Susan's Place Transgender Resources

So just out of curiousity, has anyone found an anti-androgen to replace Spiro, that works well?  I am kind of getting tired of remembering the pills all the time.  I was looking into something possibly in the lines of an injectible depot that I could "fire and forget".  I am not necessarly disenchanted with Spiro...  but I am not exactly impressed with it either.  I am certain that I can talk my Endo into swapping it up...  just as soon as I get a new intern.  I have actually been trying to find something that I can just double up with my Estradiol injections...  Currently I am on 14 day estrogen injections, with daily Spiro and Finasteride.  I'd love to ditch the pills with all of my time spent outside the house.  Any suggestions?

I switched from spiro and estradiol to finasteride and estradiol.  This information does not seem like it will help you, since it sounds like you are already on both, but it helped me. I had a lot of problems with cramping on spiro.  And I only take finasteride once a day, vs. twice a day with spiro.

I feel you...  The leg cramps suck sometimes...  I just see it as such a hassle to remember and to tote around.  If I could I'd be on implants so I could just take care of it quarterly or semi-annually.  I am dealing with the 2 weeks alright, but man I hate toting around pills.  I always seem to get sidetracked with stuff and take them late... or space it and leave the house without them.

Hi Harley,

I wrote up my experiences on this here: https://www.susans.org/forums/index.php?topic=213357.new;topicseen#new

I tried pretty much every anti androgen going!

Good luck with settling on the right solution for you. x

Hello Harley,
Bicalutamide has far less adverse effects than CPA and spironolactone. It is a very effective androgen blocker. Have a look at the bicalutamide wikipedia page, it is quite informative. It is frequently updated and gives more and more details about its usage for trans women.

Bicalutamide is a very dangerous drug in my opinion. It's hardly ever used in the trans community and hasn't been approved for MtF usage. There are a significant number of reports of dangerous and potentially life-threatening side effects.

Have a look here: https://www.susans.org/forums/index.php?topic=210339.new;topicseen#new

I wouldn't touch it with a bargepole again (well I don't need to now I've had surgery) but at the very least certainly do not do so without it being thoroughly researched and approved by your physician and then get regularly monitored.

Quote from: Richenda on September 02, 2016, 03:08:35 AM
Bicalutamide is a very dangerous drug in my opinion. It's hardly ever used in the trans community and hasn't been approved for MtF usage. There are a significant number of reports of dangerous and potentially life-threatening side effects.

Have a look here: https://www.susans.org/forums/index.php?topic=210339.new;topicseen#new

I wouldn't touch it with a bargepole again (well I don't need to now I've had surgery) but at the very least certainly do not do so without it being thoroughly researched and approved by your physician and then get regularly monitored.

There is no scientific evidence in support of what you say.
I had a lengthy discussion with an urologist on that matter. He has prescribed bicalutamide for years and none of his patients have had any serious reaction or side effect with this molecule. Conversely a lot of his patients under CPA treatment had DVT or depression. Also he advised me to avoid spironolactone in reason of possible hyperkalemia and/or depression.

Apart from that there is no scientific consensus about which drugs should be prescribed to MtF. As far as I know CPA and spironolactone have not been more "approved" than bicalutamide for transgender care.

I will definitely get some reference info to blind side them with when I can go back in. On a side note, I am a little envious that you were able to get pellets... maybe some day. ;)

I'm of the opinion that every drug prescription has to be tailored to the patient with a view to all the conditions and sensitivities the patient has.  What is right for one person can be very wrong for another.

In my own, personal case, with my medical history including a predisposition to sodium-sensitive hypertension and my prior need for an extremely low sodium diet under 1000 mg/day, and the need for a diuretic due to other issues, spironolactone has been a real lifesaver.  I can block testosterone, and enjoy a relatively normal diet, indulging in treats I couldn't touch, like bagels, and (OMG!) steak dinner in a restaurant.

Your mileage WILL vary.

Quote from: Lucie on September 02, 2016, 06:33:46 AM
There is no scientific evidence in support of what you say.

