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  • dandelion@lemmy.blahaj.zoneEnglish
    3·
    16 days ago

    Just FYI, oral progesterone is filtered by your liver and you don’t get enough of it in your blood stream, see this article:

    https://transfemscience.org/articles/oral-p4-low-levels/

    [N]ewer studies using more accurate blood tests … 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.

    As weird as it sounds at first, I personally recommend and use rectal administration of bioavailable progesterone (using the same oral pills). It has worked well for me, and I mostly use it to help me sleep when my estrogen levels are high enough that my sleep might be impacted (sometimes I have trouble sleeping as long when my estrogen is peaking).

    Again, I know it sounds weird to administer it rectally, but this is not uncommon in the trans community and seems like the safer and more effective way to take progesterone (esp. since injectable options are not available in the U.S., and would require daily injections, which is a hassle).

    • OldEggNewTricks@lemmy.blahaj.zoneEnglish
      2·
      16 days ago

      Thanks! (That’s actually the same article I linked in my post :3 )

      In the section “A Note on Oral Progesterone’s Metabolites”, Aly notes that it’s not yet known whether or not the metabolites have progestogenic effects, but I’m prepared to believe that the oral route is less effective. I’m open to trying other routes.

      My pills are kind of round capsules with gel inside, so I assume they contain microscopic natural progesterone crystals, rather than synthetic progestins. But I guess it doesn’t matter too much either way.

      • dandelion@lemmy.blahaj.zoneEnglish
        3·
        15 days ago

        Ah, I missed that it was the same link, lol. Glad you’re informed, that’s the main thing.

        I’ve taken my prog orally once before, I actually found it helped me sleep less than rectal administration, but I know people’s experiences vary significantly (others report less sleepy feelings with rectal administration, and strong sleepy effects when taken orally).

        And yes, I think the gel capsules are usually micronized bioidentical progesterone:

        https://docs.google.com/document/d/1OGiomfiMk18nPb3ITKZD9pWPvWRUlyI06enxahQpHBI/edit?tab=t.0

        Synthetic progestins are usually pressed-powder tablets:

        I would guess the metabolites seem more likely to carry undesirable side effects and health risks, just like progestins, compared to bioidentical hormones circulating in the blood, but who knows.