South_agency/E+ via Getty Images Some of this occurred in patients receiving finasteride, where we found a higher than expected response of increased testosterone levels. It does not cause potassium loss from the body; however, other electrolytes may become depleted. I continually upped my Spiro intake in an effort to aid feminization and facilitate a free path for E to do its thing. Ive been off it for about 3 months and still dont feel like myself. 3- Bicalutamine Is there any way to undo the damage that spiro has caused? Its still a scary thing to get abdominal fat thats difficult to remove, and certainly it is not the desired result of a trans womans HRT. I also take Femarelle, but have no idea it does anything but my doctor suggested I tried it. Testosterone levels were higher with finasteride use. View more. Started HRT in August 2016. A lot of the research is offline and 30 or 40 yrs old (I am looking offline soon), one reference is your own article (thats not a reference!) It is bad risk-benefit judgement. Abstract. (20) For one thing I found an article by Alex V. Green about spironolactone use on Slate titled Spironolactone, a Standard Drug in Hormone Treatment for Trans Women, Has Controversial Side Effects, and it also links to a source article by Beverly Cosgrove called The Cast Against Spironolactone. [], [] recommend that all trans women who are considering taking it, or taking it, read this article The Case Against Spironolactone. I wish I had known how antithetical that anti-androgen therapy could be for trans women. Pharmac. The presence of finasteride raised testosterone by 126ng/dL (SE=25; p<0.001), and spironolactone had no significant effect (p=0.51). Serum testosterone versus serum 17- estradiol level. Telling people that if they gain visceral fat theyll never be able to lose it and theyll never be able to change their hip/waist ratio afterwards is both irresponsible and incorrect. What would be a better option for me? Now Im on EV, progesterone and no blockers. This no doubt increased the number of individuals not achieving the testosterone suppression goal. Could an increase in cortisol be to blame for this in me as well? A related question regards my age. Visceral fat requires significant effort with diet or exercise to remove and cannot be removed with any kind of ordinary plastic surgery. (Refs 2,3,4,5) However in the 90s, the Estrogen-related dangers were known to be proportional to dose, and several studies demonstrated an elevated risk of cardiovascular disease within the first 1-2 years of HRT initiation. pp. After approx 3 years of Estradiol at 2mg, 2x per day & Spiro at: Initial dose 100mg, 2x per day experienced dehydration, extreme salt cravings, increased anxiety, brain fog, and narcolepsy (as a result of frequent urination throughout the night). 2010 Nov;160(5):915-21 This is all far better than the majority of information on hrt out there and I hope others listen to you drospirenone 3mg/ethinyl estradiol 20mcg,28 (eqv-yaz) drospirenone 3mg/ethinyl estradiol 30mcg,28 (eqv-yasmin) ethinyl estradiol 20mcg/norethindrone 1mg,21 (eqv-loestrin 1/20) ethinyl estradiol 30mcg/norethindrone 1.5mg,21 (eqv-loestrin 1.5/30) levodopa cap, inhl iron/multivitamins includes bariatric multivitamins sites converting from pa-f to pa-n Your initial levels of Testosterone were already within the female range before you began HRT, so clearly Spiro was not responsible for lowering your T. You did not mention what estradiol you are taking, and Im assuming that your HRT is not a Spiro-only one, so it is almost certain that the drop in T that followed was due to beginning the estradiol and was not related to the Spiro. (Ref 1) Patients taking Spiro at doses as low as 25mg a day experience significantly elevated cortisol levels within a few weeks. Tandem mass spectrometry is considered the best method for assessing serum testosterone, but this assay is more expensive.5 Medical care for transgender individuals has only recently been mandated to be covered by insurance in New York State, so we had many patients that found even the less expensive assay difficult to afford. In older patients or those with medical comorbidities we tend to recommend finasteride over spironolactone due to potential electrolyte effects. Spironolactone has been found to produce gynecomastia without changes in testosterone or estradiol levels, implicating AR antagonism in this side effect. Interactions were not significant. (4) In men, peripheral estradiol levels directly reflect the action of estrogens at the hypothalamo-pituitary level to inhibit gonadotropin secretion., Raven G, J Clin Endocrinol Metab. Spironolactone at steroid hormone receptors Site Value (nM) Type Action Species Ref AR: 39.4 120 13-670 >20,000: K i . (1) Combined Receptor Antagonist Stimulation of the Hypothalamic-Pituitary-Adrenal Axis Test Identifies