Is Spiro really that bad??

[KageNiko]

So I finally started HRT a little over a month ago. My doctor asked me if I wanted Spiro as well, since it would help with the feminizing effects.  Before I could start taking the Spiro, however, I started hearing a lot of negative things about it - that it's really bad for your health.  And yet, even though I now know that it's not good for you, I find myself still taking partial doses every once and a while because I'm desperate for the feminization.  I have a few weeks before I see her next, so in the mean time I just do what I do.

Am I being paranoid or is it really bad news?
~Niko

[Dena]

There are three issues with Spiro. You retain potassium so you need to limit your intake. Your body will require more table salt so you will need to up your intake. If you don't have enough you will crave it and muscles cramps may happen. You must also increase your water intake and you will make regular trips to the bathroom. If you don't get enough water, you may have muscle cramps and you may feel weak. Compared to other blockers, Spiro is relatively safe but if you have questions about any of the drugs you take, you should discuss your questions with your doctor.

[Dani]

Spironolactone is the safest, most economical anti-androgen available in the US. As Dena said, the most troublesome side effect is the hyperkalemia (too much potassium). Up to 25% of people taking high dose Spironolactone have experienced hyperkalemia to some degree. Looking at this from the other way around, 75% of these same people have no problem with Spironolactone.

It is important to limit your intake of all foods high in potassium.

Here is a list of foods high in potassium.
Avocado
Acorn squash
Spinach
Sweet potato
Wild-caught salmon
Dried apricots
Pomegranate
Coconut water
White beans
Banana

Also, you may want to stop taking multivitamins with added  minerals and salt substitutes that contain potassium.

On the plus side, once you have GCS or an orchiectomey, you no longer need to take an anti-androgen.

[KathyLauren]

I find spiro is more a nuisance than a problem.  I specifically asked my doctor about sodium and potassium.  She said, don't worry about them unless my blood tests show a problem or I start showing symproms. 

Getting up to pee twice a night is a nuisance, but that's all.  Remembering to take a bottle of water with me everywhere I go is a nuisance.  Luckily, there are no bathroom laws here to violate, because I sure would be putting them to the test if there were!

I really felt a difference that I didn't like when my doctor reduced my spiro dosage, so she upped it again on the next checkup.

Check with your doctor about side effects, specifically sodium (not enough) and potassium (too much), and follow their advice.

[josie76]

Like all medications Spironolactone has side effects.

Lowers blood pressure: for some this is an issue

Low sodium / high potassium: these two are in a balance in the body. Potassium is an important element in nerve tissues but the human body has a narrow range of safe blood levels for it. Sodium blood levels actually control free potassium levels. Spiro flushes sodium but not potassium from the body.
My experiences was not great but controllable. Last year I worked on large machinery outside. In the summer I often had weak and sick spells. I started carrying salt packets from gas station stops with me. When I would start to feel sick I would open two or three packets and pour the salt on my tongue and wash it down with plenty of water. The effect was actually pretty quick and I could continue to function. Hydration and salt intake as well as not eating high potassium foods was important for me working in the heat.

Having to stop and pee a lot: spiro is a diuretic so nothing you can do about needing bathroom breaks. Since I worked on the road I knew the best gas stations to stop at pretty well. 

Spiro has other non target side effects in the body: by blocking the glutocorticoid and mineralcorticoid receptors it does also has a net increase of stress hormone production of cortisol. This stress hormone tends to increase fat storage in the mid section of the body. Not everyone reacts strongly in this way but some do.

Spiro also inhibits a number of enzyme productions. It does tend to slightly lower T production in the body along with blocking the cell receptors. It can have a very mild mixed effect on estrogen receptors which could reduce E effect for some people slightly. Other enzymes inhibition can cause depressive symptoms for some people.

Screenshot Spiro by Josie H, on Flickr


The medical community considers Spiro to be ideal because it has a long use history for blood pressure control and is cheap. It is low risk but has many side effects that are considered mild for most.

What appears to be a more ideal androgen blocker from our perspective as a transgirl is Bicalutamide.
This is an anti-cancer drug invented specifically to block androgen receptors. It is very efficient at doing its purpose and has no secondary endocrine side effects. Its one side effect is 3% of patients have increased liver enzyme levels with about 0.5% needing to stop taking it because levels went above safe so blood monitoring is required like a lot of drugs that can raise liver enzyme levels. Many doctors have never prescribed it because it was a prostate cancer drug so they stick to spiro.

