(13-11-2016, 05:27 AM)Skye is on fire Wrote: RunsWthSzissors ...For my money, even sublingual administration of oral estradiol is too risky, but again that's your call.
Hope that helps
Sublingual bypasses the liver and avoids most of the risks...although there are always some risks with hrt in general. Just what I learned through the years.
Well, you may hope that, but your statement illustrates a fundamental misunderstanding of the first pass through the liver. It also assumes, without any evidence that I can find comparing PO (oral) and sublingual administration, that no portion of the tablet being dissolved is swallowed and entering your system by the GI tract. I seriously doubt that you can keep from swallowing some portion, possibly a substantial portion, of any tablet you are dissolving sublingually. If you need the same dosage sublingually that you would take orally (PO), then you are definitely NOT avoiding the risks of PO administration
To me, that is a risk I'm not willing to take. I think it's rather similar to the risk of deadly consequences from vertebral artery dissection following chiropractic adjustment to the cervical spine. The risk is admittedly small compared to the estimated number of cervical adjustments performed, but when it goes bad, you're dead, literally not figuratively.
Also, literally EVERYTHING that is in your systemic circulatory system (i.e.. ALL drugs regardless of administration method) ARE metabolized by the liver. The advantage of transcutaneous and IM (intramuscular) administration methods is that you don't have to take an increased dosage to account for what is lost in the first pass through the liver. In my opinion, sublingual administration has yet to be proved as effective or safe as either transcutaneous or IM injections. If you are willing to accept the risks, and the OP said they were, go for it. It's your life. I'm just trying to contribute to the OP's understanding of his endo's concerns.