HRT question

[Astyria]

I have a question to ask and would appreciate insight.

I am under the care of a good endocrinologist.  She is intelligent, sympathetic and caring.  However, I seem to be running into a problem that we dont quite fully understand yet...so I thought that I would ask here to see if anyone else was either experiencing or had experienced the same thing.

I feel fine just taking estradiol...wonderful even.  However, when I take spirolactone and/or finestride, it feels as though I hit a brick wall and am really fatigued.  My endocrinologist says that the spiro shouldnt be affecting me that way, but it's proving differently.  We are working on problem solving it, but I was wondering if anyone had any similar problems.  I dont know if it's an intolerance to the pill itself, or if my body cant function with the reduced testosterone...or maybe the combination of the estradiol and it.  I've also thought about an orchiectomy, but if the truth of the matter is that my body has a problem with low testosterone, then that probably wouldnt be good to go thru with...

Thank you,

Astyria.

[LynnER]

How long has this been going on?
When you go on a full HRT regimine at first it usualy causes fatuige.... and after being on it for a while, going off does the same thing... and Ive heard it can last as long as a few weeks....   Try breaking your spiro in half and space out when you take it (with your doctors permission ofcorse)... it might help...

[tinkerbell]

May I ask why you are on both medications, spironolactone and Finasteride?  I am not a doctor but I work in the health care industry.  Normally when anti-androgens are given to TS patients, endos or physicians opt to prescribe only one form of anti-androgen, the most common (in TS patients) prescribed anti-androgen medication in the US is Aldactone, or Spironolactone as it is mostly known.  Finasteride (or Proscar, Propecia) is mainly prescribed to prevent male pattern baldness, so you may want to talk to your prescribing physician.  It woud seem that your blood pressure tends to go down (result= fatigue) which is very common in patients who are on Spiro.  Neverthless, perhaps your dosage needs to be adjusted or maybe one of the two drugs (spiro or finasteride) needs to be discontinued all together.

tinkerbell

PRESCRIBED FOR: Spironolactone is used as a diuretic to remove the excess fluid caused by congestive heart failure, cirrhosis of the liver, and kidney disease. It can also be used to treat elevated blood pressure in combination with other drugs and in resistant cases of low potassium (hypokalemia). Spironolactone is also used to counteract the effects of excessive adrenal aldosterone production. Aldosterone overproduction can occur from a tumor in the adrenal gland, or when enlarged adrenal glands produce an excessive amount of aldosterone.

DOSING: May be taken with or without food.

DRUG INTERACTIONS: Spironolactone can lower blood sodium levels while raising flood potassium levels. Excessively high blood potassium levels can lead to potentially life-threatening heart rhythm abnormalities. Therefore, spironolactone usually is not administered with other agents that can raise blood potassium levels, such as potassium supplements, ACE inhibitors, indometacin (Indocin), or other potassium-sparing diuretics. Spironolactone can cause elevation of blood digoxin (Lanoxin) levels, requiring adjustment of the digoxin dosage.

SIDE EFFECTS: Enlargement of the breasts (gynecomastia) is a not infrequent side effect. Rare side effects include diarrhea, cramps, drowsiness, rash, impotence, irregular menstrual periods, and irregular hair growth.

GENERIC NAME: finasteride
BRAND NAME: Proscar
DRUG CLASS AND MECHANISM: The prostate gland is located around the tube which empties urine from the bladder (urethra). As the prostate gland enlarges, usually after 50 years of age, it can obstruct or partially block the urine flow. This leads to symptoms which include dribbling of urine, narrow stream, problems starting urine flow, interruption while urinating, and a feeling of incomplete emptying. Other symptoms include wetting and staining of clothes, urinary burning, and urgency.

Prostate gland enlargement (Benign Prostatic Hyperplasia or BPH), is directly dependent on DHT (a hormone converted from the male hormone testosterone). Finasteride inhibits the enzyme necessary for the conversion of testosterone to DHT in the prostate. Therefore, administration of finasteride lowers blood and tissue DHT levels and helps reduce the size of the prostate gland.

Although reductions in the size of the prostate gland can occur in virtually all the patients who take finasteride, only 50% will experience improvement in the symptoms of BPH. Patients generally respond to finasteride in several weeks, but it often takes 6 months for the patient to receive the full effect of the drug.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Tablet *****(mg).

