High T, Endo recommends Leuprolide

[Robyn37]

Last week I saw my endo and had my first lab tests since starting HRT 2 months ago. Estrogen came back 82 pg/mL which is great, but testosterone is still pretty high at 380 ng/dL. He prescribed me Finasteride at the appointment which he said would help with body hair reduction, and continued my oral estradiol and spironolactone regimen. He says I may benefit from initiation of Leuprolide, which will reduce the pituitary signal to the testes to make testosterone. I am still deciding what I want to do at this point, and would like to see if anyone has any opinion about this or would like to share their experience with this Leuprolide medication, as I have not heard much about it. All of my other tests came back good and I am in excellent health with no other issues. I will call and discuss with my endo for sure and get his opinion, but I value all of your experiences and opinions as well. Thank you!

[KayXo]

You should know that E levels range from as low as 20 pg/ml to up to 640 pg/ml in ciswomen during their menstrual cycle while levels go way higher during pregnancy, up to 75,000 pg/ml. Regardless, the important thing, I think, is that you feel good and feminize well on your regimen.

About leuprolide, it will completely shut down testicular production of androgens and sperm. Spironolactone also inhibits T production through another mechanism though and blocks androgens from binding to receptors so that levels tested are not an accurate indicator because some of it is blocked by Spiro. T levels are usually lower than 100 ng/ml in ciswomen.

Estrogen can also do the same as leuprolide but levels need to be higher.

Best of luck.

[Robyn37]

Thank you so much! I didn't know the actual mechanism behind what the spiro actually does. I feel like the feminization is happening at a good pace, with breast development and muscle mass lowering. The engineer in me looks at those numbers though and thinks it could be better! I spoke to my therapist and she said my estradiol dosage is low compared to most other people she works with, and we agreed I should raise my estradiol dosage and give that a few months, see where everything is at. Thanks again!

[KayXo]

I didn't know the actual mechanism behind what the spiro actually does.

From what I gathered over the years,

- inhibition of androgens (including testosterone) at the point of 17-hydroxylation http://en.wikipedia.org/wiki/CYP17A1 (read steroidogenesis section), leading to potential slight increase in progestogens
- blocking androgens at receptor sites
- increase in catabolism (breaking down) of androgens
- increased (peripheral) conversion to estrogen
- displaces estrogen from SHBG making more E bio-available

[Steph34]

With such a high testosterone level, seriously consider the leuprolide in consultation with your doctor. The problem is, it can be very expensive and insurance companies do not like to cover it. It can also temporarily cause T levels to spike before dropping, so one should continue the spironolactone for the first month. I wish my first doctor had told me that. He was so incompetent that he sent me away with leuprolide and low-dose estrogen, then acted all dazed and confused when my testosterone level shot up to 1000.

About leuprolide, it will completely shut down testicular production of androgens and sperm.

I wish that were true for me. I have been on leuprolide since July. As recently as October, I had wet dreams. My testosterone level remained high for a woman, despite falling 85% from baseline. I had to add other medication and still cannot stop the occasional bursts of testicular activity. It is so bad that my doctor actually recommended an orchiectomy to stop the testosterone poisoning, as nothing else has worked. I will be seeing another doctor to discuss that next week.

[KayXo]

It is so bad that my doctor actually recommended an orchiectomy to stop the testosterone poisoning, as nothing else has worked. I will be seeing another doctor to discuss that next week.

Have you considered bicalutamide?

[Robyn37]

Thanks for the advice! I ended up doubling my dose of estradiol for now. I have experienced pretty good feminization so far for 2.5 months on HRT (breast growth, soft skin, loss of upper body mass) and I havent experienced any negative side effects from my current regimen (other than peeing all the time lol, and a little lower energy levels). If levels are still high after my next labs in 3 months, I will probably switch medications based on my endo's recommendation.

[Steph34]

Have you considered bicalutamide?

I asked my doctor about it, but she did not want to prescribe it due to a concern it would cause anemia. I had previously tried flutamide, and it made me feel very weak and look anemic after only a few days. My hemoglobin, hematocrit, and red blood cell levels have already declined rapidly since switching to E injections, leaving me badly anemic by male standards, barely normal for a woman. That is despite my occasional use of supplemental iron to make sure I am getting enough. Anything that could further reduce hemoglobin would be contraindicated in me. Anemia is awful for hair, so that is something I must take very seriously.

[calicarly]

With such a high testosterone level, seriously consider the leuprolide in consultation with your doctor. The problem is, it can be very expensive and insurance companies do not like to cover it. It can also temporarily cause T levels to spike before dropping, so one should continue the spironolactone for the first month. I wish my first doctor had told me that. He was so incompetent that he sent me away with leuprolide and low-dose estrogen, then acted all dazed and confused when my testosterone level shot up to 1000.
I wish that were true for me. I have been on leuprolide since July. As recently as October, I had wet dreams. My testosterone level remained high for a woman, despite falling 85% from baseline. I had to add other medication and still cannot stop the occasional bursts of testicular activity. It is so bad that my doctor actually recommended an orchiectomy to stop the testosterone poisoning, as nothing else has worked. I will be seeing another doctor to discuss that next week.

Interesting, it shows the uniqueness of every case and how individual approaches must be considered. good luck Hun.