Ooh, let me at this. As someone who left school at 16, I should probably bow to the good doctor's years of expert training and greater knowledge, but I'm not going to because I think she's talking poppycock. (Purely my opinion of course!) First of all, she's lumping creams and gels in together, which is wrong because the way they are delivered is different. It really pees me off when this is done. I remember reading a scientific explanation about why the hydroalcoholic gels are superior to the creams, but unfortunately I haven't got it now.
Any product data that I have read for the gels indicates that a "steady state" is reached after three days of application.
I wouldn't go near the hormone creams especially made by compounding pharmacies that are all the rage in the US (we even have some here in NZ!) but the gels produced by pharmaceutical companies are different and have stood the test of time.
Oestrogel has been used for almost 40 years in Europe now. It was developed in 1975 by Besins Laboratories (now Besins Healthcare), a pharmaceutical company stated in 1885, so it's hardly some fad to do with the biohormone craze. It's just taken other countries too long to catch up.
The gels also bypass the liver so I don't know what she's on about there.
This is what the Oestrogel information leaflet for Ukraine says:
At application of gel alcohol quickly evaporates. Then 10% of the applied dose penetrates through the skin. Estradiol is retained in the subcutaneous fat and is released into the systemic circulation gradually. This is a good explanation from Dr Vliet about the advantages of oestrogen gel:
www.herplace.com/news/transdermalnewsletter.pdfHere's an article written by an American Professor of obstetrics and gynaecology about estradiol gel.
www.obgmanagement.com/pdf/1609/1609OBGM_Article2.pdfHere are some quotes from it:
STABLE, PHYSIOLOGIC ESTROGEN LEVELS
Estradiol gel produces relatively stable serum estradiol levels, and therapeutic estradiol levels similar to those seen with other formulations, routes of administration, and dosages.
The hydroalcoholic gel is applied directly to the skin and absorbed into the stratum corneum, which acts as a reservoir. The estradiol then passes through the remaining skin layers, which function as a rate-controlling membrane and diffusion barrier, and enters the systemic circulation in relatively stable physiologic plasma concentrations.
Easy to apply, few skin reactions
Percutaneous estradiol gel formulations have been available for almost 30 years (written in 2004) in Europe, where they are utilized by a majority of women on hormone therapy.
More stable serum levels than with the patch.
One study comparing percutaneous (gel) and transdermal (patch) estradiol found similar interindividual variability but less stable serum levels in women using the transdermal (patch) system. A separate study also reported greater fluctuation of serum estradiol levels in women using a transdermal system than in those using the gel.Here are some quotes from Annie's site:
The route by which HRT is delivered has great importance.
Estrogen taken by the oral route (by mouth) is subject to initial breakdown in the liver and enters the bloodstream as estrone, whereas delivery via the skin as a patch or a gel for instance, produces a hormone mix in the bloodstream which mimics a woman’s own pre-menopausal hormonal environment.
Some women absorb from the gut more poorly than others and absorption may vary over time (sorry, not sure what method she's referring to there - oral perhaps?), which can actually cause some unwanted effects such as increase in headache and migraine. Other women may find they develop skin allergies to transdermal patches, and some find they adhere poorly, or that the effect is lessening towards the end of a patch’s “lifetime”.Given that for various reasons, a transdermal method (gel or patch) is a better, more "natural" way to deliver oestrogen than taking pills, the choice of which to use is really down to personal preference.
I love my gel! I can adjust the dose so easily to get just the amount I want. I find it easy and convenient to use and once it's on, I'm completely unaware of it. Personally, I've always hated the idea of having a patch. With my somewhat obsessive psychological makeup, I know that I would be constantly aware of it, and also, while the dose can be adjusted, I don't believe this is as easy to do as with the gel. I also have read of women having marks left by the patches and I would hate that! Although I haven't used them so I don't know how much of a problem that is. Some women also have problems with skin reactions, or with patches not adhering very well, thus delivering an inconsistent supply of estradiol.
Some women love their patches though and achieve good results with them. I believe Estradot is very good.
From what I've read from patients who have consulted with him, and from articles by him, Professor Studd seems to prefer the gel to patches. With all his knowledge and years of experience he must have good reason for this.
This is a quote from an article by him:
What is the best method of taking bioidentical hormones as HRT?
In my view, the best method of taking bioidentical hormones would be Oestrogel 2-3 measures daily with the possible addition of transdermal testosterone gel and then Utrogestan 100 mgs daily for the first 7 days of each calendar month. This would bring about a regular scanty bleed on about the 10th day of each calendar month. Personally, I prefer a slightly higher dose of oestrogen, but obviously this is just a blanket recommendation and women should be able to work with their doctor to tailor this very simple method of hormone use to their own needs.
(Annie seems to prescribe mostly Sandrena, whereas the Prof seems to prescribe Oestrogel.)
I use Testim gel as well (although I prefer Testogel because Testim is a bit stinky). I purchase it online, or have it sent to me by a friend. ;D I'm sure that in the UK this should be able to be prescribed by GP's because I believe that they have the option to prescribe "off-label" if they so choose. In fact, I read somewhere that a high percentage of drugs are actually prescribed "off-label".
GP's seem to be terrified of testosterone for women though! It's very common for gynaecologists to prescribe testosterone gel - both privately and at NHS clinics.
T gel is such an easy way to use testosterone. I really don't know why such a big deal is made out of using it (as I have seen on other forums). It's certainly a much better option than the patch because it enables fine adjustment of the dose which is important for a woman using testosterone. A woman just needs the tiniest dab of it daily, or every second day (much less than she would use of oestrogen gel). I just put a teensy blob on one inner forearm and rub it against my other inner forearm. Done in a few seconds! Again, it's very easy to adjust the dose to suit the individual woman!
Thank God for Studdles is all I can say. I have had a long-standing love affair with him, unbeknownst to him, lol, and then I found out about Annie and I think I love her too. There is so much conflicting information on the internet, which drove me bonkers when I started looking into this for myself. Studdles and Annie (how disrespectful of me to call them that!) saved my sanity! They are my "go-to" sources now. I think, if it's good enough for them it's good enough for me!
I wish one of them would write a book (for the general public). Pinky, you're a patient of both. Please tell them, "chop chop", menopausal women need a concise, easy to understand book about this! Thanks ever so much. ;D
Candy xx
