Hormones and Anti-androgens Post-Orchie

[Wynternight]

It's entirely possible that due to medical reasons/complications some of which are related to my almost certain PAIS that I may have to get (I'm going to ask) for a bilateral orchie. One teste is undescended which, due to risk of germ cell malignancy, often leads to removal and the other has multiple cysts which are painful and something I don't want to deal with if they come back.

With that in mind what is the general expectation in regards to continued anti-androgen use and HRT in general? Complete removal of the anti-androgens from the regimen or would the adrenals cause an unsatisfactory T level? Decrease AA use? What about estradiol? Same dose as present use or decreased?

[mm]

Wynternight, everyone need t or e in there system, in most all cases the adrenals gland do not make enough so you must take one or the other.  With your problems and having PAIS removing both testes maybe the best for you.

[Laura_7]

You could have a look here:
https://www.susans.org/forums/index.php/topic,190296.msg1695059.html#msg1695059

estro should be high enough... well in the female range...
bioidentical progesterone might help some...
and a low dose of t might be added, it might help with overall drive and orgasmic capabilities...


hugs

[EmmaMcAllister]

I'm having a bilateral orchie on August 14, and my doctor has advised that I won't need to take an AA afterward. I'm already on a very low dose of Estrogen, so that will either stay where it is or go up just a bit. In general, an orchie is no different than SRS as it relates to HRT.

[Tessa James]

I am also planning a bilateral orchiectomy and have been informed that my blood levels will continue to be monitored but I should be able to quit the spiro entirely and take about half of my current estradiol dose.  This reduces my risks from taking medications and is one reason I am going there.

[AnonyMs]

I asked my endo about this recently. Most people don't need AA's anymore, but for some the adrenal glands compensate by raising their testosterone output. Apparently there's different forms of testosterone, and the standard test my endo uses won't detect this form. You can have zero on the test but still have problems with high testosterone.

The treatment is a a reduced level of AA's for perhaps a year, and tapering off if I recall correctly. I think you'd know if you had this problem though. No need for a blood test.

[Wynternight]

I haven't had any side effects from the spiro but saving some money would be nice. I'd like to stay on the dutasteride for what it's doing to my hair and if could get the E in half, more saved money.

[HughE]

It's entirely possible that due to medical reasons/complications some of which are related to my almost certain PAIS that I may have to get (I'm going to ask) for a bilateral orchie. One teste is undescended which, due to risk of germ cell malignancy, often leads to removal and the other has multiple cysts which are painful and something I don't want to deal with if they come back.

An undescended testicle and epididymal cysts makes it sound a lot like DES exposure. DES can produce genital abnormalities that look very similar to PAIS. I saw a paper in which they did a genetic analysis of people who'd been diagnosed with PAIS, and only around 25 percent of them actually had anything wrong with their androgen receptor. So clearly it's a diagnosis that gets overused, and the majority of people diagnosed with it are actually intersexed for some other reason. In your case, it sounds a lot like it's DES exposure. If that's what it is then, yes, you probably are at increased risk of testicular cancer, so, if you definitely don't have any use for them any more, an orchie is probably a good idea from that point of view.

The other thing is that, if it is DES exposure rather than PAIS, then you're not actually androgen insensitive, and testosterone will masculinize you just as effectively as it would anyone else. That probably explains why you've found it necessary to use AAs up to this point! If you have an orchie, your endogenous T production should fall to a low enough level so that you can come off them, which is a very good thing as they all have quite negative long term effects on your health.

[Wynternight]

Confirmed exposure to DES in utero. A doc gave them to my mother when she began bleeding and he was afraid she was going to miscarry.

It's entirely possible that due to medical reasons/complications some of which are related to my almost certain PAIS that I may have to get (I'm going to ask) for a bilateral orchie. One teste is undescended which, due to risk of germ cell malignancy, often leads to removal and the other has multiple cysts which are painful and something I don't want to deal with if they come back.

An undescended testicle and epididymal cysts makes it sound a lot like DES exposure. DES can produce genital abnormalities that look very similar to PAIS. I saw a paper in which they did a genetic analysis of people who'd been diagnosed with PAIS, and only around 25 percent of them actually had anything wrong with their androgen receptor. So clearly it's a diagnosis that gets overused, and the majority of people diagnosed with it are actually intersexed for some other reason. In your case, it sounds a lot like it's DES exposure. If that's what it is then, yes, you probably are at increased risk of testicular cancer, so, if you definitely don't have any use for them any more, an orchie is probably a good idea from that point of view.

The other thing is that, if it is DES exposure rather than PAIS, then you're not actually androgen insensitive, and testosterone will masculinize you just as effectively as it would anyone else. That probably explains why you've found it necessary to use AAs up to this point! If you have an orchie, your endogenous T production should fall to a low enough level so that you can come off them, which is a very good thing as they all have quite negative long term effects on your health.

[Serenation]

I don't know how AIS effects dosages, (it's diagnosed by seeing of the body responds to testosterone injections?) but my endocrinologist said post op you take exact same medication as early onset menopause woman that's had a hysterectomy, and that's what they put me on. Said if I ever need to see a gp stealth for hormones just ask for medication for that condition.

So to be vague my pre-op and post-op meds are different from the same endo.

[Dena]

I don't know if this information will help you, but I was on premarin only and the doctor quartered the dose post surgically. Yes, we didn't have blockers so any blocking effect came from the premarin alone. Even at a quarter dose and having been on hormones about 5 years before surgery, I continued to see changes.

[Jill F]

Post orchi I no longer take dutasteride. I do a low-moderate dose (still trying to find the sweet spot) of topical E and a 12 day cycle of topical micronized P.  Whatever T my body still makes is easily adequate for me.

My testes were abnormal (persistent mullerian duct syndrome), as was one of my brother's.  I suspect DES, but I never bothered to find out for sure.  Frankly it doesn't matter to me if it was DES, PAIS, XXY or some other form of trans alphabet soup.  I'm just happy to be on with my life.