What is your anti-androgen of choice?

[Orchid]

So, I'm looking at other options,or maybe a combination of medication. Currently I am taking Spiro and estradiol valerate. I switched over to injections recently because I thought pill-form wasn't doing enough for me,which showed in my blood tests. Now, I'm thinking that Spiro was the culprit. I'm not sure why, but I don't think it is satisfactory for my body.

So, I'm looking for alternatives, or a combination of Spiro and other. Unfortunately, androcur is not approved in the united states. I don't know a whole lot about other possible options, so I am curious.

(: Thanks for reading.

[Laura_7]

None.
With implants and injections estrogen can be kept well in the female range, which drives testosterone down into the female range by a feedback loop. Its considered safe only with implants and injections.

Its a well known effect an endo should be able to look up if told it exists.
With bioidentical estrogen and internal application its considered safe by many endos.
With pregnancy levels are also raised without adverse effects.


*hugs*

[Orchid]

Really...  I have been wondering why I've felt almost 'drugged' or lethargic, even less emotional. Do you think it could be because of the combination of the injections and Spiro? Even if I am pre-op? I remember Kayxo mentioning this in another thread of mine, too...This is something I'm going to ask my doctor on Monday, but I thought I'd ask it here because I've learned so much more in these threads than really at the doctors office, which is an interesting prospect.

[Laura_7]

Really...  I have been wondering why I've felt almost 'drugged' or lethargic, even less emotional. Do you think it could be because of the combination of the injections and Spiro? Even if I am pre-op? I remember Kayxo mentioning this in another thread of mine, too...This is something I'm going to ask my doctor on Monday, but I thought I'd ask it here because I've learned so much more in these threads than really at the doctors office, which is an interesting prospect.

Well many doctors are simply not that versed in transgender subjects given they have not many transgender clients.

You might talk with your doctor about weekly injections instead of biweekly ones.
Levels do not rise that much the first day and do not drop that much the last days.
With biweekly injections levels rise very high and drop to low levels the last days.

Well you might try a higher dose and leave away spiro and see if its enough to keep testo in the female range.
Many endos strive for levels of 60 ng/dl or below.

You might talk about it with your doctor.


*hugs*

[KayXo]

So, I'm looking at other options,or maybe a combination of medication. Currently I am taking Spiro and estradiol valerate. I switched over to injections recently because I thought pill-form wasn't doing enough for me,which showed in my blood tests. Now, I'm thinking that Spiro was the culprit. I'm not sure why, but I don't think it is satisfactory for my body.

So, I'm looking for alternatives, or a combination of Spiro and other. Unfortunately, androcur is not approved in the united states. I don't know a whole lot about other possible options, so I am curious.

In my experience over the years, I have come to the conclusion that Estradiol Valerate injectable, ON ITS OWN, is enough to bring down T to female range so any anti-androgen is really unnecessary.

[elham_egypt]

I would prefer small dosage of estrogen and finastride ( very effective ) and low estro dosage can do it.

[April_TO]

Since I am on sublingual pills, I say CPA (Cyproterone Acetate) at the dose I am given I have seen more changes in two months than being on Spiro for almost a year and a half. Also, I can see an accelerated breast growth based on the tenderness and some pain associated with it. 

[KayXo]

Since I am on sublingual pills, I say CPA (Cyproterone Acetate) at the dose I am given I have seen more changes in two months than being on Spiro for almost a year and a half. Also, I can see an accelerated breast growth based on the tenderness and some pain associated with it.

Be sure to have prolactin levels regularly checked as CPA tends to raise them significantly and has been, in the past, often associated with the incidence of prolactinoma in transwomen. If you notice milk leaking from your breast (galactorrhea), advise your doctor immediately. This *may* be a symptom of a prolactinoma. Persistent headaches or vision problems are also something to watch out for as they can be sometimes be the result of a prolactinoma or a meningioma, also linked to CPA. Those problems most often come up when one takes high doses of CPA. Lastly, CPA can, in some people, cause depression and extreme tiredness.

Better be warned than not, just in case!

[April_TO]

Thanks Kayxo for the reminders! I am on the lowest dose possible and blood work every 3 months since I've been on HRT has been my doctor's regimen Sometimes I feel lucky that I live in a country that provides utmost care to trans patients like me My last blood work back in FEB has been normal and my mood has been stable

All in all even with the possible side effects of CPA, I'll choose it over Spiro.
Spiro made my kidneys work extra hard!

