In India, estrogen hormones are administered in many ways. But in India the endocrinologists didn’t even recommend the injections even when they were available so are there risks associated with injections that are difficult to manage?

Estrogen Injections

Dr Kalra says that “they were using estrogen injections, but now it is not available.” So estrogen injections are not available. Additionally, Dr Kalra says “With the injections, in one go the dose becomes very high and so the complication rate might be a little bit higher.”

Patches

Though there is no need to worry because Dr Kalra has a solution. She says, “The safest is the patches. They are the safest with the least complications because they avoid the hepatic first-pass metabolism though in some situations they are not very comfortable for the patients.”

Availability

Patches are available. According to Dr Kalra, “In Bangalore they are available. In most other cities they are available, except for some as of now. But in one or the other pharmacy, you will get it because it is available in India.”
And where do these come from? Are all of them from abroad?

Dr Kalra clarifies this by saying, “Yeah, one is imported from the UK and some are in-house manufactured also.”

Problems with patches

There are a few problems with patches. Dr Kalra says “If there is a lot of humidity and the atmosphere is hot, the patches might come out otherwise the patches are the safest option. They are also a little bit costlier than tablets.”

Tablets

Tablets cost less than patches but Dr Kalra thinks, “If you ask about the safety and the least side effects then I would recommend patches. But yes, I agree in a few climate situations it is not possible to use patches so we use tablets. But injections as of now are not available so we are not using them. Additionally the injections and tablets have similar side effects.”

What about bicalutamide?

Dr Kalra says that bicalutamide has liver toxicity. “At the moment it is not recommended under any of the International Guidelines to treat Gender Incongruence. So that’s my answer, don’t try anything that you find online on Google, which is not approved. The incidents of hepatotoxicity from using bicalutamide are high so at the moment the guidelines are not recommending its use over spironolactone. As of now, even the international Guidelines are using spironolactone and not using this.”

So, do not use things that have not been prescribed to you, listen to your doctor and do exactly as they say.