[Devlyn]

Spiro wasn't the end of the world for me,  but I sure was glad to get off it.

[Harley Quinn]

as others have stated... More of an annoyance.  I find the frequent dizzy spells extremely obnoxious... but all in all, its not horrible.  Just watch your fluids and your electrolytes; make sure you keep bathroom access in mind. LOL. I personally do not like Spiro.

[Chloe]

LOL. I personally do not like Spiro.

Was considering 'spiro' for weight loss, water retention (God forbid intended purpose?) but after reading this thread think NOT! Once upon a time used it but Casodex mucho mejor! 

[PurplePelican]

No, spiro is not particularly safe or effective. This is a stance supported by my endo, consulting oncology endo and my GP.. I also have studies to support this. Spiro is also known to have negative neurological and mental health effects. I challenge any one claiming otherwise to show the science.

AA's were first prescribed to trans women back when it was found that conjugated Estrogens, like Premarin, and synthetics, like ethynilestradiol, caused a much greater clot risk than previously thought. Despite the fact that these are not used any more (or shouldn't be), doctors are still reticent to prescribe E only. They continue to prescribe small doses of E with an AA out of a fear of clots that is long since disproven. E alone is sufficient in most people to suppress T, doctors are holding on to the past, despite advances in other areas of medicine.

[Devlyn]

I do miss the salt cravings. Spiro let me eat things I can't now. 

[Kendra]

I don't know from personal experience because I was prescribed just estradiol from the start, never spironolactone.

[Ellement_of_Freedom]

My issue was that it brought my blood pressure so low that I could have fainted at any minute. Not a good situation to be in. If your BP is in normal range (or low normal) you really shouldn't be on Spiro in my opinion. When my doctor took my blood pressure after being on it for about 8 months, I heard a gasp.

[SammyHatesGreenEggs]

As noted elsewhere in this thread, I'm a huge proponent of bicalutamide, due to the lack of side effects.  When doing consultations with endocrinologists with familiarity with the trans population, I primarily picked mine due to his familiarity with bicalutamide.

[Harley Quinn]

Was considering 'spiro' for weight loss, water retention (God forbid intended purpose?) but after reading this thread think NOT! Once upon a time used it but Casodex mucho mejor! 

I haven't seen a "good" effect from using Spiro.  I still get bloated and pee a lot at the same time, and haven't noted any weight loss, just that I have to get up slowly since fast movements get me dizzy/tunnel vision/blackout very quickly.

[Dani]

No, spiro is not particularly safe or effective. This is a stance supported by my endo, consulting oncology endo and my GP.. I also have studies to support this. Spiro is also known to have negative neurological and mental health effects. I challenge any one claiming otherwise to show the science.

I do challenge your assertion that Spironolactone is not particularly safe or effective. For every drug we ingest, we must weigh the benefits versus the adverse side effects. Every drug has it's adverse side effects.

Most all of the side effects from Spironolactone are expected consequences of what the drug does and how it works. This includes breast tenderness and enlargement, low blood pressure and electrolyte imbalances. 

For the intended purposes, as defined by the US Food and Drug Administration, Spironolactone is safe for human use. This does not mean that we can have a free for all and take this drug whenever the notion strikes us. Dosages must be carefully adjusted to give the patient an acceptable response. With the large doses needed to suppress the Testosterone receptors, the adverse side effects do become more frequent.

For the purpose of blocking Testosterone receptors, Spironolactone is very effective. It does have it's side effects and if any one particular patient cannot tolerate the side effects, then they should not take Spironolactone. There are many other people who can take Spironolactone and are not bothered by the potential side effects. A blanket condemnation of Spironolactone is not warranted. When safer, more effective alternatives become available, doctors will shift their prescribing to the newer drugs. 

I say this as a licenced Pharmacist for over 40 years.

If you have experienced a bad reaction, there are other drugs available that will also block the Testosterone receptors. Consult your doctor.

[PurplePelican]

I do challenge your assertion that Spironolactone is not particularly safe or effective. For every drug we ingest, we must weigh the benefits versus the adverse side effects. Every drug has it's adverse side effects.

