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185 Estrogen taken orally undergoes transformation in the liver prior to reaching the systemic bloodstream, a phenomenon known as first pass. The by-products of estrogen metabolism in the liver have more negative side effects, particularly cardiovascular effects, than estrogen

Instead of continuing full therapeutic doses, many patients transition to lower or maintenance doses under medical supervision

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15 As such, GIP, secreted by enteroendocrine K-cells, and GLP-1, released from corresponding intestinal L-cells, collectively referred to as the incretin hormones, are well-studied for their roles in glucose homeostasis and energy balance

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