Estrogen but No Anti-Androgen

[likealolita]

Hi, all, I have a question regarding my HRT therapy.  I'm currently taking a low dosage of Estrodial each day and was recently prescribed an anti-androgen (Spironolactone).  However, I'm having second thoughts with regards to the anti-androgen.  The Estrogen is working well so far (my skin feels a little softer and my breasts and nipples are starting to develop, slowly, but surely), but I don't think I want to lose the use of my penis as I quite enjoy the erections I receive when I think about a beautiful woman (my sexual preference).  I don't consider myself 100% a woman trapped in a man's body, which is why I'm having reservations.

Basically, is it okay to be solely on Estrogen and no AA?  With regards to my overall appearance, I epilate my arms, legs, and chest/stomach area, and will be going for a FFS consultation with Dr. Spiegel out in Boston, so that isn't a problem.  But do I absolutely NEED an AA for feminizing my appearance or can I do with merely an Estrogen prescription?

[Princess of Hearts]

Some people don't care for spiro'.   I take a small daily amount of oestrogen but no AA and I have noticed some feminising effects so oestrogen on its own works in my case.

[Shantel]

But do I absolutely NEED an AA for feminizing my appearance or can I do with merely an Estrogen prescription?

Yes estrogen will work on it's own over an extender period of time, however AA's block testosterone and also is effective in reducing excessive testosterone from converting to dihydrotestosterone (DHT) which causes male pattern balding. Estrogen by itself will in part be converted by the male body into testosterone. This is probably more information than you bargained for but it's an interesting article that unravels some of the mystery of how and why hormones work.

Excerpts taken from The Journal of Clinical Endocrinology and Metabolism
                       By Luigi Gennari, Ranuccio Nuti, and John P. Bilezikian

     It is known that sex steroid hormones play an important role in the maintenance of bone mass in males as well as females. Even though androgens are the major sex steroids in men, their primacy in regulating male skeletal remodeling has been increasingly questioned as direct and indirect evidence emerges suggesting that estrogens also play a major role in male skeletal health. Recent data suggests that a threshold of bioavailable estradiol is needed to prevent bone loss, and that with aging an increasing percentage of elderly men fall below this level. The testes account for, at most 15% of circulating estrogens in the male; the remaining 85% comes from peripheral aromatization of androgen precursors in different tissues.
     Aromatase is an enzyme that is responsible for a key step in the biosynthesis of estrogens. Aromatase converts testosterone to estradiol and is a member of the cytochrome P450 superfamily whose function is to aromatize androgens thus producing estrogens. It is an important factor in the development of female characteristics. Human models of aromatase deficiency demonstrate the critical importance of the conversion of circulating androgens into estrogen in regulating skeletal homeostasis. Evidence comes from recent interventional studies in adult men using aromatase inhibition, which confirmed that estrogens are critically important to the male skeleton by helping to control rates of bone remodeling. Intriguingly, common polymorphisms in the human aromatase (CYP19) gene have been associated with differences in aromatase activity, bone turnover, and rates of bone loss in elderly men, suggesting that variations of aromatase efficiency may also be relevant for skeletal homeostasis. The enzyme called aromatase works naturally to convert some testosterone into estrogen as it is being produced or introduced into the body. Aromatase is most concentrated in the skin, especially over adipose tissue and in the scrotum. Fat cells contribute a great amount of aromatase, many nutrient deficiencies can also produce higher levels. Testosterone and estrogen levels are often adversely affected by household chemicals and environmental toxins from pesticides, plastics, synthetic foods, and drugs.

[Tyler]

Alright I have been on spiro for almost five months I think. No estrogen yet just spiro. I've had a few feminizing effects, however you don't lose the ability to get an erection. I can still get just as horny as I did before, however they aren't random, I have to want one to get one not just random throughout the day. If you want only estrogen though, so be it that's how is used to be.