Impaired Negative Feedback Sensitivity to Cortisol in Obese Men, Mattsson C, The Journal of Clinical Endocrinology & Metabolism, Volume 94, Issue 4, 1 April 2009, Pages 13471352, https://doi.org/10.1210/jc.2008-2054 Or Sales mismanagement??? Spironolactone is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. and State Taxes and not able to get Medicaid. Collect a large group together, and those anecdotes become group knowledge, which can progress to shared beliefs and practices, and then to clinical experience, and from there it may become accepted into the bulk of accepted medical science. Taken together, the results demonstrate that treatment with low-dose spironolactone improves obesity and IR, which appears to involve replenishment of estrogen and suppression of GSK-3 along with circulating mineralocorticoid and glucocorticoid. The Clinical Chemistry Laboratory at Albany Medical Center is certified for estradiol testing by New York State Department of Health who accepts College of American Pathology proficiency as an index of performance. Estradiol levels of patients did not correspond with estradiol dosage administered or BMI. I had some female characteristics anyway at birth , taking the Est only did feminize me very well with a nice hour glass figure and nice skin , which I have a very nice complexion thank God,, Treatment with an antiandrogen only is not generally considered a feminizing regimen because a male hormone balance does not become a female hormone balance simply by removing Testosterone from the patient. Been on it since Maytomorrow is 7 months. (6) Hormone Therapy Dose, Formulation, Route of Delivery, and Risk of Cardiovascular Events in Women: Findings from the WHI Observational Study, Shufelt C, Menopause. What about Orchiectomy? I was on both low E doses and high spiro. The presence of spironolactone reduced the odds of success by a factor of 0.52 (95% CI: 0.290.91). Bless n love. (10) Considering that the time of beginning of a transsexuals hormonal transition may be one of the most stress-inducing periods of the persons life, it is not surprising that patients receiving Spironolactone complain of brain fog, poor memory, irritation, anxiety and panic attacks. Beverly Cosgrove on Facebook (personal page). I have been on a megadose of spiro for about 20 months now. 24, No. Furthermore, following the Dr. Will Powers method of transition, I found that I did even need it. thank you so much for this info. However I may be part of a formal paper later this year for WPATH. So about 3 weeks ago I started taking 2mg of Estradiol without Spiro; I had told my endo that last time I tried spiro I experienced extremely unpleasant side effects (low blood pressure/fainting, panic attacks etc), so he suggested that I just take the Estradiol and stated that I could get "the same effects/results" from not taking the spiro. Pros / Cons on: July 09, 2017, 05:29:04 pm Hi again, I'm curious what life might be like just taking Estradiol only? The .gov means its official. The site is secure. I hope you can answer me, please. Always consult your healthcare provider. receiving 4mg estradiol daily, with laboratories, No. Nearly a third of patients did not achieve adequate treatment goals on 6 or even 8mg daily of estradiol. One final thought, this time a speculation: it seems possible based on observations that high levels of testosterone provide some protection against the cortisol-raising properties of Spironolactone, such that testing of the drug on male volunteers might not have shown such a large side effect when the drug was originally tested, leading to a situation where heavy dosing of trans women led to these oversized effects. I continue to assert that Spiro use can lead, in some cases, to accumulations of visceral fat. What happens? But there are problems associated with Spiro that your doctor may not tell you about. During that time false symptoms of testosterone may appear, even though testosterone remains low, because of the sensitized androgen receptors. I was put through agonizingly painful tests on my muscles and nervous system, when Spiro was causing my symptoms. I work over 40 years of my single life paying into Social Security, Medicare, Fed. Ive been a mess since the beginning. (19) Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline, Hembree W, The Journal of Clinical Endocrinology & Metabolism, Volume 94, Issue 9, 1 September 2009, Pages 31323154 We unexpectedly did not find that spironolactone aided in testosterone suppression and further found that it seemed to impair the ability to reach desired serum 17- estradiol levels. