Estradiol patch question

[Diana L]

I have been taking estradiol orally for almost 3 years. I am thinking of asking my Dr. About switching to patches. I'm wondering about dosages and if some brands work better than others. Ani input will be helpful.
Thanks

[Frances]

I use Estradot and they fine. Dosages depend on absoption. I wear mine on my love handles.

[I Am Paula]

I use Estradot. Your Endo will know the proper dosage to correspond to your oral dose. I've never had anything remarkable, good, or bad, with them. I've been told they're easier on the liver.

[Jennifer-GWN]

Diana; tried patches for a short time but didn't feel they attached sufficiently for absorption and given it the time time I was flabbier and sweat a lot leading to more showers I quickly switched to injections.

Just my perspective.

Cheers... Jennifer

[Nigella]

I have been on patches from day one, as Paula has said, there is nothing to go through the liver. I believe that the equivalent dose with a patch will be lower than either oral or injection, again simply because the E doesn't pass through the liver.

A number of members have said in the past they have had issues with adhesion, but speak to your Endo, they are in the best place to guide you through a change of delivery.

[Lindsey C]

I forgot to ask my Endo, does anyone know if you can wear medical/sports tape over the patches to keep them on?

[Melissa Rose]

The general rule is patches if you are around 40 and oral if you are under 40. Research has shown there are fewer problems with blood clots which are more common in those over 40. Your buttocks and lower abdomen are the recommended application locations per the instructions. Areas where there is a lot of subcutaneous fat is best. The instructions say do not apply directly to breasts. The trick is to apply the patch in an area where a patch edge does not get too much friction. I've had the most success with a patch in the middle of my butt cheek. My underwear totally covers the patch and none of the patch peeks out. This helps to hold it in place. With only a few exceptions, mine have stayed on for 7 days including taking long, hot showers.

[Barbara Ella]

I started on patches,but they never got my E above 43, just a high male level. Dr. switched to pills, sublingually. He felt this method lowered the amount passing through liver and posed no more risk than injections. Levels have been perfect.

Barbara

[BOBBI G.]

Lindsey,
I use a paper tape occasionally, if I am going to do any yard work, and then leave it on until time to change the patch. Down here, you know the humidity and heat can get intense, and does release the adhesive, sometimes. I never asked my endo or my gyno about that, but it is a valid question. If you do ask yours, before the end of the year, could you let my know the answer? At this point, ignorance is bliss, and I'm the happiest I have ever been.

Bobbi

[Shelby11]

I wear two patches a day for a week, hope to inject soon, to help them adhere I use Benzoin Compound it is a liquid that is very sticky I apply to the skin first then the patch and then put over the patch, I have not had any issues with the patches coming off, I went to my pharmacy they ordered it and keep extra there I buy two bottles at a time,

[Lindsey C]

Sure thing Bobbi. I sent a message to my Endo asking about a bunch of stuff and the assistant replied back that they will get in contact with me shortly to discuss all the details, after my endo has reviewed my lab results. I'll let you know what she says about keeping the patches on.

[Eryn]

I have been taking estradiol orally for almost 3 years. I am thinking of asking my Dr. About switching to patches. I'm wondering about dosages and if some brands work better than others. Ani input will be helpful.
Thanks

Discussion of dosages has been forbidden on the forum. You will find some general information here: http://www.transgendercare.com/medical/resources/tmf_program/

In short, transdermal administration is much more efficient than oral administration so the numbers will be smaller.

Going to the doctor isn't a test. You are allowed to take a cheat-sheet of the questions you need to ask!

[Ann Louise]

I always used waterproof tape, overlapping, to hinder the entry of water while in the shower and generally to be sure that the (pesky) things stick all week long. And there was small seemingly perpetual clumps of glue gunk always surrounding them. Luckily, a friend of mine was doing her E via injections and taught me how she goes about it. Easy peasy. I was thereafter granted a prescription for injectable estradiol, and find that I actually look forward to my weekly injection, sure that my entire dosage of E is making it into my body, as it should be.

[Kate T]

I would suggest against using any sort of adhesive actually between the patch and your skin. The delivery studies are based on direct contact between the skin and the delivery surface of the patch, anything in between the two is likely to alter absorption. How significant this effect is going to be is going to be dependent on a wide variety of variables.

[Karen62]

With oral, I was concerned about both the damage to the liver by metabolization as well as the highly differentiated levels of functional doses due to the highly varied liver metabolic rates between people, and I had heard about troubles (with adhesive failing prematurely and also with removing the goo from the skin), not to mention the high costs, of patches. I, like Jennifer, opted for intra-muscular injections of estradiol valerate. I am not needle-phobic, so this approach doesn't bother me. It's actually quite easy to do, pretty much painless when you do it right, and I only need to do it once per week (Sunday mornings -- I LOVE Sundays!).

I did learn that the commercial version of estradiol valerate was difficult to work with as it is in a castor oil base, which is quite viscous, at least for the narrow injection needles. I found a US-based, licensed compound pharmacy who mixes their own EV using cottonseed oil, so it is much less viscous and so much easier to both draw into the syringe and inject. Love it.