[Alainaluvsu]

Estradiol in high enough amounts within the human body will halt testosterone production. Therefore, it's not necessarily anti androgens you need to be worried about if you do not want to lose erections. However, many MTF transsexuals need anti androgens in order to keep the overwhelming amounts of testosterone in their body from occupying the receptors that it binds to (and in turn, halt or minimize feminization).

My personal experience? My erections are not spontaneous and are no longer very firm. However my estradiol levels are over 3x the levels where my doctor wants them at.

[Joelene9]

  In a lot of cases the Spiro is needed due to the estrogen is not enough.  I had a very high T level before.  The herbals I did may have lowered it a little, but all that did was made matters worse.  When I went on HRT, the Spiro was the recommended start because of my high T level and the high PSA numbers.  This depends on the person taking the HRT regimen.  A few here on Susan's had a hard time getting their T levels down.  Most of those got the T down when the delivery system was changed such as from pills to injectables. 
  Nonetheless, The HRT regimen you are taking is to give you a more feminine body and there is not much to be done about keeping the erections.  This was one of the things we all here must consider when we are in transition.  I did enjoy those erections while a woman is in sight, but I had too much involuntary ones from no kind of stimulus at all. 
  Joelene

[Princess of Hearts]

This might not be to reliable because I have never had much of a sex drive, but I have noticed on oestrogen alone than that the number of incidents of you no what has dropped to once or twice a week.  The resulting emission of the fore-mentioned act is noticeably thinner and less in amount.

I think that it is important to remember that everyone is different and that one-size-fits all thinking is not all that helpful.

Jung wrote that you might take 1000 pebbles from a beach weigh them and find that the average weight was say 1.1grams.  However, Jung continues, there is a very good chance that not a single one of those pebbles weighs 1.1grams.

[Flo]

My two cents but may not matter because I agree everyone's body & mind are totally different so there is no set "norm".

I have been on Estrogel (topically applied) for 3 years now, and have found that my ability to achieve an erection or ejaculate has diminished greatly.  Interest in sex has also diminished.  My Endo is great though and we review effects etc. on a regular basis.  For me, starting HRT was a major step to achieving some inner peace, balance and acceptance...before I jumped off the cliff...

So, personally the changes in sexual desire etc. is fine as my desire was in helping my overall well being.

Since I am on meds for other conditions not related to HRT, spiro and some of the other AA's were not an option.  But you may be able to get to the level of saneness (kidding...kind of) without.

You can email me if you want to...as the "rules" don"t allow much detail with these things.

Flo.

[mikidiki]

I am also in the same boat as the OP. I don't wish to take anti-androgens as I don't want to diminish my sex drive. The estrogen has not effected my erections or sex drive in any way - in fact if anything it might have increased it. I am considering taking just the lowest dose of anti-androgens available but I'm not sure if it's really worth it as it really wouldn't do anything. Your thoughts?

[Jayr]

(I'll gladly delete my comment if guys weren't allowed to comment, just let me know.)

Here's my two cent...

You don't NEED it, but once your hair starts falling out you'll wish you had taken all the spiro in the world.
I know my girlfriend freaked out when she thought her hair was thinning.

And you don't lose erections, lolol I can get my girlfriend hard in less than a minute and she's been on HRT for over a year

[=celestica=]

*is the girlfriend*

[kelly_aus]

As has been mentioned, you'll wish you had dealt with the T when you go bald..

And what is it with this whole 'AA's make it impossible to get hard and destroy my libido' thing? I only seem to come across it here at Susans. I no longer get spontaneous erections, but when I want it to, it works just fine. And just for interests sake, the last result for my T level was 0.06 - or essentially none..

[Shantel]

As has been mentioned, you'll wish you had dealt with the T when you go bald..

Oh sister, don't I know!! :  (

And what is it with this whole 'AA's make it impossible to get hard and destroy my libido' thing? I only seem to come across it here at Susans. I no longer get spontaneous erections, but when I want it to, it works just fine. And just for interests sake, the last result for my T level was 0.06 - or essentially none..