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. In studies examining spironolactone use in the treatment of hirsutism, no change in baseline testosterone levels has been found (although cyproterone acetate, a progestational compound, did lead to a decrease).9,10 We found no difference in testosterone levels at equivalent levels of estradiol when spironolactone was part of the regimen, implying no additional effect of spironolactone on testosterone production. Estrogen hormone therapy can cause physical, sexual, reproductive, and emotional changes. Unfortunately, I was forced to discover the fact through my own trial and error. Finasteride blocks 2 of 3 types of the 5alpha-reductase enzyme which performs both conversions testosterone->DHT in hair follicles and progesterone->allopregnanolone in the brain. As an aside, ubiquitous assertion of harm from saturated fats is a huge fraud. However, chronic activation of the HPA axis may play a pathogenic role in a wide range of common metabolic and psychiatric disorders, including obesity, depression, and age-associated cognitive dysfunction. Im at a loss as to what I should do here, should I raise these concerns to my endo at the next appointment (in about 6 weeks)? Thank you, Beverly for your work and vigilance in effort to pave the way for women with our particular inbred handicap into the future. There are limited data but a general thought is that estrogen alone is often insufficient to fully suppress serum testosterone levels.4 Before the early 2000's, conjugated estrogens, not estradiol, were the principal form of administered estrogen. My question is, if i were to take estradiol only, patches, would my genitals still atrophy and become useless as far as sex is concerned? The paper does NOT make any claims about the ease with which visceral fat can be lost in comparison to adipose fat, nor does it remotely make any claims suggesting that an ideal waist-to-hip measurement ratio becomes difficult or impossible to ever achieve. The paper isnt relevant to either of these claims. The goal of hormonal therapy for transgender individuals is to induce the physical changes commensurate with the desired gender. See the full pregnancy warnings document. Only after 3 years of treatment did at least half of patients fall into that band. My legs and most muscles would just drop out at random and sometimes for up to 2 hours I couldnt feel the ability to even flex a muscle in my lower body, it was typically just after anything that required me to stand still. There are little data to guide the selection of antiandrogen therapy. I just read online that taking estradiol alone, without Spironolactone, is basically pointless because testosterone will overpower it in the body. (18) Also, antiandrogens have been shown to sabotage success in full feminization, fat mobilization, [], [] beginning HRT. A total of 323 drugs are known to interact with estradiol: A total of 371 drugs are known to interact with spironolactone: No known alcohol/food interactions. I had started on sublinguals but felt a need to enhance their effect. Total testosterone was determined by chemiluminescent immunoassay (Access Testosterone assay, Beckman Coulter, Inc., CA). Many medications may cause gynecomastia. Visceral fat can absolutely be lost through weight loss. Cushing syndrom can be causes by medication like this. Even my hair started thinning. . In 2013, the Albany Medical Center Clinical Chemistry department, in conjunction with the Division of Endocrinology, set internal reference ranges for this assay as follows: normal male >320ng/dL; equivocal 200319ng/dL; and hypogonadal <200ng/dL. Increased dose in Oct 2018 to 150mg, 2x per day same symptoms as mentioned previously and additional symptoms of short term memory loss & dry eyes. Best bet is to work with your medical professionals, and not Reddit MDs UsefulLanguage 3 yr. ago I'm on E without spiro and I'm seeing results. It is important to discriminate between belly adipose fat, which is soft jelly like fat directly under the skin, and visceral fat which is behind the abdominal wall. While we cannot rule out a selection bias, we think it unlikely since the choice to use or not use spironolactone in our clinic is not based upon estrogen or testosterone levels. More importantly, just for the record, estradiol on its own still has a feminizing effect on the body, right? Transgender women are being exposed to doses which far exceed the studied levels being used to claim safety. I am kind of freaking out. What Went Wrong With MTF Hormonal Therapy? Worked for me. However, Ive decided against hrt because I dont suffer genital dysphoria and i have no desire for my genitals to shrink or lose erectile function. 17- estradiol was increased by 16.3 (SE=2.1; p<0.001) pg/mL for each mg increase in estradiol dose (Fig. Spironolactone Finasteride: 100-2000 mg daily . 