Susan's Place Transgender Resources

I had my quarterly check-up today, and yay everything checked out fine. :) My endo asked if I had my testicles removed, I'm like 'nooope'. He was very surprised, because my testosterone went from around 500 to 26, and I was only on a 'low-to-intermediate' dose of Spiro as my AA. ;D

Anyway, I wanted to change up my meds, so I asked about Prometrium and Bicalutamide to replace my Provera and Spironolactone. And, well, he gave me scripts for them but we didn't talk about them much. I don't think he totally knows what he's doing. Or just, isn't very experienced with trans women. He gave me the standard Prometrium dosage for post-menopausal women and he had to look-up the Bicalutamide. Sometimes it feels like assisted self-medicating. >_>

So I'm wondering, does anyone have experience with either of these? 

Think for me the question is why would you want a change?

Seeming to me a low dose of spiro is going a great job.

Am i missing something here?

Sometimes we over think things to a point of screwing things up.

Isabell

I certainly understand prometrium over provera as the side effects are dramatically worse in provera for many people (but it is a lot cheaper) but Bicalutamide seems a bit strange to me, as I understand it Bicalutamide is very effective but harder on the liver and does some stuff I don't understand to the hormone chain.

I am doing basically doctor assisted self meddling, I like having the control but I also like the doctor supervision after all if you don't check on obscure things like potassium levels with spiro it could kill you. Just make sure your doctor knows what blood tests they should run if they seem unfamiliar with something. I find it quite strange that some doctors know so little about transgender hormones because as a condition being transgender isn't actually all that uncommon.

Quote from: mind is quiet now on February 10, 2014, 09:15:28 PM
Think for me the question is why would you want a change?

Spiro was making me very drowsy. It's a blood-pressure med (AA is only a secondary effect) and my BP is naturally on the low-end. There'd be times I felt like passing out. Plus I don't like that it's potassium-sparing, makes me paranoid about what I eat and drink. >_< Just hoping to try something new that might work better for me.

First i would think your Endo might lower the dose of spiro and see how that would work. Sometimes you might be able to stop the Spiro and add more estrogen and things come into a normal female range?

Yes for some time you have to worry about standing up to fast or you get light headed. That will pass in time. The being tired comes more from the fast drop in your T level.

Maybe it would be a good idea to get a Orchie done before changing up to the Bicalutamide. There is not to much information or positive feed back on this used for cross hormone therapy in transgenders.

If your doctor has made the change then i guess it is up to you and him to know best. I do wish you the best.

Isabell

I was on bicalutamide for six months.  I could not use spironolactone due to an adverse drug interaction.

Bicalutamide had a surprising side effect for me ... it eliminated almost all the hair on my legs, from the crotch down.

I'm familiar with both bicalutamide and prometrium. Took them both pre-op and prometrium post-op.

Prometrium (micronized progesterone) is identical to the progesterone that our bodies naturally produce.  It doesn't have all the negative side-effects of Provera (medroxyprogesterone acetate) like androgenic activity, mood disturbances, negative cardiovascular effects. It is also not associated with an increased breast cancer incidence amongst natal women. It is recommended to take Prometrium at bedtime because it will make you drowsy, sleepy at first until the body adjusts weeks later. Taking it with food increases its bioavailability (concentration/levels in blood) but may also increase its sedative effects so watch out for that. It has a short-half life so is advised to take twice daily BUT at lower doses, you can still take it once daily before bedtime. It may perhaps be taken rectally as well since it is similar to Utrogestan and the latter has been found to be effective that way. Taking it rectally will bypass the liver to a large degree and reduce the sedative effects associated with progesterone as it is metabolized much less and as a result, there is a much lower concentration of its metabolites, namely allopregnanolone which is known to also reduce anxiety. If taken with finasteride or dutasteride, the sedative effect can also be much reduced and even eliminated as both drugs inhibit metabolization of progesterone to allopregnanolone. Progesterone is mildly anti-estrogenic, as are all progestins, since it increases conversion of estradiol to weaker forms such as estrone and downregulates (decreases) estrogen receptors. Estrogen, on the other hand, upregulates progesterone receptors. Progesterone is not androgenic or anti-androgenic but has antimineralocorticoid activity similar to Spiro which means it reduces water retention, much more if taken non-orally as some of its metabolites (i.e. deoxycorticosterone) when taken orally, have the opposite effect. Progesterone may improve sleep, may make you depressed and lethargic if too much is taken relative to estrogen, may increase skin/hair oiliness, may strengthen your nails and make your hair/skin softer. It is known to increase fat accumulation. It also stimulates lobuloalveolar growth in breasts, makes them fuller, rounder, stimulates nipple growth, if I'm not mistaken and may assist estrogen in further developing areola and darkening it.     

