Spironolactone and Breast bud fusing

[Bardoux]

Was sitting through a talk given by the London GIC consultant Endocrinologist and he was stressing why he does not subscribe spironolactone to his patients despite their insistence. Apparently spironolacatone inhibits the full development of the breast tissue to the point where breast bud tissue ends up fusing and the breasts have a far lower incidence of developing beyond tanner stage 3/4. He was referencing a paper published by the GMC dated last year. Now of course here i am thinking, my goodness i have been on spironolactone for nearly 9 months, and couldn't really settle for the rest of the talk as my mind was reeling. However at the end of the talk i asked if, coming off spironolactone would the breast buds be able to un-fuse, to which he replied there was no studies out there to give any real idea, but he would giess that it would depend on which tanner stage the breasts had developed to, and how early you can come off the spiro. 

Anyone else read anything similar? It's another week to my next appointment with my endo, and i don't think he generally prescribes anti-androgens - preferring higher doses of estrogen and progesterone.

[Cindy]

Never heard that but I'm talking to my endo tomorrow, she has 25 yrs experience in TG endo treatment.

Thanks for the comment

Can you send the endos name BY PM if you wish

[Bardoux]

The Endo's name is Dr Leighton Seal, i don't believe he published the paper himself, but was referencing a study published by the British General Medical Council. He also showed a graph correlating types of anti-androgens and the incidences of those that needed and didn't need breast augmentation for each medication. Of course needing and choosing a breast augmentation is entirely subjective, but the graph showed a ratio of 5 to 1 for those on spironolactone as their AA, needing breast augmentation, compared to far smaller ratio's with cyproterone Acetate, Finasteride, Dutasteride and GnRH.

[Jennygirl]

Same with my endo, he never prescribes the stuff and scoffed at me when I asked him about it during my second appointment 10 months ago.

I hit a full B tanner stage III at around 7-8 months of HRT , very little fat despite gaining some weight and nearly all breast tissue. Now at Tanner stage IV and still at a full B even after losing about 15lbs. For sure, all breast tissue.

Spiro is not necessary, and I'm not surprised he was lecturing about it. Estrogen and progestins seem to be the most important from my own experience. I've never put a single tablet of estrogen, progesterone, or spiro into my mouth and I never will (it's all been pellets with a few booster injections). I hope nobody ever puts a pill in their mouth, but I know it takes time.

Come on modern medicine, wise up for us! This isn't the stone ages. You don't treat gender dysphoria with prostate medicine and horse hormones.

Sorry if my rant is a little brash. It frustrates me to know that people aren't getting the care they deserve.

[Kayla86]

This is the first place I've read this information and it seems to contradict what 90+% of Doctor's prescribe.

Any chance there's a link to this research paper, because something seems off about this....

[Jennygirl]

And herein lies the problem, there's virtually no conclusive research to be found for those of us who seek cross gender hormone therapy- so most doctors rely on old methods without questioning it. They stick to the book, and they do not ask questions. What do they do (as endocrinologists for mainly cis people) if the book is old and there is nothing new? They stick to the book and tell you to shut up.

And herein lies the next problem, how do you research and develop new HRT methodology for treating a broad spectrum of people when every person has different needs both hormonal and preferentially? You can't. It's a black art science by nature because there are so many unique things at play for each individual... dependent on their individual eating, sleeping, behavioral, emotional intricacies. Endocrinology is not like general medicine at all, which is especially unfortunate for us- because we perhaps need the most special care considering the changes we are asking our bodies to make.

There are a few endos out there who truly (and wholeheartedly) care about advancing hormonal treatments for transgender people. It sounds like Dr. Seal is one of them.

Edit: Once again I feel the need to apologize. Apparently this is a really triggering topic for me. I am deeply sorry if I have upset anyone. Please have mercy on my gung ho attitude right now. Rargh.

[Kayla86]

I'm not upset by any means of the word don't think that... <3

I'm a scientist myself and its important to learn where information comes from since its a newer field of study.

[Bardoux]

Dr Seal does seem like a nice guy, but he is also unfortunately one of those who flat out refuses to consider progesterone, and does also subscribe AA's just not spiro. I believe the NHS prefers the GnRH injection which puts the gonads to sleep as he put it.

I'm sorry Kayla i haven't found the link for the paper.

Jenny don't feel the need to apologise, i totally agree with where your coming from.

[Bardoux]

It's also worth mentioning that the question was put to him whether an AA was always necessary, to which he replied that in 99% of cases an AA would be needed, and only in some cases if a patient was over 50 that they could possibly get away without prescribing one.

[Jennygirl]

I'm not upset by any means of the word don't think that... <3

I'm a scientist myself and its important to learn where information comes from since its a newer field of study.