Karen

[Kate T]

Again just make sure you are doing it with direction preferably of an Endo or at least a pretty experienced GP.

One of the reasons for the high viscosity is because GENERALLY the higher viscosity carriers will have a slower release (particularly for something like Estradiol where you don't want to fiddle with the salt too much). It's possibly worthwhile if you haven't already done so to get your E levels done at 24 hours post injection and Just before your next injection just to see how much variability there is and check with your Endo if that is within reasonable targets.

And just be aware cotton seed and corn oil have MUCH high contamination rates so be really careful with your prep of BOTH the bottle and injection site. Check with your Endo but I would suggest swabbing the injection port on the bottle with Chlorhex or alcohol before and after withdrawing a dose (a step often forgotten) to minimise contamination.

[Mary Lee]

I us Dial soap the gold bar to wash the area ware the patch is to be attached. The soap removes a lot of body oil and moisturizes from the area. I use the same soap before applying my self adhering breast forms.

[Lady Catherine]

I use a generic brand and it's working fine so far. I also work outside in the Florida Keys and it stays on fine without help.

[Eryn]

I've just started on Alvogen weekly patches as well and I'm on my third set. Adhesion hasn't been an issue, but my main problem is finding an application site that doesn't stretch or wrinkle as I move. I've tried rear and tummy as those are the suggested sites. On my rear the patches get pretty beat-up by the end of the week.

My other issue is that the sticky adhesive (which also contains the medication) oozes from the edges of the patch and gets onto my clothing. I end up with my panties stuck to the patch and I have to carefully peel the cloth away from the patch so as not to dislodge it. The adhesive is very tenacious and remained embedded in the cloth even through machine washing.

My interim solution is to put a circle of plastic wrap over the patch and let the oozing adhesive hold the wrap on. Not attractive, but it did keep my panties from sticking. I make sure that the plastic is at least a half inch beyond the edge of the patch so that it won't fold under if the patch lifts a bit.

I've also seen it suggested on hysterectomy forums that powder is a solution to oozing edges, but I haven't tried this. My endo is adjusting my levels and I don't want to mess things up by losing a patch. Right now I'm trying patches on my tummy and they seem to be doing OK, though I understand that absorption is about 10-15% better on the rear.

I'm thinking of trying twice-weekly patches at my next appointment as I'm leery of my ability to keep a patches in place for an entire week during the hot summer. Twice-weekly patches are also physically smaller than my current 25cm^2 patches and probably wouldn't be as susceptible to wrinkling and lifting.

[I Am Paula]

Mine stay on fine, and do ooze a bit. They don't stick to my panties, but they do leave a yucky outline that is really hard to remove. I'm NOT kidding- On really sweaty days, I've stuck a piece of duct tape (usually black) over it. I work in places there's a roll of duct tape every ten feet. Tres elegant.

[JohnH]

I do injection also, and I also get my estradiol from a compounding pharmacy in the Northwest.

Ah yes, duct tape! That seems to fix everything. If we did not have duct tape we would have to go back to chewing gum and bailing wire. :)

[Starling]

I used Climara patches for two months--and hope to again. I applied the patch to the area just around the corner from my hip bone, near the top of my rather ample butt, switching sides each week. This spot seemed to be the least subject to rubbing or flexing, while still fitting the placement criteria.

A patch loosened once on a very humid day and almost fall off, but when I carefully pressed it back in place it stuck pretty well--as long as I was careful in the shower and when I put my panties on. I completely lost only one, through my own clumsiness, and had to apply a fresh one. I found the gumminess around the edges unappealing, but not particularly bothersome. It seems to me that broad paper surgical tape would solve both problems, loosening and staining, although in my brief time on the patch I never had to resort to it.

By the way, it was glorious to be on the stuff, and it was the saddest day of my life when I had to stop.

Does anyone here know what medium is used to carry the Estradiol through the skin?

:) Lallie

[Eryn]

Does anyone here know what medium is used to carry the Estradiol through the skin?

:) Lallie

Do a Google search on "Climara prescribing information" and you'll get plenty of data.

[DebbieL]

Doctors usually look at the blood work to determine when to switch from oral to patch or injections. They look at prolactin levels which are a good indicator of how much estrogen is actually getting to you bloodstream and being metabolized. They also look for signs of liver and kidney issues. Switching delivery means that they have to be more watchful of clots.

It's always a good idea to discuss options with your doctor, including alternative delivery methods, but they should be in the context of discussion options, rather than trying to tell your doctor what you want.

[KellyTG]

I always put some water proof tape over my Climara patches just in case. I have yet to have one come off so far.

[Starling]

Good idea, Eryn. And here's the info:

"The active component of the system is estradiol. The remaining components of the system
(acrylate copolymer adhesive, fatty acid esters, and polyethylene backing) are
pharmacologically inactive."

