Author Topic: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!  (Read 2140 times)

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Offline LexiDreamer

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Since I've had to explain this to many transwomen on this site, I thought I'd just post this in it's own thread.

I keep pretty detailed notes:

1/11/16 Total Testosterone = 1310 ng/dL (yes, that's Thirteen Hundred - normal male range is 250-1100!)
7/8/16 Started taking normal HRT full dose of Spiro... and regular full dose oral estradiol
8/9/16 Total Testosterone = 38 ng/dL
9/12/17 Total Testosterone = 916 ng/dL (T spike)
9/21/16 Doctor upped my dose to 1.5 x normal dose (maximum recommended dose for HRT since it spiked so high)
12/19/16 Total Testosterone = 37 ng/dL (reduced spiro, back to regular full dose)
6/12/17 Cut my Spiro dose in half
8/31/17 Total Testosterone = 18 ng/dL
9/22/17 Cut my Spiro does in half again (1 quarter of the initial full dose at starting full dose pharma HRT)
10/18/17 First Estradiol Valerate injection (stopping oral Estradiol completely)

11/27/17 Total Testosterone = 14 ng/dL (Estradiol = 212 pg/mL and Estrone = 171 pg/mL)

No more Spironolactone for me!
My estradiol level is high enough and steady enough to keep my T production to a minimum.
My testicles are literally about a 3rd the size they used to be.

No orchiectomy necessary....

*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline Devlyn

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #1 on: December 07, 2017, 03:10:01 pm »
Glad you found your answer. In my case, testosterone went up after starting standard HRT (spiro & estradiol)  and an orchiectomy was necessary.

Hugs, Devlyn

Offline LexiDreamer

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #2 on: December 07, 2017, 03:10:25 pm »
A few more details as some people tend to ask...

Am I still functional?.... Yes! (with the right stimulation)
Cannot maintain an erection for a long time like I used to.. but still functional
With sildenafil I can maintain a very rigid erection for an extended period of time.

Can I ejaculate? Yes! (but it's small in volume and clear in color)

Not trying to be graphic here, but some transwomen want to maintain a certain sexual function with their significant others and I think this is important information.

Of course everyone's mileage will vary (as they say)... but don't believe all the hype!
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline LexiDreamer

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #3 on: December 07, 2017, 03:17:28 pm »
Glad you found your answer. In my case, testosterone went up after starting standard HRT (spiro & estradiol)  and an orchiectomy was necessary.

Hugs, Devlyn

My T spiked for a little while as well (916), a couple of months into the HRT.
My primary upped my Spiro dosage to the max recommended dosage until I tested at the 37 ng/dL a couple of months later. The side effects were pretty strong but I guzzled lots of water and ate lots of salty food.

I added that info to the post. Thanks for mentioning that!
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline Charlie Nicki

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #4 on: December 07, 2017, 04:14:34 pm »
Interesting! Thanks for the info.

Online Laurie

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #5 on: December 07, 2017, 04:24:57 pm »
   I am curious what your doctors have to say in regards to stopping your AA medications? Is this something they recommended for you or did you come to this conclusion yourself? If this is your own doing, may I ask what your medical credentials are that qualifies you to give medical advice?

Maddie86

Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #6 on: December 07, 2017, 04:57:08 pm »
I'm only about 5 months into HRT, so it's early, but I see my doctor in a week and I'll ask him about stopping spiro eventually. I don't like it, and I don't wanna worry about too much potassium anymore! I love potatoes and peanut butter!

Offline fairview

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #7 on: December 07, 2017, 05:26:48 pm »
You are correct however E2 levels generally needs to be maintained between 200-300pg/ml consistently to suppress testosterone production.   Testosterone is converted to estrogen by way of the aromatase cycle.   High levels of E2 indicate there are high levels of testosterone present.   Between 200-300pg/ml of E2 testosterone production will decrease and eventually cease.  Only the adrenal glands will be producing it.   

The challenge in obtaining that level is that IM delivery on a 4 day injection schedule is the only cost effective way to maintain consistent levels above 200 and keep estrone in balance with the E2.

By way of oral delivery the first pass liver converts most of the pill to estrone at about a 2-1 or better ratio.   Patches and creams work but the amount necessary is very costly.   Sublingal will deliver the proper ratio however instead of a consistent level being maintained the estrogen is delivered in pulses.   

