I am not going to mention dosages in this post, even though my prescription is not made with HRT in mind.

If you are over 50 years of age, have a prostate, and are not on cross-hormone therapy, there is about a 50% chance you have "benign prostate hyperplasia" (enlarged prostate - BPH).  Along with that, you may have an increased risk for prostatitis and prostate cancer.   

Those of us who have a prostate and are on HRT, reduce those risks.  Some here have even reported experiencing symptoms that are consistent with the sloughing of prostate tissue through the urinary tract after starting HRT.

A little over two years ago, I had a prostate-specific antigen test that was elevated (just under 10 as I recall).  I had been symptomatic for BPH and had a history of bouts with acute prostatitis for several years.  As I was also seeing a therapist for the gender issues, I was referred to a physician to start HRT.  At the time I was prescribed Bicalutimide (Casodex), both as an anti-androgen as part of the HRT regimen, and because it is a very potent pure anti-androgen that binds to the androgen receptors and blocks testosterone, and may be preventative for prostate cancer.

Bicalutimade also has a anti-hirsute effect.  My six month experience with this medication was that I lost almost all of the hair on my legs, my beard growth slowed, and my torso hair greatly diminished. YMMV

So when the BPH symptoms popped up again recently, I knew what I was dealing with.     This past Thursday I saw my endo to get my end-of-the year orders for lab tests.  I mentioned the symptoms, and came away from the appointment with a prescription for generic Proscar - Finasteride.



I am going to get to see the "side effects" of the medication first hand.  Finasteride is a Type II 5-alpha reductase inhibitor.  As such, it is considered a "weak" anti-androgen.  It works to block the formation of of dihydrotestosterone (DHT) from the testosterone that is in the body.  My T levels are rather low to begin with, so it is going to be interesting to see if I experience scalp hair regrowth (Finsateride prescribed as Propecia is 1/5th the dosage for male pattern baldness - MPB), or if my gynecomastia is in any way reactivated.

A similar medication to Finasteride is Dutasteride (Avodart), which has similar properties and collateral effects.

I intend to post back to this topic from time to time.  I may change my screen name to "Lab Rat."   

If anyone has had experience with these medications, please feel free to add to the discussion.

I started HRT with a "full" dose of Spiro but showed some signs of kidney irritation about 3 or 4 months after starting it.  I was a little surprised about that, I was so intent on all the other vitals that the kidney issues were a shock.  BUN was OK but Creatinine was 0.1 click over the max (3.6 max?).  I was surprised that my doc reacted so harshly to just that slight overage but, she's the doc.

She started me on "BPH treatment" levels of Finasteride (as opposed to lower hair growth stimulation levels) with only 1/4 of the Spiro level.  I asked about Casodex (Bicalutamide) on the recommendation of an acquaintance here (who just might be the OP  ).  She has significant experience in administering HRT but had never heard of Bicalutamide as an anti-androgen.  She did consult with her sources as well as contacting WPATH officials.  She finally declined to prescribe Bicalutamide because of its' potential for causing liver damage (which is an issue for me, I show elevated liver enzymes on occasion.)

As a result of her delving a bit deeper into alternatives to Spiro, she did find out that Finasteride is somewhat slow in becoming fully effective as an anti-androgen.  It is more effective against DHT, the more potent grade of Testosterone that is often the culprit in causing MPB (male pattern baldness), but not as effective against plain-Jane, vanilla T.  It can require 9 months for Finasteride to become fully effective.  Thus, she added a very high dose of Progesterone to my HRT combination as an added AA.

I miss Spiro!  I notice some amount of T creeping back into my system (for reasons that I won't elaborate here).  I don't mind the Progesterone for it's other benefits, but the Finasteride is a bit expensive for the limited use I get from it.  (my avatar is my own hair BTW, I do have that as 1 of my few physical blessings in regards to transition).  I'm likely going to transfer the administration of my HRT back to my GP now that it is under way and going smoothly.  I'm going to explore going back to full Spiro with him.

