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Estrogen Patches for Hormone Replacement Therapy: What, Where, and How

Everything you need to know about estrogen patches for HRT.

A purple and blue gradient background with an illustration of torso wearing a bra, underwear, and estrogen patch.

Illustrations by Leo Mateus.

Estradiol transdermal patches are one way for transgender, non-binary, and gender-fluid people to take estrogen for gender feminizing hormone replacement therapy. These patches are placed on the skin of the body and release estrogen hormone over a gradual period of time. 

What are estrogen patches?

Transgender and non-binary people looking to change their gender through estrogen replacement therapy may choose estradiol patches because of their ease and safety.The easy-to-use skin patch is applied to the skin like a sticker and delivers estradiol through the skin and directly into the bloodstream. Compared to injections, hormone levels fluctuate less with patches and the absorption of hormones through the skin makes it safer for people who are at risk for blood clots. Some common brand names of estrogen patches are Climara, Alora, and Vivelle-Dot

The side effects of estradiol patches themselves are minimal, but will still contain the common side effects of estrogen as a hormone. The main concern with transdermal patches is that they are more likely to fall off due to sweat, showering or bathing, or through friction with clothes. 

If you're considering using transdermal patches for your estrogen hormone therapy, it's important to know that the patches only go up to a certain dose. Increasing the dose means using additional patches- up to a maximum of four patches at a time. For those who are using twice per week patches, that means eight patches in a week, and 24 in a month!

If you're curious about the difference between estrogen patches, oral estradiol, and injectable estradiol, check out this article

Common side effects and things to consider when taking  estrogen: 

When you first start your estrogen HRT journey, you might feel an increased sense of comfort and ease within yourself. This can be an exciting new time, and you might be feeling a range of emotions. Many trans women and transfeminine people report feelings of more joy and overall wellbeing, as well as an increase in self-confidence. Alongside these positive changes, there are some side effects that you should be aware of when taking estrogen.

The major side effects of estrogen to keep an eye on are blood clots, heart attacks, and strokes. Your provider can help you better understand the likelihood of these concerns. Other less common side effects of estrogen include: increased fat and/or cholesterol in the blood, increased blood pressure, increased risk of diabetes, and headaches. If your family has a history of heart disease, liver disease, kidney disease, severe headaches, or gallbladder disease, consult your provider before starting estrogen HRT therapy. For more information on estrogen and its side effects, check out this article

The common effects of estrogen HRT include physical changes such as breast growth, softening of the skin, thinning or slowed hair growth on the face or body, body fat redistribution and hips and thighs, and decreased muscle mass and strength.

How do I apply estrogen patches?

Some estrogen patches are changed once a week, while others are changed twice a week. Either way, patches can still pose a few problems when it comes to adhesives. But we've got you covered with a few ways to make it easier.

Estrogen patches stick best when placed on clean, dry skin on a relatively flat area that doesn’t tend to sweat heaps or have a tons of dense hair. It’s also best to avoid any bony or bendy areas like an elbow or a knee.

Common locations to apply estrogen patches are generally:

Belly, back, or upper buttocks: on areas that can be reached, and don’t go under where a waistband might hit.

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Upper arm or thigh: but it’s important to note that with how much these limbs may move on a daily basis might lead to the patch unsticking sooner than preferable.

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There are a few things to watch out for when applying patches:

  • Avoid sensitive body areas: Sensitive spots such as the breast, chest, or genital areas should generally be avoided.
  • Avoid putting the patch on freshly shaved areas: trimming any body hair in the area for a patch to better adhere can absolutely help, but applying a patch right after shaving could cause skin irritation.
  • Don’t put the patch on anywhere irritated or healing: Make sure the skin where you place the patch is intact, and avoid placing the patch over any cuts, scrapes, burns, or sores. 
  • Patches can go on tattoos, as long as they’re healed: If there are no tattoo-free areas to put a patch, it’s okay to put one over a tattoo, as long as it’s healed.
  • Make sure multiple patches don’t overlap: If using multiple patches for a higher dose, patches can go on different spots on the body. If they are in the same area, it’s important to just make sure they aren’t overlapping. They should each have full contact with the skin so that you are able to get your full dose!

Once you have a clear spot, applying the patch is easy as!

To apply:

  1. Wash and dry hands AND the spot where the patch will be applied.
  2. Open the pouch package at the notch: cutting open with scissors may accidentally cut the patch, so it’s best to tear.
  3. Peel off the backing, stick the patch to the spot and hold firmly for 10 seconds.
  4. Keep the patch on at all times until it’s time to change it out, according to prescription instructions.

To remove:

  1. Peel the patch off gently, starting with one corner, and hold down the skin around it.
  2. If there is adhesive left, let it dry for 15 minutes, then use lotion or oil to rub any sticky residue off.
  3. Fold the patch in half to dispose of it, sticky side in, so leftover medication isn’t exposed. Throw it away immediately in a child and pet-proof container. Don’t flush the patch down the toilet.
  4. Get ready to re-apply!

Lastly, it’s important to use a new spot each time to give the last area time to breathe.

Try not to use the same spot for at least a week after taking a patch off. Some skin irritation or redness under the patch is common after removed, which is why switching spots can be helpful.

Unfortunately, estrogen patches just aren’t as sticky as we want them to be, but there are some ways to help.

Estrogen patches are waterproof, and although they can be used in the shower or during a particularly sweaty workout, they tend to stop sticking well after a few days. If a patch isn’t sticking to the body for the duration of time the prescription has stated, there are a few tips and tricks:

  • Don’t submerge underwater for a long period of time: patches can absolutely be worn in the shower, bath, or swimming, but it’s generally best to try not to keep it submerged underwater for long periods of time which can cause it to unstick.
  • Use bandaids or medical tape to help hold it down: If the patch starts to peel off or lose its stick at the edge before it’s due to be changed, then medical tape can be used to tape the patch back in place.
  • Avoid heating pads and direct sunlight: Using a heating pad over the patch or exposing the patch to direct sunlight for long periods of time can increase irritation and lead to changes in how the medicine is absorbed.

If an estrogen patch comes off completely, first try to re-apply it to a new clean, dry spot if it has some stickiness left. If it is no longer sticky, use a new patch. If you end up using more patches because they’re not sticky enough, make sure to let a provider know, as this may lead to needing a refill early.

How are estrogen patches used outside of HRT?

Estradiol transdermal patches are not exclusive to HRT for transgender people and have also been used to treat conditions related to decreased estrogen levels in the body including menopause (hot flashes, sweating, and spontaneous feeling of warmth in the body), osteoporosis, and vaginal dryness, itchiness, or irritation. Some younger cis women who do not produce enough estrogen naturally will also use estradiol patches to supplement their baseline levels. 

Some brands of estradiol patches, like CombiPatch, that include estrogen and progestin (a synthetic progesterone) are often used to treat severe symptoms related to menopause. The progestin acts to reduce the risk of uterine cancer which is related to increased estrogen levels.  

What are the different doses for transdermal estrogen patches?

Most brand name estradiol patches will come in 100mcg doses which lasts for three to four days. The average weekly dosage for estrogen HRT is 400mcg, which equates to four patches per week, two patches at a time for 3-4 days each. For those interested in starting with low-dose estrogen, the transdermal patches come in varying strengths. 

For those ready to get started with FOLX for estrogen hormone replacement therapy, the process begins here. For existing FOLX members with questions about their dosage, don't hesitate to message or schedule time with a clinician. And for those who’ve just got some more questions, read up on estrogen here, and feel free to reach out to us at support@folxhealth.com.