Spiro after Estradiol.... any problems starting it later?

[abd789]

Seems the web claims more people start Spiro before E rather than vice versa....

does it matter?

I got both scripts, but only started E, one reason is I was concerned about how it would affect me and wanted to be on only one thing at a time. I also was dealing with a UTI which was making me pee like crazy, when I was warned about Spiro making me pee more.. I wanted to clear the UTI... so now that is over and I feel better and off of antibiotics, Im ready to start Spiro... but I am 10 days into E

I have not discussed any of this with my doctor... its not a simple procedure to ask and since we all get prescribed the same thing in the same doses pretty much... I dont think its a individual case basis...

[Deborah]

This is just an uninformed opinion but given my experience I don't think it matters.  The spiro will have gradual T suppressing effects over months.  So the difference of a week or two is insignificant.


Sapere Aude

[Dena]

I wouldn't think it matters much as long as there is enough time between the two that you will know if one causes you problems. The only thought is that the relief from the TG feeling will be dated from the time you start the Spiro. Just make sure you are drinking plenty of water and if you crave salt, use more.

[Obfuskatie]

I was under the impression that you should do both at the same time.

Spiro causes your testosterone to lower significantly and we need a replacement hormone to stay balanced. Otherwise we are susceptible to premature bone density loss and osteoporosis.

Estrogen by itself will not have nearly the same effect. If you imagine the hormone balance you had before any changes as a tug of war between the different hormones you create, throwing off that balance can cause your body to attempt to self-adjust as you metabolize the estrogen.
Eg: women who have very low levels of endogenous estrogen after pregnancy or a major surgery are usually give mild doses of testosterone to get their body to start ramping up its estrogen production back to standard levels. My mom went through this, and it worked for her post-hysterectomy.
By adding spiro to the mix you're leaving the estrogen to do its work, and not risk bone loss.


     Hugs,
- Katie
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[KayXo]

I was under the impression that you should do both at the same time.

I don't think Spiro before E is a good idea as it will put you in menopause and give you negative symptoms. One at a time is best to see how you react to each substance, you can isolate cause and effect.

Spiro causes your testosterone to lower significantly and we need a replacement hormone to stay balanced. Otherwise we are susceptible to premature bone density loss and osteoporosis.

And other stuff, like mood deterioration in some, hot flashes, night sweats, fatigue, etc.

Estrogen by itself will not have nearly the same effect. If you imagine the hormone balance you had before any changes as a tug of war between the different hormones you create, throwing off that balance can cause your body to attempt to self-adjust as you metabolize the estrogen.

If you take estrogen, all it will do is lower LH (luteinizing hormone) which ends up reducing testicular production of testosterone. More E =  less T. That's it.

Eg: women who have very low levels of endogenous estrogen after pregnancy or a major surgery are usually give mild doses of testosterone to get their body to start ramping up its estrogen production back to standard levels. My mom went through this, and it worked for her post-hysterectomy.

The reason testosterone worked is because she was low in sex hormones so either E or T would help except T is for males and E is for females so I see no good reason to prescribe T and not E. T does not ramp up estrogen production, on the contrary, it reduces it through negative feedback inhibition, the same way it does in transmen who take T and want to reduce E. Post surgery, if gonads are removed, T will not increase E, it will only serve to masculinize, not a good thing at all.

[Obfuskatie]

I don't think Spiro before E is a good idea as it will put you in menopause and give you negative symptoms. One at a time is best to see how you react to each substance, you can isolate cause and effect.

And other stuff, like mood deterioration in some, hot flashes, night sweats, fatigue, etc.

If you take estrogen, all it will do is lower LH (luteinizing hormone) which ends up reducing testicular production of testosterone. More E =  less T. That's it.

The reason testosterone worked is because she was low in sex hormones so either E or T would help except T is for males and E is for females so I see no good reason to prescribe T and not E. T does not ramp up estrogen production, on the contrary, it reduces it through negative feedback inhibition, the same way it does in transmen who take T and want to reduce E. Post surgery, if gonads are removed, T will not increase E, it will only serve to masculinize, not a good thing at all.

Well, administering T to women for a short period of time after hysterectomy if their estrogen levels bottom out and cause premature menopause worked for my mom. So you may say it's not a good thing, but it's been done often, especially because there were a few decades where doctors were afraid of prescribing hormones over a long period of time (for cis patients, women in particular, because of thrombosis). They tried estrogen for a short period, which had little effect jumpstarting her ovaries. There was a mild replacement effect but it dropped off immediately after cessation of the hormone replacement.

Regardless, both hormones work synergistically and don't work as well without the other. It's debatable how much effect two weeks to a couple months of using one without the other will do. As long as you take your blood tests, are honest with and listen to your doctors, you should be in the clear.

