[RunsWthSzissors]

I know that that is the prevailing wisedom, but i question that a little.

Is it the liver doing the dirty work, or is it the acid and enzymes in the stomach that is breaking down the hormones into little bite size pieces that can get into the blood stream for its trip to the liver?

The liver is there to filter the blood, and all blood makes it way to and through the liver.

The lungs is the quickest way for things to get into the blood stream unchanged, followed by demal/sublingula routes. Ingestion is the poorest, which follows the traditional thoughts o

DC,

It's not just 'the prevailing wisdom', it's literally how your digestive system works. Everything absorbed via the digestive system, literally, absolutely everything, goes through the liver BEFORE entering general circulation. There is a special part of the circulatory system called the Hepatic Portal Vein system that accomplishes this. There are many reasons why this happens, but the upshot for orally administered medications is that before they get to their target tissue/organ system, they are partially metabolized by the liver. This is colloquially called 'the first pass through the liver.' Everything that is absorbed via the digestive system gets a 'first pass through the liver.' This has nothing to do with stomach acid or any other digestive system function.

Dosages for oral medications are increased to allow for the first pass through the liver so that afterward they are at an effective level in the blood stream. Absorption through the lungs is certainly faster than digestive absorption, but only for medication that can safely be aerosolized. Sublingual absorption is probably just as quick and certainly safer than aspirating any powdered medication. Intramuscular administration also releases the drug directly into the circulatory system and is the preferred administration method for a more timed release that helps maintain a relatively steady amount in the blood.

Hope this helps.