It's not magic.  Just science. .   

kelly_aus

Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #8 on: December 07, 2017, 08:23:42 pm »
   I am curious what your doctors have to say in regards to stopping your AA medications? Is this something they recommended for you or did you come to this conclusion yourself? If this is your own doing, may I ask what your medical credentials are that qualifies you to give medical advice?

I'm not the OP, but my doctors are completely on board with an estrogen-only regimen. It was my suggestion originally, but the research is out there to show it works and the doctor agreed that it was worth a try. Nine months on and it's all been fine. There's a growing number of doctors who are moving away from long term AA usage, partly due to the lack of research in to their long term use and the fact that prescribing unneeded meds is never a good thing. And even short term, neither spiro or cypro is terribly friendly.

I'm sorry you feel that a medical qualification is required to question your doctors, I feel that as a patient, it's in my best interests to be as educated as I can on the topic, so that I can contribute to my care in a useful, cooperative manner.

Offline Drexy/Drex

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #9 on: December 07, 2017, 10:41:45 pm »
My doctor wanted me to take spiro , but i knew because of all my years on male Hrt that my t would be shut down ,so i waited for bloods and sure enough 6weeks later my t was like 0.05 just under a healthy womans level with no free testosterone e was under the female range so e was bumped up and dr wanted me again to take spiro....to stop hair growth😧
But im waiting again for bloods because if i am lucky the e will continue to be suppress t production
Hmmm i hope i dont have to get cut ....well at least until i look like a woman😳

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #10 on: December 07, 2017, 11:05:09 pm »
I'm going through this as well.  My first labs after taking Spiro was 5.  So my doctor asked me to cut Spiro 25% which I did, and my next labs still showed 5.  So my doctor asked me to cut it again 25% from the initial. Her goal into get down to zero Spiro, which is fine by me if I don't need it.  I've been non functional since starting Spiro which I like.  I hope it stays that way.

Bari Jo
you know how far the universe extends outward? i think i go inside just as deep.

11/6/17 - came out to sister, best day of my life
9/5/17 - formal diagnosis and stopping DIY in favor if prescribed HRT
6/18/17 - decided to stop fighting the trans beast, back on DIY.
Too many ups and downs, DIY, purges of self inbetween dates.
Age 10 - suppression and denial began
Age 8 - knew I was different

kelly_aus

Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #11 on: December 08, 2017, 12:07:06 am »
You are correct however E2 levels generally needs to be maintained between 200-300pg/ml consistently to suppress testosterone production.   Testosterone is converted to estrogen by way of the aromatase cycle.   High levels of E2 indicate there are high levels of testosterone present.   Between 200-300pg/ml of E2 testosterone production will decrease and eventually cease.  Only the adrenal glands will be producing it.

Can we not call the level "high" or at least state by which standard you feel it is "high" - my medical team (and others) would disagree with you..   

Quote
The challenge in obtaining that level is that IM delivery on a 4 day injection schedule is the only cost effective way to maintain consistent levels above 200 and keep estrone in balance with the E2.

The required level can be achieved quite easily with sublingual administration.. Suppositories are also a compoundable option.

Quote
By way of oral delivery the first pass liver converts most of the pill to estrone at about a 2-1 or better ratio.   Patches and creams work but the amount necessary is very costly.   Sublingal will deliver the proper ratio however instead of a consistent level being maintained the estrogen is delivered in pulses.   

It's not magic.  Just science. .

The variance in levels isn't really an issue with the sublingual delivery - it was suggested to me as an alternative due to issues with a dependable, reliable supply of injectables here in Australia.

Online Cindy

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #12 on: December 09, 2017, 01:17:25 am »

After review I wish to caution people to make sure that the advice and personal opinion that they give is clearly that, personal opinion.

Endocrinology is a complex science and the feedback loops involved are not as straight forward as assumed by some.

I am not advocating for or against AA nor do I have any bias for or against, at a personal level they are an irrelevance and at a professional level I am not qualified to comment.

However breaking of TOS 2 is another matter. Anyone breaking TOS 2 can expect serious repercussions.

Offline natalie.ashlyne

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #13 on: December 09, 2017, 04:19:45 am »
For me after 7 months on Hrt my endocrinologist wanted to take me off of spiro as he said my levels where unmeasurable I had to ask to keep the and he put me on the lowest dose to keep me happy.

