So, I'm looking at other options,or maybe a combination of medication. Currently I am taking Spiro and estradiol valerate. I switched over to injections recently because I thought pill-form wasn't doing enough for me,which showed in my blood tests. Now, I'm thinking that Spiro was the culprit. I'm not sure why, but I don't think it is satisfactory for my body.
So, I'm looking for alternatives, or a combination of Spiro and other. Unfortunately, androcur is not approved in the united states. I don't know a whole lot about other possible options, so I am curious.
(: Thanks for reading.
None.
With implants and injections estrogen can be kept well in the female range, which drives testosterone down into the female range by a feedback loop. Its considered safe only with implants and injections.
Its a well known effect an endo should be able to look up if told it exists.
With bioidentical estrogen and internal application its considered safe by many endos.
With pregnancy levels are also raised without adverse effects.
*hugs*
Really... I have been wondering why I've felt almost 'drugged' or lethargic, even less emotional. Do you think it could be because of the combination of the injections and Spiro? Even if I am pre-op? I remember Kayxo mentioning this in another thread of mine, too...This is something I'm going to ask my doctor on Monday, but I thought I'd ask it here because I've learned so much more in these threads than really at the doctors office, which is an interesting prospect.
Quote from: Orchid on March 19, 2016, 05:04:39 PM
Really... I have been wondering why I've felt almost 'drugged' or lethargic, even less emotional. Do you think it could be because of the combination of the injections and Spiro? Even if I am pre-op? I remember Kayxo mentioning this in another thread of mine, too...This is something I'm going to ask my doctor on Monday, but I thought I'd ask it here because I've learned so much more in these threads than really at the doctors office, which is an interesting prospect.
Well many doctors are simply not that versed in transgender subjects given they have not many transgender clients.
You might talk with your doctor about weekly injections instead of biweekly ones.
Levels do not rise that much the first day and do not drop that much the last days.
With biweekly injections levels rise very high and drop to low levels the last days.
Well you might try a higher dose and leave away spiro and see if its enough to keep testo in the female range.
Many endos strive for levels of 60 ng/dl or below.
You might talk about it with your doctor.
*hugs*
Quote from: Orchid on March 19, 2016, 04:41:00 PM
So, I'm looking at other options,or maybe a combination of medication. Currently I am taking Spiro and estradiol valerate. I switched over to injections recently because I thought pill-form wasn't doing enough for me,which showed in my blood tests. Now, I'm thinking that Spiro was the culprit. I'm not sure why, but I don't think it is satisfactory for my body.
So, I'm looking for alternatives, or a combination of Spiro and other. Unfortunately, androcur is not approved in the united states. I don't know a whole lot about other possible options, so I am curious.
In my experience over the years, I have come to the conclusion that Estradiol Valerate injectable, ON ITS OWN, is enough to bring down T to female range so any anti-androgen is really unnecessary.
I would prefer small dosage of estrogen and finastride ( very effective ) and low estro dosage can do it.
Since I am on sublingual pills, I say CPA (Cyproterone Acetate) at the dose I am given I have seen more changes in two months than being on Spiro for almost a year and a half. Also, I can see an accelerated breast growth based on the tenderness and some pain associated with it.
Quote from: April_TO on March 23, 2016, 08:04:22 AM
Since I am on sublingual pills, I say CPA (Cyproterone Acetate) at the dose I am given I have seen more changes in two months than being on Spiro for almost a year and a half. Also, I can see an accelerated breast growth based on the tenderness and some pain associated with it.
Be sure to have prolactin levels regularly checked as CPA tends to raise them significantly and has been, in the past, often associated with the incidence of prolactinoma in transwomen. If you notice milk leaking from your breast (galactorrhea), advise your doctor immediately. This *may* be a symptom of a prolactinoma. Persistent headaches or vision problems are also something to watch out for as they can be sometimes be the result of a prolactinoma or a meningioma, also linked to CPA. Those problems most often come up when one takes high doses of CPA. Lastly, CPA can, in some people, cause depression and extreme tiredness.
