Hi everyone. I've been speaking to some girls IRL recently about their HRT and so on, and one girl told me that since her natural T levels were very low (she reckons partly due to being vegan...), she was not prescribed a T blocker but oestradiol alone. After six months, her T levels had dropped almost to zero. I haven't got all my first blood results back yet, but I suspect that my T levels will be quite low, since my E levels were described as "normal female" (about 440 pg/mL). So, I hope that the same thing will happen with me - all the T blockers I've heard of sound like various degrees of nasty and unnatural.

Anyway, another woman made me aware that there's a lot of controversy about whether T blockers are in fact a good idea in general. There seems to be a lot of contradictory information out there - does excess oestrogen overpower the testosterone in one's body and reduce the T levels, making T blockers unnecessary; or, does the excess oestrogen actually get converted into testosterone? What about this thing about excess T converting into E? Of course, googling "testosterone blocker controversy" only yields media "debate" about whether transgender people should be allowed to exist, or whether it'd be better  for everyone if we all just kill ourselves right now; so, I'm finding it difficult to get any research done here.

Can anyone present some solid arguments in favour of, or against, T blockers, especially in the case of low natural testosterone?

(Or, am I simply thinking about things to wrong way? Since my libido is my most hated thing, perhaps I should take a T blocker regardless to try and kill it?)

J xx

Testosterone can convert to Estrogen however Estrogen is the end of the road and will not convert to Testosterone. As for blockers, often Estrogen can block Testosterone but not always. If you have hight Testosterone levels, a blocker may be required however sometimes after Testosterone has been lowered it's possible to tapper off the blocker. We have members who started with a blocker but were able to taper off after their levels were sufficiently low.

Sounds too complicated to me. Why not just try it and see what happens?

Hi Jenny;
It all depends on how low your T levels are when you commence HRT. I re-started HRT just under 5 years ago and after the initial blood tests, it turned out that my T level was just 5.9. which is very low for a male  (higher than a female), but well under a normal male (lowest is normally 8.0). So my doctor decided to put me on Oestrogen only. In January of this year(2017)  my Oestrogen levels were 605 and my Testosterone levels were just 2.1 (Female range is 0.0 to 2.5). I just recently had another blood test and my Testosterone level is 0.9. Also in the last month, I have been put on Progesterone (Prometrium)  as well, initially taken continuously (for the first 3 months). I take my Oestrogen tablet twice a day at 10am and 10pm, and my Progesterone tablet last thing at night with a hot (fatty) milk drink. I have never had T Blockers. The results though have been very evident feminisation with 44C bust and well rounded buttocks. I have also noticed a rounding out of the upper pole of my breasts since commencing Progesterone. In fact its quite noticeable.

Judith

My Dr doubled my estrogen 3 months ago to alleviate some menopausal symptoms I was having.  She cut my spiro dose in half and my t when from 35 ng/dl to 10 ng/dl even with the spiro dose cut.  It is possible, per se, but spiro let's us take a lower dose of estrogen and still get feminizing effects.  My dose was increased but still lower than what was comonly prescribed to people before blockers were used along with estrogen from what I have read.

It depends on the person. I was diagnosed with a testosterone imbalance (high) and even now with Spiro and estrogen maxed out my testosterone levels were 48 ng/dl. I was swallowing my pills at that point, but at my doctor's recommendation I switched to sublingual.

Hi girls, thanks for the replies and examples. I actually just found out that my T level is normal male =( Not sure if I'm supposed to cry or hit something. LOL. So there's no way that I'll not need a T-blocker.

I'm trying to look at this in a positive way: I hate testosterone, in myself, in others, it's the devil, so I guess a T blocker is a good thing for me anyway. It also means that I will get genuine changes from my HRT - I'm hoping to kill my libido as much as possible. And, I'll try and get a three-monthly injection of decapeptyl rather than daily spyro, which will be nicer.....

After several months of Spiro my doctor wasn't satisfied with the results, and I was miserable taking it. We decided to go with an orchiectomy. I can say that in my case, removing the T is much better than blocking it.

Hugs, Devlyn

Quote from: Devlyn Marie on December 04, 2017, 11:38:44 AM
After several months of Spiro my doctor wasn't satisfied with the results, and I was miserable taking it. We decided to go with an orchiectomy. I can say that in my case, removing the T is much better than blocking it.

Hugs, Devlyn

Thank you for sharing. I've been going back and forth on getting an orchi because I want get off spiro.

The only thing I miss is the daily break for a bag of Doritos. 

Quote from: Daisy Jane on December 04, 2017, 02:01:42 PM
Thank you for sharing. I've been going back and forth on getting an orchi because I want get off spiro.

How long have you been on Spiro?

I've cut my dose in half twice now, as my T levels are below cis-woman range. The estradiol will take over.

My spiro dose is so low now, I don't experience any of the side effects I used to have when I was on 4 times as much.

I just had my blood drawn for another T test and I'm awaiting the results to see if I can ditch it all together, as I think it will be the case.

