Post-Op HRT Question

[Guest EvaO]

So, I was wondering about hormone intake post-surgery -- and, of course, this is a question for the ladies who have had vaginoplasty. I was reading a few forum posts here about some women who continued to take anti-androgens, like Spironolactone, after having surgery; this surprised me because I always thought that having srs meant you didn't need any more T-blockers, because the surgeon removed your testes. Am I wrong?

I've asked my former supervisor at work (we had that kind of relationship), and she told me that she didn't take any anti-androgens, so, just wondering why some post-op ladies here still take Spiro...

Also, I do realize you have to continue taking estrogen after surgery, but how much estrogen does one actually take post-op? I mean, are we talking popping a pill once a day or would I have to continue my daily dosage of xx mg, 2Xday? Again, my supervisor/friend said she took xx mg of Estrodial once a day...is this the average dosage?

Any feedback would be much appreciated! Thanks in advanced!

Love,

Eva

Edited September 8, 2013 by Megan Rose
Removed dosage per T&C

[Guest Jenni_S]

I wouldn't know what the "average" dose is, but I have continued with estradiol and discontinued, per my doctor, with spironolactone after my surgery.

[Guest]

Hi Eva,

Before I had surgery, I asked my doctor about postop dosage, and he told me to discontinue spiro and cut my estrogen dosage in half. My surgeon said to cut the estrogen to a third of my previous dosage. I went with the half-dosage because it was too difficult to measure the 1/3 number.

Love, Megan

[Guest Angel Heart]

everyone is different. yes, i know you probably don't need spiro when you're post op. i didn't know some girls took it still

i think it all depends on you. might take a few months and some tests to figure out what dosage you need following surgery

[Drea]

I still take Spiro which is atypical. There is a reason I do. I suspect if you say "posts" referring to staying on spiro on this board it is a good chance it might have been me.

In order to avoid a piece of lay information getting passed along such that by the fourth iteration it is told as fact I won't go into the reasons.

You are correct though that there isn't generally a reason. And I don't think I have any special condition really requiring me to take it, but there is a good deal of, lets call it tribal knowledge among the docs which doesn't necessarily have hard scientific basis.

I would note that some post SRS actually take some T to improve libido. One would expect in such circumstances that one would not want to take spiro.

The testes aren't the only part of the body that creates T and it is possible if that area produces enough that one might take Spiro to reduce the amount.

As for me, the bit I take has had no effect on T levels and it isn't related to the above. If you want to know why I take it, feel free to PM me.

[Guest EvaO]

Actually, Drea, it was a few posts that got me thinking about this (don't remember, but I don't think you were one of them). Either way, I appreciate the feedback! I also thought later about how the testes are not the only organs that produce testosterone -- after all, everyone produces both hormones in their body, regardless of whether they have testicles or not -- so thanks for pointing that out too.

And thanks, everyone else too, for the feedback!

[Guest LizMarie]

Drea is correct. Generally people are told to discontinue spiro but there may be specific cases where spiro is continued. This would be between you and your doctor so be sure to clarify this before your surgery.

Odds are pretty high that you won't be taking spiro after surgery but if your doctor feels you should, you should be able to get a clear reason as to why it's necessary in your case.

[Paula ult]

I am also a bit atypical, after my surgery i was told to discontinue Spiro but stay on my pre op dosage of estradiol, when i went back to my Endo after surgery he wanted to cut my estradiol dosage in half until i told him what my surgeon said, he said ok. Someone with a heart condition might be told to stay on Spiro, that is what it was initally produced for, this would be between you and your doctor.

A few months after surgery i was feeling larthegic and had low libido, a blood test showed my T level was way below the female range, i called my surgeon and she prescribed a small dosage of T, it worked wonders.

Everyone is different, what works or is prescribed for me by my doctors may not be right for you.

Paula

[Guest N. Jane]

They didn't have blockers when I transitioned and had SRS nearly 40 years ago at age 24 so I was never on them. It wasn't a problem though because I had been on HRT since I was 17.

In my 40s my GP wanted to discontinue HRT because of the risks and my body DEFINITELY paid the price for NOT being on HRT or anything else. In the 15 years I was off of HRT my body masculinized quite a bit and it was a giant step in the wrong direction. I got back on HRT in my 50s and the problem stopped but the adverse effects can never be undone. Obviously the "background" level of T was still there and without estrogen to counteract it, it HAS an effect.

Too many doctors don't really know what they are doing with hormones and all of us should be under the care of a knowledgeable endocrinologist!

[VickySGV]

I am still with my Spiro, but my reason for being on it is hypertension, and thus it started, thus it stayed. My endo did not originally put me on it, but another diuretic I was on kept crashing my K and my GP missed my E on the chart and was telling me the negative effects of lowering my T effectiveness when he re read the med list, and then joked, that I would not mind the side effects where others might. My pre surgery E was half of the dose Dr. B. recommended, so I have stayed on that one, but my Endo called Dr. Bowers and let them know, so all cool.

[Guest EvaO]

Vicky, you were one of the posts I remember reading. Thanks for the input!

[Guest Leah1026]

So, I was wondering about hormone intake post-surgery -- and, of course, this is a question for the ladies who have had vaginoplasty. I was reading a few forum posts here about some women who continued to take anti-androgens, like Spironolactone, after having surgery; this surprised me because I always thought that having srs meant you didn't need any more T-blockers, because the surgeon removed your testes. Am I wrong?

I've asked my former supervisor at work (we had that kind of relationship), and she told me that she didn't take any anti-androgens, so, just wondering why some post-op ladies here still take Spiro...

Also, I do realize you have to continue taking estrogen after surgery, but how much estrogen does one actually take post-op? I mean, are we talking popping a pill once a day or would I have to continue my daily dosage of xx mg, 2Xday? Again, my supervisor/friend said she took xx mg of Estrodial once a day...is this the average dosage?

There is a very small number of people who have to keep taking Spiro after SRS because their adrenal glands go into overdrive making T (yes, your adrenal glands do make some T). Usually that is temporary, but not always. In addition, do remember that Spiro was originally marketed for hypertrension (high blood pressure). Some people may be taking it for that.

In general post-op estrogen doses are approximately half what your pre-op dose was. Keep in mind I said "in general" and "approximately". Exactly what your dose will be is up to your doctor.

[Guest NatashaJade]

I've always been on a lower dosage of Estradiol. After surgery, I stopped spiro and added progesterone, which served very well for added padding in all areas where added padding is a lovely thing.

[Guest ~Ashley~]

Interestingly enough, I was on progesterone prior to GRS along with Spiro and E. After surgery, my endo cut the spiro AND the progesterone. My E stayed the same. I find this odd as Dr. Bowers had advised I stay on progesterone albeit cycled every 2 weeks. It just goes to show there are still a lot of differing opinions as to which medications yield optimal results.