Stunted growth after switching Anti-Androgen?

[teeg]

When I first started HRT, my Endocrinologist started me on Estradiol, and of Finasteride. I started seeing significant progress. Then I switched to Estradiol, and Spiro. It seemed to stop all of my progress and keep me at the point I was at where I switched. I've since lowered my estrogen , yet still no changes in progression. I made the change from Finasteride to Spiro a handful of months after first starting, so my progress couldn't have been completed coincidentally when I switched. Might Estradiol and Finasteride work better for my body than Estradiol and Spiro? I've heard they work in different ways... Does anyone know the differences in how they effect the body? I started a few months after I turned 21, I'm 23 now - unsure if age is a factor or not to such an abrupt halt in progress when it coincided right when I switched my anti-androgen...





Edited for Dosages

[V M]

Hi Teeg 

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V M

[KayXo]

Spiro has mild anti-estrogenic and yes, even mild androgenic effect but its anti-androgenic effect should overcome all that. I wouldn't know how to explain this sudden stop.

Finasteride is less potent (strong) than Spiro in terms of anti-androgenic effect. So, again, I'm stumped. Perhaps the increased estradiol has made you more anxious and this increased anxiety has negatively affected your growth? I don't know. Just exploring possibilities. Perhaps some further discussion with your doctor would elucidate the mystery.

[MaryXYX]

The hospital endo here says that Spironolactone stunts breasts development so he doesn't prescribe it.  He prescribes Finasteride to combat hair loss - not as an anti-androgen.  We do need to do our own research so we can go back to the doctors with reliable information.

[KayXo]

I've never heard of Spiro being detrimental to breast growth...and many women do very well on it. Men who take it often develop gynecomastia.

How would it stunt breast growth? By what mechanism? Despite its mild anti-estrogenic effects, and apparent androgenic effects (in rats), I'd think that its antiandrogenic effects and increased conversion to estrogens from androgens would overcome this or not? I would be very curious as to hear why your doctor thinks so.

[MaryXYX]

He says it's his own observation that women who have been on Spironolactone are more likely to end up with breast implants than the ones who were on Decapeptyl.  I got the idea that he intends to publish something and isn't saying too much before he's ready.

[KayXo]

Interesting...

[930310]

I don't believe in what your endo says. In the studies I've seen there has always been a tendency for gynecomastia/breast growth when you take spiro. And since spironolactone is a stronger anti-androgen than anti-estrogen this will lead to a higher amount of estrogen than testosterone in you, which will stimulate the feminization of your body. Does he have any other evidence than his empirical observations? How many transgender patients has he treated? Because if the number is low this would indicate that it's a standard deviation from the average.

[KayXo]

Yes, it would be interesting to find out how many he treated, his sample size...how much Spiro he gave, etc? I think it's probably a matter of equivalence...that a certain dose of Spiro will be as effective as analogues but perhaps that dose results in too many side-effects so cannot be increased so much.

[Jennygirl]

Fwiw my endo is religiously against Spiro unless the person has extremely sensitive t receptors or abnormally high t levels. And even then he prescribes a super low dose of the stuff.

My own take: spiro wasn't necessary for me. I've had excellent feminization from pellets (e+p) alone. I'd say if you want to get off spiro go for it, and maybe a bioidebtical progestin would be a better replacement.

There was also that recent study about spiro and breast augmentation. People who did not take spiro were less likely to have BA than those who didn't. Add me to that statistic

[KayXo]

I think just taking bio-identical E (+ P, if necessary) is always best. Can you cite link to study? I'd be interested in reading about it. Thanks.

[930310]

I would be interested in reading this study too.

[MaryXYX]

I don't believe in what your endo says. In the studies I've seen there has always been a tendency for gynecomastia/breast growth when you take spiro. And since spironolactone is a stronger anti-androgen than anti-estrogen this will lead to a higher amount of estrogen than testosterone in you, which will stimulate the feminization of your body. Does he have any other evidence than his empirical observations? How many transgender patients has he treated? Because if the number is low this would indicate that it's a standard deviation from the average.

I don't know what evidence he has, but he is the endocrinologist at Charing Cross, which is the only hospital in the UK that does GRS.  Other endos can prescribe but anyone who goes the normal route goes through Charing Cross.

[teeg]

The hospital endo here says that Spironolactone stunts breasts development so he doesn't prescribe it.  He prescribes Finasteride to combat hair loss - not as an anti-androgen.  We do need to do our own research so we can go back to the doctors with reliable information.

My original Endocrinologist prescribed me Finasteride as a mild anti-androgen to, "clean up what Estrogen didn't block naturally". I may be mistaken, but I remember hearing from somewhere that Finasteride (and Dutasteride) directly blocks DHT, and produces an enzyme that converts T to E, or stops the conversion of E to T? I thought this might mean the body would then have, "its own" estrogen that perhaps it might like better. Unfortunately I never had hormone levels checked during this time, but perhaps when I was only on E and Fin my body was exposed to more of my own E, where on Spiro and Cypro they remove the T that converts to my body's E? Also, when I was on E, Finasteride, and Spiro, my E levels were significantly higher than with the same dose of E and Spiro with no Finasteride. Perhaps this is due to that conversion making more E?

