Ladies, my question here is directed at those of you whom are on HRT under the supervision of an Endocrinologist. My doctor prescribed me Avodart as the anti androgen and of course estradiol to inject intramuscularly about a 19 months ago. I see this doctor every 90 days for a check up, and get a blood test every 6 months. I feel ok, no complaints, but have always wondered if anyone has ever heard of Avodart (dutasteride) being used as an anti androgen; I thought every one took spironolactone for their AA.
I have expressed this question to my doctor a handful of times, and each time he explains that Dutasteride blocks the absorption of testosterone in male patients, or MTF transsexuals. And unlike spiro, Dutasteride doses never get increased.
So I'm 19 months into this gig and just within the last 3 months my sex drive has come back crazy, even though the estrogen and avodart levels haven't changed.
Can anyone else give any personal experience, advice, about Avodart?
Thanks :-)
Ok, I just searched for and found this post "AVODART OR SPIRO??????????????? Help Please............" from - July 21, 2007, 07:49:49 pm.
This was 6 years ago... And back then, it was said in the posts that Avodart does not block testosterone so spiro still had to be taken with it. The reason to ADD Avodart was to aid in male pattern baldness hair regrowth...
Dutasteride is a dihydrotestosterone (DHT) blocker. DHT comes from testosterone, is more potent than it and is the cause of male pattern balding. However it's in pretty small amounts compared to testosterone, which causes, I think, most of the masculinization.
Dutasteride is normally a DHT blocker, and that's what it's used for, as far as I know. However, maybe it does block testosterone too. I don't know. But if it does, then why does every case I've heard of combine it with a more usual antiandrogen?
Normally, to block testosterone, you're going to use either cyproterone acetate (very potent but also slightly more risky) or spironolactone (a bit less potent, but I think it's less risky). Cyproterone acetate is basically used everywhere in the world minus in the US. The US haven't approved the product for some reason, so Americans are prescribed spironolactone instead.
Then, if male pattern baldness is a serious issue (and there are probably other reasons for using it, I dunno), sometimes doctors will supplement the regimen with additional finasteride or dutasteride.
Now all of this is only what I've read about people's hormone regimens. To be honest I hardly know what I'm talking about. But this I know: look at your blood levels in your next blood test. If it's good, it's good. If not, then perhaps you have something to worry about.
Also, weird sudden returns of libido after a while on HRT do happen. I can't explain it, but mine did somewhat come back after over a year of near-zero HRT.
From Medicine Net:
SIDE EFFECTS: Sexual problems (such as decreased sexual interest/ability, decrease in the amount of semen/sperm), increased breast size, or breast tenderness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Your endo may be counting on the side effects. DHT is also linked to male general development. So depending on your age this may be a pretty good thing.
I think maybe you need to look at your levels? Are they in the range of a cis female?
Maybe the IM estrogen is doing good enough job fighing the t levels and the Avodart is used more for its DHT blocker to help?
I do not know for sure. I would say knowing my Endo it comes down to what the test are showing how my progress is. And maybe something in your test is keeping spiro out of your list of HRT?
I would ask if that might be the case? There is no magic pill or amounts that everyone takes. It comes down to you, your health and the tests. Everything is then adjusted to all these factors.
Stay positive but remember get informed as you are here now and ask the hard questions, you are your own health advocate. You can also do search for: Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. might also help you understand a little.
Izzy
My .02 - I am on a low dose HRT regimen and I was talking to my new endo specifically about advodart vs. spiro and he said it's an "excellent" AA. I don't know if he meant it is "excellent" for me or "excellent" overall, but he's the doc.
Since I now know that I'm TS I'm curious if that will change when we up my HRT dose to a transitioning dose.
It does seem to be a case of no two endocrinologists who are specialists in treating trans*people never agree with each other.
Depending upon your T levels the requirement for AA is often controversial. My T went on E alone to zilch. I went on Spiro to modify my hair growth pattern from male to female. I did not require it for any 'feminizing' reason.
Spiro seems to be preferred by many endocrinologists treating trans*woman as it has far less effect in inducing severe depression, a known and very nasty side effect of cyproterone acetate. Particularly in a client group who may have depression problems to begin with!
One thing I think worth mentioning is to establish a good rapport with your endocrinologist, (and your psychiatrist/therapist). These people will be looking after you for a long time and we need to be on good communicative terms with them so they do explain why they prefer substance X over Y, and not just because it is what they always use.
My hormone regime has been tailored to me, I had all sorts of problems when going on E, (one reason I'm very much in the 'get a medic to supervise' me camp, I would have had a very good chance of not getting to my next birthday if things had not been picked up).