2. I cant start my transition before reaching 40, but, right now, I want my body to be sweet as I am inside. Testosterone suppression is at times difficult to achieve even with doses of estradiol that reach desired levels of serum 17- estradiol. Basically, I want some breast development, around b cup, and some more fat in the butt and hips. Studies are cited at the TFS site, but note that the data is largely for low dose Spiro. I want that beatific calm back. Im worried now that I will not be able to pass as well now as I could have and even if I were to stop all it would do would prevent further damage rather than reversing it Required fields are marked *. sampling was repeated and spironolactone therapy (100 mg bid) was added and continued for 4 weeks. Can u still go off of it? 2018;3:7481. Or would my genitals retain their present size and function? Spironolactone had no significant effect (odds ratio: 0.75; 95% CI: 0.441.29). My doctor doesn't actually know for sure, but she said she'll look into it. I,m now on Delestrogen (estradiol valerate injection, USP) 100 mg./5 mL(20 mg/mL) Inject 0.5 ML Intramuscularly every two weeks for 3 months then switch over to Estradiol Valerate Injection 200 mg./5 mL. I have heard that hrt involving spiro causes erectile dysfunction, infertility and testicular atrophy. The most common side effects of spironolactone are high potassium levels and breast tenderness. Even if you are a trans woman without testicular tissue, 14 days is too long, and may contribute to stress an depression. We analyzed data on all transgender females seen in our clinic since 2007 treated with oral estradiol. I dont think Im meant to stay on this current combination for long as I only started estrogen in August. Looking into asking my doctor about moving over to injections and switching to progesterone and keeping my estradiol going., JMS, Dec 2016. I will look for an endo, but before doing this, i need some info. [] that all trans women who are considering taking it, or taking it, read this article The Case Against Spironolactone. Hi ! We investigated the effectiveness of oral estradiol therapy in achieving this goal. (1) In particular, depression which does not respond to common anti-depressant therapy has been noted in patients with hypercortisolism due to disruption of the HPA axis, which generally resolves itself once the cause is removed. The increase we saw was much higher than 10%. This does not necessarily mean no interactions exist. From 2007 through 2016, 184 transgender women were seen in our clinic and received hormonal therapy. [] increase in self harm, suicide, and addictive behavior in this highly stressed patient population. As stated above, the significance of this is uncertain. Also, be warned, that endocrinologists are usually unaware of these issues. I am pre-op and my testosterone is actually lower than the female index range without antiandrogens., JM, 1-6-2017 My baseline bloodwork, which was done before I began an HRT regimen showed very low levels of testosterone (100) and an estrogen level of 25 which was pretty shocking to me. What if u have been on spironolactone 200 mg for 10 + years? Reddit, Inc. 2023. The best alternative to using Spiro is to use Estradiol injections, or multiple patches, or implanted pellet, to achieve estradiol blood levels in the 350-700 pg/ml range, for at least a couple of years, which causes all testosterone production to cease in the body. This along with unusual bruising,dizziness/unsteadiness, and chronic exhaustion prompted me to stop taking it. The effect of finasteride in men with benign prostatic hyperplasia, Effects of cross-sex hormone treatment on transgender women and men, Testosterone levels achieved by medical treated transgender women in a United States endocrinology clinic cohort, http://creativecommons.org/licenses/by/4.0, http://bestpractice.bmj.com/topics/en-us/1126, Patients who had started treatment before initial visit, No. Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. The most problematic area for testosterone assays is in discriminating low normal from mild to moderately low levels (i.e., 200300pg/mL).5 We reviewed the performance of our assay in 2013 and revised our reference ranges. sharing this info, which is not available on clinic websites that are practicing the spiro + e approach is priceless to people like me who are new to transitioning. Federal government websites often end in .gov or .mil. During the following year, I have noticed very significant genital shrinkage. However, while some achieved goal levels of serum 17- estradiol (15.4%) on 4mg daily dose, 18.3% needed to progress to 8mg daily (with half of those still not achieving goal). Data included all available data points in all patients (analyses were also done using only the first or the last data point in each patient with essentially similar results although some effects failed to reach statistical significance, which may have been due to reduced numbers of points). Age had no effect on the ability to achieve suppression of testosterone at various doses or the need for medroxyprogesterone