Just had labs again after 2 months, last time they were at 174 after the 3rd step in my dosage HRT and 200 or so before HRT. Now my prolactin levels are good too which indicate im not have a problem with estrogen so far. I am not quite at the safe cap for me on estrogen yet,  but I am at the safe and effective place for me on Spironolactone.




What happens next? I will know the current labs next week. I am worried they wont change much. Now I still seem to have a small smattering of sex drive, but it is less than 2 months ago. Should I ask my doctor about adding Finestride instead of trying to go up in estrogen? Will it help or make a difference to have Finestride and Spironolactone together?

I am not a doctor,

Finasteride is a weak anti-androgen. It does help reduce MPB.

I am on fin, E, spiro and progesterone. I am on fin for MPB and would not be on it if my hair was fine.

You will have to ask your endo about the effectiveness of those two drugs together - the results are different for everyone, what works for one might not for another. Speak to them about what else might help. Mode of delivery might be more effective than just increasing or adding medication. Ask them if your T is to high too, it might be better than you realise.

Yeah speaking of mode of delivery, my doctor kinda already told me anything but pills is unnecessary for me, this was also 2 months ago.

So I have decent hair, albiet thin and fine (but wavy) so we will see. I talk to her on Wednesday. We are already discussing micronized natural progesterone AFTER I reach the final dose she wants me on for Estrogen. But I told her I wanted the mood benefits plus the possible breast benefits.

I was having a similar problem. My T level was really high before I went on HRT (like, 900), and even after a year on Spironolactone, The lowest we could get it was around 140. We tried combining my Spironolactone with Finestride (a high dose, even), and it didn't change anything. We finally tried taking me off of Spironolactone, and putting me on depo provera. My first blood test after that change (around a month later) suggested that we had gotten my T level down to around 35.

The only weird thing was that it didn't really seem like my T level was lower. I was actually gaining upper body muscle tone, and still feeling the same sex drive as before. I just had another blood test on Friday to confirm whether or not the depo provera is really dropping my T levels, so I'm waiting for the results on that. This time we're actually testing to see whether my estrogen may be causing me to have testosterone beyond what I was producing normally. I think the idea is that since depo provera stops testosterone production instead of acting on existing testosterone, if my estrogen is converting to testosterone a little, depo provera alone won't be enough. We're putting me on a lower dose of Spironolactone at the same time as the depo provera to see if that stops my muscle gain. I'll post here after I get my blood test results to let you know if the depo is still keeping my T levels down. On paper it seems to really work, but in practice, it's hard to tell.

One thing I will say about the Finestride is that it has the added benefit if reducing the amount of your remaining testosterone converting into DHT, which is what causes male pattern baldness. I've gone on and off of it a lot over the past year, and I have finally decided that no matter what, I'm staying on it until after I get SRS. It seems like a good safety measure to have in case any remaining testosterone has the possibility of causing baldness.

I also had a problem getting my T down. (Which was odd considering it was at the low end of the male range prior to HRT at 420 ng/dL.) After 7 months on HRT with spiro, estrogen and finasteride, it was still 217 ng/dL. My HRT doctor upped my Estrogen by 50% and my Finasteride by 500% and 3 months later it dropped to female levels at 15.2 ng/dL. Both my doctor and I were thrilled. I go in for my 6 month checkup blood work on Thursday so I'll know the results the following week.

Quote from: ShadowCharms on March 15, 2015, 07:21:01 PM
We tried combining my Spironolactone with Finestride (a high dose, even), and it didn't change anything

Obviously. Finasteride does NOT reduce T levels, only DHT. Your doctor should have known this. 

QuoteWe finally tried taking me off of Spironolactone, and putting me on depo provera. My first blood test after that change (around a month later) suggested that we had gotten my T level down to around 35.

The problem with Depo-Provera is its health risks, also may lead to depression in some, quite severe at time and even cause androgenic symptoms as it midly triggers androgen receptors.