I don't think one urologist compensates for growing concerns Lucie, for which there is plenty of scientific support:

http://medlibrary.org/lib/rx/meds/casodex-2/
http://www.macmillan.org.uk/cancerinformation/cancertreatment/treatmenttypes/hormonaltherapies/individualhormonaltherapies/bicalutamide.aspx
http://www.ehealthme.com/ds/bicalutamide/interstitial+lung+disease/
http://synapse.koreamed.org/DOIx.php?id=10.4046/trd.2010.68.4.226&vmode=PUBREADER
http://www.ncbi.nlm.nih.gov/pubmed/14633092
http://www.ncbi.nlm.nih.gov/pubmed/9498983
http://www.ncbi.nlm.nih.gov/pubmed/21537882
http://www.sundhedguide.com/pdf/1132143512.pdf
http://www.mayoclinic.org/diseases-conditions/interstitial-lung-disease/basics/definition/con-20024481


Those are peer-reviewed academic studies, not anecdotes.

Quote from: Lucie on September 02, 2016, 06:33:46 AM

Apart from that there is no scientific consensus about which drugs should be prescribed to MtF.

Which is why I started this thread:

https://www.susans.org/forums/index.php?topic=213357.new;topicseen#new

x

Injections of estradiol alone yield high enough levels of E so that gonads are arrested and stop producing androgen. Hence, there should, theoretically, be no need for any anti-androgen while taking E parenterally. It appears that in the case of estradiol valerate, 2 weeks might too long of an interval so that one may experience lows, similar to PMS. Most do well on 5-10 day schedule.

LhRH agonists are preferred in the UK due to better side-effect profile while Spiro is used in the US because CPA (cyproterone acetate) is banned there. CPA can stimulate prolactin far too much and potentially lead to a prolactinoma (also meningioma, at higher doses), lead to depression/fatigue in some, interfere with adrenal function, and cause liver problems at very high doses. Spironolactone, on the other hand, can result in electrolyte imbalance and all the effects from that.

Regarding bicalutamide:

Expert Opin. Drug Saf. (2014) 13(11)

"Diarrhea has been reported in only 2 - 6% of patients in
Bicalutamide monotherapy studies [29-31,43,44] and only isolated
cases of elevated liver enzymes were observed [67]. To
date, only one case of Bicalutamide-induced hepatic failure
has been reported in the literature [68]. This hepatic failure
was attributed to Bicalutamide because of the absence of other
etiologic factors, the temporal relation with drug administration
and the resolution of hepatitis following drug discontinuation
[68]. However, the authors note that the patient was
previously treated with Cyproterone and Flutamide and
hypothesize that these drugs might have sensitized the patient
to Bicalutamide toxicity [68]."

"Interstitial pneumonitis induced by Bicalutamide is an
extremely rare event [69]."

"Finally, caution is required when Bicalutamide is used
together with other medications that depend on CYP3A4
and, to a lesser extent, CYP2C9, 2C19 and 2D6 metabolization
[70]. Moreover, the use of Bicalutamide as well as of
Nilutamide or Flutamide in patients taking drugs with high
plasma protein binding such as warfarin, phenytoin or theophylline,
will increase the free-drug serum concentration of
these compounds, which might result either in increased
efficacy or in increased toxicity of these drugs [71]."

It should be noted that these effects are reported in men who typically take higher doses than those typically prescribed to transsexual women.

I would have to agree on the 14 day cycle leading to "lows"...  I had recently increased my dose as they thought I might have just metabolized the shot too fast with my crashes.  So after the "lows" and crash complaint, they doubled my Spiro, which had no effect on my crashes...  then they increased my E dose by 50% at the same concentration.  Which helped mildly reducing my lows to about 3 days from the 5 I had.  I am still trying to get imperical data as to why I get my lows rather than guessing and riding it out for 6 months at a time.  But I have that on another thread...  My biggest one right now is I have zero loveloss for the Spiro being taken twice a day or even once a day.  Which is why I posted to find a possible 2 week depot shot/pill.  However, if I may be able to ditch the AA's all together...  Oh, what a happy girl I'd be!!

You could ask for half the dose of E to be injected weekly instead of biweekly. :)

LhRH agonist is an injectable depot anti-androgen or can be given as a pellet. On a monthly or every 3 month basis. But, I would think E alone should suffice.

I would personally stay away from Depo-Provera due to side-effects. There is Proluton-Depot, a progestogen which appears to be safer which acts quite similarly to bio-identical progesterone.

As always, discuss these options with your doctor. :)

Best of luck.

KayXO, as always, you're amazing!  Thank you so much and I greatly appreciate your reference posts! 

I beg to differ Harley but Kay and I haven't seen eye to eye over bicalutamide for some time. She champions it across the internet but the extensive links I posted to academic peer reviewed articles in reputable scientific journals raise cause for concern and are not addressed.

