Medical estrogen is a first-choice hormone for people needing estrogen hormone replacement therapy (HRT). One positive aspect of estrogen is that there are many ways to receive it. Each method has pros and cons, but the variety means that every patient can find a best-fit for their body.
Keep reading to learn about the many different ways estrogen can be administered, and what makes each one special.
Estrogen as a hormone replacement
Estrogen can be used to treat estrogen deficiencies in transfeminine and cisgender people. In cisgender patients, estrogen is often used to treat the symptoms of menopause. Menopause causes a natural decline in estrogen production, and HRT can address some of the undesirable physical and mental changes that come with it.
Estrogen can be administered as the primary sex hormone to transfeminine patients. Here, it is the center of a feminizing hormone therapy regimen that can include anti-androgens, progesterone, and other medications. In transfeminine people, estrogen is feminizing – changing the body from masculine to feminine – before its maintenance function kicks in to sustain these changes.
Administration routes
Oral administration
is the simplest type. The hormone is prescribed as pills in milligram doses and taken as instructed by a clinician. Adjusting the dose is as simple as adding or removing pills from the daily routine. Oral estrogen is commonly prescribed for its convenience and wide availability.
Many people start and end their HRT journey right here, but some seek out alternatives. Oral estrogen is very good at supplementing natural production, but some transfeminine people find that it doesn’t produce ideal results.
Transdermal patches
are sticky patches applied to the skin that release medication over several days to a week. Doses can be quickly adjusted by adding or removing patches. Transdermal patches are good for maintenance therapy in cisgender women, and are convenient and easy to remember.
Although convenient, the effectiveness of transdermal patches can also vary between people due to different absorption rates due to skin composition and age.
Injections
can deliver estrogen into the body for steady absorption. One injected dose of estrogen can provide enough hormones for a week (or longer!), and it absorbs smoothly. The injection can be delivered by patients (after instruction) or clinicians. There are a range of injection sites offering different degrees of inconvenience, as well as a choice between subcutaneous (under the skin) or intramuscular (into the muscle) injections. Injections are a first-choice for many transfeminine patients who want a potent, consistent source of estrogen.
The challenges related to injections are often related to access and anxiety. Injected estrogen is not always widely available, and patients must contend with their fear of needles to use this method.
Subdermal pellets
are one of the newest innovations in estrogen delivery. The pellets are inserted via a small incision. This is an outpatient process using local anasthetic. Once in place, the pellet begins dissolving and releases estrogen over the next 4-5 months. Estrogen pellets offer an effective and stable source of hormones that requires minimal input after insertion.
Although effective, the subdermal route requires a trained clinician to implants after depletion. Dose adjustments can be difficult due to the implant’s long-acting nature. Availability can also vary from state to state.
Topical administration
arrives as a cream, spray, or gel and is applied to the skin. Like transdermal patches, topical estrogen is absorbed through the skin and into the bloodstream for effect. Topical estrogen is normally applied daily and is a low-hassle way of supplementing the body’s estrogen demands.
As with transdermal patches, topical estrogen absorbs differently in different people. Users should also take care to not wash the area after application, as this may remove the estrogen before it has fully absorbed.
Vaginal administrations
can be dispensed as a cream, suppository, or ring. No matter the form, they are applied to the vaginal area or inserted into the vaginal canal. This administration route is often used to treat menopausal symptoms like vaginal dryness. Usage intervals vary from days to months (in the case of insertable rings), and this method is great for targeted treatment to the vaginal area.
Vaginal administration is generally not prescribed to trans women, who may lack vaginas or would benefit more from a whole-body dose over a targeted, local dose. However, it is excellent for treating the vaginal symptoms of menopause.
Finding your fit
Hormone replacements aren’t a one-shot medication for a single illness, but a treatment regimen that can last for the remainder of a person’s life. It’s important to find the medication and administration route that fits each patient best, so that their treatment is as pleasant as possible.
Even if the variety is a bit confusing at first, your clinician will be available to walk you through the pros and cons of each option and how it can fit. There’s a good pick for anyone who needs it, no matter their lifestyle, medical, or budgetary needs.
Note: This article was reviewed by Dr. Raj Singh prior to publication.
