Estradiol taken by injection (i.e. estradiol valerate) will safely and sufficiently suppress T levels on its own so no need to add Spiro, I think. If cardiologist is concerned about health risks, explain that cardiac risks are associated with other forms of estrogen that are not bio-identical (Premarin, birth control pills that contain ethinyl estradiol), always taken orally (where BP tends to rise), that cardiac risk increases in post-menopausal women when their estrogen levels DROP and that estradiol is known to increase dilation of blood vessels through nitric oxide, thus reducing blood pressure and heart risk. When you take estradiol by injection, you emulate the way women get their E and you get the same E as them, same molecule and all. Pregnant women reach levels that will much be higher than you will ever reach on injections.
Your free T levels decreased because a small dose of oral E significantly increases SHBG (sex hormone binding globulin) levels which strongly bind T, thus reducing free T. But oral E affects slightly more clotting factors due to more significant passage through the liver.
Hopefully, you can share this with your doctors and have them prescribe what is safest and most effective for you. It's critical, I think, to be informed and share with your doctor (s).