EDIT:  I've never shown signs of BPH via PSA, it's always been below 1.0, although I was experiencing mild ED (possibly BPH related).  I dabbled in the various ED treatments prior to starting HRT just as a lark.  I can recommend Cialis over the 2 other better known types (Viagra and Levitra).  Coincidentally, Cialis is still effective at improving ED even after 4 months on HRT.  (Sorry if that is TMI, I am just a curious kind of girl!).

SECOND EDIT: The OP mentioned observing the effects of Finasteride on gynecomastia.  One thing I noticed about the time of the above changes in my HRT was a change in breast growth.  The girls were going gang busters until that time but seem to have slowed down since.  They are still sore all the time but it seems to be taking forever to fill that last gap in my boob gauge bra, a size 46B underwire.  While the soreness has remained, it has a subtle shift in nature, it seems to be centered about the nipples, running from the areola to deeply beneath.  Likely it's become more glandular than adipose growth.  Hard to say if it's the Finasteride, the Progesterone, reduced Spiro or just the natural evolution of the process.

  Great post Jamie ! It is of particular interest to us high mileage folks here.I see my endo on Dec 17 to find out about hrt and should leave with my script as I have passed all the preliminary tests just fine.This just gives me something to ask about and my PSA scores are rising.  Pat

For what it is worth, my PSA score in the summer of 2011 was almost 10.  My most recent score, July 2013, <1.

(Edit:  I just looked it up.  My PSA reading was 0.6 ng/mL.  Anything under 4.0 is considered normal.)

It is possible I had a false, poorly calibrated, or anomalous score, but otherwise, there was a big improvement in two years.

That, of course, made the recent symptoms somewhat annoying.

The PSA screen is notoriously inaccurate and is only used, or should only be used, as an indicator for further investigation and is basically meaningless as a stand alone test.

That said my gynecologist recently told me to include one in my latest screen.  When I was being bled the nurse said ' Why are you having a PSA? That's for guys!' I told her it was also a screen for ovarian cancer in older women. She said in that case she would have one herself at her next checkup!

Whoops I've started a round of over servicing!

All the best for dealing with that Jamie! Heading to 48 I'm mindful of that silly little gland.

Quote from: Jamie D on December 07, 2013, 04:57:55 PM
Some here have even reported experiencing symptoms that are consistent with the sloughing of prostate tissue through the urinary tract after starting HRT.

What would that be like? (I know it's probably a bit eyew, but I'm curious.)

You are peeing out dead prostatic tissue.

Quote from: Jamie D on December 07, 2013, 04:57:55 PM
I am not going to mention dosages in this post, even though my prescription is not made with HRT in mind.

If you are over 50 years of age, have a prostate, and are not on cross-hormone therapy, there is about a 50% chance you have "benign prostate hyperplasia" (enlarged prostate - BPH).  Along with that, you may have an increased risk for prostatitis and prostate cancer.   

Those of us who have a prostate and are on HRT, reduce those risks.  Some here have even reported experiencing symptoms that are consistent with the sloughing of prostate tissue through the urinary tract after starting HRT.

A little over two years ago, I had a prostate-specific antigen test that was elevated (just under 10 as I recall).  I had been symptomatic for BPH and had a history of bouts with acute prostatitis for several years.  As I was also seeing a therapist for the gender issues, I was referred to a physician to start HRT.  At the time I was prescribed Bicalutimide (Casodex), both as an anti-androgen as part of the HRT regimen, and because it is a very potent pure anti-androgen that binds to the androgen receptors and blocks testosterone, and may be preventative for prostate cancer.

Bicalutimade also has a anti-hirsute effect.  My six month experience with this medication was that I lost almost all of the hair on my legs, my beard growth slowed, and my torso hair greatly diminished. YMMV

So when the BPH symptoms popped up again recently, I knew what I was dealing with.     This past Thursday I saw my endo to get my end-of-the year orders for lab tests.  I mentioned the symptoms, and came away from the appointment with a prescription for generic Proscar - Finasteride.



