Estrogen is the primary hormone used in feminizing gender-affirming hormone therapy (GAHT) to promote secondary sex characteristic changes such as breast development, fat redistribution, and reduction of testosterone effects. In the United States, estradiol is prescribed in several formulations including oral tablets and transdermal patches.
Oral Estrogen Tablets
Oral estradiol tablets are pills taken by mouth and sometimes sublingually (under the tongue) to enhance absorption and reduce some metabolism differences.
- Taken daily at prescribed doses (often once or twice per day).
- Easily adjustable dosing.
- Requires hepatic metabolism (processed by liver before systemic circulation).
Transdermal Estrogen Patches
Transdermal patches deliver estradiol through the skin directly into the bloodstream, bypassing first-pass liver metabolism.
- Applied to clean, dry skin (often on lower abdomen, buttocks, or outer arms).
- Typically replaced on a regular schedule (e.g., twice weekly) depending on product and dose.
- Provides more stable hormone levels compared with some oral dosing.
Comparison
| Feature | Oral Estradiol Tablets | Transdermal Estradiol Patches |
|---|---|---|
| Route of Administration | By mouth (may be taken sublingually) | Through skin (patch) |
| Metabolism | First-pass liver metabolism | Bypasses first-pass effect |
| Dosing Frequency | Daily | Typically 1–2 patches per week |
| Hormone Level Stability | More fluctuation | Steadier delivery |
| Common Brands (US) | Estrace, Femtrace, generics | Alora, Climara, Minivelle, Vivelle-Dot, Estraderm, FemPatch, Menostar, generics |
| Typical Retail Cost (30-day supply) | ~$10–$60 | ~$25–$150 |
| Notes on Cost | Often cheaper with generics | Generic patches generally cheaper; specific brand premiums vary |
| Potential Advantages | Daily oral dosing | Stable levels |
| Considerations | Greater liver metabolism | Patch adhesion/skin irritation |