Pills – Pills are by far the most common and convenient administration of estrogen. In the United States, pills are the standard treatment however they are also common in the United Kingdom and the EU. One of the biggest advantages of using pills is how cheap they are to produce and buy. The average pill costs about 0.13 USD and it’s common for you to receive 90 or 180 pills at a time. Dosing usually ranges from the 2mg – 8mg range, however, the right dosage for you could be out of that range. Different routes of administration for pills are available such as oral, sublingual, and buccal, all of which have different results. Taking your estrogen pills orally, swallowing them, is the most common route of administration. When swallowing your pills, they are metabolized by the liver, this interaction is called first-pass. During this time, an increase of estrone is produced which may or may not be what you want.
Image reference of increased estrone when taking pills orally
Other methods, such as buccal and sublingual both have an increase in estradiol in comparison to oral. Sublingual is where you put the pill under your tongue and let it dissolve. During this, the pill is absorbed into your sublingual glands and then into your bloodstream. This avoids first-pass and gives you more estradiol over estrone in comparison to oral. However, no one is perfect and you will end up swallowing some of the pill or saliva. Buccal administration is administered through the check and entirely enters the bloodstream. Both buccal and sublingual give similar results of estradiol and estrone.
Image reference for increased E2 (estradiol) when taking pills sublingually and lower E1 (estrone).
Since the pill is being absorbed quickly into the bloodstream when dosing as sublingual or buccal, the half-life of the medication will reflect that. For comparison, the half-life of estrogen pills taken orally is 13 – 20 hours while pills taken sublingually are about 4 hours. Generally, you want to be redosing before the half-life of the medication. Any pills that are tablets can be taken orally, sublingually, and buccally safely and properly. Crushing your pill beforehand will increase the surface area and speed up how fast the pill gets absorbed.
Injections – Injections as of late have been growing in popularity, and now they are just as common as taking pills. The biggest disadvantage that comes to mind is that some people are terrified of needles, so the idea of injecting yourself with estrogen weekly may be out of the question. If you are a person who doesn’t mind giving yourself injections, the convenience of only having to worry about dosing once a week may be very appealing. You can of course go to the doctor’s office and have a nurse administer your injections for you, but that can be time-consuming. The vast majority of people who use injections get trained at a doctor’s office, and then administer it themselves.
There are 2 methods of injections, subconsciously (injection into fat) and intermuscular (injection into the muscle), both of which are viable options. When you inject into either fat or muscle, the dosage slowly drips into the bloodstream through the muscle or fat. This may result in more consistent levels, however, it can differ from person to person.
2 types of injections are available for you to purchase, estradiol valerate (EV) and estradiol cypionate (EC). The half-life of estradiol valerate is about 5 days while the half-life of estradiol cypionate is about a week. Estradiol valerate is more common than estradiol cypionate for the sole reason that estradiol cypionate is much more expensive. Speaking of price, some might be turned off by the idea of injections because of how expensive they can be. A vial of estradiol valerate can run you $500 USD, however, if you use a good RX coupon with your purchase you can get the price per vial down to $68 USD. The website below has great information on injection pricing as well –
Many different types of vials are available such as 10, 20, and 40 mg/mL. Dosage of injections can range depending on the type of vial you are using, however, anything from 2 – 8 mg injected every 5 days, week or two weeks is common. The way you would calculate that is by dividing the amount injected by the vial, for example, .2ml x 40mg/mL = 40/5 = 8mg per 5 days. If you are a person who wants to switch from pills to injections, it’s a good idea to start with the dosage that you were already taking in pills and take the same in injections. Since you are fully avoiding first-pass you will have more estradiol than estrone, however, estrone is still an important hormone. To combat that, some supplement by swallowing pills for a week or two every month or by adding pills to their injection regime.
Patches – Patches are the standard in Nordic countries such as Norway and Sweden. They are available in other countries, such as the U.S.A, however they are not as common as other forms of administrations. One of the most appealing traits of patches is that they are very safe and give stable levels, as shown below.
Image reference for stable levels when on patches
Trans girls who have problems with mood swings or inconsistent energy levels or for older folks who have problems with their livers, patches can be a great option. However, they do have to be worn at all times of the day. Not only that but it can be difficult for you to hit your target levels on patches alone. It’s not uncommon for you to have to wear more than one patch at a time for you to get the levels you want. One 50mcg patch is about 1 mg of estrogen pills for comparison. For those who have sensitive skin as well, patches may leave marks or may hurt the skin. Making sure to rotate the area the patches are applied to can help with markings or irritations. How your body reactions to hormones is very individualized for every method of administration, but specifically with patches, problems can arise with how much or how little your body absorbs through your skin. Commonly trans women will talk about how the skin is not absorbing as much estrogen as you need to, through patches alone. As of a result, some trans girls may add pills to their regime on top of their patches.
Patches and injections both give similar results because both are absorbed into the bloodstream, fully avoiding first-pass. Since they both give similar results, for those who are unable to take injections, patches can be a good substitute. Patches can also have the problem of falling off, for those who have this problem, adhesive tape may help keep the patch on.
Gel – Gels are very similar to patches in the way your body processes it. Both fit into the category of transdermal, absorption through the skin. Similarly to other methods on this list gels can be on the expensive side and may not be covered by insurance. However, those who have skin problems associated with patches, may not have the same reactions with gels. Dosage can vary heavily depending on what type of gel you get, but generally, you want to be in the same range as other dosages on this list, 2mg – 8mg. Some gels have a pump system, one pump is about .75mg, so if you want 3 mg you would do 4 pumps.
Common places to apply the gel to are arms, armpits, thighs, and even the scrotum but any place with high absorption would work well. Places that you should avoid applying the gel to are the breasts, doing so will highly raise the chance of contracting breast cancer. The half-life of estrogen-based gels tend to be around 36 hours, so it would be a good idea for you to be dosing every day.
If you are a person using gel you need to make sure to not make contact with other people or animals before the gel is properly absorbed, to ensure the gel does not rub off of you and onto them. You want to avoid someone touching the area of absorption for around an hour to two after dosing, if they do, wash the contracted body part with soap and water.
Pellets/ implants – Pellets are a common method in both Australia and New Zealand. They are available in countries such as the U.S.A or the EU, however, they need to be surgically implanted under your skin every 3 – 12 months. Not all doctors can do this, so a specialist might not be available where you live. You are under anesthesia while the pellets are inserted. Since you are under, the price will be much higher than other methods such as pills. It can cost anywhere from $350 – $1500 U.S.D. For those who want to add progesterone to their regime, it can also be added as a pellet during this time. Pellets are a great option for those who want stable levels and lower dosage. The majority of the time that you are on pellets results in stable levels since the pellets are slowly dripping in the bloodstream. The first weeks can result in peak levels while the last weeks can result in the lowest. The number of pellets can range vary heavily depending on what you want your dosage to be, overall most tend to be around 2 pellets but some will be up to 4.
List of advantages and disadvantages of different methods of Estrogens – https://mainefamilyplanning.org/wp-content/uploads/2019/07/Feminizing-Therapy-Packet.pdf
Graphs of medications – https://en.wikipedia.org/wiki/Pharmacokinetics_of_estradiol