• dandelion@lemmy.blahaj.zone
      link
      fedilink
      arrow-up
      4
      ·
      edit-2
      2 days ago

      not all HRT, just progesterone, and because other routes of administration don’t make sense. See: Oral Progesterone Achieves Very Low Levels of Progesterone and Has Only Weak Progestogenic Effects

      Abstract / TL;DR

      Oral progesterone is the most widely used form of progesterone in transfeminine hormone therapy. Because of previous studies using inaccurate blood tests (immunoassays without adequate chromatographic purification), it was thought that typical therapeutic dosages of oral progesterone produced progesterone levels that reached typical luteal-phase levels in cisgender women (which range from about 7 to 22 ng/mL). However, newer studies using more accurate blood tests (immunoassays with adequate purification and mass spectrometry-based assays) have shown that 100 mg/day progesterone—with or without food—achieves very low peak progesterone levels of only about 2 to 3 ng/mL and average progesterone levels over 24 hours of only about 0.1 to 0.6 ng/mL. In accordance, oral progesterone has often shown only weak progestogenic effects in clinical studies. Higher doses of oral progesterone that might achieve better levels are limited by persistingly low progesterone levels, pronounced neurosteroid side effects caused by the first pass of progesterone through the liver, and substantial variability between individuals. While the progesterone levels with oral progesterone are apparently sufficient for endometrial protection in cisgender women, they are unlikely to be adequate for desired effects in transfeminine people. For these reasons, transfeminine people and their clinicians may wish to avoid oral progesterone if the aim is therapeutic progestogenic effects. Instead, non-oral forms of progesterone with greater bioavailability like rectal or injectable progesterone can be used. Alternatively, progestins, which are likewise fully effective progestogens, can be employed.

        • dandelion@lemmy.blahaj.zone
          link
          fedilink
          arrow-up
          1
          ·
          edit-2
          7 hours ago

          there is no such thing, and even if they put progesterone in something like an oil with estradiol (so it’s a 2-in-1 medication like those jars with both peanut butter and jelly in a single jar, which is what I assume you’re imagining), the problem is that progesterone metabolizes completely differently than estradiol.

          Prog has a half-life of like 22 - 26 hours when taken intramuscularly. Estradiol valerate has a half-life of around 3.5 days when taken intramuscularly.

          You wouldn’t be able to inject them at the same time, they need to be taken at different frequencies.

          Also, I’ve never heard of people getting their hands on injectable progesterone, at least in the U.S. As far as I know, it’s not a common way to take the medication, while it is common to take it orally, vaginally, and rectally.

        • dandelion@lemmy.blahaj.zone
          link
          fedilink
          arrow-up
          1
          ·
          14 hours ago

          I know everyone associates prog with breast growth, but I take it to help me sleep - 100 mg taken rectally before bed helped me sleep 10+ hours again, where before with just estrogen I struggled to sleep any longer than 8 hours. That said, I was taking large doses of estrogen for monotherapy then. I don’t know what my sleep would be like on my current estrogen dose without prog.

          • Rymrgand's Daughter @lemmy.world
            link
            fedilink
            arrow-up
            2
            ·
            5 hours ago

            that’s a thing? I know I typically don’t sleep much at all if I don’t take my bipolar meds but I didn’t think it had anything to do with taking e. 🤔

            • dandelion@lemmy.blahaj.zone
              link
              fedilink
              arrow-up
              2
              ·
              5 hours ago

              Yes, I used to need to sleep 11 - 12 hours every night pre-transition, and I usually didn’t feel rested even when I actually was unconscious and slept well that long.

              When I started estrogen, I started sleeping 6 - 8 hours and feeling rested for the first time since I was a kid. However, I sometimes felt like I would like to have slept a little longer, and there was a feeling that the high estrogen kept me from sleeping as much.

              As mentioned, taking progesterone rectally is what changed that for me, now I can sleep as long as 10 - 11 hours (usually I can’t sleep 12 hours, and most of the time I can’t sleep more than 10 hours).

              However, I wonder since my orchi and lowering my E dose significantly what my sleep would be like without prog 🤷‍♀️

              • Rymrgand's Daughter @lemmy.world
                link
                fedilink
                arrow-up
                1
                ·
                22 minutes ago

                huh, well I had to look at my medical records because I knew I had been diagnosed with insomnia about the same time as I started hrt but it was at least 8 months before I started so I don’t think it would help me. especially since I don’t think I’d have ever been on high dosage e since I was not mono until recently.