STORAGE: Finasteride should be stored at room temperature in a tight light resistant container.

PRESCRIBED FOR: Finasteride is used to treat symptoms of BPH. Finasteride is approved for use with the alpha-blocker, doxazosin, to reduce the progression of symptoms of BPH.

DOSING: Finasteride is metabolized mainly by the liver, and caution should be used in patients with liver dysfunction. Finasteride may be taken with or without food.

DRUG INTERACTIONS: Drug interactions are generally not a problem.

[Astyria]

When I started, I started with just the estradiol...eased into it.  No problems.  After a while I started in on the spiro.  That's when I started experiencing some fatigue, but i could live with it.  This went on for about six months when I had to move and subsequently had to get a new doctor (I was also fairly fatigued, but could still manage).  This new doctor took me off estradiol and put me on delestrogen shots and spiro...but, he was more of a quack than anything.  After some research I found that he had me on double the normal dose for deles.  So, I left him, went back on my orals, and went in search of a new doctor, the endocrinologist (which i found with the help of my therapist).  However, this took some time...and in the meantime I had migraine headaches starting up.  Or rather, I dont know if they were true migranes or not, but i had days where i felt like dying, and weeks where i just had this dull cotton-headed pain that wouldnt go away for love nor money.

The endocrinologist had me continue with the orals since that is what had worked well in the past.  But, I couldnt get rid of the headaches and the fatigue was worse...I was pretty sure it was the spiro due to some past experiences, but she was confused how this could be since it was used in other therapies with no real report of fatigue...so, she took me off spiro and had me try finastride.  Unfortunately this did not really do anything to help and the headaches got to the point where i decided that i needed to come off of everything.

After I stopped all meds, it took about a month for everything to subside.  No more headaches and energy levels are back up.  Kindof a "resetting" period.  I then consulted the endo and we decided to try just the estradiol....and then just the spiro and see how things go.  We can then make a decision of whether or not to continue and if so, how.

Currently I'm just taking estradiol.  I feel fantastic...no headaches, no real fatigue.  I did cheat once and try a spiro, but it was almost immediate fatigue akin to taking an ambien for sleep.  Im just wondering if anyone else has experienced anything like this and/or might know what is happening.

And just to make sure i clearly answer one of the questions...no, i am not taking spiro and finas at the same time. =)...it was an attempt to troubleshoot whether or not the spiro was causing me problems.  I'm starting to think that for whatever reason my body cannot deal with the decrease in testosterone...sigh.

Again, Thank you,

Astyria.

[HelenW]

May I ask why you are on both medications, spironolactone and Finasteride?  I am not a doctor but I work in the health care industry.  Normally when anti-androgens are given to TS patients, endos or physicians opt to prescribe only one form of anti-androgen, the most common (in TS patients) prescribed anti-androgen medication in the US is Aldactone, or Spironolactone as it is mostly known.  Finasteride (or Proscar, Propecia) is mainly prescribed to prevent male pattern baldness, so you may want to talk to your prescribing physician.  It woud seem that your blood pressure tends to go down (result= fatigue) which is very common in patients who are on Spiro.  Neverthless, perhaps your dosage needs to be adjusted or maybe one of the two drugs (spiro or finasteride) needs to be discontinued all together.

tinkerbell

I was prescribed Avodart, last March, as a treatment for an enlarged prostate.  Finasteride is also used for that purpose, at higher doses than are used to treat male pattern baldness.  The two drugs inhibit the action of enzymes that convert testosterone into a more potent form called dihydrotestosterone.

I'm still taking Avodart along with Spiro and Estradiol.  I figure that my endo continued it because it would inhibit the testosterone that the spiro didn't "get" and keep it from being transformed into its more potent form.  I'm on a lower than usual dose of spiro so that may be why my endo has me continuing the avodart.

Astyria, take a peek at our WIKI at https://www.susans.org/wiki/Main_Page  for more information about HRT, it's quite good, imo.  And please, if you would, let us know a little more about yourself with an intro in our Introductions forum.  It's not required but it would be nice to get to know you better.

I hope you and your doc get the drug thing sorted out!

hugs & smiles
helen

[tinkerbell]

It has always been my opinion that the less medication one takes the better although I am aware that sometimes that is not possible for a number of reasons.

