Effects of spironolactone

[Elizabeth1]

Hi there, I am a newbie here who is awaiting contact from gender clinic in Edinburgh after my psychologist diagnosis. My gp who has been supportive prescribed me spironolactone last year without estrogen to help me. My mood improved, skin softened, and there ws minor breast growth.  Unfortunately I have osteo arthritis in my hip and I felt more  pain when taking tablets. I did some checking noting that taking spironolactone only can cause bone density to reduce. This is a problem. I decided to stop spironolactone until I can take it again with estrogen which I'm told improves bone density. Do I have other options for now? My gp only gave me spironolactone to help with body hair removal and by choosing  to stop voluntarily may have undermined my progress. Maybe I should just remain patient until I get my hormones? Any thoughts re anti androgen medication?

[KayXo]

When taking any anti-androgen, it is always advised to take enough estrogen as well to avoid not only losing bone mass, but to avoid things like mood disturbances (depression, anxiety), increased aging, low energy, cognitive deficits, hot flushes, insomnia, etc, etc. Your loss of androgen must absolutely be replaced with estrogen. Please advise doctor of this and make according adjustments, for your own well-being and health.

[Joelene9]

  I'm on estrogen only at this time.  I started with Spiro but had to drop it due to the diuertic effects of the drug flushing out my sodium and the B vitamins this past fall.  I am diagnosed with very painful peripheral neuropathy (PN) in my feet and the B vitamins, especially B₆ and B₁₂ are needed to slow the progression of this condition.  The location and cause(s) of my PN are not known after many tests.  The things I noticed getting off of Spiro is that my legs are thinning, the beard is thickening and my body hair is growing back with the grumpiness that comes with these conditions. This illustrates the need for the androgen inhibitor with the estrogen in a body with testes.  I am 61 and the dysphoria and depression that would occur with such conditions are replaced with pain and frustration. 

  Be lucky that you're young and can transition without this misery.  Also HRT in ciswomen is touted as a cause of PN, this effect to the male body is unknown at this time.  My PN predated my HRT usage my at least 30 years.  This is a slow progression of my particular condition. 

  Joelene

[Riley Skye]

I suggest taking estrogen asap as you need it for bone health actually, humans are meant to have sex hormones in their system and it isn't the healthiest thing to be off them for too long

[Hikari]

It is reasonably common to prescribe an antiandrogen for a few months before prescribing estrogen (though the opposite is also reasonably common, which really makes me wonder if doctors have a clue on HRT). Now I know each persons medical situation is different, but if a doctor prescribed it, without replacement estrogen I am assuming that the doctor thinks that it will only be a few months before you get estrogen.

If you are worried that your bone density loss is too great, and your doctor can't speed things along you could stop taking spiro and let the T return to do it's job, but if you are anything like me, that could be psychologically damaging if nothing else. If you explain that T is unacceptable to your mental health then in the interest of harm reduction it might be possible to convince a doctor to prescribe E sooner.

[Elizabeth1]

I intend to start estrogen ASAP. waiting for gender clinic to contact me regarding commencement of treatment. I'm sorely tempted to restart the spironolactone but I fear a reaction to my osteo arthritis. I also fear regression having not taken blockers for past 9 months. At nearly 50 this is depressing me greatly. Need to feel good about myself! Thank u for your concerns.

[KayXo]

  I'm on estrogen only at this time.The things I noticed getting off of Spiro is that my legs are thinning, the beard is thickening and my body hair is growing back with the grumpiness that comes with these conditions. This illustrates the need for the androgen inhibitor with the estrogen in a body with testes.  I am 61 and the dysphoria and depression that would occur with such conditions are replaced with pain and frustration.

You can do two things.
1) Ask your doctor to be prescribed the anti-androgen bicalutamide (Casodex), low doses are quite effective for us or if your insurance covers it because it is quite expensive, LhRh analogues like Lupron, Zoladex, Synarel, etc. About bicalutamide, it might not reduce sex drive or spontaneous erections but the estrogen you are taking should take care of that, if enough is taken. Bicalutamide can also be quite expensive but much less if low doses (effective for us) are taken.
2) Or ask for injectable estrogen (estradiol valerate intramuscular, Delestrogen or generic). It should, on its own, reduce testosterone quite effectively. Best to be taken weekly to avoid ups and downs.

Also HRT in ciswomen is touted as a cause of PN, this effect to the male body is unknown at this time.  My PN predated my HRT usage my at least 30 years.  This is a slow progression of my particular condition.

When you say that HRT in ciswomen may be a cause of PN, has this been observed with bio-identical estradiol alone or Premarin (conjugated equine estrogens)/Ethinyl Estradiol with progestins such as Provera (medroxyprogesterone acetate)? Because the effects observed with one cannot be generalized to the other, these estrogens differ in several ways. And the addition of a progestin can make a difference.

[Joelene9]

KayXo,

  Those others are being looked at by my doctor.  My doctor wants to get my annual blood screening done this April before going back to Spiro. Those LhRh analogs may as well cause a problem with the PN as well as the thyroid and the estradiol I'm taking.  There may be a rise in the PSA levels as well.  Meanwhile, I have to put up with this mess.

  Joelene

[KayXo]

How would analogues/agonists interfere with thyroid and estradiol? They are being prescribed and used quite successfully in transgendered women.

J Clin Endocrinol Metab. 2012 Dec;97(12):4422-8. doi: 10.1210/jc.2012-2030. Epub 2012 Oct 9.
Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens.

"Antiandrogens are not routinely used in the clinical protocol but GnRH analogs are routinely used to suppress testosterone production."

Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):586-92.
Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist.

"Sixty male-to-female transsexuals were treated with monthly injections of gonadotropin-releasing hormone agonist (GnRHa) and oral oestradiol-17beta valerate for 2 years to achieve feminisation until SRS. There was a significant decline in gonadotropins, total testosterone and calculated free testosterone. In general, the treatment regimen was well accepted. An equal increase in breast size was achieved compared to common hormone therapy. Two side effects were documented. One, venous thrombosis, occurred in a patient with a homozygous MTHFR mutation. One patient was found to be suffering from symptomatic preexisting gallstones. No other complications were documented. Liver enzymes, lipids, and prolactin levels were unchanged. Significantly increased oestradiol and SHBG serum levels were detectable. In addition, an increase in bone mass density, in the femoral neck and lumbar spine, was recorded. We conclude that cross-sex hormone treatment of male-to-female transsexuals using GnRHa and oestradiol-17beta valerate is effective, and side effects and complication rates can be reduced using the treatment regimen presented here."

[Joelene9]

  I should've stated the sentence clearer.  I meant that the thyroid and estradiol as a problem inclusive to the PN and not with each other or the anti-androgens.  There are some cases that these meds do worsen the condition of PA and the PA cases have many primary causes, some yet unknown.  The Synthroid is taken 1/2 to 1 hour in the morning before anything else, including food. 

  Joelene