I am going to get to see the "side effects" of the medication first hand.  Finasteride is a Type II 5-alpha reductase inhibitor.  As such, it is considered a "weak" anti-androgen.  It works to block the formation of of dihydrotestosterone (DHT) from the testosterone that is in the body.  My T levels are rather low to begin with, so it is going to be interesting to see if I experience scalp hair regrowth (Finsateride prescribed as Propecia is 1/5th the dosage for male pattern baldness - MPB), or if my gynecomastia is in any way reactivated.

A similar medication to Finasteride is Dutasteride (Avodart), which has similar properties and collateral effects.

I intend to post back to this topic from time to time.  I may change my screen name to "Lab Rat."   

If anyone has had experience with these medications, please feel free to add to the discussion.

Bicalutimide is expensive and I think that's the generic form.

Thank you for this subject & all posts.

I added fin to my normal spiro & E patches one month ago & so far I feel good. 

Quote from: Amy1988 on December 08, 2013, 08:16:54 AM
Bicalutimide is expensive and I think that's the generic form.

Casodex is one of the brand names of Bicalutimide.  On my prescription plan Bicalutimide was $10 as a generic for a 1-month supply.  It is a very strong anti-androgen.

You are correct.  It is very expensive out-of-pocket.  If it had not been prescribed, I could not have afforded it.

Quote from: Jamie D on December 08, 2013, 05:25:32 PM
Casodex is one of the brand names of Bicalutimide.  On my prescription plan Bicalutimide was $10 as a generic for a 1-month supply.

My doc's first impression was that it's expensive also.  I did find it online, where I also get E patches, for a reasonable price, sorry, don't recall the exact numbers.

I don't recall, either, what the non-prescription price would have been, but I think hundreds.  Bicalutimide is strong because it was developed to stop testosterone from feeding some forms of prostate cancer.

Okay, so it has been two months on finasteride at the standard Proscar dosage.  As I mentioned in the first post, I had symptoms of BPH, and a history of prostatitis over the past decade.

I have had no symptoms since this past November (started treatment in December).  Okay, that's a plus.

One side effect of finasteride is scalp hair regrowth.  (Finasteride is branded as Propecia when used for MPB.)  I have not noticed anything yet.  But the literature suggests that noticeable regrowth takes several months.  So, let's call that a no decision at this point.

Another common side effect of finasteride treatment is breast tenderness and gynecomastia.  No tenderness, but I swear they seem fuller.  Maybe it's all in my head, but it sure feels like it's on my chest!

Two month report: so far, so good.

Quote from: Jamie de la Rosa on February 13, 2014, 12:02:04 AM

Another common side effect of finasteride treatment is breast tenderness and gynecomastia.  No tenderness, but I swear they seem fuller.  Maybe it's all in my head, but it sure feels like it's on my chest!

Jamie,

  The side effects of Finasteride are definitely not in your head, maybe on top of your head!! Also, the gynecomastia is very real for a select few of us. The medical literature reports about 1% of Finasteride patients will experience this side effect.  A few months ago, I too was a 46B. Now, after several months of serious diet and exercise, my chest is down to a 43. I am going to wait for a more weight loss before I have myself measured again. However, my breasts feel so much larger, more than a hand full each and each breast has a tender lump inside. I am not complaining, actually, I love my breasts.

I had started Finasteride 3 months prior to starting HRT(the high dose). During that period I had slight gonad sensitivity but no hair regrowth. I started HRT which was AA, E and fin. At the 6 month HRT mark (9 months Fin) I noticed a lot of small hairs. Now 11.5 months on Fin  have a lot for hair regrowth (50% of the bare spots) and small hairs elsewhere.

When I started HRT my T dropped like a rock to below 20 ng/dl. I had 1 month Dutasteride but the PA discontinued the script stating it just is not needed due to such a low T.

