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Everything was aligning for my Orchiectomy until surgeon said my testosterone had to be 50 or less.  Yesterday's labs show my testosterone is 240+.  So now I need to start Spironolactone. Still waiting for the doctor to prescribe it but know she will. 

Will it take weeks, months or??

Thanks,
  Coral

Why are they prescribing Spiro to do that?

Spironolactone starts blocking androgen receptors within hours to days, but it typically takes 8 to 12 weeks to notice visible physical changes and up to 3 to 6 months (or longer) to see significant drops in actual hormone levels or maximum clinical results.

You can get a Leuprolide injection that lasts up to six months and blocks testosterone production at the source, not blocking the androgen receptors. The biggest issue with leuprolide is cost. I received the 90-day injections and I believe they ran about $400. But that was every 90 days, so it was worth it.

I was on leuprolide and bicalutamide for just over a year. This combination is a form of chemical castration that is prescribed for cancer patients and sometimes repeat sex offenders. It is very effective.

Spironolactone and Finasteride are NOT testosterone blockers. They have a side effect of interfering with androgen receptors via the 5a-reductase enzyme. They are not the same thing. By interfering with 5α-reductase, they also interfere with all hormones, which can throw things into confusion.

If your insurance will cover it, or you can afford it, please talk to your doctors about using leuprolide instead, unless they have a valid reason to need you to be on a diuretic. If their only reason for Spiro is to drop T-levels, they need to do their homework, and it is up to us to educate them.

My testosterone is < 0.5 nmol/L using Spiro so it does work but I have been using that for years. I would have thought they would want your levels down faster than that, so as Lori says GnRH injections are the way to do it fast.

Not really sure why they need to get them down before the op though? They are cutting the damn things off, you will have pretty low T levels after that!😃

GnRH or cyproterone acetate. Both nuke T very fast.

@Lori Dee @Stottie Girl @Charotte Kitty

Thank you for all the valuable information. I will pass this on to my doctor when I see her on 1st of October.  I always have a typed sheet of items to cover, other info, etc.  I will include your information on sheet(s) I give her.

Cost is not my issue. I have Kaiser Permanente Senior Advantage insurance.  They pay well but doctors are very determined to follow their standard processes. So not much chance to get any options, but I will try!

I have been on finasteride for 7 years.  It does not appear to do much by itself.  Hoping doctor will prescribe the Spironolactone this week after the holiday before I see her.  I sent the request a few days ago.

Patiently waiting,
   Coral

There are one or two other meds that may do the trick like bicalutamide but it's a non-licensed use.

Kinda scratching my head a bit as to why your Dr wants you to lower T before orchiectomy? I mean, an orchiectomy will sure as heck lower your T 😀

Ok so you'd get some hot flushes but I kinda want to push back and ask why they think it's so important to get T down before your orchiectomy? What am I missing here?

Spiro didn't reduce my T at all, which led to the orchiectomy. Your surgeon may be waiting for the WPATH recommended six months of HRT, and maybe he's just reckoning that your T levels are going to be below 50 by then? Without knowing the whole conversation between the two of you it's hard to guess.

The thing to realize is that Spironolactone, Finasteride, and Bicalutamide do not reduce T-levels in the blood. They block androgen receptors, so any T in the system has no effect.

Since the goal is to remove the major source of T via surgery, leuprolide is the one that targets the source and shuts it down.

Just talk to your doctors about what it is they are trying to accomplish.

Quote from: Lori Dee on September 06, 2026, 09:04:25 AMThe thing to realize is that Spironolactone, Finasteride, and Bicalutamide do not reduce T-levels in the blood. They block androgen receptors, so any T in the system has no effect.

Since the goal is to remove the major source of T via surgery, leuprolide is the one that targets the source and shuts it down.

Just talk to your doctors about what it is they are trying to accomplish.

So, just to be the Devyl's advocate, the forums are full of people who were on spiro and had their T levels supressed. Is that because it allows your system to become estrogen-dominant?

With the most common HRT regime (i.e. spironolactone + estradiol), it is the estradiol that reduces testosterone.  The spiro is just there to prevent the T that is still being produced from doing anything androgenic.

Kathy is right the Spiro plays a much smaller roll in lowering testosterone. Hugs
Mariah

I had an average amount of testosterone before my orchiectomy. I recall that the estrogen lowered it to some degree but it was the orchiectomy that really did that for me. Currently I am at 17 ng/dl and i'm hearing now that that's "too low" apparently.

I don't think I'll do anything testosterone-wise until after a vaginoplasty. (When I become sexually active in other words.)

I agree with the others here that the best way is through the orchiectomy itself. I was on Spiro for over 3 years. My T was above 50 at the time but my surgeon still did the procedure.

Quote from: CosmicJoke on September 06, 2026, 08:18:07 PMCurrently I am at 17 ng/dl and i'm hearing now that that's "too low" apparently.

I have been at <12 for almost a year now. My Endos have never said it was too low. If they aren't worried about it, I'm not going to worry about it. It seems like every provider has their own ideas about what our levels should be, or should not be.

Quote from: KathyLauren on September 06, 2026, 10:46:40 AMWith the most common HRT regime (i.e. spironolactone + estradiol), it is the estradiol that reduces testosterone.  The spiro is just there to prevent the T that is still being produced from doing anything androgenic.

This is so true. Estrogen is the biggie for T reduction other than surgery.

All,
 
I appreciate every one of your responses.  I agree with all of them.  I will push hard to find out why it is so important to reduce testosterone before the orchiectomy.  Surgeon wants it down to 50.  I am currently at 240.

It is definitely on top of my list to discuss with my PCP.  I do not understand either.  I was told for the 7 years I've been on estradiol patches that Spironolactone was needed to lower testosterone, but I could not have it due to being diabetic.

Believe me, I will push for a resolution!

Thanks,  Coral

The one thing I didn't say before I feel I should now and that is your milage may very meaning for some people different things will get to the level it needs to be and for some that means surgery. Hugs
Mariah