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submitted 21 hours ago* (last edited 20 hours ago) by Kayday@lemmy.world to c/mtf

Trying hard to trust the process, and while I have seen other expected changes in skin, hair, and mood, I am getting anxious that nothing is happening under my shirt. I had some minor sensitivity within the first two weeks, but never anything painful.

This Friday will be 6 weeks on HRT. 2mg Est, 4mg Prog, 200mg Spiro daily.

Edit: thanks for talking me off the cliff everyone, I'm much less anxious now ๐Ÿ˜…

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[-] Filetternavn 1 points 8 hours ago* (last edited 8 hours ago)

I wouldn't recommend doing this if you have been prescribed oral estradiol (that is, taking the pill you are prescribed daily in a single sublingual dose). The significantly higher bioavailability of sublingual administration can cause incredibly high spikes, and the significantly shorter half life over oral necessitates taking the estradiol 3-4x daily to maintain (only semi) stable levels. This requires a dosage and schedule adjustment; it is not sufficient to simply take the same dose of oral prescription and start taking it sublingually once daily.

Additionally, the stomach does not destroy estradiol. The reason behind the low bioavailability of oral estradiol (and by extension, also oral progesterone) is that it passes through the liver before entering the bloodstream. The liver processes the estradiol before it enters the bloodstream, resulting in significantly less E2 available in the blood. This also presents an additional long term problem that has been well documented at this point: liver flooding. The high concentration of estradiol entering the liver in a short amount of time puts an incredible amount of strain on the liver, and can cause long term liver damage. This is alleviated through sublingual administration.

The sublingual route has its own pros and cons (mainly the incredibly spiky and unstable hormone levels and requirement of frequent 3-4x doses per day), and it is not advisable to recommend someone take the medication their doctor prescribed them in a manner that is not consistent with their prescription. OP's prescription was written with the intention of it being taken orally, thus the dosage has been planned for that, not for sublingual.

I took mine sublingually for awhile, but I am now switching to injections, as I am not happy with the dosage frequency. I've missed doses because I also struggle with ADHD, and it's resulted in me feeling really off when my levels get too low. I would never do oral, as it isn't an effective way of taking estradiol. It's incredibly inefficient and presents its own health issues. Injections are the most convenient and most stable option (although I haven't looked too deeply into the implants, those may potentially be more stable, but estradiol cypionate allows me weekly injections that peak at ~175ng/dL and trough at ~135ng/dL, which is very stable inside my target range), as well as being quite cheap and well studied.

TL;DR: Either talk to your doctor about adjusting dosage and scheduling for sublingual administration, or do the due diligence of reading about it. I recommend the meta-analyses from Transfeminine Science. The dosage and scheduling need to be adjusted if switching to sublingual.

this post was submitted on 05 May 2025
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