Oral Estrogen: To swallow or not to swallow.

[Guest Risu]

So I've been wondering everyone's thoughts on this. I can't seem to find much regarding research about the delivery method of oral estrogen and which is better for the body and also which provides the most effective results.

I am around 10 months on HRT now and for the first 9 I have been swallowing my estradiol tablets. Recently I learned oral estrogen tablets are specially made so they can also be dissolved under the tongue quickly and with out a bad after taste (No wonder they always seemed to dissolve before I could swallow them!).

So my question here is to those who are taking Estradiol in pill form or who have taken it in the past, What method do you use and why? Obviously it's all personal preference and there is no research to support which is better or if one provides superior results to the other so I am asking you. I have not asked either of my doctors handling my HRT about this but the next time I see them I plan to.

So, from some of the research I've read here is are a couple of things to consider about the different delivery methods.

*Swallowing the pill means it is processed in the liver and may produce an estrogen byproduct which is still helpful in feminizing and transition but also that it may not be effective since it's not going directly into the blood stream.

*Dissolving the pill under the tongue means potentially exposing the estrogen in the pill to saliva which may begin to break it down before it is absorbed by the tongue membrane. This may also reduce effectiveness.

So, thoughts? Experiences?

In the last month or so since I've been dissolving the pill under my tongue it seems it has been a little easier for me to cry. Even thinking of something sad can be enough to bring tears to my eyes. I'm not sure if this means this method has been more effective for me or not and ultimately I'll need to monitor this method longer to see if I notice any other effects.

Ultimately I'm still on the fence about which method may be better for me. I've had results from simply swallowing the pills and I don't want to diminish or slow them by changing the way I take them.

Looking forward to what others here have to say.

Thanks in advance!

~Jade.

[Svenna]

I began with swallowing the E...

But after a few days, I switched to putting the tablet under my tongue..

The tablets dissolve very quickly and I can tell I took it almost immediately, not so when swallowing them...

I have had wonderful results so far, after just 5 months of starter-dose levels. I have no way to know what would have happened had I gone with swallowing the whole time, but I suspect that my results would not be as impressive...

I was at a B cup at about 3 months, if I recall correctly.

I don't know, cause YMMV, of course. But I am stickin' with sublingual, for sure!

Love ya! S

[Guest Robin Winter]

I just swallow my pills, and I'm developing just fine. I'm very happy with my current rate of development and I'm filling out in all the right places. I'm inclined to believe it doesn't matter how you take them, but that's just me.

[Guest Erica Kaylee]

I googled the topic and it led me to a similar thread on Susan's: http://www.susans.org/forums/index.php?topic=40929.0

Very interesting. I'll be trying sublingual with my next dose and see how it is. Thanks Jade. I was completely unaware of this method till now, and same with my girlfriend!

[Guest Elizabeth K]

Either way is effective, obviously. The saliva is less potent than stomach acid, I think. It seems the under tongue method gets it into your blood stream quicker, and it also seems to put some bypassing the liver because of the direct absorption.

But its not the only sub-lingual pill on the market. My OTC B-12 pills are also taken this same way. I use the under-tongue method because (1) it tastes good and makes me aware I AM TAKING ESTROGEN! YEA! and (2) I am taking so many other pills (HRT, cholesterol inhibitor, insulin sensitizers) that maybe it helps give my liver a break by not loading it up so much.

Lizzy

.

[Guest Stormrider2112]

My prescribing physician said that sub-lingual was more effective, ergo, I take it sub-lingually

[Guest paddy]

After I had my Bilateral Orchiedectomy my Endocrinologist but me on to Estradot Patches as been the best way to deliver my HRT, and

so far they seem to work well. I have to change patches every two and half days (like Saturday AM and Tuesday PM)

[Guest Lauren~]

Either way is effective, obviously. The saliva is less potent than stomach acid, I think. It seems the under tongue method gets it into your blood stream quicker, and it also seems to put some bypassing the liver because of the direct absorption.

But its not the only sub-lingual pill on the market. My OTC B-12 pills are also taken this same way. I use the under-tongue method because (1) it tastes good and makes me aware I AM TAKING ESTROGEN! YEA! and (2) I am taking so many other pills (HRT, cholesterol inhibitor, insulin sensitizers) that maybe it helps give my liver a break by not loading it up so much.

