Alternatives to spiro?

[rachel89]

I have been taking spiro for almost two months now. Although it has helped in some ways (slightly slower hair growth, "guy smell" is gone, feeling a little calmer, reduced sex drive) It still has its problems. 1. Is that my T was at 416 ng/dL. 2. The diuretic thing is a problem. Can anyone tell me about other AA's like Androcur, decapeptyl, and finasteride? Also, can anyone tell me about getting orchi and the cost and everything.

[Ms Grace]

When I was on Androcur back in the early 1990s I ballooned up from water retention, that's one of the good things about taking Spiro and its diuretic properties. I was taking it with another anti androgen that I can remember the name of, my endo had me on quite a cocktail. I also can't remember my levels but judging by what was going on for me my T was low, but then it is on Spiro too. You really should talk to your endo about your options. What works for one person may not for another.

[rachel89]

I don't have an endo, I have a family doctor instead. She has a somewhat conservative approach where she prescribes spiro and a low dose of estrace, with a limit that is below the maximum safe dose. She prefers to stick with that approach as nmuch as possible. Its not going to kill me, but its gotten to be annoying. I'm seriously considering an orchi sometime in the future so I don't have to deal with AA's or worry about my T-levels.

[Cindy Stephens]

I have been on HRT for over a decade.  Much of that was with spiro.  It really made me feel bad.  My wife and I eat a lot of fresh vegetables, most of which are loaded with potassium.  Spiro "spares" potassium and it builds up in your body leaving your electrolytes off base.  My doctor took me off Spiro and put me on Depoprovera.  I know, I know it has this really bad reputation.  I'm sure someone will post dire warnings of immanent death, massive hair growth, etc.etc. in response to this post.  I have found none of it to be true, for me.  It is the drug used by a number of states for "chemical castration." It also has a long history of use in both woman for birth control and in transgender Hrt.  At the southern comfort gathering several years ago the endocrinologist in charge of the transgender program at the Unversity of California was there, and that is what they use, and that it is very safe.  My T levels are basically zero.  It directly turns off T production at all points of production.  In fact, the one problem I have with it is that my T is too low.  I have been debating having an Orchi myself so that my T levels will go up a bit to female levels.  The one extra thing is that when I switched over I had a lot of breast growth and went up at least one tanner level. 

[rachel89]

So my K+ levels were just fine according to the doctor (I was taking spiro for 1 1/2  months before I started seeing this doctor who has more experience with with trans patients in this area, before, I got my prescription from a psychiatrist who just wrote the script so I wouldn't have to discontinue and wouldn't do something that we cannot discuss here). Basically the issue is that it makes me have to pee all the time, and I want something that won't do this.

[Cindy Stephens]

 depoprovera does not cause you to pee.  That was also an issue for me with Spiro.

[rachel89]

I think I will ask about Depoprovera at my 3 month follow up. What should I know about it if I can get it?

[Cindy Stephens]

It is just pretty straight forward.  I do injections of e but it sounds as if you are on a very conservative path so they will probably give you pills. check out this
<Link Removed>
It can cause mood swings and weight gain.  In Europe Spiro isn't used at all, they use Androcor which is slightly diferent from provera but has similar effects and problems.  Androcor isn't legal here.

Mode Edit: Dosage

[KayXo]

My doctor took me off Spiro and put me on Depoprovera.  I know, I know it has this really bad reputation.  I'm sure someone will post dire warnings of immanent death, massive hair growth, etc.etc. in response to this post.  I have found none of it to be true, for me.

Keywords being "FOR ME". Suppose she doesn't tolerate Provera and takes it by injection. She is stuck with it for quite some time. Provera also increases risks of getting clots, cardiovascular problems and breast cancer. Just not worth it.

Since there are far better alternatives, why even choose this?

Androcur is slightly better and can be used together with Spiro as the latter will counteract the water retention from Androcur. Bicalutamide (Casodex) is also a potent anti-androgen. Decapeptyl and similar other drugs like Synarel have few side-effects and will also suppress testicular androgen production after the first couple of weeks.

The last 2 can be quite expensive but if covered by insurance, are doable. Bicalutamide in small doses is also more affordable.

Finasteride is NOT a substitute for an anti-androgen. It is more a complement. It can help but not be used as your sole anti-androgen. Not potent enough and the proof is that it is prescribed to men for baldness.

Finally, estrogen given by injection or implants can, taken alone, suppress T sufficiently without the need for an anti-androgen.

I think I will ask about Depoprovera at my 3 month follow up. What should I know about it if I can get it?

VERY bad idea.

I do injections of e

Injections of E taken alone will do the trick. No need to take an anti-androgen.

they use Androcor which is slightly diferent from provera but has similar effects and problems.

They are somewhat different also in the sense that Provera has been linked more significantly to a greater tendency to clot and cardiovascular problems and that Provera is slightly androgenic at the receptor level whereas Androcur is anti-androgenic.



 

[rachel89]

Is cyproterone acetate WITHOUT ethinyl estradiol prescribed in the U.S. for the purpose of transition?

[iKate]

Is cyproterone acetate WITHOUT ethinyl estradiol prescribed in the U.S. for the purpose of transition?