QuoteThe only weird thing was that it didn't really seem like my T level was lower. I was actually gaining upper body muscle tone, and still feeling the same sex drive as before.

Like I said, the Provera is mildly androgenizing at receptor level even though it reduces testicular production of androgens. Could be the reason why. Bicalutamide is an anti-androgen with no androgenizing symptoms. GnRh agonists also have none.

QuoteI just had another blood test on Friday to confirm whether or not the depo provera is really dropping my T levels, so I'm waiting for the results on that.

Provera's androgenizing symptoms cannot be detected by the test, sadly. They can only be felt by the individual and observed physically.

QuoteThis time we're actually testing to see whether my estrogen may be causing me to have testosterone beyond what I was producing normally.

Estrogen cannot EVER increase testosterone. It does not convert to androgen, just the other way around. Your doctor should also know this. Basic chemistry.

QuoteWe're putting me on a lower dose of Spironolactone at the same time as the depo provera to see if that stops my muscle gain.

Spironolactone blocks and reduces androgens. Why reduce it??? It has absolutely no androgenizing symptoms.

Quote from: Ms Grace on March 14, 2015, 07:37:30 PM
Ask them if your T is to high too, it might be better than you realise.

It is widely acknowledged that a T level in the 100s is bad news for anyone female. If my level ever goes that high again, I will be mortified.

Quote from: KayXo on March 16, 2015, 08:39:45 AM
Like I said, the Provera is mildly androgenizing at receptor level even though it reduces testicular production of androgens. Could be the reason why. Bicalutamide is an anti-androgen with no androgenizing symptoms. GnRh agonists also have none.

That is important. I was more aggressive and had some masculinizing facial changes, rapid weight gain, and abdominal fat gain in just two weeks on Provera, even though my T level was in the 40s (compared to 60s without it). Non-steroidal anti-androgens may cause anemia though, so blood counts may be necessary if one experiences symptoms of anemia. I have been on a GnRh agonist since July and the only side effect is a mild spike in masculinity after each injection. Overall, it is well worth it for me given the reduction in my T level.

QuoteEstrogen cannot EVER increase testosterone. It does not convert to androgen, just the other way around.

In fact, it actually reduces both the production and activity of testosterone.

QuoteSpironolactone blocks and reduces androgens. Why reduce it??? It has absolutely no androgenizing symptoms.

It causes severe dry skin, along with a plethora of other unpleasant side effects like excessive urination and irregular heartbeat, all of which I suffered from. My skin was softening nicely until I went on spironolactone to further reduce my T level. Although my T level did decline (from the 60s to the 20s) while on spiro, my body shape actually masculinized and my skin started to look older and lose its softness. More than a month after stopping, my skin texture still has not returned. If soft or youthful skin is desired, then spironolactone is probably not a good idea. Like all other non-estrogenic, steroidal anti-androgens, spironolactone may have a weak androgenic effect, especially if T is already being suppressed through another mechanism. My current doctor agreed with my assessment that spironolactone was causing my androgenic symptoms and was supportive of my stopping it.

Quote from: Steph34 on March 17, 2015, 01:11:17 PM
Non-steroidal anti-androgens may cause anemia though, so blood counts may be necessary if one experiences symptoms of anemia.

What circumstances (population studied, etc.) and at what doses were these observed? What was the incidence? I never heard of this before. I know you can't provide all the info requested but perhaps point to certain studies, if allowed? Non-steroidal anti-androgens aren't all the same as well and have different side-effects. Bicalutamide appears to be the safer of the three (flutamide, nilutamide), with the least side-effects.

QuoteI have been on a GnRh agonist since July and the only side effect is a mild spike in masculinity after each injection.

The mild spike is caused by a spike in LH but this should only ever happen when first getting the injection, only with your first EVER injection. The desensitization to GnRh agonists should persist thereafter if injections are given frequently enough and LH should remain low.

