Dr. Rachel Rubin

They are safe for every human on earth, including your 99-year-old mother-in-law in the nursing home who potentially could die of a urinary tract infection. So this is kind of the two separate areas. And I think the question you're asking me is, let's talk about systemic estrogens.

They are safe for every human on earth, including your 99-year-old mother-in-law in the nursing home who potentially could die of a urinary tract infection. So this is kind of the two separate areas. And I think the question you're asking me is, let's talk about systemic estrogens.

Because I got a lot to say about that one. So systemic estrogen has a toolbox. We have patches. We have gels. We have rings, which go vaginally. We have oral estradiol. Those are the big ones. There are injections. That's kind of an old school way that I use sometimes, injections of estradiol, Valerate or Cipionate. And so each one has pros and cons.

Because I got a lot to say about that one. So systemic estrogen has a toolbox. We have patches. We have gels. We have rings, which go vaginally. We have oral estradiol. Those are the big ones. There are injections. That's kind of an old school way that I use sometimes, injections of estradiol, Valerate or Cipionate. And so each one has pros and cons.

And it's nice to have the toolbox because not every product works for every patient. And the key is, is getting it right for that patient because you need something that they're going to do and that they're going to do it for a long time because these are not things that you just do for a weekend.

And it's nice to have the toolbox because not every product works for every patient. And the key is, is getting it right for that patient because you need something that they're going to do and that they're going to do it for a long time because these are not things that you just do for a weekend.

I don't use it much, but that's not to say that it isn't useful. I think it is actually very useful. I think it's underused. For example, people are used to taking birth control pills. They're used to taking pills. They like pills.

I don't use it much, but that's not to say that it isn't useful. I think it is actually very useful. I think it's underused. For example, people are used to taking birth control pills. They're used to taking pills. They like pills.

doing for a healthy person with no major risk factors of cardiovascular issues, taking an oral estrogen really is not going to increase your risk of blood clots or heart attacks or anything like that at any significant worrisome level.

doing for a healthy person with no major risk factors of cardiovascular issues, taking an oral estrogen really is not going to increase your risk of blood clots or heart attacks or anything like that at any significant worrisome level.

Less. It's less.

Less. It's less.

I tend to always start transdermal. And again, this is my sex doctor hat because we learned from this study called the KEEPS trial where they looked at oral estrogen versus transdermal estrogen. And it's a fascinating trial. But in that trial, they found that, yes, there's a slight increase of blood clots with oral estrogen, but sexual function is better in transdermal.

I tend to always start transdermal. And again, this is my sex doctor hat because we learned from this study called the KEEPS trial where they looked at oral estrogen versus transdermal estrogen. And it's a fascinating trial. But in that trial, they found that, yes, there's a slight increase of blood clots with oral estrogen, but sexual function is better in transdermal.

And that's because of what happens to sex hormone binding globulin. So when you take oral estrogen, we talk a lot about first pass metabolism through the liver. It goes through the liver, the liver, lots of things go through the liver when you take medications. And this one in particular, it can pump out more clotting proteins.

And that's because of what happens to sex hormone binding globulin. So when you take oral estrogen, we talk a lot about first pass metabolism through the liver. It goes through the liver, the liver, lots of things go through the liver when you take medications. And this one in particular, it can pump out more clotting proteins.

So if you're at any risk of blood clots, just like birth control pills, if you're a smoker, if you are overweight, if you have a genetic predisposition to blood clots, we're not going to use an oral hormone product. Now, I want to paint this because this is actually an area where I would love to see research.

So if you're at any risk of blood clots, just like birth control pills, if you're a smoker, if you are overweight, if you have a genetic predisposition to blood clots, we're not going to use an oral hormone product. Now, I want to paint this because this is actually an area where I would love to see research.

I was speaking at a Harvard testosterone course with Abe Morgan Tyler and Mo Cara, who you've had on the show, and I was speaking about women's testosterone use. And the speaker who got up there to talk about transgender hormone therapy talked about sublingual estrogen. He kept referring to sublingual estrogen. And I ran to the microphone. I said, What are you talking about?

I was speaking at a Harvard testosterone course with Abe Morgan Tyler and Mo Cara, who you've had on the show, and I was speaking about women's testosterone use. And the speaker who got up there to talk about transgender hormone therapy talked about sublingual estrogen. He kept referring to sublingual estrogen. And I ran to the microphone. I said, What are you talking about?