Be sure to have prolactin levels regularly checked as CPA tends to raise them significantly and has been, in the past, often associated with the incidence of prolactinoma in transwomen. If you notice milk leaking from your breast (galactorrhea), advise your doctor immediately. This *may* be a symptom of a prolactinoma. Persistent headaches or vision problems are also something to watch out for as they can be sometimes be the result of a prolactinoma or a meningioma, also linked to CPA. Those problems most often come up when one takes high doses of CPA. Lastly, CPA can, in some people, cause depression and extreme tiredness.

Better be warned than not, just in case!

[KayXo]

Does your doctor check prolactin levels?

[April_TO]

Does your doctor check prolactin levels?

Yes she does, it part of the Sherbourne Health Clinic list of things to check including a host of different blood markers (i.e. estradiol, free and total T, thyroid stuff, CBC, Cholesterol, Sodium, Kidney function etch and this list goes on) LOL they would always draw 5 vials of blood from me.

[KayXo]

Great! I know about them, I live right next door, in Quebec. I don't totally agree with everything they do HRT wise but it's ok. Could be better.

[April_TO]

Great! I know about them, I live right next door, in Quebec. I don't totally agree with everything they do HRT wise but it's ok. Could be better.

I know whenever you're here in TO - just let me know.

[Richenda]

Hi just posted this over here: https://www.susans.org/forums/index.php/topic,206954.new.html#new

Covers the same ideas so I'll paste in the bits with my thoughts on this:

Fwiw, I did the same as you for a long time with finasteride + estradiol though I much prefer the normal rather than conjugated oestrogen. About a month back I switched from finasteride to dutasteride. I'm not entirely sure why I did that except that dutasteride is a better T to DHT blocker. I have had what I think are some side effects so I'm coming under an endo out here in Thailand where I now live as well as my UK one.

There are plenty of people on here who will tell you that you need to be on a 'proper' T blocker i.e. one which stops T production rather than just the T to DHT conversion. Personally I don't think you need necessarily take much notice of that. Finasteride or Dutasteride in conjunction with oestrogen will do the job perfectly satisfactorily. Your overall T level, not just DHT, will drop away. I now have no ejaculate at all: I mean literally nothing comes out. My T level recently has dropped through the floor whilst my E level has gone way into female range. That's without using any of the conventional T blockers like spiro or androcur, both of which are nasty nasty drugs imho. The UK NHS will not prescribe spiro for transgender and, as you know, androcur (Cyproterone acetate) is a flippin dangerous drug esp in its form with diane 35 - a banned drug in the US and therefore topic on here. Avoid that one like the plague. I would also personally avoid spiro as it's not intended for the purpose of transitioning and I think it's also a dangerous drug.

The other route to go down is GNrH analogues about which others know way more than me. It's those which the NHS prescribe. My T levels have vanished without any recourse to them but it may be something I consider for the sake of my liver. All these drugs are toxic to our bodies. It's one of the biggest reasons why I'm pulled to go the whole way for SRS.

[Vii]

Since I am on sublingual pills, I say CPA (Cyproterone Acetate) at the dose I am given I have seen more changes in two months than being on Spiro for almost a year and a half. Also, I can see an accelerated breast growth based on the tenderness and some pain associated with it.

My experience has been the opposite of this for some reason.
My T and especially DHT levels weren't very satisfactory on spiro, so I upped the dosage and all was fine, DHT was still bothersome but nothing big and I felt okay.  I eventually switched to CPA and my levels were fine from the get-go, but I actually grew MORE body hair again  heck, I even feel manlier again, but on paper everything seems perfect. I'm very confused.

[KayXo]

Cyproterone acetate binds to androgen receptors but is not a pure anti-androgen in the sense that it has no effect on receptors. Studies have shown an agonist effect where it can actually trigger effects similar but weaker to androgens such as T and DHT BUT those studies were in animals, also in-vitro so not sure how much and to what extent these can be generalized to us.

Also, spiro and both cypro bind to androgen receptors, thereby blocking DHT and T so levels in the blood only tell part of the story. Also, sensitivity to hormones is not measured so your levels may be "ok" but you may still remain hypersensitive to them.

Why not address this concern to your doctor? Also, cyproterone acetate has been implicated in the only meningioma cases reported in transsexual women and in several cases of prolactinoma although non bio-identical estrogens were also used. Keep an eye on prolactin levels. It may, in some, also cause depression.

