I have had bad experiences with spiro in the past, when I first started my transition ten years ago.  The medication caused my blood pressure to drop to dangerous levels and ended up in the hospital.  The doctor took me off the medication right away after that.  Recently I asked to be put back on the medication, just so I would have at least smoother skin, I've been only taking Estradiol, pill form and Finasteride for the last 8-9 years. My estrogen levels are good and my T levels are low, however it did not do much in the way of smoother skin, only the Spiro combined with Estrogen and Finasteride that it did that.  I took two dose already over two days at a very low dose, doctor recommended, and I noticed that my energy levels went up, which is a good thing, but I also noticed that I started becoming confused and dizzy and at night when sleeping it seemed like I was not getting enough blood or oxygen to the brain, hard to explain, but it is something I do not care for.  I stopped the Spiro yesterday and the symptoms disappeared, although I feel dead tired today, like a freight train hit me. Are these symptoms normal with Spiro and if so, do they disappear over time?  My blood pressure has not been affected this time around.

I get similar symptoms if I let my salt and water intake get too low.  To compensate for the spiro I normally eat around 7000 mg of salt per day and drink a minimum of a gallon of water.


Conform and be dull. —James Frank Dobie, The Voice of the Coyote

Maybe you should look at an alternative anti-androgen. My doctor also took me off Spiro upon taking my blood pressure. It was dangerously low, she said I could have fainted at any time. I'm on Androcur now.

On Spiro, you definitely need to eat ENOUGH salt and DRINK enough water. Androcur (cyproterone acetate) has its own set of problems and that is why it is not FDA approved or used any longer in the UK for transsexual women. It can increase the risk of meningioma ( 8 of the 9 cases in transwomen associated with Androcur ), raise prolactin levels and has been associated with prolactinomas in transwomen (5 of 8 cases), can lead to depression, especially in predisposed individuals, lead to abdominal weight gain, slightly increase the risk of blood clots, may oppose estradiol's beneficial vasodilating effects on arteries and can mess with adrenal gland function due to its glucocorticoid actions, in the same manner as corticosteroids (i.e. prednisone) do. In higher doses, it can cause extreme fatigue and liver problems.

Other safer anti-androgens, according to the scientific literature, include LhRh agonists like goserelin, leuprolide, buserelin acetate and bicalutamide. Yes, these also may have side-effects but they appear to be much less as compared to the above and this is why the UK now uses LhRh agonists for their transgendered clients. Paid out of your pocket though, these may be cost-prohibitive. 

One last approach is sticking with estrogen only, bio-identical estradiol, preferably non-orally, to keep T levels down.

These issues need to be discussed at length with a doctor who is familiar with these matters.

Thank you KayO.  I will be calling my doctor's office today to see if he wants me to stay on the Spiro or not.  He has no other alternatives for me, I have already asked him about alternatives of Spiro and he said he does not recommend anything else.  I am taking Finasteride, have been taking that forever.  Estadiol, I am taking orally under the tongue.  It is the best route of administration for my body, I have tried injections in the past and my body got rid of the medication immediately, their was no benefit to the injections for me, I also tried patches and the same thing occurred.  Each body is different, I guess. 

Maybe you should seek a second and third opinion. It's strange that no other alternatives are recommended when there are indeed alternatives that are relatively safe. You could always bring these up to your doctor and see what they say. What have you got to lose?

With sublingual estradiol (estradiol under the tongue), levels peak and fall quite rapidly, within 2-3 hours. Finasteride has been associated with depression/anxiety in a few people but I guess this is not an issue for you as you've taken it for so long and would have noticed something by now.

Best of luck.