Estrogen Patches advice

[dreamer_2.0]

After 14 months on HRT, my endocrinologist has finally listened to me agreeing that the Estrace pills aren't having much effect. Despite being on the max dose, my E levels continue to be low. So, starting today, I am now reluctantly on patches. I say reluctant as I've heard multiple times that they're a pain in the butt and often fall off. Given my experience with them is roughly 13 minutes, would anyone here be able to share their own experiences? How difficult was it keeping them on? Do they survive showers okay? Any favourite places to stick them? If they start falling off, could I tape them back in place? ...does that even work?

[Sandra]

Nigella is having a bit of a break from the forum or she would answer this but seeing as I'm here with her I can say that she doesn't have a lot of problems, and has never had any come off in the shower, sometimes they have come off for no apparent reason and all she has done if left them off until it was time to renew. She puts them on the side of her thighs and alternates legs each time. I guess it is trail and error fro each person.

[dreamer_2.0]

Thank you, Sandra. I appreciate your input. Currently I have one patch on each shoulder but will try the inner thighs too. Trial and error indeed, though I'd prefer not to waste any patches. :)

Thanks again! :)

[Sandra1746]

Hi, I have used CLIMERA patches in all the dose levels for the past 3-years and am familiar with "non-stick" issues. My solution, and one endorsed by my pharmacist and physician, is to cover the patch with a BIG waterproof "Band Aid". The ones I use are 1 3/4" x 4". My favored placement is on the side of the butt cheeks but the abdomen also works. just avoid places where clothing rubs like the waist.
Good Luck,
Sandra1746

[becky77]

I just stopped patches as the transdermal approach wasn't working for me.
My patches never came off, showers and bath included. It's important to make sure your skin is dry and clean (no oil/moisturiser) first.

The pamphlet said to put them on the tummy beneath the belly button, after someone's suggestion from on here I had greater success with the patch on the fatty part of my buttock, then just alternated sides.

[dreamer_2.0]

My solution, and one endorsed by my pharmacist and physician, is to cover the patch with a BIG waterproof "Band Aid".
Sandra1746

Thanks for those ideas!


I just stopped patches as the transdermal approach wasn't working for me.

Glad to hear you had no non-stick issues though your message here is concerning, since I'm coming off pills as they weren't doing it for me. Would you mind elaborating? Send me a PM.

Thank you!

[arbon]

Some stayed on good, some not so well. They got dirty and sticky all around the patches. I did not like them and quite after a couple months.

[Donnagirl]

Have you considered estrogen implants? I have recent had the procedure and the results are really good. I should get about a year before I need to repeat the process. It was cheap, relatively painless and now I have nothing to worry about, they can't fall off nor can I forget to take them one morning...

[STACY B]

Don't get me started on those Patches,,lol,, I had a Hell of a Time,, They didn't like me much, I guess cause I am an oily person? But went through 3 the first week and like other said some stick and some don't ,, But I put mine on the Butt and sometimes they stayed. I even put athletic Tape on them to help,, They hate the shower also,, I did them for about 3 months. I went to the shots thank God,, No more trouble now,, Short and sweet. You have to stretch out the skin where ever your gonna put it so it will not move while your moving ,, And make sure you Air Dry after showers before putting it on, If it comes off blow dry it and heat it up and put it back on.

[Joan_CD]

I use two Vivelle Dot patches at a time and place them either on my backside or just below the waist panty line in the front. In almost three years I would say I had a problem three times. They work great for me.

[I Am Paula]

I use the Estradot patches, and only had two come off accidentally in two and a half years. Maybe I've just been lucky.

[Alex R]

The pamphlet said to put them on the tummy beneath the belly button, after someone's suggestion from on here I had greater success with the patch on the fatty part of my buttock, then just alternated sides.

The opposite for me; I've found on the tummy is better than on the bum. Showers and swimming are okay; no problems there.

Have graduated over the years from a low dosage to a relatively higher dose. I've found this higher dose definitely does work, so have no problems recommending patches.

