Transfem

You shouldn't really ever take estradiol pills orally imo. Higher risk of blood clots and cancer for no real benefit other than it being a bit easier than sublingual doesn't seem like a good trade.

I would edit squeamish to say something about phobias instead.

I would also add that many of these paths need blockers which are generally not great for your health in the long run (not so bad that no HRT is better). Injections are the most available path that makes it easy to bypass using blockers all together.

1. The first things to consider are injections and implants as these can be done without blockers. I don't know much about implants tbh as they are not super available. Injections are very consistent and safe.

2. The second thing to consider is patches. Patches release hormones continually so there are no lows or highs and it's simply more convenient. Some people have problems getting them to stick, but sometimes medical tape or applying them somewhere else etc help. There can be supply line issues with patches so they might just suddenly be out for a little while. You'll need blockers which can be uncomfortable and have long term side effects.

3. The third thing to consider is spray/gel. Patches/spray/gel deliver hormones poorly to some people as they simply absorb poorly through their skin, but for others it's a great route. Spray/gel has to be applied two or three times per day and it needs to dry. The area you apply to can also accidentally deliver hormones to animals and people that touch you for a little while, so best to not apply with your hands. Don't apply to the arm you take blood tests from (to check hormone levels). Don't spray while near someone. You'll need blockers which can be uncomfortable and have long term side effects.

4. The fourth thing to consider is pills sublingually. It's safer than swallowing pills, but you will accidentally swallow some and therefore have slightly elevated risks. Sublingual like the skin can be a bit hit and miss. Some absorb this way better than others. Not all pills can be taken sublingually. You'll need blockers which can be uncomfortable and have long term side effects.

5. The last thing to consider is swallowing pills. Take this option when you have no others available.

Be aware that often the bad side effects are really only a concern when it's over a long stretch of time. Taking pills orally for a few months or a year isn't a big concern. Taking blockers for a year isn't either. It's an issue when you have to do this for the rest of your life and when there are better options available. Some people also have nasty short term side effects from blockers so avoiding them in the first place is best imo.