Once the testicles stop making T they begin to atrophy and shrink. The more this happens the less T they can make anyhow.

Roughly 1.5 years, maxed out since February. My last blood test about a month ago showed my T levels still at 48 ng/dl.

Quote from: Daisy Jane on December 04, 2017, 03:38:01 PM
Roughly 1.5 years, maxed out since February. My last blood test about a month ago showed my T levels still at 48 ng/dl.

That's roughly how long I have been on it currently.

48 ng/dL is still lower than cis-woman levels.

I halved my dosage around 5 months ago and a month later my T level tested at 18 ng/dL. I then halved it again since I started taking Estradiol Valerate injections, roughly 2 months ago.

Just for reference, my T was at 1310 ng/dL when I first started on it!!!

I think owe some of the T lowering to increasing my Oral Estradiol dosage around the same time. Other than my T being lowered I was unhappy with my results on the Oral Estradiol so I am very happy about switching to IM EV.

Your T levels might also depend on how much Estradiol you're taking.

You could try tapering the spiro a bit and see where that gets you. Have you discussed it with your doctor?

Not yet. I didn't even know that was a possibility until after my last visit, but it's certainly something to consider for next time.

On my 1 month I was up to 57 estradiol and a bit down with 381 testosterone. My estradiol was only 20 when I started! That's a 37 increase in a month by swallowing pills. My E increased but not spiro. I'm hoping in January when I go in for my 4 month follow up my T will be even lower. I started with 461.

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I'm on a blocker, I haven't had any adverse side effects other than peeing more often, I trust my endocrinologist with this, she's pretty experienced with male to female patients.

Quote from: Pisces228 on December 03, 2017, 09:54:09 PM
My Dr doubled my estrogen 3 months ago to alleviate some menopausal symptoms I was having.  She cut my spiro dose in half and my t when from 35 ng/dl to 10 ng/dl even with the spiro dose cut.  It is possible, per se, but spiro let's us take a lower dose of estrogen and still get feminizing effects.  My dose was increased but still lower than what was comonly prescribed to people before blockers were used along with estrogen from what I have read.

Many find that no additional estrogen is needed.. Also, doing a pre-blocker and post-blocker release comparison is like comparing apples and oranges. We've had bio-identical estrogen since then - and that doesn't have the risks that things like Premarin and other synthetic estrogen-like drugs.

I suspect, in time, we will see a change in anti-androgen usage. That change being that long-term use will cease to be the norm. I started out on cyproterone acetate as my AA a few years back, 9 months ago, with my doctors concurrence, I stopped taking it. So far, my T level hasn't varied any more than it has previously and is certainly within female levels, my E level has actually come up a little and this is all on the same dose of E as I was before I ceased my AA.

The available research suggests that it is possible to sufficiently suppress T using only E. Androgen Deprivation Therapy is an interesting niche of oncology and there have been some interesting studies done on the best way to suppress T, some of which is using only E. There is some anecdotal evidence that progesterone is indeed a useful addition when on an E only regimen.

Because I have an Ovary, many doctors have refused to prescribe me Estrogen, but will prescribe me some Progesterone with Aldactone. So in the least "like" in MY situation I would say I need T Blockers. Keep in mind I've been in my transition for 5 years and 3 medically (in Jan 2018)

My first visit with my endo he said spiro is a shortcut to drop T effects quickly. He used to use just estrogen therapy but that was old synthetic estrogens which might have packed more punch in less dosage but had a big risk involved. Now he prescribes only oral estradiol and spiro. After a trial period with the patient at low E dose to see if it results in a better mental state, he ups the estradiol and offers a progestin.

I used medroxyprogesterone for 3 months and E at a mid-low dose. I asked him for bioidenticle Progesterone and he gave me that instead. His only reason for MPA is it is cheap and does react with some of P effect.

My endo has been providing HRT for trans patients for many years. He was likely the first in my local metro area (St Louis) and is the only one he said, at the BJC Hospital/Washington University Medical School Endocrinology Dept that is "comfortable" threading trans patients. His wording.

So on that mid-low dose, my midday E was 55pg/ml. Still way inside of menapause range. My T was within female range at 35ng/dl. He was happy with that, I wasn't. Using my low E level I did get him to raise my E dose by 50% but he said I am maxed out. I am slowly lowering my spiro dose. Right now I cut my evening dose in half. In a few weeks I plan to cut the morning in half as well.


Within the community it has become accepted that E levels of 200pg/ml will surpress T very low. E between 200-450 is the ovulation through luteal phas levels of a cis girls cycle. Progesterone will also surpress T. Cis girl's bodies produce 5-20ng/dl of P during these same phases.
To clarify ovulation is high on E and the lower side of P. Luteal phase P goes to its max and E comes down. I personally would love to hit a stable mid range of both. I am not sure where I am with that just now though.

For me, spiro is absolutely necessary as a high dose of estradiol to counteract the testosterone instead would be too dangerous for me (potential clotting issues). Luckily, I've had no issues with being on a high dose of spiro other than peeing a lot in the first month or so.