Paws crossed chapter 1: Awkward Encounter
THE COMMUNITY RESPONSE ALREADY IS MAKING ME TEAR UP WAWAWAW
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Paws crossed chapter 1: Awkward Encounter
THE COMMUNITY RESPONSE ALREADY IS MAKING ME TEAR UP WAWAWAW
I'll stop killing doctors the moment I stop reading people say "1mg E 50mg spiro"
let's learn together, here's a chart of estrogen levels following a single 2mg dose of estradiol valerate taken orally in postmenopausal women
That pink line on the left graph is estradiol, also called E2. That tiny little bump from 30 pg/ml to ~45 pg/ml is the main reason I'm killing doctors.
The purple line is estrone, or E1. During first-pass metabolism, which happens when you take something orally, the liver turns E2 into E1. Roughly NINETY-FIVE PERCENT of oral estrogen gets turned into E1 during first-pass metabolism. Increased E1 levels are most of why estrogen carries an increased risk of blood clots. Injectable estrogen still carries this warning but, according to everything I've read and my endocrinologist, that's just because they err on the side of caution. That giant fucking purple mountain is the second reason I'm killing doctors.
(Estrone/E1 is not inherently evil. The research is, as always, fucking abysmal, but it's thought to be important for breast development. It's not important enough that you need 95% of your E2 converted to E1.)
Taking it sublingually (under the tongue) or buccally (tucked into your cheek) avoids first-pass metabolism by introducing it into your bloodstream directly. Patches, gel, and injections do the same, just much more effectively, both because you're not inevitably swallowing some of the dose and because they're designed for direct absorption.
Reader, I beg of you: Do not accept the 1mg dose. Your doctor is slow-walking you in the hopes that you're Not Actually Trans.
(I am not a doctor or medical professional, skate at your own risk)
This post makes me so happy. I wrote a thing to try to take care of girls and now girls are taking care of girls in the notes and that's so beautiful.
So, let's talk about sublingual estrogen and how it's different than just swallowing it (and different from injections). Before that, though, always remember: More estrogen does not mean better transition. It's more complicated than that.
This is a graph of hormone levels for someone taking 2mg of estradiol valerate 3-4x/day.
That's pretty high! Given that, on average, 200 pg/ml is enough to achieve 90% suppression of testosterone and 500 pg/ml suppresses 95%, many people would not need a T blocker with these levels. I personally had E at 207 pg/ml and T at "<15" ng/dl (the test only goes down to 15), which could be too low, with no blocker.
That being said, it's important to note that I use injectable estrogen, which (unlike sublingual) has a built-in extended release mechanism. Transfem science has this to say about sublingual estradiol:
Oral estradiol tablets can be taken sublingually instead of orally. Sublingual use of estradiol tablets has several-fold higher bioavailability relative to oral administration and hence achieves much higher overall estradiol levels in comparison. Sublingual use of oral estradiol tablets can be employed instead of oral administration to reduce doses and hence medication costs or to produce higher estradiol levels for the purpose of achieving better testosterone suppression when needed. However, sublingual estradiol is very spiky in terms of estradiol levels when compared to oral estradiol and has a short duration of highly elevated estradiol levels. As such, it may be advisable for sublingual estradiol to be used in divided doses multiple times throughout the day in order to maintain at least somewhat steadier estradiol levels. The therapeutic implications for transfeminine people of the spikiness of sublingual estradiol, for instance in terms of testosterone suppression and health risks, have been little-studied and are mostly unknown. In any case, when used as a form of high-dose estradiol monotherapy and taken multiple times per day, strong though still incomplete testosterone suppression has been observed
Here's a graph of hormone levels after a single sublingual dose of estradiol (ignore everything but the pink E2 line):
That's what "very spiky" means. The half-life of a medication works the same as radiation, it's the amount of time it takes for your body to eliminate half the dose. Sublingual estradiol has a half-life of a few hours, so it can be very tough to maintain levels sufficient for monotherapy. For comparison, here's a graph of simulated hormone levels on injected estradiol valerate:
The blue line is a single dose, the orange line is 4mg every 7 days, and the pink line is 2mg twice a week (what I take). There are longer-lasting esters than valerate (enanthate is very popular in the DIY community), but all available injectable esters have a half-life measured in days. This is a big part of why injectable monotherapy is so popular: you don't have to take pills multiple times a day and, for most people, you don't need to worry about an anti-androgen. I'm less knowledgeable about gel/patches, but to my understanding they're between sublingual/oral and injected estrogen in terms of half-life with patches essentially being a more controlled version of gel. Regardless, don't fall into the anxiety trap that is trying to "optimize" your medical transition. Tragically, the science just isn't there, that's why the best most helpful doctors are the ones willing to let us experiment and see what works for us. There are in fact plenty of girls who have gotten a lot of results out of doses that would horrify us if we heard about it on the internet with no context. You should still learn about this stuff to be a better advocate for yourself.