I continue therefore to urge caution and, equally, strongly to suggest that anyone considering taking this drug visits a qualified medic, which is something neither Kay nor I are. On that at least we can agree.

Be wise.

Quote from: Richenda on September 02, 2016, 04:15:43 PM
I beg to differ Harley but Kay and I haven't seen eye to eye over bicalutamide for some time. She champions it across the internet but the extensive links I posted to academic peer reviewed articles in reputable scientific journals raise cause for concern and are not addressed.

Richenda, none of the references you give relate to transgender care. Moreover reference given by Kay is at least as pertinent as yours.

Quote
I continue therefore to urge caution and, equally, strongly to suggest that anyone considering taking this drug visits a qualified medic, which is something neither Kay nor I are. On that at least we can agree.

Unfortunately no endocrinologist (at least in my country) is informed about using bicalutamide for transgender women. My urologist wrote a memo to the attention of my endocrinologist telling her that he approved the use of bicalutamide as an A-A for transgender HRT. If she had not read this memo (together with the informations I shown her) she would not have accepted to prescribe bicalutamide for me, she said, for the sole reason that she did not know it !

Please note that yes, I am under the care of a doctor or 6...  I am asking due to wanting possible alternatives to ask about, and discussion points so that I can be somewhat educated and speak intelligently about what I am asking my Endo for and why...  If they don't agree, they will feel more compelled to back up their decision with a little explanation...  I hate flying blind on my own health. 

I have been on Spiro for quite some time and have had a history of issues that I have been dealing with and attempting to compensate for as the medication doesn't quite fit with my health requirements.  I mean no disrespect, or as to come off as unappreciative or dismissing.  I do appreciate ALL the references...  And once I get through with all of the posted material I will be requesting an audiance with my Endo to discuss several options to cut Spiro out of my transition.  I have been having horrible Vertigo today and my head isn't quite in it if I came off as anything other than appreciative for all the information.

Harley, I'm constantly surprised at how we have to become the experts on treatment and bring our doctors up to speed on what is available and what might suit our needs.  Sometimes I worry that it doesn't take much for an unscrupulous practitioner to claim to be a transgender care specialist.  I'm pretty sure "I saw one on the subway this morning" doesn't count.

Spironolactone can really mess someone up who already has problems with low blood pressure, or high potassium levels, for example.  None of this stuff is exactly candy mints!  LhRG antagonists have their own issues (avoid if you have irregular heartbeat, liver issues, over 225 lbs) as does bicalutamide.

It's really up to all of us to do as Harley is doing, and round up as much information as possible.  Blanket "Everyone use/avoid this" stuff doesn't help me.  I like facts and references! This stuff is all 'off-label' for our unique condition.

Harley I really hope you feel better soon honey. I concur with all the excellent points above. Vertigo is horrible. FWIW spironolactone did me no favours with very low blood pressure and extreme vertigo. I generally had a pretty awful time with the anti androgens, hence the orchiectomy which ended all those adverse issues. Is that an option you could consider? x

Yeah, it's an option. I would rather not hit that up quite yet and explore other avenues. My last Endo offered to give me an orchie the same day I met her and she gave me my first injection. I was like "Whoah... Easy Trigger! One step at a time... and definitely not on the first date. " Remember that I have all "Fellows" and I don't get the audience with the king... (aka the Attending).

I have no clue what my next Endo will be like... but hope for the best and prepare for the worst.

Drinking enough water and eating as much salt as you crave might help with the vertigo and other potential side-effects associated with Spironolactone. Best of luck in finding what works for you. :)

Quote from: Harley Quinn on September 03, 2016, 08:13:47 AM
Yeah, it's an option. I would rather not hit that up quite yet and explore other avenues. My last Endo offered to give me an orchie the same day I met her and she gave me my first injection. I was like "Whoah... Easy Trigger! One step at a time... and definitely not on the first date. "

;D  :D ;D :D

Suprefact (nasal) is a very good alternative. If your insurance can cover it and you Dr. agrees then it's the best in Testosterone suppression. It's an GNRH agonist.

Quote from: Harley Quinn on September 03, 2016, 08:13:47 AM
Yeah, it's an option. I would rather not hit that up quite yet and explore other avenues. My last Endo offered to give me an orchie the same day I met her and she gave me my first injection. I was like "Whoah... Easy Trigger! One step at a time... and definitely not on the first date. " Remember that I have all "Fellows" and I don't get the audience with the king... (aka the Attending).

I have no clue what my next Endo will be like... but hope for the best and prepare for the worst.

Sorry, what medical system is this?