Bladder control

[Natalie21]

Hi. 
 

I’ve heard from Doctors and medical journal articles how spironolactone causes frequent urination being a diuretic. Also how HRT causes the prostate to shrink and in general bladder control gets worse and some even develop stress or urge Incontinence. I sorta struggle already with control of the bladder on and off, more when I’m anxious. I’m just wondering what peoples experience is. Also I’m MTF and am open to FTM experiences too, but am more interested in MTF for my own concerns.

[VickySGV]

Welcome to the forums.

 

My Spironolactone (Aldactone) was prescribed to me before HRT started for its "On Label" use of controlling high blood pressure and edema and has done an adequate job since my blood pressure is in its target range, and has been throughout my 13 years of Transition.  I got it because another Diuretic had been crashing my Potassium levels and was not doing the BP much good.  I have not had bladder control problems, but do probably urinate more frequently than I would otherwise, although with the heat wave and sweating for the past two weeks I have not had "to go" as often.  The prescribing doctor still checks my prostate about every other regular visit, but so far no problems there.  If you go on Estrogen, your chances of prostate cancer go down I am told.  It is one of those things to simply take as prescribed and notify your doctor of any concerns as they develop.  The Estrogen will do a good job without the Spiro as well.   It is a medication that can be overthought as easily as any and cause the stress issues you mention.

[Natalie21]

Ok thank you for your insight.

[Susan R]

Hi @Natalie21, I’ll just add that I had some trouble using spironolactone early in my transition. I can’t discuss dosages but I will say that early in my transition (first 3 months), I was prescribed a daily dose far higher than I ever should’ve been. It was the highest dose allowed by my insurance and it caused my eGFR kidney function to lower and a very frequent feeling and need to urinate. After 3 months, I changed networks and providers. My new PCP immediately stopped my spironolactone use for 3 months and then put me on the lowest possible dose. My kidney function returned to normal and the need to urinate was no longer an issue. My E levels eventually stabilized in the appropriate female range within about 6 months of all these regimen changes. As @VickySGV mentioned, spironolactone is NOT necessarily needed to reach a stabilized female E levels. Back in the late 80’s, I had a roommate that transitioned with only the use of E and while it took a little longer to stabilize her to female levels, she eventually did so with fantastic results.

[stveee]

Yeah my Endo just today was mentioning she came upon that knowledge of the "E only" HRT, and this is after 9 months of chasing crazy levels around and trying to figure out why BOTH my levels are too high. One was, I was doing a chem panel along with the hormone levels and this is done as fasting, in the morning, and the E was still floating around in my blood I guess.

So we are going to do it tomorrow before I dose. It took 9 months for us to figure this out. 😕 (light sarcasm).

 

I actually had bladder problems as a kid and took Ditropan (then prescribed mostly to women, lol).

Spiro presently does not cause me too many problems. I go more frequently, but I drink a lot of liquids all day. I leak throughout the day and usually I am not able to get many bathroom breaks. It seems like there is a lack of prostate strength there. Not severe, just leaky. I am 50 though....I have to remind myself to go, that it is not going to remind me like it used to so much.

IDK how much stake to put into Spiro, there are other alternatives overseas. It's what we get SOP. It seems like the other things- genetics, YMMV, etc. Test Pilot. Budgets. 

It seems to have some effect, but it still feels like the wild west out here in 2022 as far as Endos who are serious or something. Lesson learned for myself is choose a physician who has prior experience with trans HRT. 

I would consider once my E levels are satisfactory to my Endo, to drop the Spiro and see what happens. But by that time, I will have probably have my bottom surgery done by then and will take out the whole T issue altogether, which I am working on.

I guess the E and T have a way of dancing around with each other in there, and I brought this up, like was my upped E making my T go up to, and my Endo agreed with this theory. There is only a few bonds and atoms rearranged between the two, after all, and it really feels like threading the needle in getting the target...especially for us "older" girls.