Quote from: Dani on February 13, 2014, 04:06:57 PM
Jamie,

  The side effects of Finasteride are definitely not in your head, maybe on top of your head!! Also, the gynecomastia is very real for a select few of us. The medical literature reports about 1% of Finasteride patients will experience this side effect.  A few months ago, I too was a 46B. Now, after several months of serious diet and exercise, my chest is down to a 43. I am going to wait for a more weight loss before I have myself measured again. However, my breasts feel so much larger, more than a hand full each and each breast has a tender lump inside. I am not complaining, actually, I love my breasts.

Thanks for the reply, Dani.  I have had breasts since I was a young teen - "persistent pubertal gynecomastia."  It was just due to my screwy hormones (low T and high E).  When I had a six-month course of HRT, they definitely blossomed.  But I had to stop E due to a medical condition.

I'm not sure, but I think I am getting a bit of female pattern fat distribution. 

Quote from: Cynthia Michelle on February 13, 2014, 06:23:41 PM
I had started Finasteride 3 months prior to starting HRT(the high dose). During that period I had slight gonad sensitivity but no hair regrowth. I started HRT which was AA, E and fin. At the 6 month HRT mark (9 months Fin) I noticed a lot of small hairs. Now 11.5 months on Fin  have a lot for hair regrowth (50% of the bare spots) and small hairs elsewhere.

When I started HRT my T dropped like a rock to below 20 ng/dl. I had 1 month Dutasteride but the PA discontinued the script stating it just is not needed due to such a low T.

Thank you for the report.  Yeah, I would expect several months to see any regrowth of scalp hair.

Quote from: Cynthia Michelle on February 13, 2014, 06:23:41 PM
When I started HRT my T dropped like a rock to below 20 ng/dl. I had 1 month Dutasteride but the PA discontinued the script stating it just is not needed due to such a low T.

Even if T levels are low in the blood (serum), DHT levels might still be significant in tissues. That's why I think that for those who want to regrow scalp hair and are particularly sensitive to losing hair due to genetics, it is worthwhile to add finasteride/dutasteride to inhibit DHT formation in tissues. I prefer finasteride because it's cheaper and for scalp issues (vs BPH), appears to be equally effective.

Prog Brain Res. 2010;182:321-41. doi: 10.1016/S0079-6123(10)82014-X.
Hormonal therapy of prostate cancer.

"after castration, the 95-97% fall in serum testosterone does not reflect the 40-50% testosterone (testo) and dihydrotestosterone (DHT) made locally in the prostate from DHEA of adrenal origin. In fact, while elimination of testicular androgens by castration alone has never been shown to prolong life in metastatic prostate cancer, combination of castration (surgical or medical with a gonadotropin-releasing hormone (GnRH) agonist) with a pure anti-androgen has been the first treatment shown to prolong life. Most importantly, when applied at the localized stage, the same combined androgen blockade (CAB) can provide long-term control or cure of the disease in more than 90% of cases."

While Spiro may weakly block androgen receptors in tissues, the further inhibition of DHT production could prove useful. You may want to show this to your doctor.

Not surprising to observe gynecomastia with finasteride/dutasteride as both reduce DHT concentrations and androgen (especially T and DHT) inhibits breast formation. I'm actually more surprised that the incidence is so low. Perhaps, it's because the concentration of alpha-reductase (enzyme responsible for converting T to DHT) is not so high in breast tissue or that T is a more potent inhibitor of breast formation than DHT?? Not sure. 

Thanks again for all posts. Age 50 was long ago. I use dot type patches for E, some spiro & some Finasteride. So far no problems.

This is all VERY interesting! I should be starting HRT sometime in the next two weeks, though just E at first, then adding in AAs if needed. My doctor was likely going to go with Spiro 'til I mentioned that I wanted Androcur, but I'm wondering if I should request something like Bicalutimide. Especially since Finasteride isn't covered for me (only for cancer patients), hair is a *major* worry for me because I've already lost a fair bit in the front and it looks like the sides are thinning too  !