[Michelle789]

Holly,

I know this may be a silly question, but are you on spiro? And how are your testosterone levels? I've heard transwomen who take estrogen without spiro and don't get much of a result.

[Eryn]

I have a fair amount of experience as I've been on them for about 4 months. I wear three and that keeps my levels just above 100. Despite the low levels I am happy with the results. I've only had one patch come off and that was early in my trial. I just stuck it back on and I was good to go.

I have found that the twice a week patches are better than the once a week patches. They are smaller and less likely to peel off. I put all of mine on my upper buttocks. That area has slightly better absorption. My generic patches, made by Sandoz, are the generic version of the Vivelle Dot which just came off of patent.

My only complaint is that the patches tend to ooze around the edges and stick to my underwear. I cut an oval of saran wrap and apply it over the patch and that cures the issue.

I swim and shower normally and I'm just careful to wear underwear to bed so that I don't dislodge the patches on the sheets.

[Frances]

I have been on patches since 2008. No problems here.

[Diana L]

I have been using estradiol patches for about 3months and haven't had one come off yet. My only concern is the dosage is much lower than the pills.

[Debb]

I have been on patches for a month, and haven't lost any. I place them around my abdomen on my back, near my belly button, and on the sides.

[Peggie Lee]

I always clean the area with alcohol before applying the patch, I found that my body wash soap although leaves the skins silky my patched would not stay on.

[Eryn]

I have been using estradiol patches for about 3months and haven't had one come off yet. My only concern is the dosage is much lower than the pills.

It can be lower because the estrogen doesn't pass through the liver on the way to the body as it does with oral estradiol. That's easier on your liver.

What counts is your blood levels.

[dreamer_2.0]

Holly,

I know this may be a silly question, but are you on spiro? And how are your testosterone levels? I've heard transwomen who take estrogen without spiro and don't get much of a result.

Yes, I am on Spiro and have been since day one. My T levels are "great" according to my Endo, he says they're in the female ranges. Don't ask me for an exact number though, I'm not really sure. I just know he's been more concerned about my E levels than T.

[Eryn]

Don't ask me for an exact number though, ik not really sure. I just know he's been more concerned about my E levels thank T.

I am always concerned about my numbers because it is my body that they apply to! I have a fantastic T level of 7 to 11, but my E level was 108 and then dropped to 87 where we would like it to be near 200. I'm pretty well maxed out on E so I live with what I have, and thankfully the results have been good.

My endo seems to be primarily concerned with getting my T down, as she says that it can interfere with utilization of E. So far, her regimen has worked very well.

[Persephone]

Your patches are on your shoulders? Was that specifically recomended by your doctor? Did you read the directions? Unless yours are a patch I'm not familiar with, most are intended to be on fatty tissue like your lower abdomen/butt. The presence of bodyfat is necessary for the transfer to occur.

I agree with Peggie Lee, I wipe the area with alcohol and let it dry prior to patch application. Also press firmly on the patch for about 20 seconds to hold it in place.

I've been on generic weekly patches, mostly marketed by a company named Alvogen (I suspect they are actually manufactured by 3M) and did not like them. They were awkward and left a lot of residue everywhere. Now I'm on twice-weekly generic patches from a company named Mylan and they are far superior. Like Eryn mentioned, the twice-weekly patches are smaller and while they do leave a residue, it is a much smaller amount. They appear to be sturdier and made of thicker material and seem way easier to apply.

My proceedure is to use 1/4 of my abdoment/butt each week. So over the course of four weeks I do right front belly (below waistline), right rear, left rear, left front, and keep repeating.

So far I have never had a patch fall off, even when swimming or showering. If there is any body hair in those areas you should probably shave.

I feel that patches are a great way to go. Like Eryn pointed out, they eliminate that ""first pass" through your liver so they should be healthier. But, like everything medical, your milage may vary.

Hugs,
Persephone.

(I am not a medical doctor nor do I pretend to offer medical advice. Consult your physician).