Better be warned than not, just in case! :)
Thanks Kayxo for the reminders! I am on the lowest dose possible and blood work every 3 months since I've been on HRT has been my doctor's regimen :) Sometimes I feel lucky that I live in a country that provides utmost care to trans patients like me ;) My last blood work back in FEB has been normal and my mood has been stable :)
All in all even with the possible side effects of CPA, I'll choose it over Spiro.
Spiro made my kidneys work extra hard!
Quote from: KayXo on March 23, 2016, 09:12:58 AM
Be sure to have prolactin levels regularly checked as CPA tends to raise them significantly and has been, in the past, often associated with the incidence of prolactinoma in transwomen. If you notice milk leaking from your breast (galactorrhea), advise your doctor immediately. This *may* be a symptom of a prolactinoma. Persistent headaches or vision problems are also something to watch out for as they can be sometimes be the result of a prolactinoma or a meningioma, also linked to CPA. Those problems most often come up when one takes high doses of CPA. Lastly, CPA can, in some people, cause depression and extreme tiredness.
Better be warned than not, just in case! :)
Does your doctor check prolactin levels?
Quote from: KayXo on March 23, 2016, 09:46:14 AM
Does your doctor check prolactin levels?
Yes she does, it part of the Sherbourne Health Clinic list of things to check including a host of different blood markers (i.e. estradiol, free and total T, thyroid stuff, CBC, Cholesterol, Sodium, Kidney function etch and this list goes on) LOL they would always draw 5 vials of blood from me.
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi.imgur.com%2F4S8xZxq.jpg&hash=e24558e93baed61569065b6f1fd249c6db42f930)
Great! :) I know about them, I live right next door, in Quebec. I don't totally agree with everything they do HRT wise but it's ok. Could be better. ;)
Quote from: KayXo on March 23, 2016, 10:19:11 AM
Great! :) I know about them, I live right next door, in Quebec. I don't totally agree with everything they do HRT wise but it's ok. Could be better. ;)
I know :) whenever you're here in TO - just let me know.
Hi just posted this over here: https://www.susans.org/forums/index.php/topic,206954.new.html#new
Covers the same ideas so I'll paste in the bits with my thoughts on this:
Fwiw, I did the same as you for a long time with finasteride + estradiol though I much prefer the normal rather than conjugated oestrogen. About a month back I switched from finasteride to dutasteride. I'm not entirely sure why I did that except that dutasteride is a better T to DHT blocker. I have had what I think are some side effects so I'm coming under an endo out here in Thailand where I now live as well as my UK one.
There are plenty of people on here who will tell you that you need to be on a 'proper' T blocker i.e. one which stops T production rather than just the T to DHT conversion. Personally I don't think you need necessarily take much notice of that. Finasteride or Dutasteride in conjunction with oestrogen will do the job perfectly satisfactorily. Your overall T level, not just DHT, will drop away. I now have no ejaculate at all: I mean literally nothing comes out. My T level recently has dropped through the floor whilst my E level has gone way into female range. That's without using any of the conventional T blockers like spiro or androcur, both of which are nasty nasty drugs imho. The UK NHS will not prescribe spiro for transgender and, as you know, androcur (Cyproterone acetate) is a flippin dangerous drug esp in its form with diane 35 - a banned drug in the US and therefore topic on here. Avoid that one like the plague. I would also personally avoid spiro as it's not intended for the purpose of transitioning and I think it's also a dangerous drug.
The other route to go down is GNrH analogues about which others know way more than me. It's those which the NHS prescribe. My T levels have vanished without any recourse to them but it may be something I consider for the sake of my liver. All these drugs are toxic to our bodies. It's one of the biggest reasons why I'm pulled to go the whole way for SRS.
