In a previous thread, Katya asked for more commentary on the route for taking HRT. Rather than highjack the original thread, it was suggested that a new one be started, so here goes. First, the myth that one route is better for your liver than another. To address this, one needs to understand how estrogen is metabolized by the body. Certain forms of estrogen, generally the oral forms, go through the liver and have chemical groups on the main molecule altered, which converts the molecule into a more biologically active compound. Then, the compound goes out to the end organs where it reacts at the tissue level. The metabolites are then returned to the liver for excretion. Hence, the “two passes” through the liver. There is nothing dangerous about this, just metabolism at work. This assumes a healthy liver. Frankly, if the liver is too sick to handle the “two” passes, then the person is unlikely to be taking estrogen. The drug companies who first released the patches, used the fact that their estrogen was absorbed directly into the blood stream and bypassed the liver the first time around as part of their sales pitch. Drug company sales pitches may have some basis in fact but are generally designed to increase sales and make money.
Now for the route of administration. Estrogen comes in several different forms, and how they are administered, in part, determines which form is taken. All of the different forms have different biological activity which is the potency of the drug at the tissue level. The efficiency of drug getting to the tissues varies according to the route administered. Oral is the least efficient, intramuscular (IM), subcutaneous (SQ) injections and transdermal (TD) are similar, and direct intravenous (IV) is the best. Topical estrogen is only efficient when applied to mucosal tissue such as that found in the vagina. Now for the wrench in the works…humans. We are all different in how we handle medications. But in general, we will react similarly. For example, if we take one hundred people starting HRT, the majority will be able to take an oral, and usually, cheaper form. However, when sitting across from Ms. Jane Doe and planning a treatment regimen, the physician can only guess what will be the best route. Frankly, that decision may be influenced by how many preconceived notions the patient has, how much she can afford, the physician’s experience (which may be quite limited), the impact of the internet, and the phase of the moon. No route is the best. The route may be changed based on the patient’s subsequent hormone levels. Even those hormone levels can be a little shaky because of things like the time of day the levels are drawn (hormone levels have a circadian rhythm), different levels of other things that may impair the biological activity of the hormone (food or antibiotics, either orally ingested or shots, when taking the oral hormones) etc.
And you wonder why you see so many different regimens discussed here. It would almost be easier, after getting a good history and physical, to draw something out of a hat and go with it. The best route for you is the one that works.
But, the regimen that grows D sized breasts in three months, sheds 30 pounds from ones weight, decreases the waist to 28 inches, increases the hips to 36 inches, causes all facial hair to fall out and never return, and cures baldness will be released...in the future.
