Suggesting Oestrogel isn’t as good as Premarin is something like saying tea isn’t as good as coffee. Premarin can certainly be effective at feminisation. It is a combination of oestrogens derived from horse urine. Horses are bigger than humans, their oestrogen is quite possibly “stronger”. But they are also horses, and humans are not…
It’s the next down on the list of risky forms of oestrogen after ethinylestradiol. One does have to be careful with it, but having said that, it has been prescribed to possibly millions of women (more so in the past) as a form of post-menopausal HRT. My mum used to be on it, her GP advised her that 8 years was long enough and she should come off it. Personally I wouldn’t want to use it long term, one should be aware that post-op women ought to be taking an adequate dose of some form of oestrogen for the rest of their lives to prevent osteoporosis and other problems. Health and risk factors therefore become extremely important when considering a hormone regime.
However, it’s all about dosage and absorption. For most people there is no reason why a sufficient dose of estradiol shouldn’t equal the effects of Premarin. Doctors tend to prescribe as little as possible though, and consequently dosage is not sufficient to achieve the effects of the much stronger horse oestrogen. Some people may react badly to Premarin, others may not absorb estradiol well, but either of those scenarios is probably quite unlikely. So if it works for you then that’s fine, but don’t stay on high risk hormones for too long. Spiro also has risks associated with it, and 200mg per day is not a small dose. Consuming too much potassium is one of the biggest risks, so one has to be constantly careful what is eaten; ie avoiding all potassium rich foods. But I’m sure you know that, Rose. I missed eating bananas amongst other things, and am glad to be off the stuff. The need for anti-androgens at all in fact (even pre-op) is greatly overrated in my opinion.
Oestrogel doesn’t coarsen the skin or cause hair growth, that would almost certainly be down to taking too small a dose. As we’ve suggested, it would take EIGHT squirts a day to equal the effects of TWO 100mcg patches. No doctor would or should prescribe that, because we simply don’t have enough suitable skin to allow that amount to be used daily. Sandrena however is a viable alternative…
8 pumps of Oestrogel would contain 6mg of estradiol. As I’ve said it’s probably impossible to be precise, but it is suggested that 2mg of Sandrena is equivalent to 6mg Oestrogel (and two 100mcg patches). There are two possible reasons for the difference in efficiency between Oestrogel and Sandrena:
Oestrogel is less concentrated; there is a lower estradiol to gel ratio, which could account for poorer absorption. Oestrogel has 0.75mg estradiol in 1.25g gel, Sandrena has 1mg in 1g gel, if I remember correctly. Also Sandrena contains propylene glycol, Oestrogel does not. This is thought to improve the amount of estradiol that actually enters the bloodstream. Hence the unusual looking equivalents.
But don’t fret about only using gels or patches. If you’re using Oestrogel then boost your intake of estradiol with tablets (such as Elleste, Estrofem, Zumenon). They are extremely safe (se my earlier comment on equivalent risk factor for birth control pills).
I’d also like to try injections like Marsha, another extremely safe form of HRT (assuming it’s done correctly!) but I haven’t dared asked my GP about this, and wouldn’t want to do it myself. I know some people on the NHS do get injections, but it doesn’t seem to be that common, and certainly not recommended by Charing Cross, my former gender clinic.
Oh well, pills and gels for me for now.
xx