Efficacy of Spirinolactone

[Celine]

Hello all,

I'm a 68yo AMAB in Maine (USA) hoping to finally move toward some sort of transition; it's been a rough life from the disphoria standpoint...

As I have been researching hormone regimes, I've noticed a number of anecdotal reports about poor results from the common (USA) use of spirinolactone to suppress testosterone for mtf transitioners. Some info can be found here: https://moderntranshormones.com/. Today I found news of a relatively new study on the Medscape website with more damning results https://www.medscape.com/viewarticle/893280 claiming 75% of Transgender Women Fail to Suppress Testosterone to female levels with spirinolactone. I can't get to the formal report, but Medscape summarizes it. I'd love to read the whole paper if I could get my hands on it.

Has anyone else out there been seeing similar reporting of failures of spiro?

Celine

[josie76]

According to my endocrinologist, Spiro is a shortcut. It does not surpress T production directly on it's own. It simply latches to and then makes unavailable the cells androgen receptor. Spiro can by a side effect lower T production but it's not a direct effect or even a garentee.

My endocrinologist uses Spiro to help lift the mental effects of testosterone. Estradiol then is what causes the body to lower T production. Enough E will drop T into female range but Spiro helps stop T effect on the body even at the lower production levels.

For me Spiro did help. It helped to slow body hair untill it mostly thinned. However after I had an orchiectomy I quit taking Spiro and have had some times where body hair grows a bit. It's not bad but every so often it's like my body has a flush of growth. My endocrinologist asked me iff I wanted to stay on Spiro at the lowest dose because even after removing the T production, the adrenal gland produce other androgens type hormones. These can stimulate body hair even though those hormones do not work like T and cannot be converted into T or DHT.

[Sarahthenerd]

Welcome,
I believe Spiro is used so commonly because of its cost and availability. It's efficacy is pretty much up to the biology of the individual, however I'm sure it would not be used if it didn't have a decent record. All drugs are like this to some extent. With side effects, and possible interactions to other drugs.

This would be something an endocrinologist would have no problem detecting, and there are other drugs that can be substituted if it's necessary.

I'm still learning the biology behind transition myself. And am definitely not a medical professional. But my best advice is to seek a professional, your pcp or a therapist is a great start.

Sent from my P00A using Tapatalk

[Dani]

Spironolactone will suppress Testosterone receptors if the dose is high enough. Since we cannot mention dosages here, I cannot tell you what dose you need to suppress Testosterone. I will tell you that the dose to suppress Testosterone is much higher than the cardiac dosages. This usually means that the side effects are more common.

I started my transition in my mid 60's as well and I was on Spironolactone at the higher T suppression doses until my testes were removed during GCS. Spironolactone worked for me just like it does for many other people who need to suppress Testosterone. I had no troublesome side effects except for being thirsty all the time.

[christinej78]

Hello all,

I'm a 68yo AMAB in Maine (USA) hoping to finally move toward some sort of transition; it's been a rough life from the disphoria standpoint...

As I have been researching hormone regimes, I've noticed a number of anecdotal reports about poor results from the common (USA) use of spirinolactone to suppress testosterone for mtf transitioners. Some info can be found here: https://moderntranshormones.com/. Today I found news of a relatively new study on the Medscape website with more damning results https://www.medscape.com/viewarticle/893280 claiming 75% of Transgender Women Fail to Suppress Testosterone to female levels with spirinolactone. I can't get to the formal report, but Medscape summarizes it. I'd love to read the whole paper if I could get my hands on it.

Has anyone else out there been seeing similar reporting of failures of spiro?

Celine

Hi Celine,                       11 September 2018

I never used spiro or any other AA; I started on Estradiol 27 March 2018 and had my orchie on Friday 13 April 2018. Prior to doing anything, I did a lot of research; I found too many negative side affect from spiro, a potassium sparing diuretic. It's use as an AA is an off label use of this drug, which is used to treat heart failure. I personally have an aversion to all drugs but am realistic enough to realize some are necessary, as is my Estradiol transdermal patch system.

Prior to HRT (Estradiol) my prostate was quite enlarged making it very difficult to urinate. I was taking Flomax, which provided little relief. At four days on HRT I was peeing normally for the first time in 20 years. I stopped Flomax and use my HRT patch system as prescribed. One of the reasons I had my orchie so soon after beginning HRT was to rid my body of Testosterone production and the nasty side affects from it, and to reduce the possibility of contracting prostate cancer. Yes, the adrenal gland produces testosterone, but usually at the female level.