Quote from: Cindy on September 09, 2013, 02:51:13 AM
It does seem to be a case of no two endocrinologists who are specialists in treating trans*people never agree with each other.
Cindy, as one of my friends - medical practitioners - told me, it does not have to be about trans-treatment. We all think that medicine is very precise and exact science - search for symptoms 1-2-3-4, check, apply medication X,Y,Z, check - see the follow-up, rinse and repeat. Uh huh... No way. They do tend to disagree on everything and sometimes they even make several camps which support the one or the other theory and very hostile against each other. Funny, but it is the same situation with law as well - people cant understand why two courts can come up with two opposite decisions in two very similar cases :)
Quote from: -Emily- on September 09, 2013, 03:13:38 AM
Cindy, as one of my friends - medical practitioners - told me, it does not have to be about trans-treatment. We all think that medicine is very precise and exact science - search for symptoms 1-2-3-4, check, apply medication X,Y,Z, check - see the follow-up, rinse and repeat. Uh huh... No way. They do tend to disagree on everything and sometimes they even make several camps which support the one or the other theory and very hostile against each other. Funny, but it is the same situation with law as well - people cant understand why two courts can come up with two opposite decisions in two very similar cases :)
My specialty is hematological-oncology, our weekly review meetings are an art in not agreeing with each other. It is a very good technique to allow a group of specialists to ensure we have all thought through the ramifications of an individual opinion. Open minded debate and expression of opinion in a free forum is a very powerful way of reaching sensible decisions on complex problems.
Just felt compelled to chime in. There's so many negative remarks around cyproterone acetate ( androcur ) about. This is one of the reasons I was apprehensive about using it.
But let me just state, that this stuff is my saving grace! With a body that refuses to respond properly to spiro, androcur has become a game-changer for me. And no depression in sight :).
Quote from: SamC on September 09, 2013, 03:35:33 AM
Just felt compelled to chime in. There's so many negative remarks around cyproterone acetate ( androcur ) about. This is one of the reasons I was apprehensive about using it.
But let me just state, that this stuff is my saving grace! With a body that refuses to respond properly to spiro, androcur has become a game-changer for me. And no depression in sight :).
Definitely! It is excellent for many, it is a minority who have adverse effects.
Quote from: SamC on September 09, 2013, 03:35:33 AM
Just felt compelled to chime in. There's so many negative remarks around cyproterone acetate ( androcur ) about. This is one of the reasons I was apprehensive about using it.
But let me just state, that this stuff is my saving grace! With a body that refuses to respond properly to spiro, androcur has become a game-changer for me. And no depression in sight :).
It does work well, apart from the depresion, which I got.. I don't know how long you've been taking Androcur, but it took a little over a year for the depression to appear, which it did quite suddenly.. 2 weeks without it and I was all back to my usual cheerful self..
You don't want something that just blocks the absorbtion of testosterone, you need to get rid of the majority of t in your body. The testosterone will continue masculinization as your estrogen is trying to feminize. Talk to your endocrinologist and have him switch you to spiro, or find another endo. I believe that we women shouldn't worry about our loyalty to a doctor or endo, we need to worry about what they do correctly to help us.
A lot of people feel they know exactly what everyone needs in all sorts of aspects of life, not just medicine. So they dictate rather than make flexible determinations based on individual needs. And even I fall into that trap every now and then, so you don't need to listen to me either.
Take care of yourself.
Kathy
Uhm, is the reason why cyproterone can cause depression because it decreases testosterone levels so much compared to spiro (on average)? If not I really wonder how. Does anyone understand it?
PS: In all honesty, I thought the reason Americans didn't like cyproterone was that it was a bit of a harsher substance, and maybe because they were against it having such drastic and rapid effects on testes.
Cyproterone just will not pass the F&D in the states. Not sure why.
I was on Spiro in the states, and Androcur in canada. Depression seem for me not to be a factor of the drugs more then all the crap going around in my mind at the time. So with that said I had more depression under Spiro then Androcur being Spiro was what i was on in my early transition.
But you need to have more blood work done on Androcur. It is harder on your system then Sprio.
Izzy
I am also on dutasteride and what A posted is exactly what my endo told me, I was on cyprostat(cyproterone acetate) but she took me off it last appointment because my bad cholesterol was up higher than she liked and wanted to see if it was caused the medication. I worry that the effects will stop, at least I think they have slowed down as the hair on me hands while not as long or as fast growing does seem to show up a bit quicker again and my skin doesn't feel as smooth anymore. So I hope she will put me back on it at my next appointment.
I am going through that period now and i am past 2 years on HRT :( every erection makes me hate this body ever more... I checked my blood I have almost untracable amounts of T and my endo says it will pass. I hope he is right.