What goes on between your ears has everything in the world to do with it.

[kelly_aus]

What goes on between your ears has everything in the world to do with it.

And that's the key.. I thought it had stopped working and then found myself in a situation where I really wanted it to..  It worked just fine..

[mikidiki]

As has been mentioned, you'll wish you had dealt with the T when you go bald..

And what is it with this whole 'AA's make it impossible to get hard and destroy my libido' thing? I only seem to come across it here at Susans. I no longer get spontaneous erections, but when I want it to, it works just fine. And just for interests sake, the last result for my T level was 0.06 - or essentially none..

Why would you go bald?

[Shantel]

Why would you go bald?

When you go on female HRT it becomes your primary source of gender specific hormone. Most MtF's transitioning take testosterone blockers to aid in the feminization process. Testosterone becomes undesirable being a secondary hormonal source and will convert to dihydrotestosterone which accelerates male pattern baldness.

[Elspeth]

Testosterone becomes undesirable being a secondary hormonal source and will convert to dihydrotestosterone which accelerates male pattern baldness.

Male pattern baldness (where hair is lost at the crown in a pattern typical for some but not all of those born with male characteristics) is a genetic trait... not everyone has it, and not everyone who has it sees its onset at the same time. Some hair recession on the forehead, though, is also driven by testosterone, so in general, it's better to stop it as early as you can. I have very little hair loss (and it seems to be rare in my family, at least on my dad's side, which is where I seem to recall the trait would be carried genetically, since my Y chromosome did not come from my mother).

This might be a factor in how I've managed to put off HRT for as long as I have, that and my relative lack of beard shadow. If either of those had been traits I'd been dealing with I think I probably would have forced the issue a very long time ago.

[Shantel]

Male pattern baldness (where hair is lost at the crown in a pattern typical for some but not all of those born with male characteristics) is a genetic trait... not everyone has it, and not everyone who has it sees its onset at the same time. Some hair recession on the forehead, though, is also driven by testosterone, so in general, it's better to stop it as early as you can. I have very little hair loss (and it seems to be rare in my family, at least on my dad's side, which is where I seem to recall the trait would be carried genetically, since my Y chromosome did not come from my mother).

This might be a factor in how I've managed to put off HRT for as long as I have, that and my relative lack of beard shadow. If either of those had been traits I'd been dealing with I think I probably would have forced the issue a very long time ago.

Trust me, unchecked dihydrotestosterone will take all the hair off of an MtF person's head in a matter of a few years regardless of their genetic propensity. That's why many use a finasteride based medication as a back-up to combat that situation.

[Elspeth]

Trust me, unchecked dihydrotestosterone will take all the hair off of an MtF person's head in a matter of a few years regardless of their genetic propensity. That's why many use a finasteride based medication as a back-up to combat that situation.

Thanks for pointing this out. I was aware of it being in common use, and it's been a part of why I've been overly cautious about starting HRT without being very sure of the competence of those I would seek to help and monitor the situation. Reading only goes so far, and so often those who are going through this (or have been through it) are understandably assuming much common knowledge. This is the clearest I've heard this expressed. Thank you.

[Shantel]

Thanks for pointing this out. I was aware of it being in common use, and it's been a part of why I've been overly cautious about starting HRT without being very sure of the competence of those I would seek to help and monitor the situation. Reading only goes so far, and so often those who are going through this (or have been through it) are understandably assuming much common knowledge. This is the clearest I've heard this expressed. Thank you.

I used a finasteride product normally prescribed for an enlarged prostate called Proscar with great success. The unfortunate side effect is that it can cause breast development in men. Oh isn't that just a bitch?  Now I'm purposefully using a tiny amount of topical testosterone just to be able to have some libido and damned if I haven't suffered some hair loss as a result Grrrrr! ;  (