So at my upcoming yearly appointment I'm going to ask if, besides switching to injections, if I can also go off my Cyproterone and do Mono Estrogen.  My most recent blood test showed that, even after switching over the last year to taking Cyproterone every other day, my T levels are basically non existent. 

Has anyone switched to Mono E after 3 years of being on anti androgens?  Did the Mono E keep the T at the same levels as when you were on Cyproterone or Spiro?

NancyDrew, this is something to discuss with your doctor. We are all different and you can't expect what works for someone else to work for you. Monotherapy has been shown to have less risks, but it requires a holistic approach taking into account your personal history and what dose of E is appropriate for you. After 3 years on Cypro, you may not be producing significant T, and may not need to alter your E dose.

It also depends on what you are hoping to achieve, if you are needing further development or are happy with how far you have come will also determine your HRT plans.

Hugs,

Allie

It depends where you are in your GAMC operatively and what other medication you're on, Nancy. Cyproterone is an antiandrogen the main use of which is to suppress testosterone levels, whereas Estrogen has no significant effect on suppressing testosterone levels.

This means if you still have an active source of natural testosterone (some is made by the adrenal glands, don't forget!) then the swap to estrogen would likely cause your testosterone levels to rise, though how much depends on your body. if you don't have an active natural source, you probably don't need the cyproterone anyway, if that makes sense. Your clinician will be best placed to advise, as Allie suggests.

Quote from: TanyaG on June 03, 2025, 09:15:17 AMCyproterone is an antiandrogen the main use of which is to suppress testosterone levels, whereas Estrogen has no significant effect on suppressing testosterone levels.

Everything I have read indicates that Estradiol alone will suppress Testosterone for most patients, and this is the basis of mono therapy in MTF HRT. https://pmc.ncbi.nlm.nih.gov/articles/PMC11245323/ and https://academic.oup.com/jes/article/9/5/bvaf004/7965163

I have always been on mono therapy and pre op my T levels were lowered to non detectable amounts. There are some old texts which say an anti androgen is required, but these refer to synthetic Estrogen which was kept to small doses due to its increased risk factors. Modern Bioidentical Estradiol has much lower risk factors, so can safely be used at higher doses. Some individuals have stubborn T levels and do require anti androgens to fully suppress T, but studies show these are in the minority. These are things to discuss with your doctor, but due to the misinformation in outdated texts, it is best to be informed yourself prior to discussion.

Hugs,

Allie

Quote from: Allie Jayne on June 03, 2025, 08:31:45 AMNancyDrew, this is something to discuss with your doctor. We are all different and you can't expect what works for someone else to work for you. Monotherapy has been shown to have less risks, but it requires a holistic approach taking into account your personal history and what dose of E is appropriate for you. After 3 years on Cypro, you may not be producing significant T, and may not need to alter your E dose.

It also depends on what you are hoping to achieve, if you are needing further development or are happy with how far you have come will also determine your HRT plans.

Hugs,

Allie

As I said, I will be discussing it with my doctor (my appointment is in 3 weeks), however, I was wondering if others had done the same thing and what their experiences were doing mono E after being on Cyproterone or Spiro or Bicalutimide.  Did they find that with their testosterone already being suppressed by the Cyproterone, that the mono estrogen just kept it low?  I also take progesterone, so I'll be asking my doctor about that, and if it might cause my testosterone to rise or will it help the estrogen to keep my testosterone suppressed?

Quote from: Allie Jayne on June 03, 2025, 05:13:10 PMEverything I have read indicates that Estradiol alone will suppress Testosterone for most patients, and this is the basis of mono therapy in MTF HRT

That's so after the adrenal axis is suppressed, so yes, in general that's how it works for most GAMC care travelling in Nancy's direction after that's been achieved. But suppression of androgens by estrogens isn't sufficient to do that de novo, which is why antiandrogens are there in the early stages of guidelines. Ultimately, that'll be why Nancy had the cyproterone.

So it'll be Nancy's clinician's judgment about whether there's enough suppression achieved to make the switch and I'd be extremely wary of second guessing the judgment of someone who can see the trends in the results and has Nancy before them.

Quote from: TanyaG on June 04, 2025, 02:05:15 AMThat's so after the adrenal axis is suppressed, so yes, in general that's how it works for most GAMC care travelling in Nancy's direction after that's been achieved. But suppression of androgens by estrogens isn't sufficient to do that de novo, which is why antiandrogens are there in the early stages of guidelines. Ultimately, that'll be why Nancy had the cyproterone.

So it'll be Nancy's clinician's judgment about whether there's enough suppression achieved to make the switch and I'd be extremely wary of second guessing the judgment of someone who can see the trends in the results and has Nancy before them.

Well last year my NP was pretty ready to pull me off Cyproterone because my levels could not be read.  But from what I remember, because I was staying on pills, they reduced my intake from every day to every 2 days at the lowest possible amount.  But even when I think back to 2022 (yesterday and Monday were my 3rd anniversaries as to when I started estrogen on June 2, 2022 and Cyproterone on June 3, 2022), by August 1, 2022, my levels had plummeted to where I barely had any registerable testosterone.  So my testosterone has basically been undetectable for the last 35 months.

Quote from: NancyDrew1930 on June 04, 2025, 12:31:15 PMWell last year my NP was pretty ready to pull me off Cyproterone because my levels could not be read.

Then it sounds like you've everything to play for at your next appointment!