Monotherapy questions

[EasyE]

Have been reading about monotherapy lately - no Spiro/T-blockers, just estrogen for MTF. Anyone else familiar with this or use this regimen? Some suggest it can be just as effective at bringing down T levels.

 

It seems like there are some serious risks no matter what you chose. But some of the risks/side effects I see associated with Spiro give me pause. Thanks! Blessings

 

Easy

[Liz-Liz]

Well, I can give you an overview of my journey at the very least:

 

I began HRT with Estradiol injections and Bicalutamide for a blocker. My body tolerated the bicalutamide well. I have nothing bad to say about the experience. However I was encouraged to switch to spironolactone to save my life after a major MS flare-up that had me on a number of harsh medications.

 

I took the spiro for around 4 months after switching. At first I had to pee just about once an hour, every hour. Very inconvenient. Also my face started breaking out bad, and my skin became oily compared to being on bicalutamide. I quit taking it as soon as I could.

 

My doctor suggested a try mono-estrogen which increased my injection dose frequency. I tried it out but quickly decided I didn't like taking that many injections and my mood/body is sensitive to higher E concentrations. The lab work did show my testosterone levels were on par with a cis female, so in that aspect it was effective.

 

I've since had an orchiectomy to eliminate the need for a blocker. All around I feel much better having that permanently handled.

I have my first blood lab coming up for my new E (plus progesterone) treatment soon. I'm super curious to see what my testosterone levels will be without the primary production factories.

 

I've spoken with others that have had very different experiences with each medication so it really does depend on the individual...

 

Hope you get something useful out of this! Be sure to speak with your doctors about what they suggest and why, and good luck on your journey!

[EasyE]

Thanks! Doc appointment tomorrow! To at least get the referral to see an endo ... 

[AllieJ]

On 12/3/2023 at 1:27 AM, EasyE said:

Have been reading about monotherapy lately - no Spiro/T-blockers, just estrogen for MTF. Anyone else familiar with this or use this regimen? Some suggest it can be just as effective at bringing down T levels.

 

It seems like there are some serious risks no matter what you chose. But some of the risks/side effects I see associated with Spiro give me pause. Thanks! Blessings

 

Easy

 

Firstly, all of our hormones are 'off label' for gender transitioning (as no trials were done to get FDA approvals), so most of the data for hormone use has come from studies on cis people. The most popular study referenced by medical bodies is the 'Women's Health Initiative' which was published over 20 years ago from studies carried out last century on synthetic hormones, which have significant risk factors. To lessen these risk factors, lower doses were recommended, so the practice of using anti androgens to reduce T was adopted instead of lowering T with high doses of synthetic hormones.

 

All anti androgens have side effects, some can be harmful. Again, they are being used 'off label', ie Spiro is designed as a diuretic and blood pressure medication which has a side effects of lowering T. The 'Women's Health Initiative' is no longer relevant, as this century we have developed and are using hormones identical to what is naturally produced, so the risk factors are also consistent with natural hormones

 

Mono therapy for Oestrogen was developed so the overall risk factors could be reduced by avoiding the use of the higher risk anti androgens, but it usually requires significantly higher doses, and blood E levels than was recommended by the WHI, and this makes most doctors uncomfortable. This just means they haven't kept up with learnings on hormones, and are relying on outdated data. Some people are resistant to high oestrogen levels, and would still need to use an anti androgen to lower T, but the majority of people will handle higher E doses (within the natural ranges for women) quite well and can avoid the side effects and risks of AA's. Higher doses are more safely attained with transdermal hormones (injections, gels and patches) than with pills, which are processed via the liver. 

 

So using Monotherapy is dependant on how up to date your doctor is with understanding risk factors. For further information, you can read https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy (and this may benefit your doctor if they haven't already read it!)

 

Hugs,

 

Allie

[EasyE]

Thank you Allie!! I have been reading about this very topic over the past week (maybe from something you linked elsewhere). 

 

Sounds like an E-only regimen is the way to go if i had my druthers. I would feel most comfortable with a patch (hate shots and pills). We'll see what docs say.