Dr. Rachel Rubin

I've never heard of sublingual estrogen. There's no product. What are you saying? And he says, oh, you just take an oral estrogen tablet and you put it under your tongue like a tic-tac and you let it dissolve and it doesn't go through the liver and it works fabulously to increasing blood levels. And I said, oh my God, this sounds amazing.

I've never heard of sublingual estrogen. There's no product. What are you saying? And he says, oh, you just take an oral estrogen tablet and you put it under your tongue like a tic-tac and you let it dissolve and it doesn't go through the liver and it works fabulously to increasing blood levels. And I said, oh my God, this sounds amazing.

Presumably, because it doesn't go through the liver, which actually, if you think about it logically, I love logic here because we don't have a lot of data, so we love logic. I said, well, if you take an estrogen ring, a high-dose estrogen ring, and you put it in the vagina, same thing. You absorb estrogen vaginally. What's the difference there, right? A sublingual estradiol.

Presumably, because it doesn't go through the liver, which actually, if you think about it logically, I love logic here because we don't have a lot of data, so we love logic. I said, well, if you take an estrogen ring, a high-dose estrogen ring, and you put it in the vagina, same thing. You absorb estrogen vaginally. What's the difference there, right? A sublingual estradiol.

So I think it's fascinating. I don't have many patients on it, but I would love to see data look in that direction because it's cheap. Oral estrogen is cheap. You get lots of doses. You can dose it

So I think it's fascinating. I don't have many patients on it, but I would love to see data look in that direction because it's cheap. Oral estrogen is cheap. You get lots of doses. You can dose it

You can get away with a lower dose. Absolutely.

You can get away with a lower dose. Absolutely.

Yeah.

Yeah.

Again, I don't have patients on this and I haven't seen any studies on this.

Again, I don't have patients on this and I haven't seen any studies on this.

Yeah, absolutely.

Yeah, absolutely.

Again, transgender hormone therapy uses much higher doses. So my guess is one or two milligrams BID is probably what they do. If I were playing with it, I would probably be nervous and I'd probably do 0.5 check levels and I'd do twice a day. Again, this is not what I do in my clinics. But just as we think through, what are you afraid of? What are you afraid of with this?

Again, transgender hormone therapy uses much higher doses. So my guess is one or two milligrams BID is probably what they do. If I were playing with it, I would probably be nervous and I'd probably do 0.5 check levels and I'd do twice a day. Again, this is not what I do in my clinics. But just as we think through, what are you afraid of? What are you afraid of with this?

It's pretty fascinating stuff.

It's pretty fascinating stuff.

It's not that serious.

It's not that serious.