Taking only a low dose of spironolactone could leave you vulnerable to spikes in T production that can have harmful mental and physical consequences. If T is too high, it will drown out the effects of the E and prevent feminization. All of that has been happening with me. It is tempting to use as little spiro as possible due to its unpleasant side effects, but at the end of the day, they are a small price to pay for the improved feminization (especially breast development) that is made possible by the spiro. The debate between higher E and lower T ignores the fact that both are necessary for good feminization and should be pursued simultaneously.
My doctor tried to give me elestrin, but I turned it down because topical products tend to be rather ineffective at producing sufficient levels for feminization, and have been even less effective in me than in my endocrinologist's other patients. It was only after I spoke up about that, that I was offered estradiol pills. Topical products do improve mood by producing a stable baseline level, but are very costly for the low amount of feminization achieved.
Sometimes it is necessary to question the endocrinologist. I trusted mine 100% until I did my homework and realized that he is making up facts in order to deny me an effective feminizing regimen. He came off so endearing that it was hard to discover.