Quote from: April_TO on March 23, 2016, 08:04:22 AM
Since I am on sublingual pills, I say CPA (Cyproterone Acetate) at the dose I am given I have seen more changes in two months than being on Spiro for almost a year and a half. Also, I can see an accelerated breast growth based on the tenderness and some pain associated with it.
My experience has been the opposite of this for some reason.
My T and especially DHT levels weren't very satisfactory on spiro, so I upped the dosage and all was fine, DHT was still bothersome but nothing big and I felt okay. I eventually switched to CPA and my levels were fine from the get-go, but I actually grew MORE body hair again ??? heck, I even feel manlier again, but on paper everything seems perfect. I'm very confused.
Cyproterone acetate binds to androgen receptors but is not a pure anti-androgen in the sense that it has no effect on receptors. Studies have shown an agonist effect where it can actually trigger effects similar but weaker to androgens such as T and DHT BUT those studies were in animals, also in-vitro so not sure how much and to what extent these can be generalized to us.
Also, spiro and both cypro bind to androgen receptors, thereby blocking DHT and T so levels in the blood only tell part of the story. Also, sensitivity to hormones is not measured so your levels may be "ok" but you may still remain hypersensitive to them.
Why not address this concern to your doctor? Also, cyproterone acetate has been implicated in the only meningioma cases reported in transsexual women and in several cases of prolactinoma although non bio-identical estrogens were also used. Keep an eye on prolactin levels. It may, in some, also cause depression.
Quote from: KayXo on March 31, 2016, 11:30:16 PM
Cyproterone acetate binds to androgen receptors but is not a pure anti-androgen in the sense that it has no effect on receptors. Studies have shown an agonist effect where it can actually trigger effects similar but weaker to androgens such as T and DHT BUT those studies were in animals, also in-vitro so not sure how much and to what extent these can be generalized to us.
Also, spiro and both cypro bind to androgen receptors, thereby blocking DHT and T so levels in the blood only tell part of the story. Also, sensitivity to hormones is not measured so your levels may be "ok" but you may still remain hypersensitive to them.
I dont quite understand. How does this explain how I've seemed to have less androgenic effects on spiro? On CPA my blood levels are next to non-existant, so even if I was hypersensitive, when there is almost nothing to work with in my blood, how would it?
Quote from: KayXo on March 31, 2016, 11:30:16 PM
Why not address this concern to your doctor? Also, cyproterone acetate has been implicated in the only meningioma cases reported in transsexual women and in several cases of prolactinoma although non bio-identical estrogens were also used. Keep an eye on prolactin levels. It may, in some, also cause depression.
I have no references for prolactine levels. They're at 51 µg/l, but CPA for sure made me more depressed when I switched. Sadly I can not talk to my endo about this as he doesn't want to get involved in my self-medding, beyond making sure my blood levels are healthy, or rather not alarming.
Quoting a study:
QuoteNine cases were discussed in a published case series,2; and 27 cases are unpublished case reports. Of the 36 cases, 32 occurred in women and four in men. Duration of treatment with cyproterone acetate ranged from 4 years to 27 years
By the time I get SRS I'll be just over half a year on CPA, so it would be pretty bad luck if I develop a meningioma in that time.
I preferred bicalutamide to spiro but I am on spiro nowadays due to the low cost and high availability of it.
Quote from: Vii on March 31, 2016, 11:53:05 PM
I dont quite understand. How does this explain how I've seemed to have less androgenic effects on spiro? On CPA my blood levels are next to non-existant, so even if I was hypersensitive, when there is almost nothing to work with in my blood, how would it?
Next to non-existent? What are your levels and please specify units? CPA is also a progestogen (spironolactone has negligible progestogenic effects) and therefore can oppose some of estrogen's effects. This last factor could perhaps explain why you did better on Spiro.
Quote from: Vii on March 31, 2016, 11:53:05 PM
They're at 51 µg/l
If you notice your breasts leaking (galactorrhea) or have recurrent headaches, vision problems, you should immediately go see a doctor and explain these may be due to CPA and a possible prolactinoma.
