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.)
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