Medroxyprogesterone acetate - what to expect?

[Brenda E]

So I may be starting Provera tablets in the near future - what can I expect?  From my research, some people find it very helpful in terms of reducing testosterone levels, and some find the side effects really rather unpleasant (depression).  Others seem to find it neither helpful or harmful.

Is the jury still out on this medication?

[Ms Grace]

I've been on it for about ten months (?) and haven't had any bad effects.. As for benefits it's hard to say since I can't compare to what I'd be like without it. It is, as you've noted, a case of YMMV.

[Hideyoshi]

So I may be starting Provera tablets in the near future - what can I expect?  From my research, some people find it very helpful in terms of reducing testosterone levels, and some find the side effects really rather unpleasant (depression).  Others seem to find it neither helpful or harmful.

Is the jury still out on this medication?

Quote from endo after questioning its safety and efficacy:

"It's safe an efficacious."

I've been taking it for close to 9 months or so. No side effects. Can't gauge what changes I've had because I upped my E level when I started taking MPA. Pretty sure it's doing something. My E and T went to female range after starting it. Again, really hard to gauge the effects when so many other medications are in play.

[Brenda E]

My E and T went to female range after starting it.

That's the reason it's being given to me: E too low, T too high, and this is supposed to block T in a way that spiro can't and push the T down to a female level and allow the E to rise.

It's worth a shot, right?

[KayXo]

After having read the side-effects commonly associated with it, from several, some quite large studies, and hundreds of anecdotes AND considering there is a form of progestogen identical to that produced by our bodies, bio-identical progesterone (micronized), I PERSONALLY see no reason to take it and the risks outweigh its benefits. As far as i'm concerned, I would stay away from it and have a hard time understanding how it's still offered and available on the market. It's up to you and the doctor to do the research and decide together in the end...Just citing my own opinion based on several thousands of hours of research on the subject. I am NOT a doctor though.

[Brenda E]

Thanks KayXo.  Just curious - any idea why medical opinions differ so widely on this?

[justpat]

   My 2 cents ,my GYN prescribed  Prometrium  suppose to be bio identical. All I can say is overall I just feel better.can't put my finger on just one thing its just my body seems to be working and feeling better. Let me add one thing I do sleep a LOT better.

[Hideyoshi]

I am NOT a doctor though.

Thanks, so I can take your internet research with a grain of salt, and instead listen to my seasoned MTF endocrinologist and my GPs who have all accepted MPA as a safe, legitimate, and effective medication.

Thanks KayXo.  Just curious - any idea why medical opinions differ so widely on this?

You can't get two endos to agree on anything. If your doctor recommends it, and has had previous patients who have used it with good results, I would say try it.

[Brenda E]

If your doctor recommends it, and has had previous patients who have used it with good results, I would say try it.

Sounds like a sensible plan.  I see no harm in trying it for six months or more, and if it works, great.  If not, it's not as if the endocrinologist is going to be standing in my kitchen every morning forcing me to continue taking it for years and years like my mom used to do with vitamins when I was a child.

I do have every confidence that my endocrinologist is (a) not an idiot, and (b) not trying to harm me!  Worst case, my E and T levels are unchanged at my next checkup and we try something else.

[Eva]

Well it gave me a BAD headache at first LOL Never cared for it much, always made me feel like crap and I tried it a few times...

I take bio identical P and spiro along with IM injections and my T was 6 ng/dl on my last test... Them little ->-bleeped-<-ers are NOT working at all but really I guess I dont need a lab analysis to know that... We just tested again yesterday for my first 6 month checkup and if T is still cratered Im going to start to taper down the spiro a bit...

Im no doctor but my feeling is E is a more effective AA than MPA or Spiro or straight P in a high enough dosage... I also think its safer, Im no doctor though... I can tell you that for me anyway Its a much better feeling to be on higher dose EV IM injections compared to MPA and low dose E....