[Vii]

Cyproterone acetate binds to androgen receptors but is not a pure anti-androgen in the sense that it has no effect on receptors. Studies have shown an agonist effect where it can actually trigger effects similar but weaker to androgens such as T and DHT BUT those studies were in animals, also in-vitro so not sure how much and to what extent these can be generalized to us.

Also, spiro and both cypro bind to androgen receptors, thereby blocking DHT and T so levels in the blood only tell part of the story. Also, sensitivity to hormones is not measured so your levels may be "ok" but you may still remain hypersensitive to them.

I dont quite understand. How does this explain how I've seemed to have less androgenic effects on spiro? On CPA my blood levels are next to non-existant, so even if I was hypersensitive, when there is almost nothing to work with in my blood, how would it?

Why not address this concern to your doctor? Also, cyproterone acetate has been implicated in the only meningioma cases reported in transsexual women and in several cases of prolactinoma although non bio-identical estrogens were also used. Keep an eye on prolactin levels. It may, in some, also cause depression.

I have no references for prolactine levels. They're at 51 µg/l, but CPA for sure made me more depressed when I switched. Sadly I can not talk to my endo about this as he doesn't want to get involved in my self-medding, beyond making sure my blood levels are healthy, or rather not alarming.

Quoting a study:

Nine cases were discussed in a published case series,2; and 27 cases are unpublished case reports. Of the 36 cases, 32 occurred in women and four in men. Duration of treatment with cyproterone acetate ranged from 4 years to 27 years

By the time I get SRS I'll be just over half a year on CPA, so it would be pretty bad luck if I develop a meningioma in that time.

[Hikari]

I preferred bicalutamide to spiro but I am on spiro nowadays due to the low cost and high availability of it.

[KayXo]

I dont quite understand. How does this explain how I've seemed to have less androgenic effects on spiro? On CPA my blood levels are next to non-existant, so even if I was hypersensitive, when there is almost nothing to work with in my blood, how would it?

Next to non-existent? What are your levels and please specify units? CPA is also a progestogen (spironolactone has negligible progestogenic effects) and therefore can oppose some of estrogen's effects. This last factor could perhaps explain why you did better on Spiro.

They're at 51 µg/l

If you notice your breasts leaking (galactorrhea) or have recurrent headaches, vision problems, you should immediately go see a doctor and explain these may be due to CPA and a possible prolactinoma.

CPA for sure made me more depressed when I switched.

On top of giving you poorer feminization results. It's obvious what you need to do but I would strongly advise you consult someone who is a professional and is competent in the matter. Sooner than later.

Quoting a study

4 cases reported in transsexual women, all taking cyproterone acetate for at least 4 years, up to 10 yrs.

By the time I get SRS I'll be just over half a year on CPA, so it would be pretty bad luck if I develop a meningioma in that time.

It's a risk, even if quite small, I wouldn't personally take. In my opinion, there are other safer alternatives.

[Vii]

Next to non-existent? What are your levels and please specify units? CPA is also a progestogen (spironolactone has negligible progestogenic effects) and therefore can oppose some of estrogen's effects. This last factor could perhaps explain why you did better on Spiro.

My DHT is higher than I remembered at 53 ng/l, my T is at 0,2 ng/ml. Progesterone at 3,69 µg/l. not particularly much I think? For comparison, on spiro I had 370 ng/l DHT and 1,06 ng/ml T.

If you notice your breasts leaking (galactorrhea) or have recurrent headaches, vision problems, you should immediately go see a doctor and explain these may be due to CPA and a possible prolactinoma.

No, none of that. I do have silent migraine and with it recurring vision problems but that predates HRT altogether.

On top of giving you poorer feminization results. It's obvious what you need to do but I would strongly advise you consult someone who is a professional and is competent in the matter. Sooner than later.

Well it seems I can't, but this is the very first time I hear of CPA supposedly being inferior. 
I'm tempted to go back to spiro for the 3 remaining months but I needed a higher than usual dose and my DHT was still super high, which bothers me.

4 cases reported in transsexual women, all taking cyproterone acetate for at least 4 years, up to 10 yrs.

It's a risk, even if quite small, I wouldn't personally take. In my opinion, there are other safer alternatives.

I think the odds are in my favor considering I'd be the first person to get some growth 8 times faster than the fastest known cases. Most other meds I take have higher risk factors.