[BOBBI G.]

I have had trouble with the patch since I started them 2 years ago. My solution was to get a role of paper tape and just use a strip to hold the patch in place. I only use one patch a week and this method works quite well for me.

Bobbi

[charlenesomeone]

Just finishing my first box, and I do what Peggie and Persephone say and clean with alcohol prior to attachment.
No loss yet. I cover with a bandaid just to remember where it is.

[Frances]

Why would you have a patch on you shoulder? E travels best through subcutaneous fat, like the buttocks, love handles, etc. Also, your doctor told you to wear 3 patches at a time?

[dreamer_2.0]

The patches on my shoulders were placed thanks to inexperience on my part. It was suggested by the pharmacist. I'll place them somewhere fattier tomorrow after replacing them. With so much movement in my arms, the shoulders don't seem like an ideal place. As for the patches going somewhere fatty, does that really make a huge difference as injections go straight into muscle? This is ignorance speaking, please be gentle. :P

Thank you everyone for your responses. Like all things online, there is a large mixture of experiences; some good and others less so. My experience over the first 24 hours falls into the latter. The patches are kind of annoying. While they haven't come unstuck from me, their edges have which I've fixed with a couple band-aids. Having to worry about such trivial things like this isn't appealing. But, like most things, it'll get easier with experience. That said, I intend on pressing for injections again next appointment. I've now received word from a few separate people that they are indeed available in Canada, contrary to what my Endo has said.

As an aside, a few of you have mentioned weekly patches being larger than the ones you change mid-week. Wow! Those must have been huge because the mid-week ones I have are already fairly large. Now those must have been annoying!

[becky77]

Glad to hear you had no non-stick issues though your message here is concerning, since I'm coming off pills as they weren't doing it for me. Would you mind elaborating? Send me a PM.

Thank you!

I was on Estradot also, they get some fluff around the edges but they don't move.
Two reasons I've come off patches.
1, Despite 3 times a week since Feb 2014, my E levels have never been anywhere near where they should be, as I said transdermal doesn't work for everyone, skin is a barrier.

2, I was going private, I'm now under the Gender clinic and they have put me onto their own regime. Taking me off Androcur also for an injection, that's primarily because my Prolactin keeps rising, side affect of the anti-androgen.

[Eryn]

A fair number of us wear multiple patches because TS needs exceed that of GGs. Adding to this is less subcutaneous fat on genetic males, something that hopefully will be fixed by HRT.

[Frances]

Like I said, I have been on patches since 2008. I'm also Canadian and used to the conservative medical practices of a public system. Usually, patches size and quantity is ramped up. I was wondering if Dreamer girl was putting on multiple patches following directives or doing it on her own. Estradot come in three formats. If one needs a higher dose, there is no reason to wear two lower doses, for instance. I was questioning dosage, just trying to get more information.

[Badtranny]

If one needs higher dose, there is no reason to wear two lower doses, for instance. I was questioning dosage, just trying to get more information.

Yes,multiple patches at once seems a little unnecessary to me as well. Perhaps it has something to do with having testicles? I think I was on pills prior to the Orchi, so I don't really know.

My prescription is (1) patch (of undetermined dosage) every (3) days. So basically (2) patches a week. Also, all patches aren't created equal. My patches are small and stay stuck like glue, but my roomie's patches are twice the size and wouldn't stick to the business side of duct tape.

[STACY B]

See,, Melisa said it,, I had those generic patches the Bigger ones and they don't stick,, Better off now anyway,, Stick and move is my Moto,,lol,,,

[dreamer_2.0]

@Frances - Two patches at a time, replaced every three days, per instructions from my doctor. As for dosage, we'd have to speak privately for that. The patches are from Sandoz.

[Badtranny]

Holy moly Dreamer. Be sure and tell your doc if you experience any dizziness or headaches.

That seems like a high dosage to me, but I don't really pay that close attention to this stuff ...unless I experience dizziness or headaches. :-)

[Eryn]

Yes,multiple patches at once seems a little unnecessary to me as well. Perhaps it has something to do with having testicles?