Ok wheeew. After I posted that last one, I realized you might take it as me directing something at you.. when really I was just venting about the currently accepted endocrinological methodology for transgender care. I guess I get off easy this time! Thank you for reading my comments objectively, and especially for the <3.

Dr Seal does seem like a nice guy, but he is also unfortunately one of those who flat out refuses to consider progesterone, and does also subscribe AA's just not spiro. I believe the NHS prefers the GnRH injection which puts the gonads to sleep as he put it.

I'm sorry Kayla i haven't found the link for the paper.

Jenny don't feel the need to apologise, i totally agree with where your coming from.

I still think he's taking a step in the right direction which is to get endocrinologists questioning something (anything really). It will hopefully lead to further questioning and more research (the root of all scientific process).

And thank you for the reassurance on my standpoint not being too harsh. I know it's a touchy subject with some, and it was risky for me to elevate it- especially considering how many people may only have one choice for an endocrinologist depending on location. The last thing I want to do is start triggering people.

[Jenna Marie]

Hmm, that's interesting. I admit I've often wondered where this theory that trans women's breasts never fully develop came from, and wondered if it was a myth.

(I'm Tanner Stage V except that I'm not sure they're at the "final adult size," as clearly some fat is still being deposited there. [it can stop anytime - 42DDD is big enough!] But I also never used spiro or any other AA at all; I've been fortunate enough to get by with a very, very low dose of E all along, and obviously there's no risk of a future need for AAs now that I'm post-op.)

[Ashey]

Aaah, this is kinda scary lol. I wants mah boobies! I guess maybe I'll take Spiro until I talk to my endo again in 3 months, and definitely use that time to monitor my progress. I'm already a bit skeptical about whether I need it or not. I was actually more insistent about it than my endo was. :/

[AlexisB]

Just saying im being treated by the nhs and they have me on Gnrh injections for aa too lol

[Ashey]

Just saying im being treated by the nhs and they have me on Gnrh injections for aa too lol

Sounds interesting. I'm assuming it's working well for you? How often do you do it, and what's the cost? I'd rather an injection every few months than popping a couple spiro's every day. :/ As long as it works of course...

[Keroppi]

Actually the research he was referring to were published (as lead author) by him.

Seal, L. J.; Franklin, S.; Richards, C.; Shishkareva, A.; Sinclaire, C.; Barrett, J. (9 October 2012). "Predictive Markers for Mammoplasty and a Comparison of Side Effect Profiles in Transwomen Taking Various Hormonal Regimens". Journal of Clinical Endocrinology & Metabolism 97 (12): 4422–4428. doi:10.1210/jc.2012-2030.

It's behind a paid wall I don't have access to though.

The research itself may be relatively new, but it's long been the case that UK endo prefer GnRH, whereas spiro have been preferred or at least prescribed in the US/Canada. Even if we accept the conclusion, do remember that while two and half times more sounds like a lot, we are talking about "4.8 vs. 1.8%". Still a relatively small proportion of the population. Though that may be down to external factors such as money rather than breast size / shape.

[Keroppi]

Sounds interesting. I'm assuming it's working well for you? How often do you do it, and what's the cost? I'd rather an injection every few months than popping a couple spiro's every day. :/ As long as it works of course...

The standard one, at least in my experience seems to be goserelin (i.e. Zoladex). 4 or 12 weeks option. If you ever think spiro is expensive....

[Ashey]

The standard one, at least in my experience seems to be goserelin (i.e. Zoladex). 4 or 12 weeks option. If you ever think spiro is expensive....

Found the price... Wheelp spiro it is.

[Mariah]

I was able to read the article and figure I would point a few things that were interesting

1. 16 people who took Spiro wanted BA, compared to 6 people who didn't
2. Spiro is not common in the NIH and self medicating people were included. No differentiation of who took what for how long other than self medicating people were more likely to request BA.
3. Average breast size is consistent with adult women, but 60% of trans-women still want BA
4. Minimum breast size used in the study was a tanner IV.
5. CEE had a higher likelihood of causing a clot
6. People on AA were more likely to be depressed (Could this could also play into a role of self perception and BA?)

[Kayla86]

For what its worth, my HRT physician I am seeing is in charge of the LGBT sector of her hospital group. (Only been on meds for 3 weeks so far)

She's had many patients in my state and knows what she's doing so I'm going to follow her advice and go from there.

Much less scary with the 4.8% marker being noted!

[Violet Bloom]

  While this is a bit worrying to hear given that I'm on a Spiro regimen, I'm going to trust the experience of my doctor and her clinic for now.  I'd rather be safe and healthy than sorry.  She told me that most patients generally achieve an A to B cup development, and while some would consider that small I would personally be over the moon if I got there and wouldn't want to be any bigger.  I'm more concerned about them looking weird than getting big.  I would never consider a BA.