I was 77 at the time I started; yes, I know, I waited longer than I should have. I just chalk it up to ignorance on my part. I have now gained some knowledge and am enjoying the ride.

I wish you all the luck in the world on your trip along the Transition Highway.

Best Always, Love
Chris

[jade_d]

From personal experience I started with a mid range dose of Estradiol Hemihydrate, and after 6 months my T was not where I wanted it to be and I started on the average dose of spiro and my T levels bombed out so hard my doctor was worried I would get depressed and lethargic, which was not the case. I only peed a lot during the first month, then my body got used to it.

Personally spiro was a god send for me.

[Chloe]

. . . used so commonly because of its cost and availability

        Celine from a strictly cost/benefit/dosage pov Spironolactone is not necessarily the best choice, especially if older (and prone to prostrate cancer). I do not use insurance, have always paid meds in cash and, with the greater availability of generics these days, have found a regimen of Bicalutamide can actually be cheaper (than spiro) with greater benefit and less side effects.

Of course that's just "me" results may vary 

[KathyLauren]

Hello all,

I'm a 68yo AMAB in Maine (USA) hoping to finally move toward some sort of transition; it's been a rough life from the disphoria standpoint...

Hi, Celine!

Welcome to Susan's Place.  We are almost neighbours: I am in Nova Scotia.

I can't speak about spiro alone for T suppression: my doctor started me on spiro and estradiol together.  My understanding is that it is E that reduces the T levels, and the spiro is just there to catch any T that manages to get into circulation.

I am 63, and my T levels come back from the lab at < 0.1 nmol/l, which is lab-speak for off-scale low, or unmeasureable.   

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[Celine]

Welcome to Susan's Place.  We are almost neighbours: I am in Nova Scotia.

I can't speak about spiro alone for T suppression: my doctor started me on spiro and estradiol together.  My understanding is that it is E that reduces the T levels, and the spiro is just there to catch any T that manages to get into circulation.

I am 63, and my T levels come back from the lab at < 0.1 nmol/l, which is lab-speak for off-scale low, or unmeasureable.   

Hi Kathy, thanks for the welcome, and the info on the real function of the Spiro. I've known that estradiol alone will suppress T to female levels, but in researching I'd not picked up on spiro being a secondary suppressor. I've seen in various places descriptions of mtf regimens that start out with spiro and later on introduce estradiol; based on that I'd assumed that spiro was the primary T suppressor when it was used.

I'm dealing with prostate issues (no cancer, just enlargement) and I'm hoping to be able to do the orchiectomy pretty quickly to put the brakes on the prostate, skip the spiro and also be able to use lower doses of estradiol. My researching the hormones turned up the issues with spiro and I thought I'd ask here what was going on.

I've been here for quite some time in the background; I really haven't had much to offer and much to learn so I haven't posted before now. I should be a bit more visible in the future as I hopefully progress beyond my static position.

It's interesting hearing you're from Nova Scotia; my wife and I spent some time up there in 2009 looking at some properties as possible retirement options. We really fell in love with Cape Breton, but there just was no way to make US medical insurance/care work. We love the north country (more than 100 family years with a summer place near Peterborough, Ontario) so Maine ended up as a second choice. We are originally from Ohio but had been in Houston for 35 years and it was quite a change becoming aquainted with real north country winters. Perhaps we can meet up one of these days after I get the ball rolling...

Thanks again,
Celine

[Celine]

I never used spiro or any other AA; I started on Estradiol 27 March 2018 and had my orchie on Friday 13 April 2018. Prior to doing anything, I did a lot of research; I found too many negative side affect from spiro, a potassium sparing diuretic. It's use as an AA is an off label use of this drug, which is used to treat heart failure. I personally have an aversion to all drugs but am realistic enough to realize some are necessary, as is my Estradiol transdermal patch system.

Prior to HRT (Estradiol) my prostate was quite enlarged making it very difficult to urinate. I was taking Flomax, which provided little relief.

Hi Christine, I'm starting out at a point similar to what you describe. I'm been on finasteride and tamsulosin (Flomax) for several months. It's still too soon for any relief from the finasteride; the tamsulosin has helped a bit but I discontinued using it last week as one of its' known side effects really become a problem - nasal/sinus congestion. It was tolerable for a while but became worse over time.

I'm trying to set up an appointment with a new provider with whom I can also discuss the TG issues and push for an early orchiectomy and HRT. I also have some issues with the testes that may provide additional ammo along that route. The urologist who prescribed the fin/tam duo really wasn't concerned with anything beyond the flow problems; I won't be seeing him again.

Thanks for your thoughts, they're much appreciated.

Celine