saw an experienced MTF endo for my first time. This doctor (Stuart Chipkin, Amherst, Mass) claims 30 years concentrated experience with MTF HRT and he is frequently published in the literature. I asked him this exact question, along with others, and he explained:

Saliva attacks the estrogren and so he does not prefer under the tongue, but does not discourage those that ask for it as a preference.

He has seen no evidence of extra liver damage attributable to swallowing vs under the tongue. He is not convinced there is greater risk by swallowing.

He also does not see differences in blood estrogen between the two methods, so (my question) what does that say about the saliva theory?

Curiously, he also explained that he feels that the conjugated estrogens in Premarin (what I have been taking since the early 70's) are just as effective, and have no additional dangers over Estradiol. The doses are slightly different tho.

I told him this was too confusing for me, I just knew I didn't want a patch or creme 'cause I swim 90 minutes every day and didn't want to deal with my skin being attacked by anything, like adhesive, while I am already immersed in chlorine. "Your choice, advise me," I asked him. He recommended the regular Estradiol pill, saying all other things being equal, they are less expensive, so why not choose them?.

At $7 a month, they are practically free. Cost was not an issue.

I admitted up front I have no experience myself with the under the tongue method. I can only tell you what Stuart said.

Allison

[Guest Joanna Phipps]

When I started mine I asked my Dr if she had a preference for sublingual as oposed to just swallowing the E. She said she didnt know of any difference in absorption or risk of any complications, however she would look into it and let me know at my next appt on Sept 12 (btw today makes day 12 for me).

[Guest Isabella]

I'm not sure if you're at an age where liver damage starts to become a concern(35-40+), but if so & creams or patches turn out not to be for you, there is another option. I've been giving myself Dr prescribed IM injecions for 7yrs. I've never had insurance that covered my HRT & pay out of pocket through a compounding pharmacy. Includning the cost of syringes it costs me $5-$6 per month. warm regards, Isabella

[Sally]

It seems odd that the concern would be silava attacking the estrogen considering that it is a highly diluted form of the same acid found in the stomach - where the attack would in my mind be much stronger.

I'm no doctor but I do have a little bit of common sense and no matter how you take it into the blood stream it must go and once there it goes everywhere so will it effect the liver more one way than the other, I couldn't say.

Love ya,

Sally

[Guest Isabella]

It seems odd that the concern would be silava attacking the estrogen considering that it is a highly diluted form of the same acid found in the stomach - where the attack would in my mind be much stronger.

I'm no doctor but I do have a little bit of common sense and no matter how you take it into the blood stream it must go and once there it goes everywhere so will it effect the liver more one way than the other, I couldn't say.

Love ya,

Sally

The difference is that yes, everything absorbed into the blood stream does evetually make its' way through the liver, but anything that enters via the stomach has to go through liver first before it enters the blood stream & some things put more the liver under more stress than others(ie. estrogen). warm regards, Isabella

[Guest StormBird]

I decided to take my estrogen orally.

After enquiring, my endochronologist stated that to two types of hormone intake are equally as effective as a general rule.

She is very happy with my progress and estrogen blood levels, though she did mention watch my potassium intake with using the anti-androgens.

I chose swallowing as I thought a gradual yet consistant introduction of hormones in my body was better than the occasional large 'burst', but that's just me, to each their own I guess. I rarely drink alcohol too which helps significantly with my liver. lol

Any which way you choose is just fine as long as it is done properly

[Guest *Elizabeth Anne*]

Everyone misses the point here! THEY TASTE SO SWEET!

Oh my

Lizzy

[Sally]

One more point - I have trouble swallowing a lot of pills - the ones that start to dissolve quickly are the worst for me so under the tongue is a logical choice.

I have to take the spiro by sewallowing and my doctor broke my doseage into smaller pills to save me money and I blew that by not going to the right pharmacy so I am taken pills by the handfulls anyway!

Love ya,

Sally

[Guest Isabella]

Whoopsie daisy! I forgot to mention that IM prescribed estrogen is bioidentical to human produced estrogen(I'm not gonna even step into the whole pregnant mare urine issue), but is suspended in an oil, which is dissovled into fat & muscle & then released gradually thus avoiding the peak & valley nightmare.

[Guest nymphblossom]

If you taste it, you waste it

The point is a slow dissolve beneath your tongue so the estrogen can be absorbed directly into the blood stream. If you are tasting the sweetness, the tablet is dissolving too quickly and you will end up swallowing the majority of the estrogen with your saliva.

Blossom

[Shannonline]

I've read that only the micronized estrogens should be used under the tongue as they break down smaller to be absorbed through the skin better but if people are getting enough into their system by putting any form under their tongue then *shrugs* If your levels are where they should be and you feel fine then it makes sense that everything is ok.

I've read premarin is bad for the liver full stop as it is conjugated and contains a lot of hormones etc that our body can't process and they have more of a negative effect on the liver than anything good.

I'd say for the others liver damage would only be an issue if you are overloading your liver with a bad diet, not enough water and using several other meds that are known to effect the liver. Moderation?

[Guest julia_d]

Premarin is nasty stuff.. In amounts that are relevant for a transitioning person, 6-10mg a day with T blockers, the stuff is lethal.. Max recommended dose is 4mg.. and that's pushing the thrombosis risk way too high if like me you have a family history which shows deaths of both direct female ancestors from blood clots..

We need realistic treatments, not the abuse I have suffered on such a low dose of premarin and no t blockers at all (they weren't available when I was diagnosed and started on the pills) for so long all it has done is harmed my breast development.. I'm a 40 something transwoman.. not a post menopause osteoporosis risk pensioner..

[Guest Camicochan]

I had previously found this study:

http://jcp.sagepub.com/cgi/content/abstract/33/11/1116

The sublingual method is a winner for me.

[Guest nova]

What i was told is that with sublingual administration you avoid the medicine from being metabolized by first passing through the digestive tract and liver. Less metabolism can result in higher levels of estradiol itself, and lower levels of its less-active metabolites, estrone and estriol. I'm not sure I even understand this, but it sounds like under the tongue is more effective. They make micronized estradiol tablets specifically for sublingual use that dissolve quickly under the tongue. Is that the kind you ladies are talking about? I was told the regular tablets had an unpleasant taste, so when i used to take them, i just swallowed. My clinic didn't have the micronized tablets. Was I told the wrong things?

[Guest Joanna Phipps]

My doc an pharma agree that for the average person aborptions rates do not differ enough to warrant touting one method over another. I have been swallowing mine for the last 5 months and I am getting excellent results.

[Guest Sascha]

While this topic is rather old, I do want to express my thoughts about sublingual application of estradiol.

Sublingual application is a burst-like release into the bloodstream. Consequently, estradiol concentration in the blood can reach up to 26 times the normal ranges of a female within 15 to 60 minutes. Please be cautious and do not take large dosages. The less you use, the less risk. The sublingual is one of the most direct methods of application.

Sources:

• http://www.ncbi.nlm..../pubmed/9052581
  
• http://www.ncbi.nlm..../pubmed/6786097