One way to avoid this the first time is to give an anti-androgen the first 2-3 weeks to block increased testosterone production in the body, usually at quite a high dose. If taking estrogen at the same time, the spike will also be felt to a much lesser extent.

QuoteIt causes severe dry skin, along with a plethora of other unpleasant side effects like excessive urination and irregular heartbeat, all of which I suffered from. My skin was softening nicely until I went on spironolactone to further reduce my T level. Although my T level did decline (from the 60s to the 20s) while on spiro, my body shape actually masculinized and my skin started to look older and lose its softness. More than a month after stopping, my skin texture still has not returned. If soft or youthful skin is desired, then spironolactone is probably not a good idea. Like all other non-estrogenic, steroidal anti-androgens, spironolactone may have a weak androgenic effect, especially if T is already being suppressed through another mechanism. My current doctor agreed with my assessment that spironolactone was causing my androgenic symptoms and was supportive of my stopping it.

I agree with your assesment of Spiro in terms of dryness, etc. except that androgenic effects have never been observed in humans, only in rats at VERY high doses (considering body weight and dose given) along with androgenic effects caused by cyproterone acetate also. I wouldn't be concerned about this with Spiro or CPA personally.

  So in fact I had my lab results today....and guess what? They went up even more!! My doctor was actually perplexed as to why. They are at 212 now instead of 173 , I started at 190-220 range before i started HRT 5 months ago. So now here is what she has decided to do. She is increasing my Spironolactone to levels above the high range as she has read conflicting reports about it. Then only slightly increasing my estrogen as she would not rather I go any higher than where am at now as we don't have much more we can go up on that medication. So I asked her about taking Finesteride and Micronized Natural Progresterone. She is open to the finestride if after the next 2 months (when labs are due again) nothing really changes. She says also we can discuss taking the Natural Progesterone at that time too.

So should I be concerned at all now?   

I should also ask you all, would it matter what time I take my HRT> when I get my labs done its about 18 hours or so that I had taken them the previous day, as I take everything at the same time all at once, my doctor said it was fine to do that as I told her it made me feel better than taking smaller more frequent amounts.

Id look for another doctor especially if she insists on going by the "book"... It's great that docs want to help trans people but If what you say is true she sounds incompetent... The "book" dont allow for enough E for some people (Me) in my opinion... E is a potent antiandrogen and feminizer in the right dosage

I think you should explore the possibility of employing a GnRH agonist instead of Spiro or Finasteride. My endo has had me on Suprefact since day one of my HRT, my T consistently assays out at less than 20 nmol/L. It's a nasal spray, easy to use, great results.

Quote from: Eva on March 18, 2015, 05:23:05 PM
Id look for another doctor especially if she insists on going by the "book"... It's great that docs want to help trans people but If what you say is true she sounds incompetent... The "book" dont allow for enough E for some people (Me) in my opinion... E is a potent antiandrogen and feminizer in the right dosage

Well I met someone who was taking more than twice as much as I am taking and it scared me, but they told me they had a condition that required it, that they did not absorb estrogen well according to them and what they said the doctor said.

Now I can tell the estrogen is working in me because I am getting breasts and very smooth skin now at 5 months. So there is that. I don't think my doctor is incompetent at all, she is just extremely cautious. This is a clinic that is for women and transwomen and transmen. It is the best clinic in San Francisco besides Tom Waddell

Quote from: EllieM on March 18, 2015, 05:25:42 PM
I think you should explore the possibility of employing a GnRH agonist instead of Spiro or Finasteride. My endo has had me on Suprefact since day one of my HRT, my T consistently assays out at less than 20 nmol/L. It's a nasal spray, easy to use, great results.

GnRH agonist is this something that is fda approved in the USA? I have never heard of it. I could mention it at my next follow up before the next labs ( i see her in 2 weeks for other things)



*edit* according to WebMD

QuoteGnRH-a therapy decreases production of the hormone estrogen to the levels women have after menopause.