[KayXo]

Finasteride inhibits Type 2 5 alpha-reductase (while Dutasteride also inhibits Type 1, there are only two types) which converts T to DHT (dihydrotestosterone), about 5x more potent than T and responsible for scalp hair loss and body hair growth (and prostate enlargement and probably many other things as well). If less T converts to DHT, then more T is available and some of that may be converted to E, thereby slightly increasing E levels. E does not convert back to T, it's only one way, always T to E. Finasteride and dutasteride do NOT block T or DHT.

Spiro and Cypro reduce androgen levels (and your own E since A converts to E) and block androgens (T, DHT and other weaker androgens) from binding to receptors. Cypro blocks androgen more strongly. Spiro also increases breakdown of androgens, and conversion of androgen to estrogen. Both Spiro and Cypro, being progestins, are also mildly anti-estrogenic and in rats/mices, somewhat androgenic (I don't know if it's the same for us).

E also reduces androgen and also apparently...

http://en.wikipedia.org/wiki/Polyestradiol_phosphate
"blocks testosterone uptake into prostate cells, where it would be metabolized to DHT by the enzyme 5α-reductase. Estradiol also inhibits 5α-reductase directly, blocks binding of DHT to androgen receptors, and exhibits cytotoxicity on prostate cancer cells.[4][7]"

So there you go.

[teeg]

Finasteride inhibits Type 2 5 alpha-reductase (while Dutasteride also inhibits Type 1, there are only two types) which converts T to DHT (dihydrotestosterone), about 5x more potent than T and responsible for scalp hair loss and body hair growth (and prostate enlargement and probably many other things as well). If less T converts to DHT, then more T is available and some of that may be converted to E, thereby slightly increasing E levels. E does not convert back to T, it's only one way, always T to E. Finasteride and dutasteride do NOT block T or DHT.

Spiro and Cypro reduce androgen levels (and your own E since A converts to E) and block androgens (T, DHT and other weaker androgens) from binding to receptors. Cypro blocks androgen more strongly. Spiro also increases breakdown of androgens, and conversion of androgen to estrogen. Both Spiro and Cypro, being progestins, are also mildly anti-estrogenic and in rats/mices, somewhat androgenic (I don't know if it's the same for us).

E also reduces androgen and also apparently...

http://en.wikipedia.org/wiki/Polyestradiol_phosphate
"blocks testosterone uptake into prostate cells, where it would be metabolized to DHT by the enzyme 5α-reductase. Estradiol also inhibits 5α-reductase directly, blocks binding of DHT to androgen receptors, and exhibits cytotoxicity on prostate cancer cells.[4][7]"

So there you go.

Thanks for the info!

Do people take actually Polyestradiol phosphate for HRT, and/or might it be possible? Or was that just in terms of comparing its effects to other meds?

[KayXo]

It's used in Scandinavian countries mostly, I think, in transsexual women and also for prostate cancer patients. The brand name is Estradurin. It works similarly, I think, to Depo-Estradiol (estradiol cypionate) where not only estradiol acts on receptors but where polyestradiol phosphate also acts on receptors. The most common form used is Estradiol Valerate injections (Delestrogen, Progynon-Depot).

The explanation provided was for estrogen, in general, not specific to only Estradurin which is an estrogen.

[teeg]

It's used in Scandinavian countries mostly, I think, in transsexual women and also for prostate cancer patients. The brand name is Estradurin. It works similarly, I think, to Depo-Estradiol (estradiol cypionate) where not only estradiol acts on receptors but where polyestradiol phosphate also acts on receptors. The most common form used is Estradiol Valerate injections (Delestrogen, Progynon-Depot).

The explanation provided was for estrogen, in general, not specific to only Estradurin which is an estrogen.

Might you know if there's a difference, good or bad, between those two types of estrogens and say estradiol in tablet form?

How do you mean about polyestradiol phosphate also acting on the receptors?

[KayXo]

I tend to prefer bio-identical estrogen over any other estrogen that is not since it tends to have less effect on clotting, liver.

Many doctors wrongly assume that estradiol cypionate or polyestradiol phosphate only become active when they are broken down into estradiol which then acts on the body. What I was saying was that not only does the broken down estradiol act on the body but also, the unbroken molecule of estradiol cypionate or polyestradiol phosphate. Like Ethinyl Estradiol. It affects directly the body and then when it is later converted to estradiol, estradiol also affects the body. So, almost like you get a double whammy. But, where I am a little concerned is that these unnatural estrogens tend to have a stronger than normal effect on the body and estrogen receptors so increase health risks. But, it appears that polyestradiol phosphate (Estradurin) is quite safe in high doses in prostate cancer patients...so I'm not sure about this estrogen in particular.

[kira21 ♡♡♡]

spiro can cause breast bud fusing and limit breast growth too.