Dosage is much smaller for GGs, as the E levels to treat menopause symptoms is much less than that needed for feminization. The dosage for younger women who have lost their ability to produce E is somewhat higher and is the reason 0.1mg patches exist.

Unfortunately, many TG people need higher amounts due to larger body mass, reduced uptake due to less subcutaneous fat, and perhaps the effects of T. To get the proper amount some of us wear two or even three patches.

Since we are using this medication "off label" the Pharma industry has no reason to produce stronger patches.

[Frances]

Why do you keep talking about GG's, Eryn? Melissa (and I) are both post-transition women who have been on hormones for a long time. We don't need a lesson.

Dreamer,
If you doctor thinks it's right, then I guess it is. By the way, you did give a dosage in your response.

[Eryn]

I brought them up because the need for multiple patches was questioned. You might not need a lesson but others who are reading might take your questions as indicating that there is something wrong with multiple patches. There isn't, and endos often prescribe them.

[Frances]

The question was for Dreamer and her particular case, but fair enough.

There is something medically unsound with starting with a super high dose at the onset. The body may react adversely and not absorb the hormones. Especially when changing methods. If the highest dose patch is not enough, then sure, put on as many as needed. But it takes a blood test to know that. The best practice is to ramp it up slowly.

Also, since Dreamer was putting it on her arms, which is against directions, I was wondering if the multiple patch thing was her decision as well.

[becky77]

I was on Estradot, 3 patches a week.
That was three in a week separately, not all three on for the week.
It can get confusing but Dreamer has been wearing a patch on her shoulder, so worth checking if the instructions are followed properly.

Three patches at once seems excessive, I'm not an endo so perhaps that is normal, I've never heard of anyone else wearing more than one.

Is there a cost implication? Are three lower dose patches cheaper than a high dose?
The Estradot I was on if my absorption was as it should be would have put my levels right, should! But three high dose patches at the same time risks overdosing, which is why I wonder is there a reason to have three lower dose rather than one high dose?

That's a lot of stickyness!

[Badtranny]

on the other hand, I started HRT back in 2011 I think, so there may be some new protocols and whatnot.

Maybe they have figured out that mega doses are more effective for the new girls.

[dreamer_2.0]

Holy moly Dreamer. Be sure and tell your doc if you experience any dizziness or headaches.

That seems like a high dosage to me...

No complications, yet. I appreciate your concern. I've read and re-read the prescription label in case I misunderstood it, but nope it says "apply 2 patches every 3 days." There's only one way to interpret that, I think. If I'm wrong, please correct me.

Aren't doses typically higher for those pre-SRS or pre-orchi? SRS is still a ways off, though I have an orchi consultation coming up at the end of the month. Who knows when the surgery will be though.


Dreamer,
If you doctor thinks it's right, then I guess it is. By the way, you did give a dosage in your response.

I did? Guessing that was the higher doses? Figured that number represented the size of the patches as it didn't include MG.


Also, since Dreamer was putting it on her arms, which is against directions, I was wondering if the multiple patch thing was her decision as well.

Forgive me, perhaps you misread the part where I mentioned they are on my shoulders, as instructed. There is nothing I've done in my transition, so far, that's gone against instruction.

[Frances]

You seem a little defensive, which I find odd, because you come here for help and advice. That is the reason post-transition people like me stick around. We are not here to be contrarians or to belittle anyone.

EDIT: I just went back and saw this "The patches on my shoulders were placed thanks to inexperience on my part. It was suggested by the pharmacist." He may be used to nicotine patches, and he is not a doctor.


