Oral
✅ / 😐 Oral route (Pill) is generally okay for a start, but should avoided in the long term. Swallowing the pills is overall not very efficient, and leads to excessive levels of estrone, and low estradiol. Sublingual method can correct this, but can be inconvenient.
| Products | Doses | Blood values to monitor |
|---|---|---|
| Femanest, Progynon | Between 1mg and 8mg per day | Estradiol, Testosterone, FSH/LH (SHBG if you feel no effect after a few months), Hepatic enzymes if swallowed (ALAT, ASAT, GgT) |
This is a very common administration route, and easy to take.
We should however distinguish two ways to take an estrogen pill: swallowing and letting it melt in the mouth.
Swallowing
This is the easiest way, but also the one associated with the higher risks for your health, as it increases the risks of thromboembolic accidents. These risks, however, remain relative to each individual, and medication has improved greatly since the first versions of estrogen pills that used to be the norm in the transfem community (Premarin, or conjugated equine estrogens).
As stated above, the pills prescribed for HRT (bioidentical estradiol) remain significantly less risky in regards to thromboembolic events than the synthetic estrogens used in birth control medication. (Source)
The higher risks associated with swallowing are to be put on the hepatic first pass - which is the liver dealing with ingested chemicals when they are digested. This stands for any medication taken orally: all of them will mobilize this liver function, and, so to speak, making it a bit more “tired”. As a general rule, it is best to avoid oral medication when possible.
The second reason is another consequence of the liver first pass, but more closely related to estrogen. We talked about it before: the liver converts the vast majority of the swallowed estradiol into estrone. Not only is estrone associated with higher health risks, but it also significantly less potent in terms of feminizing effects.
Pros
- Easy and accessible
- Usually gives quite stable and long-lasting hormone levels
Cons
- Increases risks for health (mainly thromboembolic accidents)
- Usually give low estradiol levels, and higher estrone levels.
Sublingual/buccal method
This is the alternative to keep the pills, but avoid the hepatic first pass and hence the risks associated. It consists in letting the pill completely dissolve under the tongue, or between the inside cheek and gums (a bit like snuss).
This way, estradiol will be directly absorbed by the buccal blood vessels, and reach your bloodstream without passing first by the liver. This usually leads to a much faster absorption , with much higher levels. However, the levels tend to fall down quite fast as well. This “yoyo” effect usually leads people to take a pill every 8 to 12 hours in order to maintain correct levels.
Pros
- Easily gives higher estradiol levels
- Less thromboembolic risks
Cons
- Yoyo effects - having to take a pill every 8/12 hours
- No scientific research on the possible risks of this method (and the consequences of the yoyo effect on feminization/body development)