Lizzy

So I'm thinking about trying this tommorrow when I take my Estrodiol, but it wont be less effective will it? I read somewhere in here where someone said some of it will soak up into the tongue, and it won;t be as effective. Is this true or will I be allright trying the under the tongue thing tommorrow?

[Guest Jo-88]

sublingual every time... its safer and more effective. It goes straight into the bloodstream bypassing your digestive system and liver. Bypassing the digestive system keeps it from breaking down and bypassing the liver is just safer period.

Taking estradiol sublingually is a very similar concept to taking estradiol transdermally... with gels and patches it gets absorbed by your skin and goes directly into the bloodstream. Only difference between the two is that its the skin on the inside of your mouth that does the absorbing.

Theres a few other things... from what Ive read most doctors are starting to come to the conclusion that sublingual estradiol is the drug of choice for cross sex hormone replacement therapy. Its just as safe as transdermal but significantly cheaper. Also the pill form of estradiol (estrace, estrofem) is β-17 estradiol which is a slightly more potent form of estradiol. The only thing to be concerned with is to make sure that the particular brand that you get is not the gel coated version, that version cant be taken sublingually.... it needs to be the little chalky ones (generic basically which = cheaper anyway).

Basically its the cheapest, safest and most effective option for *most* patients. my two cents

[Guest Jo-88]

actually to correct myself... transdermal is still the *safest* option but both are pretty safe.

[Guest Lauren~]

I don't have the generic estrofem or estrace that your talking about, its just Estodiol in pill form; not generic. So does it still work like your talking about?

[Guest Jo-88]

I don't have the generic estrofem or estrace that your talking about, its just Estodiol in pill form; not generic. So does it still work like your talking about?

do they have a chalky consistency or do they have a shiny almost enamel like coatings... you want the chalky ones

[Guest Jo-88]

you know its frustrating really how little research has been done into the biochemistry of cross sex HRT. The information is scattered and conflicting with some doctors saying one thing and other doctors saying the complete opposite. We need more research done into these drugs and how they really affect us. There should be less guess work in determining the best route of treatment for cross sex HRT.

taking that even further one thing Id like to see them develop, and i believe this is completely possible with current technology. I want to see someone create a dissolving 1-2 year implant that contains the right amount of each drug and layered in such a way that each drug is released to mimic a natal female's cycle. You would have different dosed versions to cover a range of people; you wouldn't be able to fit 100% of patients with it but you could make enough versions of the implant to cover at least 80-90% of patients.

I think it would be awesome but a project like that is unlikely to get funding I'm afraid...sigh

[Guest Lauren~]

Yeah, I hate the fact that there's no funding. If it was they would know so much more about it. It would be really great, but no.

[VickySGV]

The mucous membranes in your mouth under the tongue do absorb the chemicals quickly and completely. They do a better and quicker job than the transdermal patches by a known percentage factor. The oral medication problem in the "vehicle" that holds the tiny amount of chemical in a size large enough to hold it and get it into your mouth. When this filler material is dissolved by the saliva, it can end up being swallowed. Best chance is that the body knows a bit, and considers the E itself worth processing directly, takes it, and lets you swallow the sugarlike non medicine after the fact.

WPATH did acknowledge the lack of cross gender hormone research last fall, and there are groups within it, that will do the real research themselves, or find others who have. It is an area of high concern with them. The research element is made all the more necessary by the DYI crowd who post dangerous information on the Web, and cause problems for the care givers when they prescribe one dose to a patient who thinks they are being ineffectively treated, and then the caregiver is reviled for incompetence for low doseage stuff.

[Guest Risu]

Thank you for this info Vicky

That helps make things a little easier as far is my confidence with taking the pills sublingually.

The problem with medical research is that it needs funding and since most trans people are struggling to survive and pay for surgery I doubt there are many large organizations or significantly wealther individuals out there waiting to throw money at research involving our community's health interests.

I can say that in what little amount of time I've been taking my Estradiol sublingually I've finally developed tenderness in my breasts. I hope this means they're going to start growing again soon! Especially since the left one is significantly smaller than the right... Keeping my fingers crossed for at least a C to help offset the broader shoulders.

