Why I Switched Back to Oral Estrogen from Injection

[CW: graphic description of needle injections, statistical analysis]

Almost two years to the day after I started injectable estrogen, I switched back to oral last week. One big win of injectable for me was the general aspect of my body changed for the positive with regards to fat deposition, most noticeably around my face and midsection. But from the beginning I struggled with the method and side effects, and it was a bunch of little things across three things–how they made me feel, my hormone level response, and the physicality of it–that added up to change my mind.

There were pluses and minuses on how they made me feel physically and emotionally.

The largest positive was a ten-day instead of daily cycle. It was a relief not having to take and track daily pills and overall I spent more time in what I’d call a ‘comfortable glide’ mode where I felt physically and emotionally level.

On the negative side, I’d get really bitchy in the couple days before my injection and I had a persistent feeling of not feeling ‘right’ through the whole cycle. It’s hard to describe, but it was a subtle feeling like my blood pressure was elevated, (it wasn’t,) and just generally feeling out of sorts, like my life was somehow off a fraction of degree from level. It was a discomfort that at first I thought correlated to swings in my hormone levels, (see chart below,) but changes in time between dosages, (fourteen to ten days,) and the dosage quantity did not enhance or lessen the feeling.

My hormone level response was mixed to negative and my chart shows it, (injectable started March 2017.) For those new to my blog, estrogen is the only HRT I take; I do not take any anti-androgens and my doctor aims for a ~200 pg/ml estrogen level.

My historical hormone levels in graph/chart format

My historical hormone levels (Gray line is 2 period moving average)

 

Most noticeable on the chart is the significant drop then jump in estrogen after I started injecting. (For some reason, I didn’t get blood work orders for testosterone levels for a couple of months so I don’t have those numbers.) My doctor thought the 9 August 2017 result was a lab error, but a re-testing on the 20th showed similarly low levels, so we upped my dose, and then bam! the levels jumped way up; pregnant-high up. If only!

Even after reducing the dose, the next test showed estrogen even higher, so we reduced again. That brought things down by June 2018, but it was still elevated and we continued to reduce the dose. In winter 2019, another trans woman suggested I try a graduated syringe that measured in 0.1 ml units vs. the 0.5 ml units I had been using and you can see that even with a finer resolution on dosage, my estrogen still spiked up.

Meanwhile, my testosterone was doing its own thing. Serum testosterone seemed to bounce up, then settle down, then bounced up at the end. Free testosterone generally stayed well-suppressed, but during the injectable time period I had two of the 3 highest results, excluding my baseline.

From a statistical standpoint, things were mixed. I analyzed 5 different standard deviations, (and yes, I know these data sets are small so I used these as supplemental data,) SD1 was all data points, SD2 was all minus my baseline result, SD3 was the injectable timeframe, (17 Apr 2017 – 28 Feb 2019,) SD4 was oral minus baseline, (2 Jul 2014 – 11 Nov 2016,) and SD5 was oral minus the first two data points to account for getting to a hormonal system equilibrium, (2 Oct 2016 – 11 Nov 2016.)

Hormone level standard deviations data table

Hormone level standard deviations

I think the best comparison is between SD3 and SD5 and what pops for me is that under injectable I had larger swings in estrogen, SD3=402.4 vs. SD5=127.1 and serum testosterone, SD3=6.5 vs. SD5=5.6, but free testosterone was the reverse, SD3=0.7 vs. SD5=1.7. I am not an endocrinologist so I’m not sure what this means medically, but what seems clear is my body had a greater sensitivity to the estrogen in injectable form vs. oral and while my free testosterone was more stable, it still did not suppress it as well as oral estrogen only. The end result was that I never felt like I had a dosage that led to a stable range.

I found the physicality of the act of injection and the sourcing of the estrogen, needles, and syringes difficult.

Early on, I managed to put needles through my fingers and I experienced pain at injection sites as I sought the most comfortable place on my body to do it. I started with the top of the thigh, tried the side of the thigh, then ended up in the upper, outside butt. I still wonder how much of my variance in levels had to do with injection site and how much got where it was supposed to go in the muscle compared to other tissue or fat locations I may have ended up in.

I learned that I had trouble causing myself pain with the prick of the needle and had to look away, otherwise I risked swooning. This is how I managed to jab needles into my fingers. While injection guidance is to dart the needle in, I couldn’t do that and ended up at slow insertions, and for some reason that caused me less pain but it extended the time of the injection process.

Since I don’t like needles in general, the first several took me hours to work up the courage to do it and it wasn’t until the end that I had the process down to a few minutes. Compared to popping pills, it was a large time burden.

And then there was the pharmacy/insurance/doctor’s office iron triangle I found myself in over and over. Most of the problems were on the pharmacy side. They included the pharmacy not keeping the drawing needles, syringes with injection needles, and estrogen in regular stock, my insurance only covering generic but my pharmacy didn’t carry generic so I needed to get regular pre-authorizations, and dispensing me the wrong needle lengths. I spent hours sorting things out at the pharmacy and over the phone.

In addition to the generic vs. brand-name problem with insurance, every few months there were changes to what was or wasn’t covered, so some months I had to pay for the syringes and needles, and every six months or so it was, ‘Hey, the estrogen is $497, do you want that?’ and I had to chase down insurance and my doctor to sort those things out.

My doctor’s office was generally good about responding, but things did get out of whack when I asked for an extra needle/syringe/estrogen prescription as spares for when I messed up and for an emergency kit, which confused the pharmacy and messed up replenishment cycles.

In short, there was a bunch of friction around sourcing and the act of injection that was a constant source of frustation.

Taken all together, it just wasn’t working for me.

On a more meta-level, while I’m open to returning to injectable post-GCS, I wanted to go back to a more stable and lower estrogen curve going into surgery. I’m likely to have some changes after the testes are removed and oral allows for faster dosage adjustments up or down compared to injectable. I’m hoping to get back to a stable range and then maybe trying again.

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&copy;Heather Coldstream
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About cistotrans

A Seattle-area trans woman seeking a happy spot to stay at along the path of transition.
This entry was posted in gender transition, healthcare, HRT, LGBT, personal history, transgender, transition and tagged , , , , . Bookmark the permalink.

4 Responses to Why I Switched Back to Oral Estrogen from Injection

  1. Thanks, I was told that I should ditch pill and go injectable, but I had read elsewhere that there were the spikes to deal with. I am on spiro, but surgery is scheduled for 6/4 so that will go away. I take D3 and Magnesium which helps with cramping. I need to do some research on what our levels should be so I can present it to my doctor. I do still have some patches too as that is how she started me, but those things were bloody expensive.

    Like

    • cistotrans says:

      Congrats on the surgery date! That’s exciting! ❤

      The whole hormone thing seems like such a black box sometimes. Everyone responds differently and in my case, a stable dose worked great for a bit and then didn't.

      Like

  2. Elene says:

    Hi, Heather–
    As a post-menopausal woman trying to figure out optimal hormone replacement types and dosages, I feel for you! Just have to keep experimenting….

    Best wishes for success and health with all of it.

    Like

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