Taking Bicalutamide with Spironolactone?

[ChloChlo]

So the endo at my local Kaiser is not super up to date on trans medications beyond the classic "estrogen + spiro" combination.  I have read about people discussing the effects of bicalutamide on body hair, which is a big problem for me!  I am going to ask her about it, but I am pretty sure she has never prescribed it before, and I know that it doesn't actually reduce testosterone levels.

My question is would it be easier for her to prescribe both so she can have an idea of the amount of testosterone in my blood?  Has anyone else's doctor gone this route with them?  I feel like I am going to need to take the lead a bit here, so I wan't to have as much info as I can.

Thanks!

[Dani]

My question is would it be easier for her to prescribe both so she can have an idea of the amount of testosterone in my blood? 

Taking more than one drug that does the same thing is usually not a good idea because the additional drugs will expose you to additional side effects.

Having said that, Spironolactone and Bicalutamide work by different methods. Spironolactone inhibits the production of androgens and Bicalutamide works by blocking the androgen receptor. A third type of anti-androgen, such as Finasteride, works by blocking the conversion of Testosterone into Dihydrotestosterone. All three methods are used in transgender hormone therapy, sometimes only one drug, but more often, two drugs are used successfully.

Bicalutamide does have a slight risk of liver problems. In the US, it is not considered first choice therapy.

Testosterone levels are monitored routinely during cross gender hormone therapy.

When I first started anti-androgen therapy, I was on Spironolactone for about a month. then my doctor added Finasteride. Later I added Estradiol to the mix. I took all three for about a year until I had my SRS, then I dropped the Spironolactone. I am happy with the results.

[KayXo]

Taking more than one drug that does the same thing is usually not a good idea because the additional drugs will expose you to additional side effects.

Or, seen from a different angle, taking two drugs may allow one to take less of each drug, thus reducing the potential side-effects associated with each AND also help treatment be more effective by working on two fronts, reducing and blocking androgens like what is often done in men with prostate cancer where a LhRh agonist is combined with bicalutamide.

Having said that, Spironolactone and Bicalutamide work by different methods. Spironolactone inhibits the production of androgens and Bicalutamide works by blocking the androgen receptor.

Spironolactone also blocks androgens, much like bicalutamide but the latter, I think, is more potent.

Bicalutamide does have a slight risk of liver problems. In the US, it is not considered first choice therapy

There were only 5 cases of hepatoxicity noted with bicalutamide in at least 1 million people prescribed this medication so it is indeed quite rare and this was noted in men of an advanced age with cancer. Liver enzymes may increase but this is quite rare too. Liver concerns haven't, however, stopped doctors from prescribing cyproterone acetate to transsexual women for decades, sometimes at quite high doses. So, relatively speaking, I personally think bicalutamide is quite safe. You can read the wiki page for more info.

Testosterone levels are monitored routinely during cross gender hormone therapy.

But misleading because both spiro and bicalutamide block testosterone so even if levels are somewhat high, they are partially blocked.


Good luck with the doctor.

[ChloChlo]

Well, spiro stops the production of testosterone, bica stops the testosterone from binding, but does not decrease the production.

My question was mainly many endo's monitor progress by the amount of testosterone reduced, since Bica doesn't do this, I am worried the endo I will be going to will have no idea how to gauge process.  Thats why I was curious if I should suggest trying both so I get the benefits of Bica while the spiro reduces testosterone so she can see "progress"

[KayXo]

Process can be gauged by breast development, fat distribution, facial changes, body hair distribution, etc. You don't need to measure T levels. The degree of T action can be determined by looking at how oily vs dry your skin/hair is, body odor, body hair thickness/color, increase in subcutaneous fat, decreased muscle mass/strength, less spontaneous erections, decreased libido, shrinking of testicles, amount and thickness of ejaculate.