Susan's Place Transgender Resources

I recently saw my endocrinologist (who happens to specialize in transgender hrt) and asked for Spironolactone.  He was reluctant to prescribe it to me (I was currently on just Estradiol).

His reasoning was "The only thing Spironolactone does is help with facial hair.  It doesn't serve any other function.  Your face seems really clear, so I don't see any point in prescribing it to you."

I was able to finally convince him to prescribe it to me, but I was wondering what everyone's thoughts were on what he said.  I thought it helped supplement the effects of Estradiol and also helped to increase the possibility of a bigger cup size when combined with Estradiol?  Was I mistaken in thinking that?

A "specialist" in HRT who does not see any other benefit of Anti Androgens? I would be leery of him myself.

IDK about all that. My Endo prescribed it right away. As far as I know, it is a T blocker more than anything, letting the E work easier on your system. It also makes you pee like crazy and destroys your sex life, at least for me it did anyway. I know some people don't like it and different docs have different procedures. I'm not sure why he would prescribe something he didn't really believe in though.

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I see others posted ahead of me lol. I agree, not so sure about your doc tbh.

Candice and Tiffany are so right! Why should you trust a doctor who will prescribe something he doesn't believe in? ???

Given my T is almost through the floor and the only anti androgen I'm on is Spiro I would suggest he is talking through his hat.

My prescriber popped me on E and spiro straight away.  Got to a good place right away and the prescription has stayed the same for over 8 months.  You don't want that precious E to be competing with T.  T will win alot of the time. Accepted practice is to get that T down so that the E can do its work.

I wish someone had told me that all I needed was spiro and I wouldn't have needed to spend that fortune on electrolysis ;)  Might do something on the fortunatly young and/or mostly hairless. A mature beard?  Nah.  Think its rubbish.

First: As others have said, I would be extremely reluctant to see a doctor that would prescribe a drug he doesn't believe in.

Second: While everyone is different in how they react to HRT, I personally did get some slight breast development while on Spiro alone.

(I started on Spiro only because I couldn't afford to fill both prescriptions at the time, I got my insurance issues straightened out and added estrogen to my regimen about six weeks later)

I still haven't seen a reduction in facial or body hair yet though.

Well I'll be the odd one out. E killed my T levels completely, I wasn't on any AAs. I was then put on spiro to develop a normal female hair growth pattern, which it has done with stunning effect, I have essentially no body hair.

When I first started my transition, the Doctor I had put me on a very high level of Spironolactone, before anything else was added. Wow, the tenderness in my chest area was immediate and scary. I freaked out that everything was moving way too fast. So I stopped completely, and re-evaluated. When I went back to a different Doctor, I told him my of concerns that had scared me before, he then put me on a more typical and balanced hormone regime, with a much lower spiro dose. The only thing is, now I feel that my progression is very slow. In conclusion, from my experience and only speaking for me, Spironolactone was the magical ingredient.

Great advice!  Thanks everyone for your input!  Yeah my endocrinologist freaks me out sometimes, especially since after my second appointment he STILL hasn't ordered bloodwork for me yet.  (didn't at the initial appointment either).  I have no idea what my levels are right now. 

Quote from: EmmaD on June 21, 2014, 08:51:45 PM
You don't want that precious E to be competing with T.

But E also reduces T production.

Quote from: KatelynRain on June 22, 2014, 08:30:52 AM
Great advice!  Thanks everyone for your input!  Yeah my endocrinologist freaks me out sometimes, especially since after my second appointment he STILL hasn't ordered bloodwork for me yet.  (didn't at the initial appointment either).  I have no idea what my levels are right now.

It sounds like he doesn't care.  Just wants your money.

Adding my grain of salt, Sarah's doctor perscribed spiro because it is a t blocker, softens facial hair, and lowers blood pressure. Doctor has to keep in check not only hormone levels in her system, but also sodium and potassium since she is on a low sodium diet. Since Sarah needed work in all three, doctor hit the nail on the head. Spiro is a medication, which shouldn't be taken lightly. And your doc worried me a bit.

Spiro will further reduce sodium so low sodium diet is not advisable while taking this drug. She may experience severe health complications if she limits her salt intake.

