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.

  • Helen

    I use Fortuna zinc oxide tape, to ensure my patches stay on. You may have to shop around for it though. Unsure about other brands unfortunately, as this is the only Zinc Oxide tape my local Pharmacy sells.