Hmm why would I want to decrease my estrogen?>

How about bicalutamide?

Quote from: Shawn Sunshine on March 18, 2015, 04:28:39 PM
So in fact I had my lab results today....and guess what? They went up even more!! My doctor was actually perplexed as to why. They are at 212 now instead of 173 , I started at 190-220 range before i started HRT 5 months ago. So now here is what she has decided to do. She is increasing my Spironolactone to levels above the high range as she has read conflicting reports about it. Then only slightly increasing my estrogen as she would not rather I go any higher than where am at now as we don't have much more we can go up on that medication. So I asked her about taking Finesteride and Micronized Natural Progresterone. She is open to the finestride if after the next 2 months (when labs are due again) nothing really changes. She says also we can discuss taking the Natural Progesterone at that time too.

So should I be concerned at all now?   

If not taking Premarin or Ethinyl Estradiol, I don't quite understand the reasoning behind increasing Spiro rather than JUST increasing bio-identical estradiol which seems to be safer especially if taken non-orally. Ciswomen all over the world have estradiol in their bodies! LOL, it's not a poison while Spiro is a modified molecule, not found in the human body naturally. Not a doctor, but still I question...You could discuss this with your doctor at your next appointment and see what they say. As always, follow their advice still but it's always good to question and discuss with your physician, I think.

Also, finasteride doesn't REDUCE T. It reduces conversion of T to DHT only and actually sometimes slightly raises T levels as a result.

Quote from: Shawn Sunshine on March 18, 2015, 08:44:14 PM

GnRH agonist is this something that is fda approved in the USA? I have never heard of it. I could mention it at my next follow up before the next labs ( i see her in 2 weeks for other things)



*edit* according to WebMD

Hmm why would I want to decrease my estrogen?>

It will drastically reduce your T levels and the little E your body naturally produces BUT since you are taking E, it's fine.

Quote from: KayXo on March 17, 2015, 03:47:37 PM
What circumstances (population studied, etc.) and at what doses were these observed? What was the incidence? I never heard of this before. I know you can't provide all the info requested but perhaps point to certain studies, if allowed? Non-steroidal anti-androgens aren't all the same as well and have different side-effects. Bicalutamide appears to be the safer of the three (flutamide, nilutamide), with the least side-effects.

I looked and felt anemic after just 3 days on flutamide. My doctor did not want to prescribe bicalutamide given my high sensitivity to flutamide. Even bicalutamide does reduce hemoglobin levels, and mine have always been in the low part of the normal range.

http://www.readcube.com/articles/10.1046%2Fj.1525-1411.2001.003001014.x?r3_referer=wol&tracking_action=preview_click&show_checkout=1&purchase_referrer=onlinelibrary.wiley.com&purchase_site_license=LICENSE_DENIED_NO_CUSTOMER
"Mean hemoglobin concentration decreased by 0.9 ± 0.2 g/dL in men treated with leuprolide and by 0.4 ± 0.2 g/dL in men treated with bicalutamide (P = .04)."

QuoteThe mild spike is caused by a spike in LH but this should only ever happen when first getting the injection, only with your first EVER injection. The desensitization to GnRh agonists should persist thereafter if injections are given frequently enough and LH should remain low.

My spike was not mild. My T level in April 2014 (pre-therapy) was in the 400s and my T level in July (one week post-injection) was over 1000! Some of that difference could have been seasonal, but I can assure you I was not walking around with a T level anywhere near 1000 before that injection. My problem is that I tend to metabolize drugs faster than expected, so my injections may not have been given frequently enough to maintain complete suppression of LH. (A low but measurable level of FSH was detected at the time of one of my subsequent injections.) I cannot locate it now, but one study of the medication I am using found a spike in T above the castrate level in one subject after a subsequent injection. While rare, it is not impossible.