Most all of the side effects from Spironolactone are expected consequences of what the drug does and how it works. This includes breast tenderness and enlargement, low blood pressure and electrolyte imbalances. 

For the intended purposes, as defined by the US Food and Drug Administration, Spironolactone is safe for human use. This does not mean that we can have a free for all and take this drug whenever the notion strikes us. Dosages must be carefully adjusted to give the patient an acceptable response. With the large doses needed to suppress the Testosterone receptors, the adverse side effects do become more frequent.

For the purpose of blocking Testosterone receptors, Spironolactone is very effective. It does have it's side effects and if any one particular patient cannot tolerate the side effects, then they should not take Spironolactone. There are many other people who can take Spironolactone and are not bothered by the potential side effects. A blanket condemnation of Spironolactone is not warranted. When safer, more effective alternatives become available, doctors will shift their prescribing to the newer drugs. 

I say this as a licenced Pharmacist for over 40 years.

If you have experienced a bad reaction, there are other drugs available that will also block the Testosterone receptors. Consult your doctor.

No problems, I'll dig up the studies..

Why block when you can stop production?

In the meantime, riddle me this, Madame Pharmacist, why take a drug that is not needed and has the side effect profile spiro does? Because, as a pharmacist, you should be aware that E alone will suppress T at the right levels - it's been part of oncology protocols for some time.

[Ellement_of_Freedom]

For the purpose of blocking Testosterone receptors, Spironolactone is very effective.

Absolutely not true, it takes a long time to be effective.

Pharmacists do not consult with transgender patients extensively nor review results of blood tests regularly to see the results of Spironolactone across a variety of people. Doctors do that, and mine happens to dislike Spironolactone.

[Dani]

No problems, I'll dig up the studies..

Why block when you can stop production?

In the meantime, riddle me this, Madame Pharmacist, why take a drug that is not needed and has the side effect profile spiro does? Because, as a pharmacist, you should be aware that E alone will suppress T at the right levels - it's been part of oncology protocols for some time.

We all need to have our Estradiol levels high enough to stop the Testosterone production in order to not require Spironolactone. This does not happen right away.

Spironolactone was originally developed as a potassium sparing diuretic designed to lower blood pressure. It is very effective for this purpose.

Later on, Spironolactone was found to block Testosterone receptors. For men with certain prostate issues, this is still a very important indication. Because of this, Spironolactone was added to the HRT regimen for MTF transgender seeking gender reassignment. Keep in mind, that this was done when Premarin was the primary source of estrogens.  We have improved our estrogen sources, but the need for a Testosterone blocker is still considered appropriate for HRT, especially in the first stages of HRT.

Once you have established an effective Estradiol regimen, as evidenced by low Testosterone blood levels, there is little need for a Testosterone blocker. Other Testosterone blockers such as Bicalutamide and Cyproterone (Androcur) are used elsewhere.

I took Spironolactone for about 14 months at the beginning of my transition. I feel that it helped to jump start the changes in my body. Once I had GCS, the Spironolactone was the first drug off my HRT regimen. It has a purpose, but needs to used with extreme caution.

Absolutely not true, it takes a long time to be effective.

I noticed physical changes to my body within 3 months of starting Spironolactone. I do not consider this to be a long time.

Pharmacists do not consult with transgender patients extensively nor review results of blood tests regularly to see the results of Spironolactone across a variety of people. Doctors do that, and mine happens to dislike Spironolactone.

For most of my working life, I worked in hospitals where I had computerized access to patients medical records, including their lab results. I also, have counselled patients many times on proper use of their prescribed medication. This includes transgender patients, of which, many have thanked me for useful information on what to expect and what to look out for. Even when I am not working, people come to me for advice on their medications. This is what Pharmacists in the US do.

All of us need to keep in mind that drug therapy of any kind is not a static thing. There are always improvements and newer, better ways to achieve our health goals. Opinions of the prescribers vary. Some are quick to adopt changes, while others are more inclined to wait for more compelling evidence before changing their prescribing preferences.

[Ellement_of_Freedom]

I noticed physical changes to my body within 3 months of starting Spironolactone. I do not consider this to be a long time.

If you're going off personal experience to claim that Spiro is very effective at blocking T receptors, I think it's inappropriate to follow up with "I say this as a licenced Pharmacist for over 40 years."

[Cindy]

 

I am am watching this discussion and keep it civil.