Like Cindy I have had a nice change in my body hair with spiro (I call it my man away) but certainly not with facial hair.  I can only wish that big bucks for laser and plucking were not part of my life. From my experience and others I personally know, that endo is flat wrong.  Estradiol has a greater side effect and complication profile while taking the combination may reduce the dosage needed and typically produces better results.

Quote from: KayXo on June 22, 2014, 11:41:48 AM
Spiro will further reduce sodium so low sodium diet is not advisable while taking this drug. She may experience severe health complications if she limits her salt intake.

Oops. Made a mistake. It was her potassium levels she was lowering. True, true. Sorry about the confusion. Can't make mistakes like that.

Quote from: KatelynRain on June 22, 2014, 08:30:52 AM
especially since after my second appointment he STILL hasn't ordered bloodwork for me yet.  (didn't at the initial appointment either). 

This bothers me a LOT. RUN don't walk away from this Endo. Blood work is the first thing that should be done.

Quote from: Tessa James on June 22, 2014, 11:45:05 AM
Estradiol has a greater side effect and complication profile while taking the combination may reduce the dosage needed and typically produces better results.

True if the estradiol is not bio-identical but if it is bio-identical and especially taken non-orally, the side-effects might be greater from the Spiro. Times have changed. That warning comes from when doctors prescribed ethinyl estradiol, Premarin to transgendered women.

So far I've gone through three endocrinologists saying they specialize in transgender related HRT who have proven to not be able to address even basic stuff.

The first, like yours, refused any kind of bloodwork. They said levels fluctuate so accurate readings are hard to get (which is true to some degree) and that they're very expensive (my last one if uninsured was $300+, can go higher). They threw a prescription at me and said to come back in six months.

The second said I should stop progesterone as it's a hormone only present during pregnancy (yes, she told me it's only present during pregnancy...), and also thought I might have a pituitary tumor because my high prolactin levels. She never bothered to check that the Cyproterone Acetate I take says right on the box that it can raise prolactin levels.

My most recent endocrinologist knew I was taking estrogen sublingually, knew I had three drastically different levels without any variation, and had no idea why. Wanted to run all these tests, but when I suggested maybe it's because the estrogen goes in the bloodstream all at once and quickly dissipates since it's taken sublingually. They said, "wow, that's a great observation that's probably the case."

All of them claimed to specialize in transgender related HRT, yet I had to plead for bloodwork, educate them on progesterone, do my own investigating about my levels, etc. Either they were ignorant or apathetic. But this isn't uncommon with most healthcare that I've experienced here in the US and I'd assume elsewhere in the world. I saw someone visit their doctor for a severe migraine and they sent them off with Advil. Another patient had severe GERD and they told them to get Tums...

I agree with Jessica. It's common knowledge Spiro is a very effective AA, just run away and find a better endo.

Quote from: teeg on June 22, 2014, 11:24:37 PM
The first, like yours, refused any kind of bloodwork. They said levels fluctuate so accurate readings are hard to get (which is true to some degree) and that they're very expensive (my last one if uninsured was $300+, can go higher).

I agree insofar as estradiol and testosterone goes. It's better to just go with how you feel and results to judge whether dose is effective or not.

Quote from: teegThe second said I should stop progesterone as it's a hormone only present during pregnancy

It is indeed a pregnancy hormone but so is estrogen. Both really are produced with the intention of conceiving a child. Both rise significantly during pregnancy and prepare the body not only for birth but for breastfeeding. Both hormones also help support the fetus during pregnancy. So, by that same token, you should not be taking estrogen.

Progesterone may not only prove to be beneficial physically speaking (breast growth, fat deposition, skin/hair texture) but may also improve well-being as well since it tends to relax us, helps us sleep better, etc.

Quote from: teegIt's common knowledge Spiro is a very effective AA.

In some, not all. And sometimes, the side-effects might justify the use of another AA or just taking estrogen instead.

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.

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?

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>

@Gabstar

Quote from: Gabstar on October 16, 2018, 10:03:16 PM
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>

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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:

QuoteSpironolactone 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

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.

I just found this article:

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

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