I don't understand the use of Avodart unless it is to reduce or eliminate male pattern baldness.
Summary from the clinical trials used to support the approval of Advodart "In healthy volunteers, 52 weeks of treatment with dutasteride (Avodart) 0.5 mg/day (n = 26) resulted in no clinically significant change compared with placebo (n = 23) in sex hormone-binding globulin, estradiol, luteinizing hormone, follicle-stimulating hormone, thyroxine (free T4), and dehydroepiandrosterone. Statistically significant, baseline-adjusted mean increases compared with placebo were observed for total testosterone at 8 weeks (97.1 ng/dL, P < 0.003) and thyroid-stimulating hormone at 52 weeks (0.4 mcIU/mL, P < 0.05). The median percentage changes from baseline within the dutasteride group were 17.9% for testosterone at 8 weeks and 12.4% for thyroid-stimulating hormone at 52 weeks. After stopping dutasteride for 24 weeks, the mean levels of testosterone and thyroid-stimulating hormone had returned to baseline in the group of subjects with available data at the visit. In subjects with BPH treated with dutasteride in a large randomized, double-blind, placebo-controlled trial, there was a median percent increase in luteinizing hormone of 12% at 6 months and 19% at both 12 and 24 months."
It increased testosterone in the trials!
What it does do, again from the trials is to limit the metabolism (excretion) of testosterone. "Dutasteride inhibits the conversion of testosterone to dihydrotestosterone (DHT). DHT is the androgen primarily responsible for the initial development and subsequent enlargement of the prostate gland."
What it doesn't do, from the trials "Dutasteride does not bind to the human androgen receptor."
It does not bind to the receptors.
Data is data – it's doesn't do what it is supposed to be doing.
Quote from: JLT1 on September 09, 2013, 12:56:48 PM
It increased testosterone in the trials!
What it does do, again from the trials is to limit the metabolism (excretion) of testosterone. "Dutasteride inhibits the conversion of testosterone to dihydrotestosterone (DHT). DHT is the androgen primarily responsible for the initial development and subsequent enlargement of the prostate gland."
What it doesn't do, from the trials "Dutasteride does not bind to the human androgen receptor."
It does not bind to the receptors.
Data is data – it's doesn't do what it is supposed to be doing.
You are right but please do not forget that DHT is by far the strongest Androgen in your body and responsible for your malish look and feel. Without DHT a young boy will look like a women when he becomes an adult. It also docks to rezeptors in the brain and may influence our feelings. To look more feminine it important to block the conversion from test to DHT. Testo is responsible for your fertility and your muscles. Normally with some estrogen your testo levels dropps sharply but even with low testo your DHT levels can be quite in the range of a male.
Lara
Are you sure about this? Because I don't know, with testosterone levels near the very lowest normal value for women, I have a feeling my system doesn't have much material for making DHT. If so, it would mean that genetic women would have worrisome amounts of DHT..?
I'm not completely sure that even if I stopped my antiandrogen, my testes would "come back to life". Cyproterone is also used for chemically castrating sexual delinquents, after all.
Also, I have trouble believing that testosterone is so useless that boys will not masculinize with it but no DHT. Of course, DHT is a much more potent androgen than testosterone, but shouldn't the fact that there's so much testosterone be a big factor?
Oh yeah, and I read that mostly, for the same reduction in androgen levels, using a high dose of estradiol puts more strain on the system than using an antiandrogen and a more moderate dose of estradiol. I'm pretty sure not many doctors would bother with antiandrogens at all if that were not true.
To answer one question: yes some women have too much DHT ans therefor they experience hair loss. Usually they have a higher testo level but sometimes in the upper range of women.
Lara
Uhm, the way I see it, women tend to lose their hair in a very different way than men do, and what I've heard is that DHT is responsible for MALE-pattern baldness. That is, baldness that starts at the forehead and top of the head, which I've honestly never seen in a woman. A cis woman, that is.
Quote from: Lara1969 on September 09, 2013, 02:24:41 PM
You are right but please do not forget that DHT is by far the strongest Androgen in your body and responsible for your malish look and feel. Without DHT a young boy will look like a women when he becomes an adult. It also docks to rezeptors in the brain and may influence our feelings. To look more feminine it important to block the conversion from test to DHT. Testo is responsible for your fertility and your muscles. Normally with some estrogen your testo levels dropps sharply but even with low testo your DHT levels can be quite in the range of a male.
Lara
DHT is about 5X more potent than testosterone. I cannot find normal levels of DHT in men fro a reputable source. Saw a couple putting it at about 20X less in concentration than T but always question the units and that doesn't quite make sence given clearance rates. If true, the level of T being so much higher than corculating DHT would still make T the big one. Not sure there....