:) Lallie

[Sarah M]

I never tried the patches I have been through injections since I started HRT 23 1/2 months ago with a injection every 2 weeks.Don't like talking pills. I heard different things about the patches though I do love the injections :)

[Diana L]

I went to the Dr. Today and she agreed that patches might work for me. She submitted a prescription to my pharmacy so I can pick them up tomorrow .

[KellyTG]

I always put some water proof tape over my Climara patches just in case. I have yet to have one come off so far.


I just found something that works much better. I use a 4" X 4" tegaderm clear patch over mine now. I get them off of Ebay @ 27.00 for 50 of them. They work great~

[Diana L]

I started my first patch yesterday. I noticed that the oral dosage was much higher than the patch dosage. Is this because the patch is absorbed into the system better? Also where is the best place to put the patch to get the best absorption?

[Nigella]

Oral dosages are higher because of the action of the liver removing a certain amount, at least that is what I was told by my pharmacist when I first started HRT. If you read the directions of the patches, you will see that you should wear them below the waist, in an area that is not likely to be exposed to excessive rubbing. I wear mine on my thighs, alternating the thigh and location each change.

[Laura912]

Nigella is correct. The oral route looses some during absorption through the GI tract, then a bit more in the first pass through the liver before the hormone goes off to do its thing; thence, returning to the liver for final pass and soon, excretion. Transdermal absorption skips the relative inefficiency of the GI tract.

[Eryn]

I wear mine on my thighs, alternating the thigh and location each change.

This varies with the patch and physician. My patch instructions say to apply to the upper buttocks or lower abdomen. My endo says they can go anywhere you can pinch a bit of fat. Apparently, fat helps absorption. Also, buttocks are about 15% better than abdomen in absorbtion efficiency.

I'm currently wearing 3 patches and find that the twice-per-week variety are much better than the weekly type. They are less than half the size which helps them stay put and they aren't as prone to ooze sticky stuff.

[Diana L]

Thanks for the information. I hadn't thought of the thigh.

[Nigella]

The directions for mine just state below the waist, with no specific area. For me the thighs are the best because there I less chance of them coming off if rubbed by everyday activities.

[allisonagain]

I've been on the patch for 9 months, 2 at a time. I had placed them either side of my belly button but got tired of looking at them and seeing the grey oozing adhesive outline on them as the week goes by. I recently went to my hips at the height of my belly button and they are fine there. The trick is finding a place to put them where they don't wrinkle up as your torso bends and moves. Also, adhesion hasn't been a real problem, I apply them to an area after using rubbing alcohol with a cotton ball to thoroughly clean off any oils, etc. I have had them come partially loose in a shower, then after drying off, simply applying pressure over the patch for a bit and they go right back to sticking. Less wrinkling is best for adhesion. I have used name brand and generic and both produce the same results, tenderness in the breasts, I have no other way to judge effectiveness as I only get blood checks every 6 months and haven't gotten to my first one yet, but almost. I like the idea of the buttocks and am interested in the 15% higher absorption rate mentioned earlier, although it seems it would almost take a game of Twister to visualize placing them there?

[Eryn]

Yes, the buttocks are a challenge and I'm glad I have Mimi to help!

I put them all on one side in a horizontal line just south of where the plumber's cleavage starts. I alternate sides which gives my electrologist a chance to work on the area.

I solved the stickiness problem by cutting ovals of Saran Wrap a bit larger than the patches and applying them to the patches. The adhesive that oozes out holds the wrap in place without sticking to my panties.

[Lindsey C]

I've been using patches for almost 8 weeks now and for the first four weeks was having tremendous difficulties keeping the patches on. I found an amazing solution online which is waterproof! They are called Transparent Dressing 3M TegadermTM Film 6 X 8 Inch, 10 Per Box on Amazon. It's a big sticky transparent square that goes over the patch. I have had 0 problems with showers and the patches stay 100% on no matter what. It's only $2 per patch, but it's well worth it since a patch that doesn't stay on is a loss of $10-20+ dollars.

My only qualm about the tegaderms is that it sometimes gets a bit itchy on day 6 and 7. So far they've been a bit itchy 2 out of the 4 weeks I've been using them (itchy for just 1 or 2 days each weeks) and to me it's not a very big deal. I highly recommend them and who knows, they may not be itchy at all for you.

EDIT: I should also mention that since the patch is covered by the transparent tegaderm thingy, fabric can not cling to the patch adhesive and leave marks. After taking the patch and tegaderm off all you see is a slightly red circle for a day or two. I also recommend placing the patch on your upper buttocks area. Putting in on your lower abdomen in front isn't good because when you hunch over while sitting your body bends in that spot.

[STACY B]

Funny you should mention this Today, I had to call my Doctor and talk to the nurse about them falling off, Thursday, Fell off, Friday fell off, Saturdays made it till Today and now it's gone? So she said wait a couple hours after a shower until you are really dry and then sit down and put it on top of Buttocks and maybe even Blow dry for a sec or two to make sure it sticks. But I may have to get those strips to cover it up also? We shall see,lol