Tuesday, 4 March 2014

Hormone patches and baby oil

My 2009 Event Diary has this item under 'MARCH 2009':

On 2009 0328 I got my initial batch of Estradot hormone patches from Boots in Burgess Hill.  The very first one went on at 4.10pm the same day.

How time flies. 2009, 2010, 2011, 2012, 2013, 2014.... Very nearly five years of putting Estradot patches on twice a week!

Patches are used most often by the older transitioner, whose liver can't take the punishment that tablets would inflict. Particularly (as with me) if there is existing medication (statins, in my case) that is already putting pressure on liver functions. One can also take hormones in the form of gel smeared onto the skin. Gel or patch, the idea is for the hormone to be absorbed through the skin, and then directly into the bloodstream, by-passing the liver completely.

In the case of patches, this process is intended to be a slow, low-dose leak over several days. Quite unlike the situation with daily tablets, which is a high-dose delivery method to ensure that enough active hormone gets past the liver-processing. No question, tablets are more convenient. But they mean a lot of work for the liver, and the 'daily big hit' appears to give some people problems with mood swings and other side-effects. I had no choice. It had to be patches. But I'm completely used to them, and the routine of replacing them is fully integrated into my weekly life.

Placement of the patches - where you stick them on - matters a great deal. It's no good putting them over bony parts, or anywhere without a good blood vessel network under the skin. On the other hand, it's dangerous to place them close to body structures highly sensitive to hormones, such as one's breasts. Nor should a patch be put in a position where it might get rubbed off. So it has to be somewhere on the lower abdomen. As you know from a recent post, I now pop my patches on my bottom, but where I can comfortably reach them.

It is a bit of a performance really. The patch comes out of the box in an individual sealed packet, which you have to tear open, making sure that you don't damage the transparent plastic patch within. The patch has a peel-off backing, in two halves. When ready (i.e. you have a clean, dry area of skin to put the patch on) you peel off one half of the backing, and place the exposed half of the patch onto the skin. It sticks. Then you peel off the other half of the backing, and smooth the rest of the patch onto the skin. Then, with the flat of your palm, you press firmly on the whole patch, and count up to eighty (I've just found from experience that eighty is a good number to count up to, if you want the patch to stay firmly stuck). Finally you put the two halves of the unpeeled backing into the opened packet, fold the lot, bin it, and dress.

Once the first half of the patch adheres to the skin, it's best not to attempt any repositioning if you can possibly avoid it - the patch doesn't seem to stick so well afterwards. So the initial placement needs to be just so.

The palaver doesn't end there. As the body flexes, the patch shifts around ever so slightly, and this creates an exposed sticky area all around its outer edge on which fluff will tend to accumulate. So that after a few days, when you come remove the patch for replacement, you always have a definite rectangle left on the skin, where the patch was. This has to be cleaned off specially. It won't simply wipe away. At first, I picked at it with a fingernail. But that tended to damage the skin. Then I tried gentle rubbing with a soft flannel wetted with hot water. That was much better for the skin, and faster. But although it was successful enough a method to use for almost five years, it wasn't quite satisfactory, as it was too easy to over-rub and abrade the skin.

Then quite recently (as occasionally happens) the pharmacy at Boots couldn't get my usual Estradot patches at short notice - I am not of course the only person on HRT in the vicinity, and they do sometimes run out - and had secured for me some Evorel patches instead, as a one-off solution. I took them, although I was doubtful about using them as a friend had had skin-irritation problems with Evorel. But I might not. I might as well give them a trial. It was exactly the same dosage - just a different brand, and a different size of patch.

As you can see, the patch is a quite big - more than twice the size of an Estradot patch. But I had no trouble putting it on (using the usual routine), and it came off nicely too, although (as expected) there was a monster square fluff residue left on my bottom! But I had a sure-fire solution all ready, never tried before.

The Evorel instruction leaflet was a small mine of useful information on the product. And one tip that caught my eye concerned how to clean off the skin after patch removal. They recommended baby oil. The Estradot leaflet hadn't recommended that! How remiss. And it ought to do the trick. So I got hold of a 500ml bottle of Johnson's Baby Oil.

And I've just tested it for efficacy, applying it with a wodge of cotton wool. It works. I won't say it's faster than the flannel-and-hot-water method, but the oil prevented any abrasion of the skin, and the end result was the total removal of residue and a soft, baby-like bottom. So this is a technique I'd recommend.

As for the Evorel patches, there is no sign of any skin irritation yet, and I'm thinking there won't be. Which is a useful discovery. It's always good to know that if one product isn't available, there is a decent substitute that can be pressed into service.


  1. I was never offered patches or injections. I self-medicated using tablets for a couple of months before Dr.Reed prescribed a different tablet. I know I shouldn't have self medicated but as it was only for a couple of months it wasn't a problem. I had been taking 3 x 2mg tabs/day and I was prescribed that for the next 3 years (2 years post-op) and then I was cut back to 2 x 2mg/day which I have been on since (9 years). I have to watch my cholesterol levels of course and my alcohol intake (I stopped drinking alcohol 16 months ago). Naturally I don't smoke and I exercise as much as I can. It seems to have worked well enough up to now and my next birthday (Nov) is my 69th. I am not sure I would like to have been prescribed patches though I know it works for some (and is probably necessary). How time flies eh Lucy? I remember my sister-in-law commenting on how youthful and slightly feminine I was looking a mere three months after beginning the course. She had no idea at that point but I came out to my whole family 6 months later and then it must have dawned on her! I take one tab first thing in the morning before breakfast and the other in the evening around tea-time. I also take a dispersable aspirin (the tiny 75mg ones) once every 3 days. I was taking them daily until my brother (a haematologist) advised that once every 3 days was sufficient as aspirin evidently remains in the bloodstream for quite some time.

    Shirley Anne x

  2. Timely post Lucy. I have been using your new ones from the start with the baby oil trick to soften the tide mark. Your post reminds me that for the very first time a patch has come off, probably due to me climbing up and down a ladder all day deconstructing a tree...


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