Since this is the wording in the instructions, the shoulder thing is strange (there are also pictures of the places recommended):

http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&ved=0CCUQFjABahUKEwiinaa329jHAhUE2D4KHZySD_Q&url=http%3A%2F%2Fwww.novartis.ca%2Fasknovartisphar ma%2Fdownload.htm%3Fres%3Destradot_patient_e.pdf%2 6resTitleId%3D116&usg=AFQjCNEMuY8fbft6_06hTFuuDZQMzUckpA&sig2=3J8vn9NHN6zGEYn5FXl0iw

2. Where to apply the ESTRADOT® patch
The ESTRADOT patch is rounded rectangular.
The buttock is the preferred place to apply the patch. Other
suitable application sites are the sides, hip, lower back or
lower abdomen (see Figure 1). Change the site of application
each time you put a patch on. You can use the same spot more
than once but not twice in a row.

Avoid areas of the skin where clothing may rub the patch off
or areas where the skin is very hairy or folded. Also avoid
areas where the patch is likely to be exposed to the sun since
this may affect how the patch works.

[dreamer_2.0]

I apologize for sounding defensive. I misunderstood your tone which I initially took as being somewhat antagonistic.

You are correct, the pharmacist is not a doctor and may be used to nicotine patches. If that were so however, it's unsettling to think the pharmacist is mixing up medications. Mind you, they are human too. He may have also been confused by discussing female hormones with someone who is physically male. He certainly looked confused.

Regardless, thanks for sharing that info on the patches. Neither the doctor nor pharmacist were particularly informative, though I could have asked better questions, too.

[Frances]

I put mine on my love handles and get great results. I change them after a shower and use a little rubbing alcohol to remove soap residue. I use Solvoplast II to remove glue from discarded patches. They stay put on my love handles. I tried the buttocks, but they kept coming off. I switch sides every patch change.

[dreamer_2.0]

See that's the advice I'm looking for from those who've gone before me. :P

[Eryn]

Three patches at once seems excessive, I'm not an endo so perhaps that is normal, I've never heard of anyone else wearing more than one.

I personally know of two people who are on a multi-patch regimen. I think it is more common for older patients. My instructions read "Apply 3 patches twice weekly as directed." My monthly prescription is 24 patches.

Without getting into numbers, the maximum dosage recommended by the Endocrine Society guidelines would require four of the strongest patches.


Is there a cost implication? Are three lower dose patches cheaper than a high dose?

I very much doubt it. I checked prices on-line and the per-patch price is the same for lower and higher dose patches.


The Estradot I was on if my absorption was as it should be would have put my levels right, should! But three high dose patches at the same time risks overdosing...

As you indicated, absorption varies widely. My endo started me on a lower dose, then titrated me up after my levels were tested. The levels are what create the positive effects. Monitor levels and there is little danger of overdose.

[Frances]

Dreamer and I do pay more for larger than smaller patches, based on governmental drug schedules and inssurance in our country.

[Eryn]

The question is, is the price proportional with the dose? Is a patch with half the dose also half the cost?

[dreamer_2.0]

Just took the first patch off one of my shoulders - OW!!! The stick was unexpectedly still strong. Pulled off some hair too. Haha Two birds with one stone, I suppose. Now for the other shoulder...

A little bit of residue was left after, hardly any.

Next placement will be love handles...though too bad putting them on the chest isn't a good idea as I could get rid of some hair that HRT hasn't dealt with yet. ;)

Had some slight lightheadedness yesterday afternoon, but unsure if from the apparent high dose of the patches or if because I hadn't eaten in a while. The feeling abated after eating, so I'm thinkin the latter. Still, something to be mindful of.

[Frances]

The chest is dangerous for cancer.

[Nigella]

Holly,

I know this may be a silly question, but are you on spiro? And how are your testosterone levels? I've heard transwomen who take estrogen without spiro and don't get much of a result.

This I will concur with, when I first started HRT my T levels were low for a GM, I'm not sure of the delivery methods for AAs, however, the indications were that they would go through the liver and I did not want to put more and more stuff through my liver considering the medication I am already on. I decided, after consulting with my Endo, that AAs were not an option. The E had little effect on growth and fat distribution, but did soften the skin and help with other things like body hair. E was fighting T and slowly gaining, but it was not until after SRS that the full benefits of the E kicked in.