(As always I'm not an authority, I just have an internet connection and the ability to read. Trust, but verify.)
ps subq is fine you don't have to do IM unless you are an edge case. your doctor just hasn't read shit since med school.
Thank you for including the note that <15 ng/dl can be too low.
When I started my transition, my friends and I were discussing our levels and each of us thought T was no longer necessary. None of our prescribers passed on that some T, albeit a low amount, is something that is still recommended health-wise, and it was only after seeing someone else online bring it up that we started to ask questions and do our own research.
thanks for telling me! it's hard to balance accessibility, accuracy, and breadth when writing these, so I try to leave little threads like that for people to pull on. it's nice to hear that it can be effective :)
INTERNET DENIZENS
LOOK AT THE SILLY THING I MADE
I FORGOT I HAD A TUMBLR BLOG
silksonge... tomoro.w....
IF YOU HAVENT WATCHED THE NEW SUPERMAN, WATCH IT NOW
IT WAS SO GOOD, MADE ME CRY SO MUCH
THIS IS SUPERMAN, THIS IS WHAT HE IS MEANT TO BE ❤️❤️❤️❤️
A cis woman tells me that maybe she should transition to gain male privilege as I'm recovering from getting beaten up in the men's bathrooms.
I tell her to be my guest and give me a call when she gets her jaw broken, I always carry a first aid kit and a pepper spray.
She calls me a misogynistic asshole.
A cis man tells me that he'd sure love some T.
Gave him my prescription and best of luck with the constant shortages and getting denied.
He calls me a pussy.
I'm fighting for my life and reproductive rights. I get told to get off women's fights, that it's not about me, like I shed my womb after my first T shot.
I search for support groups for SA victims, and I'm stuck in the same “women/NBs only”. Still shooting my shot, send an application. I introduce myself. Never get a call back.
I go to a trans night. Say I go by he/him. Get told back “yeah, that's how we all start !” by a trans woman. I'm too exhausted, I get up and I leave.
I hang out with my friends, one of them drunkenly says masculinity is a prison we must learn to escape. She gets rows of applause. Back to drinking alone.
Yes I could explain it. But who'd you rather be ? A delusional girl or a man made threat ?Or it could be better, I could just not exist ! And we'd bleach my corpse and I'd become a casualty. Not an F, ot an M, a W for Wound and for Wrong.
I put a candle on a single cupcake, 2 years on HRT. I blow it in the dark. Curtains closed like casket.
Batman, bursting through the window of the iceberg lounge : Stop at once!
Penguin: Never! With this final rat snuffed out the city will be mine!
Batman: Your plot will never succeed, for the sake of Gotham I’ll save him, as the people would quite like this man alive.
Penguin: Well we don’t all get what we want, and you’ll come to learn I like my men like I like my coffee … ICED! *gunshot*
reblog to remind prev they're not a bother and their presence is wanted <3
only after replaying titanfall 2 have i realized that compared to mechposting on tumblr titanfall pilots are like. the healthy side
mechposting pilots feel like they're in the wrong body whenever leaving the mech, titanfall pilots get out of the mech just to run on walls and dropkick another pilot
mechposting mechs protect their pilots no matter what, titans do aswell but BT-7274 threw cooper across a massive gap knowing that the slightest miscalculation wouldve killed him, or he could fail fighting any number of grunts without his (bt's) help as they were separated, with the only assurance being "Yeah he's got this"
world is hers
Gotta love the internet sometimes
My NSFW Catgirls zine.
With the 100 year anniversary of The Great Gatsby, we have achieved a century of mainstream tragic yaoi
Happy Trans day of Visibility Folks
I love being in fandoms that barely connect
You can’t forget the divas and the dress up dollies
And then the idiots and their handlers
The masterminds behind the scenes
The morally dark
The iconic fights in your mind
I love my little guys
Anywho time for the hell of tagging this
How my programming work goes