As far as bicalutamide is concerned, very few transsexual women take it but I personally like it a lot because its side-effects, especially at lower doses, is low as compared to some of the other anti-androgens, especially cyproterone acetate (Androcur). Liver complications may arise at much higher doses typically prescribed for prostate cancer patients but we don't need that much. I hope your doctor realizes this and the fact that it is a VERY powerful anti-androgen with much more blocking potency at androgen receptors vs spiro or androcur. It's half life is between 5 and 6 days and thus, can be taken every 2 or 3 days. It does not reduce androgen production and taken alone, actually increases it, thereby increasing estrogen concentration in the process as androgen converts to estrogen. But, its blocking power is so strong that anti-androgenic effects are still observed, so much so, that in males, bicalutamide monotherapy results in high rates of breast tenderness/gynecomastia (breast growth) up to 60%.  Bicalutamide does not cross the blood-brain barrier. Sex drive, libido is usually not affected, nor are spontaneous erections but these will be affected if estrogen is added, of course. It's useless to measure testosterone levels while on bicalutamide since this anti-androgen does not reduce it, ONLY BLOCKS IT. Beware, it can make some quite lethargic and tired at first, even at lower doses, increasing sleep time significantly. This is probably because androgen is inhibited so strongly. 

Quote from: Jamie de la Rosa on February 11, 2014, 12:11:57 AM
Bicalutamide had a surprising side effect for me ... it eliminated almost all the hair on my legs, from the crotch down.

*crosses fingers* Please happen to me toooo! :laugh:

Anyway, thanks for the responses everybody. :) I guess the Prometrium dose/schedule is normal. Didn't think it'd be the same. I guess I'll wait to see how cycling it works for me. And Bicalutamide sounds interesting. I'll try it for a month and see how I feel. I can always go back to my endo and get a script for Spiro again if I don't like it.

Could this help me with my problem. I was prescribed spironolactone only to help with hair removal. Having osteo arthritis I voluntarily ceased spironolactone  despite good effects because of bone density concerns. I am not yet on estrogen pending contact from gender clinic. I will ask my gp about bicalutamide although it is not her area of specialism hence why I have to await contact from gender clinic?

I can't say for sure if it's a good choice for you, but I will say that if you go on it, you should also be taking E.

Been about a week now, no side-effects. :) Plus I haven't been getting drowsy throughout the day, so it definitely was the Spiro. Glad I changed it. Just hope it works well in the long run. Won't have a blood test until May..

Good to hear about the dizzy spells being gone. :) Remember that on bicalutamide, there is not much point in measuring T levels as bicalutamide only blocks it, doesn't reduce it.

I get this instinctual gut feeling that the Bicalutamide isn't working well. :/ I'm regaining more functionality 'down there' and a bit more of the old sex drive and I've been a bit moody. I also have this weird anxiety that's been building the past few days and people keep asking me if I'm alright. I feel like my testosterone levels are going back up, but obviously I can't tell for sure. I know I just don't 'feel right' and certainly feel different than I did before I switched. >_< I'm also off the progesterone because I couldn't get a refill. My endo said I'd have to get another script from a GP or OB/GYN, so I'm just not bothering with it right now. But I'm tempted to get back on Spiro and maybe Provera, just to feel 'normal' again...

Anyone know any 'symptoms' of T levels coming back up?