Helen, hopefully as you continue with your estrogen therapy, your prostatic hyperplasia will improve and you will not need the Avodart.  As for Astyria, as I said on my previous post, probably your dosage needs to be adjusted to a lesser amount. 

On a different note, I also experienced headaches when I was taking estrogen and spiro.  For a while I thought that my  migraines were related to the estrogen, but now that I don't take spiro and my estradiol dosage has been reduced to a  post-operative regimen, amazingly I don't have headaches anymore.  So now I wonder, was it really the estrogen or the spiro which were causing me all those headaches? 


tinkerbell

[Astyria]

Well, we did try lowering the spiro to the bottom floor, but nothing cleared up.  That was before we tried stopping spiro altogether and using finastride instead.

Perhaps after that fiasco with that one doc my body just needs time to reset.  We'll see.

And I will see about posting an into in that section =).

I do appreciate all the feedback ive gotten so far...and so quickly.

Thank you,

Astyria.

[katia]

i've [never] taken spirolactone; my endo never considered it necessary.  my hrt consists of [conjugated estrogens and progesterone] and so far my T levels are [below] the comparable natal female norm.

[Kate]

i've [never] taken spirolactone; my endo never considered it necessary.  my hrt consists of [conjugated estrogens and progesterone] and so far my T levels are [below] the comparable natal female norm.

Really? I've always read that it takes *massive* doses of estrogen to supress T down to anything favorable, and even then it's supposedly nearly impossible to get it into female norms without an anti-androgen. I'll have to read up on this again.

As far as fatigue goes, it could be from the blood pressure drop from the spiro. Many people, including myself, report feeling "out of breath" sooner than normal after starting it. I used to get "head rushes" if I stood up too quickly, etc. That went away eventually, but carrying in the groceries leaves me panting now, where before it just wasn't a problem at all. I doubt I'm experiencing much muscle atrophy after only five months, so I'm blaming it on the BP. My blood tests are normal for sodium, potassium, etc.

I experienced mild headaches when I first started HRT, which at time was oral estrogen only. They lasting for an hour or so after pill. Once transdermals were added to the regimen, the headaches vanished. I'm guessing the consistent delivery of the transdermals created a constant buffer of serum estrogen, rather than spiking things with every pill.

I took finasteride for years before starting HRT and didn't notice any side effects aside from testicular pain for the second month after starting. No fatigue problems though.

Kate

[katia]

i know i can't say [on here] how much estrogen i take. but it's a [massive] dose as you say kate. my recent overall testosterone levels are much lower than they were two years ago, 30ng/ml, yet my t levels [were never in the normal male range] before hrt; the very last time i had my t checked [before hrt], it was only 220ng/ml. there's a story behind all this which i hope to share someday...

[umop ap!sdn]

I could be wrong but I thought that spiro took 3 days for its antiandrogen effects to kick in. (When I started, at first I didn't notice anything different but after a few days the change was amazing.) If the side effects come on so quickly, my guess would be that they are likely not from the reduced T levels.

[Hazumu]

Strange--

My regimen consists of both spiro and finasteride, basically half-and-half.  I've not personally noticed any of the side effects mentioned.

Karen

[BrandiOK]

  Yes..it does take several days of spiro for the drug to suppress T levels.  One the same note because of this missing dosages allows very quick testosterone spikes.  Taking finesteride (proscar) with spironolactone as part of HRT is not harmful in individuals with healthy livers and can often be beneficial if it is combined to accent a weak spiro response or to assist in hair growth because spiro isn't totally effective at controlling DHT. 

  As for fatigue following spiro usage I had similar problems.  I looked at it like this...testosterone (in my situation) was like a high octane racing fuel.  I had been running on this fuel for so long that when it was blocked by the spiro I felt like I was totally out of gas.  I was tired, fatigued and felt like I couldn't even mow the grass if I had to.  I'm not sure how long it last because it was years ago but I remember it going on for quite awhile.  Eventually I adjusted, so to speak, and now everything seems fine.  There was a period not long ago that I went without the spiro for a month or two because of financial reasons and the changes were rapid and disturbing.  Almost all of my "male" body hair began to come back quickly and my energy level went through the roof. So much so that I was super hyper and couldn't sit still.  I would be running around the house doing repairs that didn't need doing and anything that would get me moving.  I went to my endo finally and she said my testosterone levels were way too high and that I had to go back on the prescribed dosage of spiro.  I got the prescription filled and within a couple weeks I was back to normal....normal being MUCH different than what it was without the spiro but I like this normal much better. 

