i used the term "water soluble" and that might be a little misleading. you do want the chemical to eventually pass through the membrane into the cell. but, the basic difference between the hemihydrate (the generic) and the brand name is that the hemihydrate attaches the estrogen to a water molecule in the pill, and essentially releases the estrogen in the presence of water, whereas the brand name attaches the estrogen to a salt molecule, which only releases the estrogen when it gets to the liver, and sort of protects it from the gastric acid.
so, when you take a hemihydrate, it just dissolves in your stomach, because it doesn't have that ester to protect it from the acid - it just dissolves on contact with water. instead, you need to take it under your tongue, where it's released directly into your bloodstream. this produces a peak in blood concentration, followed by a fast decline.
when you take the brand name, the estrogen-ester compound actually absorbs into your blood, to be broken down by your liver - and will then actually even return to your liver for future storage and release. this leads to lower but more stable levels of blood concentration.
the ideal, of course, would be for high and stable levels of blood concentration, but that is hard with this chemical. you could conceivably take massive injections every couple of days, but again - that feels like a drug addiction. i don't want to do that...and i don't want needle marks on my arms. yuck.
i've clearly prioritized having stable amounts that are a little lower over having these spikes. and, let's understand what estrogen is and what these spikes can do - we're talking about crying fits, irrational outbursts, etc. it's pms, basically. every six hours. i have a sneaking suspicion that this is a part of the reason suicide rates are so high - the way this seems to be often prescribed is actually quite reckless.
cis-women can get around this by taking the pill, which is basically what i'm doing. but, let me ask all the cis-women out there - how long do you think you'd survive if your estrogen peaked and fell 2, 3, 4 times a day? that would be hell, right? that is actually what so many of these transgirls are doing to themselves, and it doesn't increase the efficacy, either.
so, the difference is that the generic should be taken under your tongue and produces a steep spike followed by a sharp decline, while the brand name should be taken orally and produces a more stable level over longer periods.
my estrogen blood tests have been sufficient. what my doctor told me, verbatim, was to not change what i'm doing, because the concentrations were quite high. i've boosted dosage twice in the last five years. how many more times? well, i've been more concerned about offloading the effects of the cyproterone acetate on my liver, which i'd like to do by removing my testicles. but, if this was hard before, it's even harder now - that's an elective surgery, and there's going to be a backlog when the virus is over.
but, i just spent some time taking a closer look at numbers coming from studies done over the last two years or so (that is, updated data), and while the general difference appears to continue to be upheld, clarification on the difference in reuptake is making me wonder if i shouldn't be optimizing this by mixing it up.
i currently take one 2 mg pill of estrace four times a day, that is every six hours (obviously, i'm rarely exactly on time). i should get about 50 pg/ml from each one after six hours, and it should stay above 35 pg/ml for almost two days. that means that at midnight every day, i should have about 200 pg/ml from the four pills i took over the previous day, and another 100+ from the pills i took the day before that, for average levels in the high 200s or low 300s, which is what i've been tested at - and is statistically higher than almost all cis-women, even if it cuts out the peaks in the cycle, which are much higher.
if i were to take it under my tongue, i'd jump up to 5-600 pg/ml as quickly as within five minutes, but it would crash within an hour. so, i'd end up with a kind of 45 minute estrogen high, followed by a long crash that is going to level me off by the time it's time to take another one. i'd have to do that every six hours which would actually probably be very difficult, emotionally.
so, i want to be clear that i want to avoid that.
but, a lot of my perception around the downside of the sublingual method was the steepness of the curve. the data i'd seen up to this point suggested you'd be at almost nothing after 6 hours, so you'd be constantly ramping up and down. while the ramp up is reflected in the more recent data, it also suggests a bigger base level, so that you're not falling all the way to zero. i even found some studies that suggest that sublingual application may decay at the same rate as metabolic use.
i still don't want my estrogen spiking every six hours. so, i still need the brand name drugs. and, the data does seem to continue to uphold the previous conclusion that average levels are higher with oral administration, which is what i actually want.
but, i'm considering experimenting with sporadic sublingual applications, just to see what happens. maybe, before i go to a concert, for example.
it's thursday, april 16th. let's see if i can remind myself to try it sublingually on thursdays at noon for the next month and see what happens.
it also seems to be that they've recently added prometrium to the formulary, which is good news. i started off on prometrium, but moved to medroxy because it was covered. i ultimately wasn't happy with the outcome of this, but i had to weight the cost-benefit analysis, and the reality is that the drug was expensive. if i can get the prometrium covered, i'll jump to it in a second...
the appointment is in may.