I think its strange nobody can point out any kind of paper that explains how it works as an antiandrogen at the low dosage usually given with MTF HRT... There is just a lot of disagreement and conflict and there are other proven safer and more effective approaches... I think Spiro and bio identical P complement each other well in low dosage with high E injected IM... Just my opinion though and thats worth nothing I guess compared to a doctor...  However as smart as he is and as much as I like my doc.... I love to point out to him that HE has NO CLUE what its like to be me, what it feels like to be essentially castrated and to change sex...  My feelings SHOULD carry more weight than some very universal one size that cant fit all "guidelines"... 

Anyway I'll take E2 over MPA any day

[KayXo]

Thanks KayXo.  Just curious - any idea why medical opinions differ so widely on this?

I believe that those doctors that still prescribe it have been influenced by pharmaceutical reps, are just prescribing it out of habit and are not familiar with all the literature highlighting the side-effects commonly associated with medroxyprogesterone acetate. They also don't know much about bio-identical progesterone, the differences, etc. Some just don't have the time to keep themselves updated or minimize research findings, giving them an excuse not to dig further which they are not interested in doing. Unfortunately, sometimes, the patient's well-being is not at the top of their priority list which it should be. That's just my opinion though...I could be wrong.

[KayXo]

Thanks, so I can take your internet research with a grain of salt, and instead listen to my seasoned MTF endocrinologist and my GPs who have all accepted MPA as a safe, legitimate, and effective medication.

I think it's important to keep ourselves informed and be proactive in our treatment so that we know what's going on. Take an active role in our health. I personally question everything and everyone, even doctors, endos as I've many times come across physicians making mistakes, they are human after all, not infallible Gods. Reading the science behind it is important as it starts to give you a better idea of how things work, what is safe and then with that knowledge, you can discuss with your doctor, suggest research papers that could be read by them that they might have missed due to lack of time. It is important, I think, to form a partnership with your doctors, discuss honestly and openly. This will lead to the best treatment possible for you and for their future patients in the same situation. By acquiring knowledge, you are contributing positively to the medical field, and making a difference.

This is the kind of relationship I have with my endocrinologist especially. We argue and discuss. We learn from each other. He may be a doctor with a diploma but I have my say as well and he respects my opinions, my input.

You could always get a second and third opinion from other physicians as well. No harm in doing so. But, in no way, am I advocating that you blindly accept what I say but simply consider it. I encourage people to do their own research, talk to their doctors and find the treatment that is most effective and safest for them.

There is no room for pride, egos. Truth and facts is what will benefit us all and when pride/ego gets involved, then there is the risk that some may suffer as a result. A good doctor/scientist, in my opinion, is someone who constantly questions, never accepts anything as the absolute truth unless there is ample evidence for it. Who remains open-minded, who has no interest in their pride as it relates to their job but interest only for the patient's well-being and as such, seeks facts. Someone who is always in tune with the latest research out there.

My 2 cents...

If your doctor recommends it, and has had previous patients who have used it with good results, I would say try it.

But, what if there is an equally effective hormone that produces similar results without or with much less side-effects such as bio-identical progesterone. Then, I think it's a no brainer. Why take a progestogen that is not identical to what our bodies produce when we can just as easily take one that IS identical to what our bodies produce? Wouldn't it make sense to go with something that our bodies naturally produce and have been accustomed to for millions of years? Instead of a new molecule that is completely foreign to our bodies and that many studies have found long-term negative effects with vs much less or none with the bio-identical version?

[Hideyoshi]

I believe that those doctors that still prescribe it have been influenced by pharmaceutical reps

MPA is a dirt cheap generic. Costs me less than $5 or less /month even without going through insurance. Prometrium is more expensive, why wouldn't they try to push that instead?

just prescribing it out of habit and are not familiar with all the literature highlighting the side-effects commonly associated with medroxyprogesterone acetate. They also don't know much about bio-identical progesterone, the differences, etc. Some just don't have the time to keep themselves updated or minimize research findings, giving them an excuse not to dig further which they are not interested in doing. Unfortunately, sometimes, the patient's well-being is not at the top of their priority list which it should be. That's just my opinion though...I could be wrong.