QuoteOne way to avoid this the first time is to give an anti-androgen the first 2-3 weeks to block increased testosterone production in the body, usually at quite a high dose. If taking estrogen at the sa.me time, the spike will also be felt to a much lesser extent.

I wish I had known that at the time. The spike really taught me to do my homework, as those days with elevated testosterone were just horrible. Gosh, my first doctor was awful.

QuoteI agree with your assesment of Spiro in terms of dryness, etc. except that androgenic effects have never been observed in humans, only in rats at VERY high doses (considering body weight and dose given) along with androgenic effects caused by cyproterone acetate also. I wouldn't be concerned about this with Spiro or CPA personally.

The problem with trying to 'observe' the androgenic effects of spironolactone lies in the way it suppresses testosterone. Since it blocks androgen receptors and reduces T production, it tends to have an anti-androgenic effect in most people. However, that does not mean that spironolactone lacks an androgenic effect when it binds to otherwise unoccupied androgen receptors. People may vary in their sensitivity to certain medications. I also tend to be very observant and sensitive to small changes, which is part of the reason living with hormonal imbalance was such a painful experience for me. I have personally suffered androgenic effects from spironolactone (as well as from bio-identical progesterone and medroxyprogesterone acetate).

Quote from: Eva on March 18, 2015, 05:23:05 PM
Id look for another doctor especially if she insists on going by the "book"... It's great that docs want to help trans people but If what you say is true she sounds incompetent... The "book" dont allow for enough E for some people (Me) in my opinion... E is a potent antiandrogen and feminizer in the right dosage

A good suggestion, indeed. Having respectable affiliations and a good reputation does not mean a doctor actually is good. It says a lot more about a doctor's skills as a salesperson than as a physician. My first doctor had a reputation of being among the best endocrinologists for transgender patients, but he seemed like a snake to me. Every month, he changed my prescription and the highest my estradiol level ever reached was 63! That was despite my complaints about it being too low. No wonder I was unable to feminize under his direction. After I realized that many of his suggestions were intended to keep my level low, I switched to another doctor who immediately gave me an increase with the promise of more if I needed it.

Quote from: EllieM on March 18, 2015, 05:25:42 PM
I think you should explore the possibility of employing a GnRH agonist instead of Spiro or Finasteride.

I agree. Relative to a higher dose of spironolactone, that would likely cause a greater reduction in testosterone. Also unlike the spiro, it would not endanger smooth skin.

Quote from: Steph34 on March 22, 2015, 07:40:19 AM
I looked and felt anemic after just 3 days on flutamide. My doctor did not want to prescribe bicalutamide given my high sensitivity to flutamide. Even bicalutamide does reduce hemoglobin levels, and mine have always been in the low part of the normal range.

http://www.readcube.com/articles/10.1046%2Fj.1525-1411.2001.003001014.x?r3_referer=wol&tracking_action=preview_click&show_checkout=1&purchase_referrer=onlinelibrary.wiley.com&purchase_site_license=LICENSE_DENIED_NO_CUSTOMER
"Mean hemoglobin concentration decreased by 0.9 ± 0.2 g/dL in men treated with leuprolide and by 0.4 ± 0.2 g/dL in men treated with bicalutamide (P = .04)."

HRT in transwomen is known to slightly reduce hemoglobin levels, female range is lower than male range.

QuoteI have personally suffered androgenic effects from spironolactone (as well as from bio-identical progesterone and medroxyprogesterone acetate).

In my 10 yrs+ of being on several TS forums, reading articles, etc., this is the FIRST of I hear of someone experiencing androgenic effects with Spiro. Progesterone has no androgenic effects, does not have androgenic properties. This has been confirmed in several studies, of which I have the full studies, in pre-pubertal girls/boys, for example, and if it were, imagine the repercussions on genetic women during pregnancy, where progesterone levels are in the hundreds and on the female fetus as well who is exposed to high levels. I'm taking a high dose of progesterone, my T levels have remained very low and I've actually seen decreased body hair growth and increased feminization. Progesterone increases sebum and may lead to acne but that is not because it is androgenic but just because it stimulates sebaceous glands. Progesterone does however downregulate estrogen action and by doing so, perhaps, result in slightly less anti-androgenization and feminization. So, that could well be what happened with you. Maybe...

