Cyproterone Acetate and Fertility

[Erin.LE]

Hello all!

I'm a MAAB non-binary transfeminine person in their mid-20s and I've been approved for, amongst other things, HRT. I have a recommendation letter to hand from the GIC I attend for cyproterone acetate, as I wish to start with anti-androgens before moving to low dose E, but my prescribing doctor is reluctant to move ahead with this just now. It seems the reason for this is that I expressed interest in gamete storage due to the wishes of my FAAB partner (really, I don't care about this at all), the procedure for which is scheduled for around 9 months from now. I'm not particularly happy with waiting so long to start anti-androgens as I've been quite lucky in avoiding the masculinising effects of T so far though I've noticed this really start to ramp up in the past 6 months - much thicker facial hair, body hair in new places, facial features becoming more masculine - which is really making my dysphoria worse, killing my moods, causing depression and making it difficult for me to cope with things that I need to do for my job.

So my very specific question is (and I apologise for posting here but the non-binary forums I haunt don't have much experience to offer in HRT for MAAB people), has anyone stored gametes after starting on anti-androgens? If so, how was the procedure, were there any specific comments made with regards to viability and so on?

I was informed by my doctor at the GIC that I should be able to start on cyproterone now and then wait with estrogen until after gamete storage so I am a little confused as to why my recommendation letter is now suggesting gamete storage before the cyproterone which is not what I agreed on. Any advice to help me fight my case with my prescribing doctor would be hugely appreciated.

Thanks! <3




No Dosages Please

[V M]

Hi Erin 

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V M

[HughE]

I thought the usual practice now is to use GNRH agonists such as leuprolide as antiandrogens rather than cyproterone acetate, since they suppress T production with far fewer side effects.

Anyway, from drugs.com:
"Fertility—
Sperm count and the volume of ejaculate are reduced at oral doses  day. Infertility is usual, and there may be azoospermia after eight weeks of therapy, which is associated with atrophy of seminiferous tubules. These changes have been shown to be reversible upon discontinuation of therapy. Spermatogenesis usually reverts to previous levels approximately three to five months after stopping cyproterone (occasionally up to 20 months). "

In other words, if you follow the GIC's advice, by the time your appointment for sperm storage comes around, it's very likely that you won't have any viable sperm left at all, and your chances of having children of your own will have ended forever (unless you want to put your transition completely on hold and come off hormones altogether for an extended period of time, perhaps as much as 2 years). That's probably why your prescribing doctor is reluctant to proceed.

If you don't want to wait until after your appointment in 9 months for sperm collection and storage, another option would be to go to a private fertility clinic and have them do it instead.

<no doses!>

[Erin.LE]

Thanks for the advice!

When I spoke with the GIC doctors both of them seemed much keener to start with cyproterone, wait for gamete storage and then switch to GnRH antagonist along with low dose estrogen. I'm not entirely sure why this would be prescribed if cyproterone has harsher side effects. 

I've gone ahead and contacted a private fertility clinic so I am hoping that I would be able to arrange something with them and start on anti-androgens sooner rather than later!

[HughE]

When I spoke with the GIC doctors both of them seemed much keener to start with cyproterone, wait for gamete storage and then switch to GnRH antagonist along with low dose estrogen. I'm not entirely sure why this would be prescribed if cyproterone has harsher side effects. 

Maybe it's part of a gatekeeping strategy they do on all their patients - by starting them on a drug with a lot of unpleasant side effects, they're trying to deter all but the most determined from going ahead with a full transition. I'm not sure why they'd start you on CPA and only later switch you to a GNRH agonist otherwise, surely it would make more sense to put you on the drug with fewer side effects from the outset.

In any case, you definitely want your sperm collected and stored prior to starting on any AA's or hormones, since they all drastically reduce your fertility and end up making you completely infertile.

[KayXo]

Maybe it's part of a gatekeeping strategy they do on all their patients - by starting them on a drug with a lot of unpleasant side effects, they're trying to deter all but the most determined from going ahead with a full transition.

If this is the case, then it is wrong, in my opinion and unethical. To really give an idea as to how it feels to be a woman hormonally, then it would be best to give high enough estrogen, in a safe way so as to reduce sufficiently T, similar to ciswomen and raise E levels. Or an agonist and E.

[Jessica Merriman]

If possible I would find another medical provider. AAs such as Spironolactone are much safer.

[antonia]

Warning, a bit personal and slightly graphic.

It's my understanding that starting Cypro before depositing is a very bad idea, although I'm on Cypro myself I can't comment on the fertility but I will say (as someone who was sterile from birth) that after starting Cypro I became what I can best describe as "dry" an hence any attempt to extract biological samples would have to be done using a needle or surgery or something of those sorts.

Not sure I agree with Cypro being more dangerous than Spiro assuming correct dosages although if you live in the US it's not FDA approved (Even if I do have to disagree with Jessica, which I don't think has ever happened before)

[Erin.LE]

Thanks Antonia! <3

The graphic and personal was kinda what I was hoping for seeing as I think learning of the experience of others has a much greater impact on my decisions rather than just reading a list of expected effects. Thank you so much for relaying your experiences!

Maybe it's part of a gatekeeping strategy they do on all their patients - by starting them on a drug with a lot of unpleasant side effects, they're trying to deter all but the most determined from going ahead with a full transition. I'm not sure why they'd start you on CPA and only later switch you to a GNRH agonist otherwise, surely it would make more sense to put you on the drug with fewer side effects from the outset.

I think the reason spiro wasn't suggested is because my health care provider doesn't have access to it. My choices were between Finasteride, Cyproterone and a GnRH analogue with cypro being recommended at first due to a better activity than finasteride and also coming in a pill form and then moving to the GnRH analogue when I start on a low maintenance dose of E.

My GP is now messing me around though, and I am almost certain this is due to a real problem with understanding non-binary trans issues so I have a couple more weeks of a waiting until an appointment (as my last one was cancelled when I arrived...) where I am anticipating needing to really stand my ground and fight for things that I want and feel would help settle my GID. At least this has given me some time to start making arrangements for gamete storage through a private provisioner! Gotta look on the bright side of things!

Hopefully I can get started on the AA before I begin laser in a month. I'd rather not have new hair springing up during that! ^_^