There is a laundry list of side effects for EVERY medication. It's important to be monitored regularly by a professional when taking any medication, much moreso HRT (yes even your bioidenticals) given the potential dangers involved.

And if you don't think your doctor's priority is the health and well being of their patients, I'd suggest finding a different doctor.

Sounds like a sensible plan.  I see no harm in trying it for six months or more, and if it works, great.  If not, it's not as if the endocrinologist is going to be standing in my kitchen every morning forcing me to continue taking it for years and years like my mom used to do with vitamins when I was a child.

I do have every confidence that my endocrinologist is (a) not an idiot, and (b) not trying to harm me!  Worst case, my E and T levels are unchanged at my next checkup and we try something else.

I'd get a blood test after a month on it to make sure nothing's going wrong. My doctor did that with all of my medications as he added them.

As for me taking MPA, I might stop eventually if it did its job at lowering my T levels. I'd like to take the least amount of medication possible, but if it works, take it.

[KayXo]

MPA is a dirt cheap generic. Costs me less than $5 or less /month even without going through insurance. Prometrium is more expensive, why wouldn't they try to push that instead?

My health matters more to me than $$$. I would rather pay more for something that is less harmful and native to my body.

There is a laundry list of side effects for EVERY medication. It's important to be monitored regularly by a professional when taking any medication, much moreso HRT (yes even your bioidenticals) given the potential dangers involved.

Indeed. But, if you take the time to carefully read those side-effects associated EXCLUSIVELY with bio-identical progesterone which is said in the leaflet to have VERY low toxicity compared to those side-effects noted with medroxyprogesterone acetate, you will realize there is quite a difference. Side-effects, always but to what degree should be considered as well and the one with the less side-effects would be safest. Ciswomen are regularly exposed to bio-identical progesterone, VERY high levels during pregnancy throughout their lifetime whereas medroxyprogesterone is not something their bodies are accustomed to. Interestingly, medroxyprogesterone acetate is NEVER prescribed to pregnant women for pre-term labor or to prevent miscarriage whereas bio-identical progesterone is, sometimes in quite high doses. The reason for it is MPA's androgenic effects which may affect the female fetus and perhaps other harmful effects on the body. Not good when a drug is contraindicated in pregnant women whereas another can be safely prescribed.

As for me taking MPA, I might stop eventually if it did its job at lowering my T levels. I'd like to take the least amount of medication possible, but if it works, take it.

Estrogen can lower T as anti-androgens can do as well. It's a question of choosing the safest hormones/medications that can do the job.

[Hideyoshi]

My health matters more to me than $$$. I would rather pay more for something that is less harmful and native to my body.

The health aspect wasn't the point. Your response ignores the point you tried to bring up, which was big pharma is pushing MPA over bioidentical, which is nonsense. This is because pharma reps aren't going to push cheap generics when there are more expensive alternatives to push

Indeed. But, if you take the time to carefully read those side-effects associated EXCLUSIVELY with bio-identical progesterone which is said in the leaflet to have VERY low toxicity compared to those side-effects noted with medroxyprogesterone acetate, you will realize there is quite a difference. Side-effects, always but to what degree should be considered as well and the one with the less side-effects would be safest. Ciswomen are regularly exposed to bio-identical progesterone, VERY high levels during pregnancy throughout their lifetime whereas medroxyprogesterone is not something their bodies are accustomed to. Interestingly, medroxyprogesterone acetate is NEVER prescribed to pregnant women for pre-term labor or to prevent miscarriage whereas bio-identical progesterone is, sometimes in quite high doses. The reason for it is MPA's androgenic effects which may affect the female fetus and perhaps other harmful effects on the body. Not good when a drug is contraindicated in pregnant women whereas another can be safely prescribed.

