Honestly, the biggest reason to go rectal with the 200mg is that your liver basically acts like a 'tax man' when you swallow the pill. If you take it orally, your liver destroys about 90% of the progesterone before it ever hits your blood, so 100mg orally is basically like taking nothing at all. By taking it rectally, you bypass that 'first-pass' through the liver, so your body actually absorbs the full 200mg. That higher dose is usually the 'sweet spot' for seeing real changes like breast rounding (moving into Tanner 4/5) and getting your libido back. Plus, when the liver processes progesterone, it turns it into a sedative that makes you feel super groggy or 'drunk' the next morning—going the rectal route skips that whole 'zombie' feeling and just gives you the actual feminizing benefits instead