Offline laurenb

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #14 on: December 10, 2017, 07:28:28 am »
This is an important thread to me which I hope keeps on going. Coming up on 1 year of HRT, I'm in the same functional way down there as you might imagine. I'd really love to get rid of the Spiro and just keep the Estradiol (4-eva). But I'm worried "it" will return.

So does anyone know of any related studies or scientifically based research that backs the assertion that after a period of AA, ones biological ability to produce Testosterone in the gonads has been deprecated (don't you love that word "deprecated"? - I got it from some software engineer talk - sounds really technical when it really means "it don't get used no more"). But seriously, anything out there? Like the long term efficacy of chemically castrated offenders, maybe? (eew, that sounds awful).
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Offline josie76

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #15 on: December 10, 2017, 08:41:28 am »
My endocrinologist told me from the first appointment that estrogen only would eventually bring testosterone levels down. He however does normally prescribe Spironolactone as it is a quick way to remove the symptoms of testosterone in the body.

His goal is to get T within female range. When he used synthetic estrogen many years ago this was possible with normal oral dosing.

These days he only prescribes Estrace (estradiol micronized tablet). He is also overly cautious about total daily dosages based on age of the patient. This is a bit of a disappointment as E2 blood levels do not remain high at mid day or mid night times between dosages. I have been lowering my spiro slowly now as spiro does indirectly lower T production along with all of its not so good side effects.

Something to consider is the addition of bioidenticle progesterone also lowers GnRH and thereby testosterone production. Progesterone also provides the building block of multiple metabolites the body uses. Effects include lowering blood pressure, decreasing thrombosis risk, providing neurotransmitter steroids that other meds can decrease the levels of. My endo prescribed my micronized P by just asking him to.
04/26/2018 bi-lateral orchiectomy

A lifetime of depression and repressed emotions is nothing more than existence. I for one want to live now not just exist!




Offline KayXo

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #16 on: December 10, 2017, 09:55:04 am »
Oral micronized progesterone is unlikely to have a significant effect on T production as the doses prescribed are usually too low. Studies have shown in men with advanced prostate cancer that estrogen ALONE in the form of patches or injections can suppress T to castrate levels so if it can be done relatively safely in them, older and stricken with cancer, it can surely be done in us, no? This is something you can bring up with your doctor and let them decide.
I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005

Online Cindy

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #17 on: December 10, 2017, 02:52:34 pm »
Oral micronized progesterone is unlikely to have a significant effect on T production as the doses prescribed are usually too low. Studies have shown in men with advanced prostate cancer that estrogen ALONE in the form of patches or injections can suppress T to castrate levels so if it can be done relatively safely in them, older and stricken with cancer,it can surely be done in us, no? This is something you can bring up with your doctor and let them decide.

I should note that oestrogen therapy for prostatic cancer has not been used for many years due to the side effects.

This is of relevance as we have had cases of men refusing treatment or refusing to seek treatment as they have read on the internet that they will be given hormonal treatment that will feminize them. This is of course not true and men with or suspecting that they need treatment for prostatic disease should not fear medical treatment.

Offline josie76

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #18 on: December 10, 2017, 06:08:21 pm »
Oral micronized progesterone is unlikely to have a significant effect on T production as the doses prescribed are usually too low. Studies have shown in men with advanced prostate cancer that estrogen ALONE in the form of patches or injections can suppress T to castrate levels so if it can be done relatively safely in them, older and stricken with cancer, it can surely be done in us, no? This is something you can bring up with your doctor and let them decide.

Which is why I said the addition of bioidenticle progesterone to estrogen therapy.
BTW I found a few studies that showed oral administration resulted is sufficient blood levels. One study specifically used a mid dose (I assume even study quotes of dosages are not allowed) of micronized progesterone administered orally could boost post menapausal women's levels to that of mid-luteal phase. This would indicate more substance to oral administration than some others would suggest. These studies show oral administration blood levels can reach their target levels at past 12 hours from administration.
Personally I am waiting to see what my levels are when I get another blood test. Then once I know my levels based on my current oral dose of P I will discuss with my endo on what I wish to do dosage wise.
04/26/2018 bi-lateral orchiectomy

A lifetime of depression and repressed emotions is nothing more than existence. I for one want to live now not just exist!