Pregnant women aren't supposed to even touch finasteride. Guess no MTF should ever take it since pregnant women can't have it. Spiro is also contradinicated in pregnancy and breastfeeding. Estradiol (oral and otherwise) is also not to be taken while pregnant. Oops.

edit: And I thought you conceded to me months ago that MPA's 'androgenic effects' are negligible to non-existent, as it would require hundreds of times the concentration of MPA to get the same androgenic effect of testosterone, and even then, it might not even behave the same way as actual T would. Yet you still, without fail, on every thread regarding MPA/progesterone, talk about MPA's 'androgenic effects'

If you don't want to take it, and think it's so dangerous, just don't take it. If other people want to try it and their doctors have patients who have taken it and have experienced no ill effects, what business do you have in shoving bioidenticals in their face every time progesterone is brought up? It gets old.

[LShipley]

The health aspect wasn't the point. Your response ignores the point you tried to bring up, which was big pharma is pushing MPA over bioidentical, which is nonsense. This is because pharma reps aren't going to push cheap generics when there are more expensive alternatives to push

Pregnant women aren't supposed to even touch finasteride. Guess no MTF should ever take it since pregnant women can't have it. Spiro is also contradinicated in pregnancy and breastfeeding. Estradiol (oral and otherwise) is also not to be taken while pregnant. Oops.

edit: And I thought you conceded to me months ago that MPA's 'androgenic effects' are negligible to non-existent, as it would require hundreds of times the concentration of MPA to get the same androgenic effect of testosterone, and even then, it might not even behave the same way as actual T would. Yet you still, without fail, on every thread regarding MPA/progesterone, talk about MPA's 'androgenic effects'

If you don't want to take it, and think it's so dangerous, just don't take it. If other people want to try it and their doctors have patients who have taken it and have experienced no ill effects, what business do you have in shoving bioidenticals in their face every time progesterone is brought up? It gets old.

You do realize she has every right to offer her PERSONAL opinion like the OP asked for just as you offered yours? If she believes it to be better and offers her opinion even saying she's not a doctor who are you to say anything? You aren't a doctor either regardless if you trust your own doctor more than everyone else. Doctors are human and their knowledge only is as far as they stay updated themselves but that's besides the point

No one is forcing you to listen to anyone else especially when they preface their comments with "PERSONALLY" and "I'm not a doctor". PERSONALLY I don't know why you WOULDNT research for yourself what you put into your body for extended periods of time. Not everyone has the same blind trust you may have. I've encountered too many doctors and nursing staff that are wrong and follow the wrong protocols. I work closely with doctors and nurses every day, they are all too human.

Bottom line everyone has an opinion and trusting anyone blindly without your own research or verification is foolish. That said many doctors don't like being questioned and may not treat you if you do. if I found out on my own something different then what they are telling me though I would ask WHY to understand.

PERSONALLY I find the comments about blindly trusting their doctor just because he is the professional far more annoying than those offering their own research.

/rant

[Lady_Oracle]

My 2 cents

Medroxy started depression in me again, I was taking it for about 6 months before I noticed its ill effects and then I switched to the bioidentical form, been feeling great ever since

[Hideyoshi]

You do realize she has every right to offer her PERSONAL opinion like the OP asked for just as you offered yours? If she believes it to be better and offers her opinion even saying she's not a doctor who are you to say anything? You aren't a doctor either regardless if you trust your own doctor more than everyone else. Doctors are human and their knowledge only is as far as they stay updated themselves but that's besides the point

No one is forcing you to listen to anyone else especially when they preface their comments with "PERSONALLY" and "I'm not a doctor". PERSONALLY I don't know why you WOULDNT research for yourself what you put into your body for extended periods of time. Not everyone has the same blind trust you may have. I've encountered too many doctors and nursing staff that are wrong and follow the wrong protocols. I work closely with doctors and nurses every day, they are all too human.