And yeah... the sugary bit doesn't always dissolve completely especially if I take the prescribed number of pills and try to dissolve them all at once which I normally don't do unless I'm pressed for time.

Thank you all who contributed I had a very difficult time finding any info on this and you all have helped tremendously.

*Hugs*

~Jade.

[Guest Lauren~]

The mucous membranes in your mouth under the tongue do absorb the chemicals quickly and completely. They do a better and quicker job than the transdermal patches by a known percentage factor. The oral medication problem in the "vehicle" that holds the tiny amount of chemical in a size large enough to hold it and get it into your mouth. When this filler material is dissolved by the saliva, it can end up being swallowed. Best chance is that the body knows a bit, and considers the E itself worth processing directly, takes it, and lets you swallow the sugarlike non medicine after the fact.

WPATH did acknowledge the lack of cross gender hormone research last fall, and there are groups within it, that will do the real research themselves, or find others who have. It is an area of high concern with them. The research element is made all the more necessary by the DYI crowd who post dangerous information on the Web, and cause problems for the care givers when they prescribe one dose to a patient who thinks they are being ineffectively treated, and then the caregiver is reviled for incompetence for low doseage stuff.

Well okay,

But do you do you also put the Spirolacton under the tongue when you take it.

[Guest Lauren~]

The mucous membranes in your mouth under the tongue do absorb the chemicals quickly and completely. They do a better and quicker job than the transdermal patches by a known percentage factor. The oral medication problem in the "vehicle" that holds the tiny amount of chemical in a size large enough to hold it and get it into your mouth. When this filler material is dissolved by the saliva, it can end up being swallowed. Best chance is that the body knows a bit, and considers the E itself worth processing directly, takes it, and lets you swallow the sugarlike non medicine after the fact.

WPATH did acknowledge the lack of cross gender hormone research last fall, and there are groups within it, that will do the real research themselves, or find others who have. It is an area of high concern with them. The research element is made all the more necessary by the DYI crowd who post dangerous information on the Web, and cause problems for the care givers when they prescribe one dose to a patient who thinks they are being ineffectively treated, and then the caregiver is reviled for incompetence for low doseage stuff.

Well okay,

But do you do you also put the Spirolacton under the tongue when you take it.

Well, I didn't mention that I started putting the Estrodiol under my tongue a few days; I really know that I'm taking it,well maybe it's all in my head, but I was wondering if I should do the same with the Spirolatone?

[Guest Robin Winter]

I don't know about you, but my spiro tablets are pretty big. It would take half the day for them to dissolve under my tongue!

I admit I've decided to try it with the estrace, though, just to see if I notice a difference.

[Guest Lauren~]

Well yeah, I would have to stick two tablets of Spirolacton under my togue and they're pretty big. I would think they would dissolve pretty quickly anyway.

[Svenna]

Well yeah, I would have to stick two tablets of Spirolacton under my togue and they're pretty big. I would think they would dissolve pretty quickly anyway.

I read somewhere that spiro under the tongue can cause a sore or something, but I don't recall the details, sorry!

I put E and Progesterone under my tongue and swallow my spiro...

S

[Guest Lauren~]

Well yeah, I would have to stick two tablets of Spirolacton under my togue and they're pretty big. I would think they would dissolve pretty quickly anyway.

I read somewhere that spiro under the tongue can cause a sore or something, but I don't recall the details, sorry!

I put E and Progesterone under my tongue and swallow my spiro...

S

Thanks for telling me

[Guest Risu]

Oral Estrogen is made to be dissolved quickly and without a bad taste under the tongue. Well, certain types of oral estrogens. If it's gel coated or something then it's meant to be swallowed but as I recall all generic forms of oral estrogens, in the US, are designed to be taken sublingually.

Spiro probably wouldn't taste good taking it this way and as Shilo said it would probably take forever to dissolve. I would stick with swallowing the Spiro until you can consult your prescribing physician if nothing else.

~Jade.

[Guest Jennifer1736]

hi i dont take estradiol at all, im on premarin, and there gell coated and ive had amzing results all said and done

[Guest Jo-88]

btw you should not take spironolactone sublingually its gross for one thing and it could lead to an overdose. Estradiol sublingual is ok though but you should still always consult your doctor before changing anything.