I was talking to my hairdresser last week and she loves injections. Guess she forgets enough that pills everyday are too much for her. I’m taking mine in the morning, evening and then progesterone right before bed. So, three times a day I have to take pills. Guess I’m curious what your thoughts about the differences are and if it’s just about convenience, as the injections are only once a week, or are there any other benefits one way or the other.
Injections all the way. (I am not trans, but I’m familiar with TRT protocols).
First, injections are easier to dial in blood levels. Pills may not come in the doses you need, and may not be readily split. It’s fairly easly to add or subtract 1mL with depo estradiol; if you needed to, you could even dilute it to get finer control, but that’s best done by a compounding pharmacy.
Second, pills tend to be hard on your liver. I know that, in the case of anabolic androgenic steroids (AAS), they’re methylated in order to avoid first-pass metabolism by the liver. Methylating is necessary to allow them to act properly–if they’re matabolized by the liver, then you get none of the therapeutic benefit–but methylating makes them really harsh on your liver, and can, in extreme cases, cause cirrhosis. (That’s much more common in body builders that are taking massive doses of drugs, rather than people that are taking them under the guidance of a doctor. Buuuuuuut one of the potential serious adverse side effects or oral estradiol is jaundice-yellowing eyes and skin–which indicates potential liver problems in some people.)
Last, pills are generally a daily or multiple times daily dose. Biological half lives of oral medications tend to be under 12 hours (unless there’s some XR version that I’m not aware of), so missing a day can significantly affect your hormonal levels. Injections–like estradiol cypionate–have a biological half life of about 5 days. If you inject weekly, you quickly end up building to a fairly stable blood level.
Oral (swallowing) bad, the good way to take estradiol pills is sublingual/buccal. Absorbed in the mouth, very little gets to the liver.
Huh. Surprising that they’re not prescribed more often. I dont know of any trans women in my area who do injections. I asked for them once but was told they pretty well never prescribe them unless you can’t take oral estradiol for some reason.
In re: TRT, doctors don’t like prescribing depo testosterone because it usually ends up getting abused. In this case, “abuse” means that men will use more than they are prescribed. Testosterone is a DEA scheduled drug, so clients taking 2x their prescribed dose ends up looking bad for the prescribing doctor. For transwomen? I really don’t know. You’d have to ask your doctor why that is.