How do you choose which way to take your estrogen when you’re trying to suppress testosterone? E comes in multiple forms and each one works slightly differently. In healthcare, we call the way we take medicine the “route.” For estrogen/estradiol, the main choices are via injection, transdermal (patch or gel,) or orally/sublingual (tablet swallowed or dissolved under the tongue.)
QueerDoc’s sibling company is QueerCME, where we teach other healthcare prescribers about gender affirming care / HRT / hormones / transgender medicine. QueerCME has a TikTok, and occasionally, we share those videos here. Although these videos were originally designed for a clinical audience, they may also be useful for the rest of us.
We often get questions about whether injected estradiol is “more effective’ than oral or a patch. Part of the answer is: the most effective method is the one that works for you!
Link to TikTok video: https://www.tiktok.com/@queercme/video/7401130805021527338
If TikTok goes away, contact us for a copy of this video!
Video Transcript of Comparing Routes of Estradiol Administration
okay
it’s purely hopefully there’s not too much road noise without my headphones on
um
there I think there have been a couple questions about um
suppressing testosterone effectively with different forms of estradiol administration
or if like patches are um more effective than oral or injections are more effective than patches or oral
or questions along these lines
I will try to remember to tag the people who posted them
um I’m 41 and like
sometimes TikTok confuses me um
but yeah I also like to be really clear: I can’t answer direct medical questions on TikTok
this content is directed at other medical prescribers um
to help their continue education.
I’m actually have a whole platform called QueerCME
where medical prescribers can subscribe
and get continuing education credits for over 40 hours of continuing education
specific to trans healthcare
it’s all about trans healthcare
so
disclaimer haha um
and yeah tell your doctor to pay me.
um so um for
um estradiol forms and efficacy
as far as I know um, last time I looked there
no studies comparing efficacy of estradiol forms for gender affirming care um
and it’s so it would be such a hard study to do frankly
because like and you could look at like
clinical objective targets like at
at serum total testosterone levels um
but that’s like really not the endpoint and gender affirming care
what we actually want is someone’s like um
desire transition goals and progress towards those
and those are um like subjective and very hard to measure and highly individualized for people
and so um
yeah the input I’m actually interested in at the clinician
would be very challenging to measure
however again
I don’t actually think there’s any trials comparing even more objective things
like serum total testosterone levels and like
how successfully testosterone is suppressed with different forms
so current like
practice guidelines which a couple people have reference like um
kind of that the guidelines are um
more built on clinical experience and um older
there’s a lot of nuance and complexity about medical guidelines
that’s like all guidelines are kind of that way
and some some ways cause guidelines have to be like
reviewed and and take all this time
and so almost at the pace at which medicine and research moves now
they’re almost like inherently outdated as soon as they’re made
but also like yeah
we would like better information
I totally agree um
so anyhow back to the original question
as far as I’m aware you know
no research indicating um
any form of estradiol tablets
patches or injections or gel um
is more efficacious or effective than any other format
and so I always tell patients
the most effective form of estrodial is the one that you um
can take the most consistently um
and and is absorb best in your body
right because like
like the vast majority of my patients start on tablets
and like probably half or more of them stay on tablets
never switched and see the changes that they want
but if someone had some kind of
you know and their tablets are originally designed to be oral
but most people take them sublingual
cause the vast majority of estradiol in United States is micronized
which allows for um
sublingual administration
it’s off label also there’s
no research on that um
as far as you know it’s theoretical
taking estradiol sublingual
we don’t have a study that says um
sublingual estradiol is better absorbed um
then oral I should
I am um
but
uh
rate the um
if someone had like you know
some type of malnutr- malabsorption like
you know an inflammatory bowel disease like Crohn’s
Ulcerative colitis or has had gastric bypass things that I
effect absorption through the GI tract
oral or sublingual will might not be the right choice for them
patches can work really well for some people if they stay on
some people with like oilier skin or more body hair
are who get sweatier or are more active
swimmers might find that patches just don’t adhere as well um
right and then some people
even when patches do it here well
like for whatever reasons
have like
even though hormones get absorbed really well through most skin
might have like um
thicker skin and less absorption um
you know an injection
some people like
get really stressed out about doing an injection
and then just postpone doing it for days um
and so I feel like again
the most effective or efficacious form
is the form that works for you in your life consistently
whether that’s like pricing
dosing routine access
things like that
all of that said
if someone is struggling to suppress testosterone levels with oral or patches
I will switch to injectable um
clinical experience from a lot of clinicians
seems to indicate that we find that
more effective at suppressing testosterone production
I don’t know if that is because dosing tends to be more consistent
I feel like in general dosing is really consistent
transgender diverse people
but like
having to do something once or twice a week
decreases like
administration error basically
um yeah
so when I’m having a patient who’s unsuccessful suppressing testosterone levels
um which is not super common
I’m usually tablets or patches will do that um
but if I’m if we’re having that
or if someone really doesn’t feel like they’re seeing as much changes
or experiencing as much as they wanted
like I do really try to understand clinicians very objectively what
what is missing like
what are we not seeing enough of
what do we want more of um
so I really understand is this something that hormones actually affects or not
um and then to what degree is it usually affected that
have I set realistic expectations for
for my patient um
rate and like
go watch the breast development videos
I talk a lot about how much breast tissue develops um
on average um
so yeah
but in that setting
um I’m still gonna think about switching to injections again
I don’t have data or research that says uh
they’re more efficacious or they work better um
but my clinical experience
and other clinicians clinical experience
seems to indicate we are more successful at suppressing testosterone um
when we switch to injections
and definitely some of my patients do feel like they get a little more
like oomph or kick um
to their experience with injectable estradiol
that being said I totally have patience to switch off of injections to tablets
because they are tired of poking themselves um
or a pricing or whatever and they don’t feel like they lose any ground
or like they’re not feeling as good or their changes aren’t as good um
and so I think it’s probably really individualized
for people who do feel like they see some extra improvement
with injectable estradiol
I don’t think that’s necessarily them
applies to every single person taking oral um
sublingual or patch or gel estrogen
I think it’s just really individuals with varying levels of absorptions
of different routes administration of estradiol um
hopefully all of that rambling made sense
Other QueerDoc/QueerCME videos:
- Harm Reduction in 2024: Extending the Shelf Life of Estradiol Valerate Vials
- TikTok Series: Estradiol Valerate Dosing Guidelines (May 2025)
Other QueerDoc articles about estrogen:
- Direct Contact Estrogen, September 2024
- All The E
- Important Things To Know About Implantable Estrogen Pellets
- Get Curvy With Estradiol: Risks, Benefits, and Timeline
- Gettin’ Nerdy on Gettin’ Curvy: Estradiol, Progesterone, and SERMs
- And many more at Our Blog Index Estrogen Section
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