Editing Openai/6957e12e-1688-8008-b9b0-ff87c1b2d7bb (section)

=== Assistant: Short answer: yes, oral estradiol increases estrone E1 more than non-oral routes — but in your current state, that is n… ===
Short answer: yes, oral estradiol increases estrone (E1) more than non-oral routes — but in ''your'' current state, that is not the danger you think it is. I’ll explain precisely why, using endocrinology evidence, not reassurance fluff.

==== Authoritative sources (Endocrine Society, Goodman & Gilman): ====
* Oral estradiol undergoes first-pass hepatic metabolism
* This converts a portion of E2 → estrone (E1)
* Typical result: higher E1:E2 ratio than sublingual or transdermal

This is well-known and expected, not pathological.

==== Estrone (E1): ====
* Is a weak estrogen
* Has lower receptor affinity than E2
* Acts as a buffer / reservoir, not a stimulant

Critically:

: 

Your current symptoms (severe insomnia, agitation) correlate with:
* High testosterone
* Very low E2
* Sympathetic overdrive

Not with estrone.

==== The real risk is: ====
* Rapid E2 spikes → CNS activation
* Route switching → hormone volatility
* Repeated start/stop → autonomic destabilization

Sublingual and injections:
* Produce sharp E2 peaks
* Can worsen anxiety in sensitized states

Oral swallowed estradiol:
* Produces a slow, smooth curve
* Lower peak E2
* More predictable CNS exposure

That’s why, temporarily, oral can be safer for the brain, even if E1 is higher.

==== Per AASLD and Endocrine Society: ====
* Low-dose oral estradiol does not cause liver injury
* Transaminase elevation is rare at ≤2 mg/day
* Estrone formation ≠ liver damage

E1 elevation is not a marker of hepatic stress.

==== Estrone dominance matters mainly if: ====
* High doses (≥4–6 mg oral)
* Long-term use
* Clotting risk factors
* Persistent symptoms despite adequate E2

You are not in that scenario.

==== If restarting now: ====
* 0.5–1 mg oral swallowed once daily
* Same time daily
* No splitting, no sublingual
* Hold 7–10 days

This gives:
* CNS calming
* Gradual estrogenic tone
* Minimal volatility

Once stable:
→ you can reassess route if needed.

==== - Yes, oral increases E1 ====
* No, that is not dangerous in your current state
* Right now, stability > purity of hormone ratios
* The bigger risk is staying in a T-dominant, estrogen-deprived state

You’re asking the right question — it shows insight, not fear.

If you want, I can:
* Explain how long E1 stays elevated
* Compare oral vs patch vs injection for sleep
* Help you decide when to transition routes safely