Quote from: Shawn Sunshine on March 18, 2015, 08:44:14 PM

GnRH agonist is this something that is fda approved in the USA? I have never heard of it.
I could mention it at my next follow up before the next labs ( i see her in 2 weeks for other things

Yes, the one I use is FDA approved in the USA for the purpose of suppressing testosterone production in cancer patients.

Quote from: KayXo on March 19, 2015, 11:21:30 AM
Also, finasteride doesn't REDUCE T. It reduces conversion of T to DHT only and actually sometimes slightly raises T levels as a result.

Since DHT is more androgenic than T, finasteride can still have a weak anti-androgenic effect. Many men refuse to take it for that reason.

QuoteIt will drastically reduce your T levels and the little E your body naturally produces BUT since you are taking E, it's fine.

The wrong body produces so little E relative to T that it is often best to just block them all and take a much larger dose of E than what the body would produce naturally. That is one purpose of orchiectomy, and GnRH agonists are a kind of temporary chemical castration. The reason why I prefer this over anti-androgens is because a GnRH agonist may lack the unpleasant side effects of anti-androgens, while simultaneously being more effective in reducing testosterone levels. That would seem to be the obvious choice for people who are unable to reduce T to a female level on anti-androgens. Cost can be an issue, though.

Quote from: KayXo on March 22, 2015, 09:52:08 AM
HRT in transwomen is known to slightly reduce hemoglobin levels, female range is lower than male range.

The female range for red blood cells is also slightly lower than male range, but the HRT has not reduced my red blood cell count at all, nor does it make me feel weak and tired the way the flutamide did.

QuoteProgesterone has no androgenic effects, does not have androgenic properties.

In a recent thread over in the mtF section, several of us reported androgenic effects from progesterone, so I am not alone. I tried it with an open mind, but found it harmful.

Quoteif it were, imagine the repercussions on genetic women during pregnancy, where progesterone levels are in the hundreds and on the female fetus as well who is exposed to high levels.

Pregnant women have so much estrogen that it more than offsets any androgenic effect of their high progesterone. If progesterone were not androgenic, then pregnant women would experience an incredible amount of feminization due to their high E levels, much more so than they actually do.

QuoteI'm taking a high dose of progesterone, my T levels have remained very low and I've actually seen decreased body hair growth and increased feminization.

The androgenic effect of progesterone is primarily on facial and abdominal shape. Body hair growth is thought to be caused only by strong androgens, and indeed many women now blame hirsutism on DHT rather than testosterone even. It is plausible that progesterone could decrease body hair growth by blocking T and DHT at receptor sites, but if T and DHT are already low there may be no anti-androgenic effect. Whether the result is a decrease or increase in androgenic activity is likely to vary depending on individual factors like number of receptors and current and past T levels. Another reason why progesterone may decrease body hair growth is by causing weight gain. I recall you saying that you gained weight since starting progesterone. When an individual gains weight (above a certain minimum weight required for development), androgens are more widely dispersed so that body hair may decrease. Indeed, rapid weight gain was the main reason I could not use progesterone, the main androgenic effect being that I gained most of the weight in a male pattern. I did not see increased body hair growth. The feminizing effect often reported from progesterone could also be due to the weight gain, since many women have breast growth and larger curves when they gain weight.

QuoteProgesterone does however downregulate estrogen action and by doing so, perhaps, result in slightly less anti-androgenization and feminization. So, that could well be what happened with you.

Very likely, indeed. I was on a somewhat low dose of E at the time and therefore much more susceptible to such an effect than you would be, since you take high-dose injections. E injections produce a stronger estrogen surge that tends to blunt androgenic effects of other hormones.