DHT plays a role in formation of the male sex organs in the fetus. Boys who are born without the ability to convert testosterone into DHT are born with ambiguous genitalia, malformed penises (pseudohemaphrodites). During puberty, DHT is responsible for the emergence of body hair (including beard), penis growth, development of the libido and sexual function and prostate. In pseudohemaphrodites these functions do not develop fully at puberty, despite having a normal level of testosterone. They only develop male musculature, with little body hair and their sexual organ is between a micro penis and an overdeveloped clitoris. However, they never develop baldness. In the adult, it maintains the health of the prostate. (Plagiarized but checked)
There does also appear to be some minor functions relating to estrogen levels. I did find that when conversion of testosterone is blocked, the result is low DHT, elevated estrogen, and increased progesterone. Some studies suggest hypogonadism (effects the testicles).
Given that there is some increase in estrogen and progesterone, there may be more of an effect that I had originally thought. If a person could get enough E, that would drop the T while the progesterone stays up.
I believe that regular blood tests would answer any potential concern and end the debate.
To be honest, I would probably just see two enemies and want to destroy both of them, and give both spironolactone/cyproterone and finasteride/dutasteride, haha.
Though JTL1, you make me wonder... Assuming that despite my low testosterone, I might still have relatively high DHT, does that mean my body hair problems would have a chance of being helped by getting on a DHT blocker? That sounds freaking advantageous. I doubt I'll be able to convince my endo, but now I really feel like asking him to add DHT to my next blood test.
IIRC, about 5-7% of T is converted to DHT, so if your T level is low, your DHT is quite likely to be low as well..
My endo doesn't check for T levels, he says it is a waste of time because the high dose estrogen I take causes the T to drop. My E levels are always right where he wants them, whatever that means.
So I think it may be correct to say that the endo is counting the anti-dht effects of the Avodart to squash what little he thinks I have.
My next appointment with the doc is going to be interesting....I have allot of questions...
Waste of time is a big word considering you need to go for a blood test anyway. My endo only stopped caring so much about my testosterone levels once they were stable and very low. Because estrogen can't do its job right if testosterone is in the way, initially checking testosterone was his first priority.
But yeah, your endo does have a pretty special approach. And I doubt it's utter nonsense. Though extra information, like testosterone levels, can't hurt, can it?
I think the utter excitement of being on HRT sort of blocked my Intelli-vision.
I do recall my endo asking me in the beginning, how fast do I wanted to go. I wasn't sure what he meant, but I told him I wanted to take my time. I was going though a nasty divorce with massive child custody issues at the same time and wanted to keep everything low key during the court hearings.
So everything may make sense if it holds true that he put me on a special-brew of HRT that is slower per say. I do know a few other ladies whom have used the same doctor and they were put on spiro, not avodart....
That's odd, though. The antiandrogen isn't something that you change to go "slow", normally. It only blocks testosterone, and as such slows/stops further masculinization, and opens the way for estrogen. But it doesn't cause any real feminization by itself. If you wanted to go slowly, the first choice that comes to mind is to block testosterone as completely as possible with a good antiandrogen, and start with a very low dose of estrogen, not reduce the antiandrogen's potency.
Sorry, but I don't think that's your explanation. You really will have to ask him, I think.
Quote from: A on September 09, 2013, 10:31:25 PM
To be honest, I would probably just see two enemies and want to destroy both of them, and give both spironolactone/cyproterone and finasteride/dutasteride, haha.
Though JTL1, you make me wonder... Assuming that despite my low testosterone, I might still have relatively high DHT, does that mean my body hair problems would have a chance of being helped by getting on a DHT blocker? That sounds freaking advantageous. I doubt I'll be able to convince my endo, but now I really feel like asking him to add DHT to my next blood test.
I think there are problems with getting good data on circulating DHT and understanding exactly what those numbers mean. In individuals who have a prostate, DHT is produced in the prostate and the skin. Once out of the prostate or skin, it gets eliminated from the body fairly rapidly so blood levels are relatively low.
The role DHT has in hair growth is interesting as well. It is the primary hormone that promotes initial hair growth while at the same time; it is also the primary cause of most hair loss as people age, in both women and men. My little corner of the world of the endocrine system is to understand the effects of zenobiotic compounds on the endocrine system, particularly in regards to reproduction. I assume that all other things being equal, both hairy and hairless people can reproduce so I am unfortunately out of my limited knowledge.
So while your question is a good one, I think it is beyond what is currently understood about the dual roles of DHT. However, if your seeing the doctor already, questions are free.
Sad thing is, I have the answer in advance. "It doesn't matter." Yush, helpful endo.