   

[Rachael]

I had some serious fatigue when i just started Spiro, it goes away.... since i started estro too, ive not noticed any tiredness aside from normal

[Astyria]

It's just strange.  I mean, it's not normal fatigue.  When I first started HRT with both estra and spiro, yea, i was fatigued.  But it was nothing obnoxious.  I did get winded more easily, but I could still function.  However, something changed where my therapist and wife saw physical impacts of my fatigue.  They said that i looked dead to the world.  Had bags under my eyes.

When I came off, I returned to normal.  But... When I tried again (after just a month being off), well, taking one finastride was near instantaneous fatigue.  Like running and then hitting a brick wall.  Then, trying just the spiro...yes, it took 2-3 days, but the same level of fatigue, that I had a few months ago, returned.  I dont think that this is normal.

I'm going to do some more troubleshooting and will see.  And, hopefully, maybe all my body needs is some time to "reset".  But, I'm not going to endanger myself by doing something that feels odd...so, if it doesnt work, even if it kills me to admit it, I might have to leave part of the meds out.

Thank you all so much for your input.  I'll take more if you have it.  And then I'll take it to my endo to see what she thinks.

Astyria.

[Kate]

Perhaps also consider prompting your endo for a round of blood tests during one of these "fatigued" periods... maybe it's not the lack of T directly, but rather some side-effect of the drugs messing with something else?

Incidentally, one of the ironic things about finasteride is that it *raises* your serum testosterone by 10-20% (while lowering DHT of course).

Kate

[Maud]

Personally I started with just conjugated estrogen then switched to bio identical at a lower dose with an anti androgen, tiredness was not an issue in either phase, to be honest I felt physically far far better so either it's because of just my chronically low testosterone level or some form of AIS but I found a normal level estrogen to be better than whatever the heck was going on hormonally before hand and now i've been off HRT for near two weeks I feel physically terrible, no energy what so ever i can barely walk in a straight line.

[Kimberly]

Tiredness or more precisely 'feeling more fatigued' has been unnoticed by me despite my T levels being below normal such that would prompt a 'fatigued feeling'. Not that I don't feel fatigued, I do, but I always have so ^*shrug* Life as normal as far as I can tell.

[Karissa_SC]

As I "worked" up my Spiro dosage, I started noticing being winded on mild exertion (exertional dyspnea if you like $10 words when I hit [what many consider a "standard" dose...edited to be a law-abiding citizen].  This was taken in divided doses twice a day.

I dropped it by 50% taken just before bedtime and it mostly went away.

In my case, I watched my BP at home and at the higher level, it was a bit too low.  Not so low that I considered myself seriously hypotensive, but low enough for this sort of thing.  Now, I'm pretty much normal BP-wise.

I wish I could take a higher dose to give the estradiol less T to oppose, but while my T levels were "normal", they were "low normal", so perhaps this is enough.

Peace,

Karissa

[Astyria]

Ive been thinking about this over the past few days.  ... Er, well, that's a lie.  I have never stopped thinking about this for about a year...heh.  But, way back when i first started I was taking a UK (United Kingdom) estrogen.  Had no problems with that and the spiro.  I did that until that fateful month where that doc switched me to the shots (delestrogen)...that's when i started having problems (he had me on double the normal amount than i should have been taking...think my estrogen count was up over 3000...when normal range is in the hundreds).  Took me about 3-4 months to catch that...

After I got away from that quack and started seeing my endo, that's when the headaches started.  I was now taking a US estrogen and spiro.  I've been toying with the idea that maybe the UK version may have been better/easier on my system...eh, i dont know.  Eh, I'm probably reaching on that one.

Whatever it is, it's not normal...and i curse that quack.  He probably screwed me up...that's why i was thinking about going off for a while and giving my body a "reset" period.  After which I could try starting up again.  I just dont know.  My endo didnt say anything about that past doc's dosage...and i did point it out.

I'll ask her again.  Heck, I'll email her =).

Astyria.