Well bicalutamide does increase T levels but it should be stopping the t from being applied. Most people on it I have talked too still maintain plenty of function down there. However, it should be fairly strong at allowing feminization regardless. Of course I understand for some having function down there can cause an increase in dysphoria.

Sex drive and functionality are not affected by bicalutamide, they remain the same because bicalutamide does not block androgen in the brain nor does it reduce T levels. But, it blocks androgen in the rest of the body, very effectively, allowing for feminization, breast growth, etc.

Quote from: Ashey on March 14, 2014, 07:40:43 PM
Anyone know any 'symptoms' of T levels coming back up?

Sort of, up until December of last year I was on a low dose of spiro since it seemed up till that point that it was working well enough of for me. I definitely had increased anxiety, just didn't feel right. Thankfully my check up was coming up soon. The blood tests showed my T had gone up to about 200. My doc upped the dosage of my spiro and things have never been better. Definitely have a talk with your endo if you keep having that "odd feeling" your t might have shot up like mine did. Then again according to what Kayxo stated, it sounds like things are going as they should be since you're on bicalutamide. Hope you're feeling better! 

Ugh, yeah.. it's definitely not working, or not working well enough. Body hair is growing back faster, sex-drive is definitely coming back (though I do understand that can happen regardless), and I don't feel 'normal' anymore. It's giving me the occasional anxiety attack and I feel like testosterone and estrogen are fighting each other. Going to go back on spiro, hopefully next week. Just can't keep this up, at least spiro was working right. >_<

Quote from: Jamie D ... adios on February 11, 2014, 12:11:57 AMBicalutamide had a surprising side effect for me ...

DITTO  ;D  ;D  ;D it eliminated almost ALL the hair on my legs, from the "armpits and chest" down.

Quote from: Kiera on April 11, 2014, 04:57:53 PM
DITTO  ;D  ;D  ;D it eliminated almost ALL the hair on my legs, from the "armpits and chest" down.

I wonder why though, I mean it is clear body hair is at least a bit androgen sensitive, but are some areas more sensitive to androgens or lack thereof than others?


Also is the hair totally gone or like the tiny clear hairs?

Quote from: KayXo on February 11, 2014, 09:07:04 AM

As far as bicalutamide is concerned, very few transsexual women take it but I personally like it a lot because its side-effects, especially at lower doses, is low as compared to some of the other anti-androgens,

I think it's important to point out for anyone searching and finding this thread that the above statement may be factually incorrect. It would be wise for anyone embarking on this to look at the following links and above all to speak carefully with their physician:

http://medlibrary.org/lib/rx/meds/casodex-2/

http://www.macmillan.org.uk/cancerinformation/cancertreatment/treatmenttypes/hormonaltherapies/individualhormonaltherapies/bicalutamide.aspx

Quote from: Richenda on June 01, 2016, 10:48:42 PM
I think it's important to point out for anyone searching and finding this thread . . .

This is an old thread. After being on a half dose of Casodex a long time I stopped entirely a couple of years ago and can report it's effects are PERMANENT, body hair growth never did came back and now am happy with a low maintenance dose of 'E' only.

Cis girls are jealous, amazed I liken it to a chemical 'orchi' without any of the fuss.

Hi Kiera,

As a matter of interest why did you come off the Bic? Sorry I don't know you: did you have the GRS?

Quote from: Richenda on June 02, 2016, 04:34:14 AM
. . . did you have the GRS?

No. The main reason I stopped was financial but then realized no ill reversing effects other than the positives. Having watched someone get an 'orchi' I would not recommend it feel Casodex, for me at least, was far more effective and obviously less invasive. Am sterile (still no fluid at all) but functional, not Impotent, and after years of tucking my 'junk' has become very diminutive.

The lack of hair thing continues to be a surprising bonus.

Upon my father's death am told WAS(?) high risk for prostrate cancer?

Being older and again working up to 60hrs/week with two new grandbabies in the house it feels nice to be in permanent 'nominal girl mode' without having to take or do anything!! LOL If people want to start noticing my A breasts then I'll start dressing more "en femme"???