QuoteCPA for sure made me more depressed when I switched.
On top of giving you poorer feminization results. It's obvious what you need to do but I would strongly advise you consult someone who is a professional and is competent in the matter. Sooner than later. ;)
QuoteQuoting a study
4 cases reported in transsexual women, all taking cyproterone acetate for at least 4 years, up to 10 yrs.
QuoteBy the time I get SRS I'll be just over half a year on CPA, so it would be pretty bad luck if I develop a meningioma in that time.
It's a risk, even if quite small, I wouldn't personally take. In my opinion, there are other safer alternatives.
Quote from: KayXo on April 01, 2016, 10:05:23 AM
Next to non-existent? What are your levels and please specify units? CPA is also a progestogen (spironolactone has negligible progestogenic effects) and therefore can oppose some of estrogen's effects. This last factor could perhaps explain why you did better on Spiro.
My DHT is higher than I remembered at 53 ng/l, my T is at 0,2 ng/ml. Progesterone at 3,69 µg/l. not particularly much I think? For comparison, on spiro I had 370 ng/l DHT and 1,06 ng/ml T.
Quote from: KayXo on April 01, 2016, 10:05:23 AM
If you notice your breasts leaking (galactorrhea) or have recurrent headaches, vision problems, you should immediately go see a doctor and explain these may be due to CPA and a possible prolactinoma.
No, none of that. I do have silent migraine and with it recurring vision problems but that predates HRT altogether.
Quote from: KayXo on April 01, 2016, 10:05:23 AM
On top of giving you poorer feminization results. It's obvious what you need to do but I would strongly advise you consult someone who is a professional and is competent in the matter. Sooner than later. ;)
Well it seems I can't, but this is the very first time I hear of CPA supposedly being inferior. ???
I'm tempted to go back to spiro for the 3 remaining months but I needed a higher than usual dose and my DHT was still super high, which bothers me.
Quote from: KayXo on April 01, 2016, 10:05:23 AM
4 cases reported in transsexual women, all taking cyproterone acetate for at least 4 years, up to 10 yrs.
It's a risk, even if quite small, I wouldn't personally take. In my opinion, there are other safer alternatives.
I think the odds are in my favor considering I'd be the first person to get some growth 8 times faster than the fastest known cases. Most other meds I take have higher risk factors.
Quote from: Vii on April 01, 2016, 05:49:43 PM
My DHT is higher than I remembered at 53 ng/l, my T is at 0,2 ng/ml. Progesterone at 3,69 µg/l. not particularly much I think? For comparison, on spiro I had 370 ng/l DHT and 1,06 ng/ml T.
QuoteWell it seems I can't, but this is the very first time I hear of CPA supposedly being inferior. ???
I'm tempted to go back to spiro for the 3 remaining months but I needed a higher than usual dose and my DHT was still super high, which bothers me.
QuoteI think the odds are in my favor considering I'd be the first person to get some growth 8 times faster than the fastest known cases. Most other meds I take have higher risk factors.
You are the one who complained of having androgenic symptoms on CPA vs. Spiro despite lower levels of androgens on CPA. If you want to stay on it, then do but I don't understand why you complain then and why you mentioned this in the first place. ??? And if you had less of these symptoms on Spiro despite higher blood levels, this goes to show you that blood levels alone don't tell the whole picture, there is more going on.
It could be that Spiro resulted in more E as I read that aromatization of T to E increases on it, and E is apparently released from SHBG due to competitive binding with Spiro. Spiro also does not have the progestogenic (anti-estrogenic) effect CPA has and Spiro can even weakly trigger estrogen receptors, CPA doesn't.
If there is growth, then why change anything? I don't know how you came up with that figure, 8 times faster than the fastest known cases...do you know all transwomen that have ever been on hormones, are you basing yourself on actual studies, have you objectively compared growth?