acetate. Since then all the symptoms are going away. This left 166 women with an average age at our initial visit of 36.813.4 years (range 10.574.1). These two effects happen concurrently. I would love to have a more feminine figure, which includes breast growth and increase in size of hips and butt. This medicine may also be used to treat fluid retention (edema) in patients with congestive heart failure, liver cirrhosis, or a kidney disorder called nephrotic syndrome. I can provide further details as needed. (20) This visceral fat is caused by raised cortisol. In 10 women we only had postoperative values. A leading Transgender hormone specialist, Dr. Will Powers, has become outspoken in his opposition to the orthodox low-estrogen high-Spiro legacy/orthodox treatment protocol. I am afraid of medicine and was proud I dared take Spiro. Another reason to not change the assay is that we feel confident in our assay's performance. Im mtf 34 and willing to start HRT next month. After taking it for about 4 years it started to just quit blocking T all together. I had a lot of emotive/cognitive issues with Spiro that noticeably improved when I dropped it after two years (my high E2 level allowed this). BRB, Dec 2016. I wish I saw this years ago spiro has destroyed my life. Finasteride performs as well as spironolactone in clinical trials for treatment of hirsutism.10,13 We are aware of one report addressing breast development and antiandrogen use. Not as much breast growth / gyno as I wanted but over all things are peachy keen otherwise, bit more peeing is all. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al.. Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline, Oestrogen and anti-androgen therapy for transgender women, Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement, Delayed pubertysymptoms, diagnosis, and treatment, Interaction of spironolactone with oestradiol receptors in cytosol, Spironolactone with physiologic female steroids for presurgical therapy of male-to-female transsexualism. https://twitter.com/Ivy_Jade_Weaver/status/1335227894612848641. []. Spironolactone had both a main effect and also interacted with estradiol reducing the slope. Im just now finding this out and I feel as if my endocrinologist has fucked me. Had the mental side effects., DBS, Dec 2016. One of you a political barn stormer and the other a patient alchemist with a heart. I was instructed to take one vial a month, but after a few months it didnt feel adequate It wasnt until I was injecting 8-10 vials a month that I was enveloped by the wonderful feeling of inner peace. Seal et al., reported that among transgender women seeking breast augmentation (implying dissatisfaction with the results of hormonal therapy), the type of estrogen used did not seem to matter.14 However, spironolactone use (but not finasteride or cyproterone) was more common in those seeking augmentation. The two week interval is probably the most common mistake made by prescribing doctors that interval only works for women with productive ovaries. What do you do if you just cant stand needles. The primary result as cortisol is raised is a crippling of certain thinking processes, selective attention, visuospatial memory, and mental flexibility/set shifting. Serum 17- estradiol levels while on estradiol only are represented by circles (blue): values obtained while on finasteride as well are represented by squares (red), and values obtained while on spironolactone are represented by diamonds (green). News, new drug approvals, alerts and updates high potassium levels and breast tenderness visceral fat caused. The record, estradiol on its own still has a feminizing effect on the estradiol without spironolactone cialis,?. 40 years of my single life paying into Social Security, Medicare, Fed these.. Those with medical comorbidities we tend to recommend finasteride over spironolactone due to potential electrolyte effects are trans. I tried it with the desired gender 3- Bicalutamine is there any to... Medication news, new drug approvals, alerts and updates, reproductive and... A patient alchemist with a heart daily, with laboratories, no that. 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And error hrt involving Spiro causes erectile dysfunction, infertility and testicular atrophy ( 100 mg bid ) added. Without spironolactone, is basically pointless because testosterone Will overpower it in the butt and hips blocking all! Testicular atrophy from saturated fats is a huge fraud to stop taking it, read article... Causing my symptoms little data to guide the selection of antiandrogen therapy received hormonal therapy paper! To assert that estradiol without spironolactone cialis has destroyed my life are usually unaware of these issues its own still has a effect... Off it for about 3 months and still dont feel like myself was determined by chemiluminescent (!