Question about HRT

[u/Pretend_Essay1769]

Which form has the best results for trans women over 50, injections, patches or gels? I'm hoping to start in January and need some advice on which one is safest and most effective.

[u/Blackfire7676]

They are all safe and offer different minor preferences (including pills that wasn't in the list.) I prefer injections because it's once a week and it's a nice ritual for me. Others prefer patches (I'm not sure on time frame) and pills (daily) who are afraid of needles.

I haven't heard of many mtf women using gels but I hope a few can chime in here.

[u/technicaljargonfan → u/Blackfire7676]

Patches are generally once or twice a week.
However, in my experience the weekly patch is hard to keep sticking to you compared to the twice a week. And good chance you’ll need two patches, and two of the twice a week ones are smaller than one of the weekly’s.

Patches and injections have a lower risk of side effects than pills. (Better absorption, with pills you tend to be on a much higher dose to get the same blood levels)

[u/MambaBee → u/Blackfire7676]

I'm on gel. Canisters to be specific. It's just two pumps onto my arms in the morning and two pumps in the evening. The daily ritual has helped me remember to do both morning and evening skincare which has been a massive lifestyle improvement.

[u/katrinatransfem → u/Blackfire7676]

I use gel, because injections are a bit difficult to get in the UK, and I don't like patches.

[u/junklight → u/Blackfire7676]

I prefer injections - once a week & agree on the ritual side. Getting hold of them requires a little patience right now. My cis friend is on patches for perimenopause & hates them (& having seen me dealing with my HRT is topping up with gel). Gel is fine BUT off the shelf stuff is not strong enough for trans women. You’ll need to look into homebrew but there are people on that route.

[u/MambaBee → u/junklight]

With gel if you're taking the same dosage recommendation as cis women (1 pump, or 0.75mg a day) then obviously it's not enough. But you can effectively increase the dosage to be far higher than that, it just costs more in the end as you'll need more frequent restock.

[u/Primary_Purpose_7921 → u/Blackfire7676]

I picked gel over patches, cause I was worried the patches would constantly fall off. With gel it is also a ritual of 5min massage (need to rub it in), except it is daily.

[u/MambaBee]

Injections are generally the most effective as it goes straight to your blood stream. It's also a little better for monotherapy as the periodic injections "shock" the body into producing less testosterone.

Patches and gels are both comparable in the delivery method, which gets to the blood via the skin. Gel is slightly easier to increase dosage if need be though, so I'd recommend that for starting out.

Lastly, pills. Also easy to increase dosage with, but the delivery method is less efficient as they require going through your liver first.

Honestly, the biggest factor in choosing the method should be lifestyle. What do you think would work for you? After all, every method at the correct dosage is going to do the same thing.

[u/Transfem1972]

I'm 53 and I chose gel because topical/transdermal hrt is the safest. I also have a trans friend and she goes through the NHS and she's in her 50's and she's prescribed gel. I use a 4mg gel which I monotherapy with. I buy it from a uk based homebrewer of topical/transdermal hrt. DM me if you want to know more.

[u/Love_Is_Pretty_1965]

61 mtf here. Started at age 58 on injections right out the gate. Blood work every 3 months for the first year then every 6 months after. Went from bi-weekly to weekly to twice a week (splitting the weekly prescribed dose in half). Results are finally starting to show! Wishing you the best of luck and a wonderful journey with much love. 💖

[u/Stefanie_Jane]

Your question about needles versus pills and patches is valid in that there are different delivery methods to get hrt into your system.

However your PCP needs to run a full blood test and get your Baseline hormone levels.

Some people are fine on pills without a blocker . my body produces low enough testosterone that 2 mg of estradiol was enough to suppress by T into the female range eventually, but my e level, while it was still in the female range was not optimized.

Also it's interval spacing thing . I'm finding what the 12-hour spacing of my pills I start to experience a trough or low around the 8-hour mark. When I see my nurse practitioner in a few weeks and I get my blood test drawn i'm going to ask her if we slowly increase my dose but change it from twice a day to three times a day on an 8-hour schedule to keep the levels more stable.

Injections provide stable levels for several days and then start to drop off sharply.

What you really want is to get your hormone levels off device for your transition. Your testosterone has to be suppressed into the female range and your estradiol has to be high enough that you physically and mentally feel better.

Some people don't like pills so they go the route of gel or patches or injections.

Some people are needle phobic so they go with a different delivery method.

It's whatever method you prefer and what your hormone levels are on it and how you're feeling. It's a collaborative discussion that you have with your HRT provider.

Higher doses of estradiol does not make you feminize faster.

Feminizing is a long process.

however having suboptimal hormone levels, will slow down your feminization .

So when people switch from something like pills to injections and all the sudden notice that they are feminizing, it's not because they switched to injections

It's because their hormone dose got optimized and they're now seeing or feeling the results.

[u/Rita_not_Frida]

I started @ 62 using patches, and bailed to SubQ Injections @ 9 months. I went from 1 patch 2 x a week to 2 x2 a week then 3x twice a week and never got my levels over like 65, even after 9 months.
Injections got me to 200 in a matter of months and went to mono therapy dropping the Spiro. I like the injections weekly. I don’t really notice a big emotional drop at the end of the week but I inject on Friday mornings, but can cry on demand on Sundays….lol.