[melissa_h]

If your T levels are high enough from the get go, starting with spiro alone does make sense. 

Staging in one or the other isn't a bad thing if you're worried about drug interaction... But if you were prescribed both, taking a long time to add the 2nd would be basically ignoring your doctors prescription


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[KayXo]

Well, administering T to women for a short period of time after hysterectomy if their estrogen levels bottom out and cause premature menopause worked for my mom. So you may say it's not a good thing, but it's been done often, especially because there were a few decades where doctors were afraid of prescribing hormones over a long period of time (for cis patients, women in particular, because of thrombosis). They tried estrogen for a short period, which had little effect jumpstarting her ovaries. There was a mild replacement effect but it dropped off immediately after cessation of the hormone replacement.

Did your mom have her ovaries removed or just uterus? Just making sure. T or E would actually decrease ovary production as LH and FSH are reduced with either T or E treatment. Both E and T would help alleviate menopausal symptoms and improve well-being except T would masculinize her when E wouldn't. Still makes no sense to me. Bio-identical estradiol is quite safe and is available for a long time as intramuscular injections.

If your T levels are high enough from the get go, starting with spiro alone does make sense.

Not if it will result in menopausal symptoms. E also reduces T.

[melissa_h]

It can, yes. But I do have faith that the doctors that choose to prescribe that way know what they're doing.

To be honest though, many start with a standard blueprint of sorts, and then alter it based on patient response.  Some that I've seen posting here have been placed on spiro only for a few months before receiving E.


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[JoanneB]

One scenario that I've heard of for starting SPiro first is a softer way to see just how you'll respond to a lowering T level. Then add in E to see how you really respond.

I've been On / Off Low dose HRT several times over the decades. With and w/o Spiro or another AA. Knowing the affects of E with and w/o an AA, I absolutely cannot imagine any physiological difference with a relative short time difference.

A major kick ass AA takes several weeks to drop your T levels into the basement. Spiro is ..... far from kick ass. I also have seen that E alone well.... doesn't. Even in a per-Jurasiac dinosaur like me. My T climbed into "Normal" male range at my dotage with a v/g dose of E after a few months. I did not need a blood test to tell me. After 3 years of bliss I had 3 months of depression.

YMMV

[KayXo]

But I do have faith that the doctors that choose to prescribe that way know what they're doing.

I personally don't. Doctors are human beings too, far from infallible. I've seen many make mistakes and their patients pay the price including my own family members. Among transgendered women, over the years, I've seen many doctors tell their patients things that were untrue, prescribe dangerous hormones and do things not always in the patient's best interest. I remain cautious and encourage everyone to be PROACTIVE in their treatment and health.

Some that I've seen posting here have been placed on spiro only for a few months before receiving E.

To me, that is totally unacceptable. Why go through menopause when we don't have to? Even one day is too long.

One scenario that I've heard of for starting SPiro first is a softer way to see just how you'll respond to a lowering T level. Then add in E to see how you really respond.

E will naturally lower T level and contrary to Spiro, will not lead to menopausal symptoms. Some need more E to lower T to castrate levels and the most effective approach is usually non-orally, by way of injections (or implants).

[JoanneB]

Without SPiro my T eventually rose back up to Low-Normal range for males after about a year hiatus. Meantime My E was on the upper end for feminization levels. No idea what my T was before starting it

[Marlee]

my testosterone was low to begin with. So I've on just estradiol for 4 months now. My doctor is trans-friendly and quite knowledgeable tho, so I guess my regimen is right for me. she actually said tho, that the E would help my bones...

[AnonyMs]

Personally I'd start with estrogen as its the one that makes you feel so wonderful. Why suffer any longer? To the best of my knowledge there's no medical reason to start the other way around, and as KayXo said you split them to isolate cause and effect.

I personally don't. Doctors are human beings too, far from infallible. I've seen many make mistakes and their patients pay the price including my own family members.

Absolutely agree with this. I've seen some unpleasant consequences of this, and one that could have been fatal to a family member if we'd followed his advice. Luckily we went to hospital instead.

[Anna R]

I was under the impression that you should do both at the same time.

Spiro causes your testosterone to lower significantly and we need a replacement hormone to stay balanced. Otherwise we are susceptible to premature bone density loss and osteoporosis.

Estrogen by itself will not have nearly the same effect. If you imagine the hormone balance you had before any changes as a tug of war between the different hormones you create, throwing off that balance can cause your body to attempt to self-adjust as you metabolize the estrogen.
Eg: women who have very low levels of endogenous estrogen after pregnancy or a major surgery are usually give mild doses of testosterone to get their body to start ramping up its estrogen production back to standard levels. My mom went through this, and it worked for her post-hysterectomy.
By adding spiro to the mix you're leaving the estrogen to do its work, and not risk bone loss.


