I had a bizarre reaction to Spiro, felt like my lungs were crushing in, so it was promptly discontinued. After that experience, I just went ahead with the orchie before starting Estrogen - and within that first year after the orchie, on E, things really changed. But I'm weird & I always have to do things my way, for better or for worse [Better because Estrogen was unopposed, worse because later down the road it kinda messed up my SRS].