Dropped Spironolactone 2 months ago, just got my blood work back

[Harley Quinn]

2 months off Spironolactone. Got my blood tests back and looks like my T will stay down. My end of cycle numbers on weekly IM injections.

Estradiol 226.5 pg/ml
Testosterone total 0.2 ng/ml
FSH 0.4 mlU/ml
LH 0.4 mlU/ml

My Estradiol went up 40 pg/ml from when I was on Spironolactone. Weird. Does that look ok? FSH and LH went up from 0.1 to 0.4.  I am unsure about if that may be concerning?

[KayXo]

On injections alone, T is usually suppressed to castrate levels so yea, not very surprising. LH and FSH, very low so not much activity taking place in and around gonads. 

Estradiol levels fluctuate quite a bit on injections so will always be higher or lower. Spiro actually tends to raise estradiol levels, based on several studies.

[Harley Quinn]

I heard back from the doctor and she wants me back on Spiro. 

[flytrap]

Would you mind sharing why you are trying to eliminate this medication from your regimen?

[KayXo]

I heard back from the doctor and she wants me back on Spiro. 

Why? Did she give you a reason? Just curious to find out...

[Harley Quinn]

Would you mind sharing why you are trying to eliminate this medication from your regimen?

I hate being on a low potassium diet, dislike taking a lot of medications, and constant urination is annoying. 

Why? Did she give you a reason? Just curious to find out...

the slight rise in my LH and FSH has her concerned that my testosterone levels may increase.  they were both at .1 with spiro and now at .4 with no spiro.

[KayXo]

Studies indicate spiro does not affect/reduce LH or FSH because of its very weak progestogenic relative to anti-androgenic activity. Sometimes, LH can even increase on it. Spironolactone appears to reduce testosterone through three mechanisms: 1) inhibition of the P450 cytochrome 2) increased metabolic clearance of T and displacement from SHBG 3) increased aromatization to estradiol.

You can perhaps bring this up and see what your doctor says? I can pm you the studies if you want.

[Harley Quinn]

Please. That would be wonderful. 🙂

[josie76]

My endocrinologist says spiro is a way to shortcut the turning off of testosterone and relieve its mental effects quickly. In my very first visit with him he said estrogen will do that on its own. My endo is a BJC Center for Advanced Medicine doctor and a Wash U St. Louis associate professor and has treated trans patients for decades. He prescribes spiro but is fine with the patient dropping it when they have supressed their T levels. I have cut mine down by half. When I get another blood test and the levels remain low, I will cut it again.

Spironolactone has a binding affinity for the cellular Androgen Receptor with a very mild agonism effect. It makes the receptors unavailable for androgen hormones. Spiro has a number of negative enzymatic effects. These are needed for further production of some androgen hormones and others.
17a-hydroxylase CYP17A1
17/20 lyase        CYP17A1
18 hydroxylase   CYP11B2
21 hydroxylase 
cholesterol side chain cleavage enzyme CYP11A1

By its mineralcorticoid receptor antagonism it prevents the body's normal feedback system, it actually increases ACTH production causing the adrenal gland to increase output of both mineralcorticoids and glutocorticoids leading to increased cortisol levels.



Screenshot Spiro by Josie H, on Flickr

[Transfused]

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I am on patches, 1 every 3 days, and I do not experience symptoms of testosterone returning.

I have a low libido, soft skin, feminine body odor and still feeling peaceful. I do not get misgendered.

I recently had my blood tested : Free T is at 0.100 ng/dl, Total T is at 17 ng/dl. Estradiol is at 114 pg/ml.

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Hugs,
Transfused.

[Kendra]

Susan has made clear on this link pinned to page 1 of this HRT forum: "You are prohibited from making medical diagnoses or recommending a specific product, or course of treatment" on this site.

[Devlyn]

Would you mind sharing why you are trying to eliminate this medication from your regimen?

I can say that getting off Spiro was one of the best things that's happened to me recently, for the same reasons Harley gave, also my blood pressure was into the hypotension range. Sigh...I do miss the salt cravings, though.    I can't eat like that without the Spiro!

Hugs, Devlyn

[flytrap]

It sounds like I'm in the lucky minority. I don't like any high potassium foods, Spiro doesn't make me pee or affect my stamina or blood pressure, and I wouldn't notice one less pill in the handful of vitamins I take every morning. But there is NOTHING that would make me risk toppling the apple cart that has been working for eight years and bringing back my dysphoria.

[laurenb]

The question I have is whether after prolonged use of Spiro, have the gonads been permanently neutralized.

If so, then why undergo an orchi, other than the physical presence of them.

At this point, in my case (1+yr on Spiro), they're no longer of any size that they bother me. I'd love to step down on the Spiro at some point and just stay on E. I worry about hyperkalemia because I'm a vegetarian. 

[KayXo]

The question I have is whether after prolonged use of Spiro, have the gonads been permanently neutralized.

Spiro does not always reduce testicular/adrenal secretion of androgens (or decrease T levels in general), even at very high doses, based on several studies. The reduction in testosterone may well be entirely due to estrogen. Spiro, however, seems to always undoubtedly block androgens.

At this point, in my case (1+yr on Spiro), they're no longer of any size that they bother me. I'd love to step down on the Spiro at some point and just stay on E. I worry about hyperkalemia because I'm a vegetarian.

Some women have stopped Spiro and found it was fine. You absolutely need to discuss this with your doctor before doing anything. Best of luck.

[Harley Quinn]

I can say that getting off Spiro was one of the best things that's happened to me recently, for the same reasons Harley gave, also my blood pressure was into the hypotension range. Sigh...I do miss the salt cravings, though.    I can't eat like that without the Spiro!

Hugs, Devlyn

Yeah, I crave the salt on a basket of Fries... which is off the menu due to the potassium restriction.  So it's a double edged sword.  I boarder on the hypotension range.  I was just getting used to not having the dizzy spells.  Thanks for reminding me. 

[Devlyn]

I actually went down and held onto the carpet a few times because it beats hitting it from five and a half feet up. 

Hugs, evlyn

[Bari Jo]

Victoria, your doctor and my doctor must be reading the same studies.  Mine is tapering me off slowly from Spiro too.  She says my e levels are now high enough to suppress t production on their own.  I'm all for that, less drugs in my system.  My total t measured 8 ng/ml and e at 355 pg/ml last week.  I'm on pellets for e.  I will miss the salt cravings too.  Interesting about bp though.  Isn't Spiro supposed to lower bp?  Mine didn't change much at all.

Bari Jo

[Deborah]

My blood pressure never really got low either. 


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[Devlyn]

Victoria, your doctor and my doctor must be reading the same studies.  Mine is tapering me off slowly from Spiro too.  She says my e levels are now high enough to suppress t production on their own.  I'm all for that, less drugs in my system.  My total t measured 8 ng/ml and e at 355 pg/ml last week.  I'm on pellets for e.  I will miss the salt cravings too.  Interesting about bp though.  Isn't Spiro supposed to lower bp?  Mine didn't change much at all.

Bari Jo

It does lower BP for some people, I would faint if I stood up too quickly. Hypotension is abnormally low BP.

Hugs, Devlyn