Like I said, the sooner you see a doctor, the better. :)
Quote from: KayXo on April 02, 2016, 12:17:58 PM
You are the one who complained of having androgenic symptoms on CPA vs. Spiro despite lower levels of androgens on CPA. If you want to stay on it, then do but I don't understand why you complain then and why you mentioned this in the first place. ??? And if you had less of these symptoms on Spiro despite higher blood levels, this goes to show you that blood levels alone don't tell the whole picture, there is more going on.
It's impossible to find any info on this though and emphasis is always put on blood levels. I'd like to know just what is wrong with CPA, as apart from depressions, so far I've seen myself be the only one who had any issues with it.
Quote from: KayXo on April 02, 2016, 12:17:58 PM
It could be that Spiro resulted in more E as I read that aromatization of T to E increases on it, and E is apparently released from SHBG due to competitive binding with Spiro. Spiro also does not have the progestogenic (anti-estrogenic) effect CPA has and Spiro can even weakly trigger estrogen receptors, CPA doesn't.
You replied to me in another thread where I was worried about too high estrogen levels. That shouldn't be the problem. You can only guess how much of it binds to receptors, but my issue was foremost increased body hair, which I don't think is something estrogen plays a big role in, as to my knowledge it's mostly an effect of DHT.
Quote from: KayXo on April 02, 2016, 12:17:58 PM
If there is growth, then why change anything? I don't know how you came up with that figure, 8 times faster than the fastest known cases...do you know all transwomen that have ever been on hormones, are you basing yourself on actual studies, have you objectively compared growth?
Like I said, the sooner you see a doctor, the better. :)
The study I quoted and also pretty much any other you can find on the matter cites patients taking CPA 4 years or longer who have had meningioma growth. By the time I have my SRS and with it, an orchiectomy, I'll have been on CPA for half a year so the fastest known case took 8 times that to become an issue.
Quote from: Vii on April 02, 2016, 12:49:39 PM
You replied to me in another thread where I was worried about too high estrogen levels. That shouldn't be the problem. You can only guess how much of it binds to receptors, but my issue was foremost increased body hair, which I don't think is something estrogen plays a big role in, as to my knowledge it's mostly an effect of DHT.
E does matter to an extent. So, if E is opposed by CPA (due to progestogenic effect, downregulation of receptors, more estradiol converted to estrone), and was slightly higher on Spiro, it could have made a difference.
J Invest Dermatol. 1997 Sep;109(3):296-300."Androgen receptor content in female frontal hair follicles was approximately 40% lower than in male frontal hair follicle. Cytochrome P-450-aromatase content in women's frontal hair follicles was six times greater than in frontal hair follicles in men. Frontal hair follicles in women had 3 and 3.5 times less 5alpha-reductase type I and II, respectively, than frontal hair follicles in men."
Suggesting *perhaps* estrogen reduces androgen receptors, increases aromatase and reduces conversion of T to DHT by resulting in less 5 alpha reductase activity.
Endocrinology. 1987 Jun;120(6):2597-603."In summary, estradiol treatment caused a reduction in androgen receptors, and estradiol withdrawal lead to a rise in androgen receptors. We believe that these results provide a mechanism whereby estradiol may directly antagonize androgen action."
Exp Dermatol. 2002 Aug;11(4):376-80."For topical treatment of androgenetic alopecia (AGA) in women, solutions containing either estradiol benzoate, estradiol valerate, 17beta- or 17alpha-estradiol are commercially available in Europe and some studies show an increased anagen and decreased telogen rate after treatment as compared with placebo."
"In conclusion, our ex vivo experiments suggest that under the influence of 17alpha-estradiol an increased conversion of testosterone to 17beta-estradiol and androstendione to estrone takes place, which might explain the beneficial effects of estrogen treatment of AGA"
QuoteThe study I quoted and also pretty much any other you can find on the matter cites patients taking CPA 4 years or longer who have had meningioma growth. By the time I have my SRS and with it, an orchiectomy, I'll have been on CPA for half a year so the fastest known case took 8 times that to become an issue.