     Hugs,
- Katie
Sent from my iPhone using Tapatalk

Fully agree on all of this.
In fact my endo insisted Spiro for a full month prior to Estradiol.

[Obfuskatie]

Did your mom have her ovaries removed or just uterus? Just making sure. T or E would actually decrease ovary production as LH and FSH are reduced with either T or E treatment. Both E and T would help alleviate menopausal symptoms and improve well-being except T would masculinize her when E wouldn't. Still makes no sense to me. Bio-identical estradiol is quite safe and is available for a long time as intramuscular injections.

Not if it will result in menopausal symptoms. E also reduces T.

Just her uterus, after she having a prolapse a couple years after having me, her youngest of two kids.

Yes T or E would decrease production in fully functional ovaries. The problem is that they were not functioning at the time. Imagine something like PCOS or whatever, after her hysterectomy, her cycle didn't resume until after receiving T for a short period of time. Yes, it caused her body hair to get darker and grow thicker for a couple months, but those effects went away because she didn't take T over the long term.

Bio-identical hormones are safe-ish, but remember that this was not done yesterday, it was in the late 80s. At the time, there had been a moratorium on prescribing long-term estrogen supplements for menopausal women because of breast cancer, heart disease and clotting(thrombosis) concerns. E CAN reduce testosterone, but it doesn't always. E and progesterone are both able to metabolize into testosterone if given too much as well.

I think it makes more sense if you think about our hormonal systems as a group of machines(glands) that process and secrete the hormones that act in our bodies. The pills and injections and etc. add a surplus of the raw ingredients for our glands and metabolism to work with. In my mom's case, the flux of T(the catalyst) was processed and the surplus converted back to estrogen by her ovaries causing them to start up again.

[KayXo]

E and progesterone are both able to metabolize into testosterone if given too much as well.

E can't ever metabolize to T, it is chemically impossible. Otherwise, pregnant women with very high levels of E would experience androgenic symptoms and E would NEVER be prescribed in such high doses to men with prostate cancer when it is.
http://www.genome.jp/kegg/pathway/hsa/hsa00140.html
http://www.angelfire.com/sc3/toxchick/images/S/steroidogenesis.gif
http://tau.amegroups.com/article/viewFile/2762/3634/49844

My levels of E are between 1,000-4,000 pg/ml, my total T at 8 ng/dl, free T undetectable. I also take a high dose of P and although P can chemically convert to T, it seems not to. My T levels are lower since adding P, not higher.

Fertil Steril. 2002 Jun;77(6):1125-7.

"To determine whether the use of oral micronized progesterone (OMP) to induce withdrawal bleeding in women suspected of having polycystic ovary syndrome (PCOS) alters circulating androgen levels. »

"Blood was sampled before (week 0) and weekly after (weeks 1 to 4) the administration of OMP (Prometrium, Solvay Pharmaceuticals, Marietta, GA)". Dose was close to what I take, considered high by transsexual women standards.

"The mean values of TT, FT, SHBG, DHEAS, A4, and 17-OHP did not change with OMP administration. However, a higher 17-OHP level was observable at the completion of OMP administration (week 2)."

"We conclude that the administration of OMP (...) to induce withdrawal bleeding in women with PCOS does not significantly alter circulating androgen or 17-OHP levels, and can be used to time blood sampling in these patients."

In my mom's case, the flux of T(the catalyst) was processed and the surplus converted back to estrogen by her ovaries causing them to start up again.

These are speculations. I am not sure T was needed at all or I ignore the mechanism.

[Randi]

E and progesterone are both able to metabolize into testosterone if given too much as well.

E can never metabolize into testosterone.  Progesterone can.

Here's a simple chart that shows how various steroids can transform:

http://www.ceri.com/q_v7n2q3.htm

[Dena]

E can never metabolize into testosterone.  Progesterone can.

Here's a simple chart that shows how various steroids can transform:

http://www.ceri.com/q_v7n2q3.htm

I am still looking for the "simple" chart.

[WendyA]

Spiro causes your testosterone to lower significantly and we need a replacement hormone to stay balanced. Otherwise we are susceptible to premature bone density loss and osteoporosis.

This is why you shouldn't take spiro by itself for a prolonged time.  Prolonged spiro usage without estrogen may put you at risk of bone loss.  But the opposite is not true.

By adding spiro to the mix you're leaving the estrogen to do its work, and not risk bone loss.

Adding spiro to the mix may indeed aid in the feminization process, but using estrogen without spiro does not put you at risk of bone loss or as far as I can tell, if it is bio-identical, at risk for anything else.