Bottom line everyone has an opinion and trusting anyone blindly without your own research or verification is foolish. That said many doctors don't like being questioned and may not treat you if you do. if I found out on my own something different then what they are telling me though I would ask WHY to understand.

PERSONALLY I find the comments about blindly trusting their doctor just because he is the professional far more annoying than those offering their own research.

/rant

The stark difference between me and Kayxo is that Kayxo bases their conclusion on:

1. Internet research

I base my conclusion on:

1. Internet reasearch
2. Physician recommendation
3. Personal experience actually TAKING the medication for an extended period of time

Kayxo trashes MPA based on their findings on the internet. They push bioidential P every time MPA or progesterone is mentioned. It's not so much that I don't want them offering their opinion, it's that their opinion is 'I DON'T KNOW WHY ANYBODY WOULD TAKE IT IT'S TOXIC POISON TAKE X INSTEAD.'

I love how just because I take my physicians' opinions into account, therefore that somehow makes me someone who blindly accepts their decisions as gospel. What a strawman.

[HughE]

The health aspect wasn't the point. Your response ignores the point you tried to bring up, which was big pharma is pushing MPA over bioidentical, which is nonsense. This is because pharma reps aren't going to push cheap generics when there are more expensive alternatives to push

Anyone can manufacture or import bioidentical progesterone because it's not a prescription medicine, so the pharmaceutical companies probably can't leverage much profit off of it. MPA on the other hand, is a lot cheaper to manufacture per dose, plus restricted to pharmaceutical sales channels, so yes, I'd say pharma companies do have an incentive to promote it.

My guess is that it's more likely to be ignorance and inertia on the doctor's part though. Doctors shouldn't be prescribing MPA as part of trans HRT for two reasons. Firstly, in the 2002 WHI study, the patients given it had considerably higher mortality rates from coronary heart disease, pulmonary thromboembolism, venous thromboembilism and breast cancer. On top of that, it's been linked to severe depression and suicides in transwomen. MPA is one of the potentially lethal hormones of yesteryear (along with premarin and ethinyl estradiol)  that used to be used for trans HRT decades ago, but should never be used any more due to there being much safer alternatives.

People seem to think that doctors are these all knowing wizards, but the reality is that most of them have little or no knowledge of endocrinology and are likely to be relying on pharmaceutical company "guidelines" (or maybe even just winging it). Having spent a fair bit of time over the last 3 years talking to people who were exposed to DES (and to another hormone treatment called Primodos), I know for a fact that, when it comes to hormones, most doctors don't have the first clue and are just following whatever the pharmaceutical sales rep told them.

Pregnant women aren't supposed to even touch finasteride. Guess no MTF should ever take it since pregnant women can't have it. Spiro is also contradinicated in pregnancy and breastfeeding. Estradiol (oral and otherwise) is also not to be taken while pregnant. Oops.

The reason finasteride and spiro are contraindicated in pregnancy is because they're antiandrogens, and a male fetus exposed to them will end up partially developing as female instead of male. That actually touches on one of the things I've been trying to make people aware of - drugs that interfere with testosterone production should, in theory at least, carry exactly the same risk of causing female development in males as antiandrogens do, and yet there are no warnings or restrictions against their use during pregnancy.

P.S. I'm fairly sure that MPA cross reacts with androgen receptors, since it's one of the progestins that turned out to have virilizing effects on female fetuses.

[Lady_Oracle]

To be fair my endo did warn me about the pros and cons of synthetics vs bioidenticals and did say prometrium is better since it's easier on the body side effect wise. He offered me both and I choose medroxy cause of the cost and thought nothing of it. However since I was just starting hrt, I didn't realize how sensitive my body would become to it's side effects. I now seem sensitive to everything, so tread carefully is my advice to those that have sensitive bodies like mine and are just starting.