Cyproterone Acetate is not FDA approved (due to concerns about liver damage) so it won't be available in the US from a US pharmacy.

You can get Bicalutamide or Flutamide which are FDA approved and are often prescribed for MTFs in the USA. They are effective even at small doses.

Honestly though, you've barely started. Give the spiro 3 months or so to work before you decide it's not effective and want to switch. This is marathon, not a sprint.

[kira21 ♡♡♡]

If you can, get on a gnra like Goserelin or buserelin. They are greatly superior.

[KayXo]

You can get Bicalutamide or Flutamide which are FDA approved and is often prescribed for MTFs in the USA. They are effective even at small doses.

Bicalutamide appears to be safer in terms of side-effects, is the newer of the two and now prescribed more commonly. It's also more potent and doesn't need to be administered 2-3 times daily, just once daily or even every 2 days (half-life is 5.6 days).

What you need to know also is that bicalutamide, like flutamide, only block testosterone (and DHT) except in the brain. They do not reduce levels in the blood at all so that even if levels remain quite high, it doesn't matter because they are blocked quite effectively such that testosterone, now unable to bind receptors, may convert more readily to estradiol through aromatase.

[rachel89]

Assuming that my doc would be willing to put me on a different AA, what is the difference cost-wise and side-effect-wise between spiro and more modern antiandrogens like flutamide, finasteride, calutamide, goserelin, depo provera, buserelin, and decapeptyl? Currently my situation is this: I don't have a lot of money, I am lucky to be on HRT in the first place, my doctor prefers to stick with spiro and low doses of E because she thinks its the safest way, the main side effect of is annoying but won't kill me, I am not having any other problems with spiro, and I won't be on it forever, because I plan to get bottom surgery, or at least say goodbye to 'Tom and Harry." Basically my options are the following:
1. Discontinue AA's, which is a non-starter.
2. Try to talk my doc into giving me something different, which is far from guaranteed to happen.
3. "Where there is a will there is a way"
4. Be a tough girl and just deal with it.

[KayXo]

Bicalutamide, buserelin, decapeptyl are expensive with the latter two being the most. Bicalutamide, at low doses, is affordable perhaps. Flutamide is not advisable, given bicalutamide is available. It also has quite potential strong side-effects like liver damage.

Depo-Provera, I personally wouldn't even touch it. But, read up, talk with your doc and do as you deem best. I don't think it's expensive but if you do follow this path, I'd strongly advise taking it orally first in case you don't tolerate it. I think this progestogen is often prescribed because of low cost with less emphasis on health, sadly. The way the world turns.

Finasteride alone cannot be taken, as mentioned previously. It can complement another anti-androgen by further reducing tissue levels of DHT which some people are quite sensitive to. It's cheap, I think, especially if you take lower doses and a study showed that very small doses are practically as effective as higher doses. Your doctor's call.

I think that injectable estradiol valerate is affordable if bought at a compounding pharmacy or if bought online with your doctor's prescription, of course. Alone, it can suppress T sufficiently. This is perhaps the path I would be considering the most if I was in your situation.

Another option, perhaps, is to take Estrace sublingually (letting the doctor know also you are doing this) so that higher levels, even if for a few hours, can suppress T on its own. Could happen...you never know!

[Deborah]

I think 2 months isn't enough time to judge its effectiveness.  My endo told me even after nine months that my hormone levels weren't done adjusting.

Also, your T level is still pretty high but where did it start from?

As for the peeing I found that when I first started spiro and again when I increased the dose I peed a lot too and had other effects like lots of dizziness.  Each time after about 8 weeks or so those side effects largely tapered off.  So I'm guessing that given time a body adjusts itself at a new level of homeostasis.


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[rachel89]

When can I just get rid of "Tom and Harry"?

[iKate]

Assuming that my doc would be willing to put me on a different AA, what is the difference cost-wise and side-effect-wise between spiro and more modern antiandrogens like flutamide, finasteride, calutamide, goserelin, depo provera, buserelin, and decapeptyl? Currently my situation is this: I don't have a lot of money, I am lucky to be on HRT in the first place, my doctor prefers to stick with spiro and low doses of E because she thinks its the safest way, the main side effect of is annoying but won't kill me, I am not having any other problems with spiro, and I won't be on it forever, because I plan to get bottom surgery, or at least say goodbye to 'Tom and Harry." Basically my options are the following:
1. Discontinue AA's, which is a non-starter.
2. Try to talk my doc into giving me something different, which is far from guaranteed to happen.
3. "Where there is a will there is a way"
4. Be a tough girl and just deal with it.

As mentioned, all of the above are going to be expensive.

You might be able to get it cheaper with insurance but it is going to be more expensive than spiro.

The thing you have to understand about spiro is that its effect is cumulative and is an antagonist (it's actually a partial agonist that behaves like an antagonist), meaning it blocks T from binding to your T receptors because it binds to your T receptors with a much weaker action. So even though your serum T level is high, because spiro binds to the receptors and blocks T your T isn't really going to do anything. Eventually your gonads will slow production and the levels will drop.

So in other words, give it time and don't just look at numbers.