I am on mulitple patches to allow for a specific dose, there is not one patch for the dose I'm on. I wear a large and a small patch, the smaller one being half the dose of the larger one. The quantity of patches worn will very much depend on your individual dose AND whether the brand you use is available in that dose in one patch, or whether you would need multiple patches to make up your dose.

[Eryn]

The only officially sanctioned locations I've read about are the hair-free parts of the lower abdomen and upper buttocks. I have no place there that is hair-free, so I epilate the location where the patch will go. I'm having my electrologist work on my buttocks so I won't have do that.

[Sandra]

Well Nigella's endo and prescribing pharmacist told her to out them on below the waist and this is supported by the patient information sheet that comes in the box.

[Suzanne F]

I just changed my patches. I use 2 patches at a time of Estradiol made by Mylan. I change them twice a week. This with Spironolactone. I am very happy with results. I apply them at top of hips and move them around.

[dreamer_2.0]

Well Nigella's endo and prescribing pharmacist told her to out them on below the waist and this is supported by the patient information sheet that comes in the box.

So that explains her choice of inner thigh. Good to know. I put the new ones on my sides and will try my thighs with the next pair.

[Sandra]

No she puts them on the outside of her thigh not inner, I imagine there they might rub on the inner thigh.

[Nigella]

Not sure where the "inner" thigh came from :)

Mine are worn on the upper thigh/hip area on the outside of the leg, alternating each leg on changing them. Please do listen to your prescribing person and read the patient information leaflet that should come with your medication. This is usually available in the internet as well, the type I use [Evorel] is listed below, just google the name, I will not link to the page as it does show dosage


Where to apply the patch

Stick the patch onto a hairless area of skin below
the waist. Most women prefer to wear the patch
on the thigh or bottom.
• Do not apply on or near the breasts
• Do not put it on top of cuts, spots or anywhere
the skin is irritated
• Do not use cream, moisturiser or talc before
applying the patch
• Do not apply the patch on the same area
of skin twice in a row
• It can be worn under loose areas of clothing.
35

• Do not wear a patch under elasticated areas
or a tight waistband
• Apply the patch to clean, dry, cool skin as soon
as you open the protective pouch

[dreamer_2.0]

Sorry, Nigella, I didn't quote properly and thought you put them on your inner thighs. I see now that was incorrect.

Teeny update. I'm on my third set of patches now (they're replaced every three days). The first set were, as you know, placed on my shoulders. A terrible idea as the constant arm movement made them lose their adhesiveness quite quickly; I could constantly feel them too so it was annoying. The second set I placed on my love handles. They were a bit better here, but still lost their stick with the natural twisting of my torso throughout the day.

So yesterday, with my third set, I placed them on my thighs and so far they are wonderful there. I only feel them when I actually go looking for them. Their edges haven't become unstuck yet, which happened quickly in the other areas. Even with some yoga, there hasn't been any trouble with the placement.

Thank you for mentioning the thigh! I'll try my butt next time. :)

[morgan pure]

Patches are the best. They should be below the waist--the pamphlet in the package says so. They will only come off if there is lotion on the spot where you put it.

[Thea Pauline]

Mine (Climara) came off all the time, but what I learned was: Alternate sides and distance from the spine and put them right below my waist (where a tramp stamp would go), covered completely by panties so my clothing didn't rub it off when I moved. Apply immediately after a shower, but before any lotions. When they did come off after a shower, I could frequently hold them in place with a towel and let the adhesive "re-set". If that didn't work I put two strips of 1" adhesive tape, one up each side, leaving the ends open for comfort. I overlapped the tape about 1/4" on the patch and the remaining 3/4" on my skin. Waterproof sports medicine tape was the best as it let the skin breathe.

Hope that helps!

[Eryn]

I discovered that cleansing the application spot with rubbing alcohol right before application improves adhesion.

I apply them at bedtime and wear panties. Laying on the patches makes them adhere better.