Offline KayXo

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Re: Orchiectomy is NOT needed to discontinue taking anti-androgens!!!
« Reply #19 on: December 11, 2017, 09:29:10 am »
I should note that oestrogen therapy for prostatic cancer has not been used for many years due to the side effects

Med Sci Monit. 2012 Apr;18(4):CR260-4. (5 years ago)

“Patients with prostate cancer progressing after androgen ablation therapy and chemotherapy were treated with transdermal estradiol patches (...) applied weekly and assessed for tolerability and biochemical activity.”

“Twenty-two patients were treated on study with all patients evaluable for safety”

“Therapy was well tolerated and no thrombotic events were observed.”

“The median age was 72 years (range 57–85).”

“Treatment with transdermal estradiol was well tolerated with no grade 4 toxicities and no evidence of thrombotic events (Table 3).”

“In the 20 patients treated beyond cycle 1, no one was removed from the study due to toxicity with the most common reason for discontinuing therapy was disease progression. The only grade 3 toxicities were transient increase in AST and increased alkaline phosphatase, likely due to bone progression.”

“Similar to the experience by Beer et al., our study supports the safety of transdermal estradiol for future studies. Both in the Beer study and our study, therapy was well tolerated without any thrombotic events. In fact, prior studies have supported that estrogen administrated via intramuscular or a transdermal route, as opposed to orally, is less thrombogenic by avoiding exposure of the liver to high estrogen concentrations from the hepatic circulation, which results in increased synthesis of thrombophilic coagulation factors [22–25].”

Lancet Oncol. 2013 Apr;14(4):306-16. (4 years ago)

“Initially, patients in the oestrogen-patch group received (...) patches (...) to be self-administered and changed twice weekly for 4 weeks. The number of patches was reduced (...) if castrate testosterone concentrations in serum of 1·7 nmol/L or lower were achieved (regimen one).”

“Median age was 74 years”

"The rate of cardiovascular events was 2·9% higher in the oestrogen-patch group than in the LHRHa group (95% CI −4·2 to 10·1). The wide 95% CI suggests no significant difference between groups

Of the 18 events among men assigned oestrogen patches, nine (50%) occurred more than 30 days (and in four cases more than 12 months) after oestrogen was stopped and LHRHa was started.

"several events attributed to the oestrogen-patches group occurred in men who had received oestrogen therapy for only a short period, or who had stopped treatment for a long time before the event occurred, or both. The analysis according to treatment at the time of the event provides a more standard assessment of toxic effects."

"No grade 4 or 5 adverse events had been reported by 6 months"

"Parenteral oestrogen could be a potential alternative to LHRHa in management of prostate cancer if efficacy is confirmed. On the basis of our findings, enrolment in the PATCH trial has been extended, with a primary outcome of progression-free survival."

49-92 yrs old

BJU Int. 2017 May;119(5):667-675.

"To compare quality-of-life (QoL) outcomes at 6 months between men with advanced prostate cancer receiving either transdermal oestradiol (tE2) or luteinising hormone-releasing hormone agonists (LHRHa) for androgen-deprivation therapy (ADT)."

"In all, 727 men were enrolled between August 2007 and October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months."

"At 6 months, patients on tE2 reported higher global QoL than those on LHRHa (mean difference +4.2, 95% confidence interval 1.2-7.1; P = 0.006), less fatigue, and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynaecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to the tE2 arm."

"Patients receiving tE2 for ADT had better 6-month self-reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynaecomastia. The ongoing trial will evaluate clinical efficacy and longer term QoL."

BTW I found a few studies that showed oral administration resulted is sufficient blood levels. One study specifically used a mid dose (I assume even study quotes of dosages are not allowed) of micronized progesterone administered orally could boost post menapausal women's levels to that of mid-luteal phase. This would indicate more substance to oral administration than some others would suggest. These studies show oral administration blood levels can reach their target levels at past 12 hours from administration.
Personally I am waiting to see what my levels are when I get another blood test. Then once I know my levels based on my current oral dose of P I will discuss with my endo on what I wish to do dosage wise.

The problem with oral micronized progesterone (I urge you to consult more studies and check pharmacokinetics, hour by hour) is that levels peak and dip quite quickly so that within 3-4 hours after the peak, levels have already dropped significantly and this can lead to mood swings. Taken rectally and vaginally, levels are more constant and drop much later. With IM, it needs to be injected daily as by 24 hours, levels have SIGNIFICANTLY dropped.
I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005

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