HRT comparison of oestrogen delivery methods

Kind of a technical post today, but this I’ve found that with groups of trans women discussing relative merits of hormones can be a common topic of conversation.

I have recently switched from taking oestrogen in pill form to skin patches. I was taking 4mg twice per day and was worried about damage to my liver and other associated health risks. Also I was finding that I was getting big mood swings as the tablets were processed over the 12 or 14 hour period.

The following is a summary of what I understand the pros and cons of the different delivery methods:

Type Pros Cons
Pill
  • Cheap
  • Easily available
  • Easy to get started
  • Easy to change dose
  • Has to be processed by digestive system; more strain on liver and kidneys
  • Higher risk of DVT / clots
  • Daily oestrogen processing cycle – can lead to mood swings throughout the day
  • Have to remember to take them
Gel
  • Absorbed through skin into fat cells
    • Does not have to be processed by digestive system; less strain on liver and kidneys
    • Fat releases oestrogen more slowly; flatter delivery curve
  • Lower risk of DVT / clots
  • Slight intrusion into daily routine – skin must be clean & product free, then you have to smear it on you and lay there for a few minutes as it absorbs; some may find this a triggering reminder
  • More expensive than pills
Patch
  • Absorbed through skin into fat cells
    • Does not have to be processed by digestive system; less strain on liver and kidneys
    • Fat releases oestrogen more slowly; flatter delivery curve
  • Expensive (several times more than pills)
  • Adhesive can cause skin irritation and redness.
  • Patches can come off (either partially or fully)
  • Looks ugly on the skin; edges get all dirty
  • Residue is hard to remove afterwards. (You can end up with a leopard print bottom)
Injection
  • Lower risk of DVT / clots
  • Injected into body directly; Does not have to be processed by digestive system; less strain on liver and kidneys
  • Much harder to access for self medders
    • Injectable estrogen is only available in a few online pharmacies
    • Needles and other supplies required
    • Injection technique is more complex than popping a pill
  • Potential oestrogen levels swing throughout dosage period
  • Some people are afraid of needles
Implant
  • Very stable delivery compared with pills
  • Nothing to remember on a daily basis / no intrusion into your life
  • Limited availability
  • Cannot be cycled throughout the month (if that is something that you’re doing, perhaps combined with Progesterone)

I decided on patches because I didn’t like the idea of having to lay on the bed and smear gel on me each day. In hindsight I think the patches look a bit unsightly. I also had to go back to the beginning with my levels & testing, which is kind of annoying as I was in the perfect zone with tablets. I started off on 100μg patches and am about to test again before increasing to one and a half or two patches in parallel. I can feel that things are low – but I need to use the numbers to manage it properly.