Right, I understand now (I misunderstood) BUT I still wouldn't take the risk. To each their own. But why continue on it anyways if you are seeing increased androgenic effects on it?
Quote from: KayXo on April 02, 2016, 01:18:32 PM
E does matter to an extent. So, if E is opposed by CPA (due to progestogenic effect, downregulation of receptors, more estradiol converted to estrone), and was slightly higher on Spiro, it could have made a difference.
J Invest Dermatol. 1997 Sep;109(3):296-300.
"Androgen receptor content in female frontal hair follicles was approximately 40% lower than in male frontal hair follicle. Cytochrome P-450-aromatase content in women's frontal hair follicles was six times greater than in frontal hair follicles in men. Frontal hair follicles in women had 3 and 3.5 times less 5alpha-reductase type I and II, respectively, than frontal hair follicles in men."
Suggesting *perhaps* estrogen reduces androgen receptors, increases aromatase and reduces conversion of T to DHT by resulting in less 5 alpha reductase activity.
Endocrinology. 1987 Jun;120(6):2597-603.
"In summary, estradiol treatment caused a reduction in androgen receptors, and estradiol withdrawal lead to a rise in androgen receptors. We believe that these results provide a mechanism whereby estradiol may directly antagonize androgen action."
Exp Dermatol. 2002 Aug;11(4):376-80.
"For topical treatment of androgenetic alopecia (AGA) in women, solutions containing either estradiol benzoate, estradiol valerate, 17beta- or 17alpha-estradiol are commercially available in Europe and some studies show an increased anagen and decreased telogen rate after treatment as compared with placebo."
"In conclusion, our ex vivo experiments suggest that under the influence of 17alpha-estradiol an increased conversion of testosterone to 17beta-estradiol and androstendione to estrone takes place, which might explain the beneficial effects of estrogen treatment of AGA"
Right, I understand now (I misunderstood) BUT I still wouldn't take the risk. To each their own. But why continue on it anyways if you are seeing increased androgenic effects on it?
Thanks for the sources. I'm just not sure whether to use CPA or spiro. As I said before, I'm tempted to switch to spiro again, but it still doesn't quite make sense in my head apart from subjective (and somewhat vague) observation. I'll just give it a try once I'm back home I guess.
I would personally rely more on how my body responds rather than levels. Many doctors share that view as well. Good luck!
Kind of wish I had access to Bicalutamide...
I read a bit more into CPA and it really does have a devilish list of unwanted effects.
Considering my DHT levels on Spiro and since I'm still shedding despite CPA I'll add Dutasteride too. With that I'm not too bothered by the prospect of going back to Spiro. Probably the next best thing after Bica :)
Quote from: Vii on April 05, 2016, 04:06:27 PM
I'll add Dutasteride too.
Beware of depression/anxiety associated with this drug. It can persist even after discontinuation.
Read entire thread https://www.susans.org/forums/index.php/topic,206700.0.html
Quote from: KayXo on April 06, 2016, 08:10:59 PM
Beware of depression/anxiety associated with this drug. It can persist even after discontinuation.
Read entire thread https://www.susans.org/forums/index.php/topic,206700.0.html
Thanks for the warning. But trust me, the depressions on CPA are no joke either.
I'm already pretty used to a variety of depression-inducing meds, but I'll know to be prepared now :)
Quote from: Vii on April 07, 2016, 04:53:08 AM
Thanks for the warning. But trust me, the depressions on CPA are no joke either.
I'm already pretty used to a variety of depression-inducing meds, but I'll know to be prepared now :)
Dutasteride and CPA aren't the only way to go about reducing androgens. There are other options where mood wouldn't be adversely affected. Just saying...As always, this needs to be discussed with a professional.