Hi Kiera,

Wow that's brilliant news. I've just pm'd you. xx

Quote from: Richenda on June 01, 2016, 10:48:42 PM
I think it's important to point out for anyone searching and finding this thread that the above statement may be factually incorrect. It would be wise for anyone embarking on this to look at the following links and above all to speak carefully with their physician:

http://medlibrary.org/lib/rx/meds/casodex-2/

http://www.macmillan.org.uk/cancerinformation/cancertreatment/treatmenttypes/hormonaltherapies/individualhormonaltherapies/bicalutamide.aspx

Once again, I repeat, these side-effects were noted at much higher doses. Transsexual women will usually take much lower doses, one cannot assume those side-effects will take place at these lower doses.

Quote from: KayXo on June 15, 2016, 01:23:42 PM
Once again, I repeat, these side-effects were noted at much higher doses. Transsexual women will usually take much lower doses, one cannot assume those side-effects will take place at these lower doses.

This doesn't actually make any sense.  The idea of bicalutamide is to block the receptors, which actually increases serum testosterone.  Unless taking some kind of combination therapy with some other antiandrogen, you WANT a complete saturation of bicalutamide so that NONE of that extra T finds a free receptor.  If using combination therapy, spiro/cypro with dutasteride is a more effective combo than any combo with low dose bicalutamide could be.  High dose bicalutamide, on the other hand, makes combination therapy useless and unnecessary.  It's actually the folks using it on-label that require only a lower dose, in combination with drugs that prevent any potential for feminization.

Abi you sound like you know what you're talking about. What would be your advice about post-GRS anti androgens for someone who has been taking them for c.18 months? Would you cold turkey on the grounds that 95% of T is cut off from its source? Or would gradually withdraw as a few people suggest? There doesn't seem to be clear guidance about this.

Quote from: Richenda on June 22, 2016, 02:14:20 AM
Abi you sound like you know what you're talking about. What would be your advice about post-GRS anti androgens for someone who has been taking them for c.18 months? Would you cold turkey on the grounds that 95% of T is cut off from its source? Or would gradually withdraw as a few people suggest? There doesn't seem to be clear guidance about this.

There isn't clear guidance because experiences differ so greatly.  Some people if they stop aa's immediately after GRS will experience some reversion before all the androgens are truly flushed.  Some can cold turkey and have no problem.  Honestly, this is something you'll have to discuss personally with your doctor and figure out what's best for you individually.

Okay thanks. That does sound wise. I will talk it through very carefully with my clinic this week.

Quote from: AbiDrew on June 22, 2016, 02:09:21 AM
Unless taking some kind of combination therapy with some other antiandrogen, you WANT a complete saturation of bicalutamide so that NONE of that extra T finds a free receptor.

Combination, high or low, I very much doubt one will be able to block all receptors.

QuoteIf using combination therapy, spiro/cypro with dutasteride is a more effective combo than any combo with low dose bicalutamide could be.

One must also consider risks and side-effects. I have personally read good results from using low doses of bicalutamide in combination with estradiol in transwomen.

Quote from: AbiDrew on June 22, 2016, 02:19:42 AM
Some people if they stop aa's immediately after GRS will experience some reversion before all the androgens are truly flushed.

Androgens are flushed quite rapidly after the op.

Urol Oncol. 2014 Jan;32(1):38.

"In men with prostate cancer, bilateral orchiectomy reduces serum testosterone to castrate levels within 12 hours [6]."

"Persistent levels of serum testosterone after castration are mainly derived from adrenal androgens."

And...

Prog Brain Res. 2010;182:321-41.

"after castration, the 95-97% fall in serum testosterone does not reflect the 40-50% testosterone (testo) and dihydrotestosterone (DHT) made locally in the prostate from DHEA of adrenal origin"

Perhaps, to optimize breast growth, some form of anti-androgen can be used until final size is reached, post-op but this must be discussed with doctor, and risks vs. benefits weighed. In some, there is apparently a temporary increase in adrenal androgen output post-op (could perhaps be due to stress) and as such, an anti-androgen could help counter this for a few months. Or the post-op androgenization could be the result of stopping hormones pre-GRS and post-GRS.