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Dermatologist Prescribed Anti-Androgens

Started by Nightwish, February 18, 2015, 10:58:17 PM

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Nightwish

I'm scheduled for a long-awaited dermatologist appointment soon to talk about hair loss. As a 19 year old biologically male person with long hair (and an affinity for feminine behavior/personality/dress), I have experienced hair loss for years since middle school, devastating me on the inside with feelings of self-loathing. I simply will NOT accept losing it further, as it's already thin.
( thanks genetics <3 ) ... Throughout the years I've had numerous blood tests to source the problem, but everything appears just dandy. No thyroid issues, well functioning kidneys, etc. Stress would not induce hair loss in these amounts. Believe me when I say it's bad. At this stage, however, I am confident that genetically-induced androgenic alopecia is playing a role, as my temples are beginning to recede :c
This is why I wish to be prescribed Propecia but more importantly Spironolactone, which could help with my high blood pressure, excessive acne and oily skin, and potentially reduce my hair loss in light of its testosterone blocking capabilities.                   
                           
The deeper reason behind Spironolactone is of course for the antiandrogenic, feminizing, effects of it, as I am considering undergoing MtF HRT in the future. As of now I am not ready to make the full commitment, a permanent change, to take hormones, but would like to reduce my masculinity through testosterone blockers so that my appearance will be at least androgynous if not feminine. That way, it'll match who I am on the inside to a degree at least. Most of Spironolactone's side effects are not permanent, so I feel this is a suitable route to take. My family being eastern European, the thought of having reduced body hair (alongside reduced sexual drive & potential breast growth) is very appealing to my unconventional gender dysphoria. I have been disgusted with my "masculine" traits ever since puberty dawned upon me, when my self-acceptance and happiness abandoned me. These past couple years of thriving testosterone in my system have made me look and feel repulsive. As a biology major studying hormones, I want to change that b/c I know it's possible :)

Also, despite me being over 18 I'm still covered under my parent's insurance. This is likely to create a problem, as my family will not accept me in light of their orthodox religious convictions. I fear to death telling them about pursuing HRT in the future. I know that if I directly tell them about why I want to take Spironolactone they will deny me the visit, mentally (if not physically) hurt me, possibly cut off their financial support in regards to University tuition, essentially throwing me out onto the street. I want to continue my education, obtain a degree, become independent, and then seek HRT. But blocking testosterone now will make the future transition more fluid.

They absolutely cannot know. But my dermatologist should... i think. Otherwise, I doubt he'll prescribe a physical "male" Spironolactone under a petty reason like acne. But I don't know. That's why I'm asking you peoples of the interwebs :) Should I tell my dermatologist privately during the visit? What should he officially prescribe the Spironolactone for? Will I be allowed to take both Propecia and Spironolactone? How should I approach this situation in general? I'd look for an endocrinologist who specializes in transgender hormonal shifts, but my current family situation forbids me from being that blatant about it.

Once again, I've waited months for this appointment & want this visit to make an impact. Thank you <3
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AnonyMs

I don't know the answer to this, but I can make a few guesses.

I don't want to be negative, but I suspect either way you go there's a good possibility of problems.

Spironolactone obviously has side effects which might make a doctor reluctant to prescribe it to you for hair loss in the belief that that its not worth it. And if they were to prescribe it then the dosage might not be high enough to do what you are really after. I think you'll stand a good chance of osteoporosis (search the forums, you don't want it), and perhaps fertility problems - I'm not sure a doctors going to do that for a 19 year old. Are you sure the side effects are temporary? You'd really want to know what the risks are and be ready to argue that you have considered them all. Being ready to make a serious sacrifice for your hair, I can't quite see it - they might refer to you a psych instead (never had a hair problem myself, so I speak from some ignorance on this).

If you do tell them then they may insist on you seeing a psychologist, or just telling you to see someone more appropriate. Its not their area and I doubt they want any trouble.

I'd also check where you stand legally, and what the chance is of the doctor telling your parents regardless of the legal issues.

I suppose you could try not telling and if that doesn't work try telling. I think the main point is to be under medical supervision as its not entirely safe.

Perhaps you should start trying to find other paths forward, just in case.
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ImagineKate

In reality doctors can prescribe anything and everything. What they do prescribe and for what is up to them.

They can prescribe you Spironolactone if you want. However, they may be reluctant due to liability issues and yes they may tell you see a psychiatrist or therapist first.

However you never know. My old primary dr told me he could prescribe HRT if I wanted.

Ask? Worse they could say is no.

With regard to parental notification, you are 19, you are an adult. Your medical records are nobody's business but yours. Your parents don't legally need to know and I don't believe your doctor can tell them unless you consent.

Regarding insurance, that may be a problem depending on how your parents insurance works. They may get explanation of benefit mailings and they will see when you went. But I don't think they'll see what you were prescribed. If they have prescription insurance there is a possibility they will get EOB mailings as well and see what you were prescribed. You can get around this by paying cash for your medicines. Walmart and costco have it cheap - spiro small dose (about 1/4 of the typical dose for MtFs) is only $4. If your parents ask what it is for, tell them it's for blood pressure as Spiro is a blood pressure medicine. Actually that's what I take it for (plus the antiandrogenic effects). However with my insurance they don't mail me anything they just fill the script and I pay the copay.
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