Doctor stated that Spironolactone doesn't help with anything but facial hair ??

[primrose]

I've been ONLY on estradiol and my T levels were brought down from 10 to 1.1 within three months after starting. I'm on private care in England with a doctor who deals with trans people and he rarely prescribes blockers due to the possible side effects. He told me spiro is predominantly used in America and that in England we do things differently.

[KayXo]

I tend to agree with your doctor as E alone is able to sufficiently lower T without the side-effects sometimes associated with anti-androgens. Your T is probably total testosterone? In nmol/L like in Canada.

So translated into ng/dl (for Americans), equals to

Baseline: 288 ng/dl, quite low already
3 months after HRT: 32 ng/dl

How are you taking your E? And if oral, is it estradiol or ethinyl estradiol in birth control pills?

[Gabstar]

Spironolactone is a steriodal antiandrogen and widely used (see NICE treatment guidlines for MTF) in conjunction with estrogen therapy. Its antiandrogen effects help reduce male body hair (not facial), and enhaces the feminising effect of estrogen by blocking testosterone. High doses significantly aid in reducing body hair  unwanted erections and reduction in gonad size. It is relatively safe but care needs to be taken to ensure that one does not develooe hyperkalemia(too much blood potassium- leading to heart irregularities which can be fatal. Always take under medical supervision.



<dosages removed by Admin>

[Jessica]

@Gabstar

Spironolactone is a steriodal antiandrogen and widely used (see NICE treatment guidlines for MTF) in conjunction with estrogen therapy. Its antiandrogen effects help reduce male body hair (not facial), and enhaces the feminising effect of estrogen by blocking testosterone. High doses significantly aid in reducing body hair  unwanted erections and reduction in gonad size. It is relatively safe but care needs to be taken to ensure that one does not develooe hyperkalemia(too much blood potassium- leading to heart irregularities which can be fatal. Always take under medical supervision.



<dosages removed by Admin>

Hi Gabstar, Welcome to Susan's Place!  I'm Jessica.
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@Gabstar
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[AnneK]

Of course there are other anti-androgens than spiro.  For example, I'm on dutasteride for BPH.  I just have to convince my doctor to prescribe Estradiol.   

Here's what Rainbow Health, in Toronto, says:

Spironolactone has traditionally been used preferentially as it
was thought to have a superior safety profile. This practice
has recently come into question as it has been anecdotally
noted that adequate anti-androgen effects are achievable at
lower doses of cyproterone at which adverse effects are less
likely. Thus the choice of anti-androgen should be made
individually for each client based on their medical history and
preference regarding respective side effect profiles.
Following orchiectomy (+/- vaginoplasty), most trans women
will not require androgen suppression. The androgen-blocker
can be tapered over the course of 4-6 weeks

[Virginia]

It's important to know how the body regulates hormone levels to understand how anti-androgens and supplemental estrogen work to affect it. When testosterone levels are high, the body converts the excess/free testosterone to estrogen. The increased estrogen level in the body triggers the pituitary gland to reduce the amount of testosterone produced by the testes in an attempt to bring testosterone levels back to normal.

Spironolactone and other anti-androgens have a twofold affect; blocking the testosterone receptor sites in the body to limit the body's reaction to testosterone; and increasing the level of estrogen in the blood/lowering the production of testosterone by the above mechanism. Anti-androgens can be thought of as a "soft" way of shutting down the testicles. Depending on how quickly a person's body converts free testosterone to estrogen, this process may take some time and will likely not bring estrogen levels to a female normal range

Supplemental estrogen reduces testosterone production directly. Alone it will not block the "effects" of testosterone, but it stops production altogether. Spironolactone can play an important role early on in an HRT regimen by blocking the effects of testosterone. As the testes decrease production of testosterone by the above mechanism, there is increasingly less need to "block" the effects of testosterone or to continue taking an anti-androgen. Low levels of testosterone can be maintained with supplemental estrogen alone until the testes atrophy or are removed via castration or gender reassignment surgery.

[AnneK]

I just found this article:

Information on Estrogen Hormone Therapy
https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy

It has some mention of spironolactone, as well as finasteride and dutasteride.