Method Matters: a practical guide to hormone preparations in the UK part 1 - oestrogen

By: Dr Rhy Brignell

Dr Rhy Brignell BA MA Ph.D

Rhy is Director of Service Delivery at Eden New Life and is responsible for ensuring all of our subscribers get fast, high quality care in accordance with our treatment protocols. They hold a PhD from the University of East Anglia and have specialised in gender services for more than 4 years, managing and advising on service delivery for thousands of patients. This is one of a series of articles where they share answers to common questions we receive from our members.

In their regular review sessions with clients, our specialists often get asked about the differences between types of oestrogen hormone preparations. There’s a lot of anecdotal information on the internet about whether some preparations are more effective than others; whether you’ll get faster or bigger results if you have patches over tablets, tablets over gels. This article offers a practical guide to the different oestrogen hormone preparations available in the UK to support your conversations with our specialists and to consider the right option for you.

What do we mean by preparation?

In this context, preparation is a term used in medicine to describe the form that the medication comes in. In gender medicine, it might refer to tablets, gels, patches, or injections. These preparations are just different forms of the same medicine. Each form gets the medicine into your body in a different way, which can lead to different effects on your health.

There is no evidence of a difference in outcomes between preparations; no preparation works better or quicker than any other. It’s important to also note that taking higher doses than prescribed does not cause desired changes to happen more quickly, and, can put your health at risk. If you are receiving hormone treatment from Eden New Life, our specialists will advise you about the different preparations and dosages in your prescription and review sessions.

What are the different preparations of oestrogen?

In the UK, oestrogen can be given as tablets taken by mouth, patches applied to skin, or a gel which is rubbed into skin. In some countries, oestrogen injections can be prescribed, but they are not currently licensed for use in UK medicine and so are not an available option for Eden New Life clients.

How do different oestrogen preparations work?

Tablets

Oestrogen tablets are taken by mouth, usually daily. The tablet is then absorbed through your gut, then the blood carrying that medicine goes straight to the liver to be processed before it spreads around the rest of the body. 

Because tablets pass through your liver first, you sometimes need bigger dose adjustments for the oestrogen to take full effect, which will be managed by your Eden specialist. Your liver also makes extra proteins when it processes the oestrogen, including the type of proteins that increase the chance of blood clots. 

Some people have a preference for tablets as they are very easy to take and don’t have the mess associated with gels or the potential skin irritation associated with patches. However, due to the way tablets work, they can put more strain on your liver and increase your chance of blood clots. Tablets are therefore not a recommended preparation for people who have certain risk factors, like smoking, obesity, clotting disorders, or other cardiovascular risks - our specialists will advise you if tablets are not an option for you.

Patches

Oestrogen patches are applied to your skin and typically changed every 3-4 days. The medicine inside the patch is absorbed through your skin (this is what ‘transdermal’ means). The medicine then gets absorbed directly into your bloodstream, rather than being absorbed into your gut and processed by your liver first like with tablets.

This means that patches have a lower risk of blood clots and are less demanding on the liver. Patches are therefore a good preparation for people who are over 45, smoke, are overweight or who have cardiovascular risk factors. Since you change them every few days, there is also the benefit of not having to remember to take a tablet or apply gel every day.

However, the glue around the outside of the patch that helps it stick can be irritating if you have sensitive skin. Patches can also come off more easily if you sweat a lot, but this can be counterbalanced by using micropore tape to help them stay stuck down.

Gel

Oestrogen gel is rubbed into your skin, usually daily. Similar to patches, the medicine is then absorbed through your skin and enters your bloodstream.

As with patches, gel has a lower risk of blood clots and is less demanding on the liver, making it a good preparation for people who are over 45, smoke, are overweight or who have cardiovascular risk factors. Gel dosage can also be adjusted up and down in small steps by your specialist, allowing for gradual fine-tuning to find the right dose for you.

Gel absorption can vary depending on a number of factors, including your skin, where you apply it, and your daily habits (like showering, bathing, or sweating). There is some risk of transfer to others via skin-to-skin contact, which may be a consideration for you if you have young children or work with young children or animals.

Which preparation is right for me?

The preparation that works best for you is highly dependent on a number of factors, including your individual health, risk factors, lifestyle, and where possible, your preferences. This article is intended to provide you with some general information about the ways different preparations work on the body and the factors that should be considered, and is not a substitute for medical advice from a trained professional.

If you are starting hormone therapy with our service, or all set for a regular review, our expert specialists will be able to talk you through the different preparations available to you and they will tailor their recommendations to your individual circumstances and health needs.