Green light: Met the endo today

[EasyE]

Hello all, met the endo today. Because I had to go to the ER a few weeks ago for something unrelated, he already had all of my blood work in front of him. Basically he gave me the green light to go when I am ready. He recommended starting with spiro, then adding e after that ... though he said I could start both together ...

 

i expressed my concerns about spiro side effects and I asked about monotherapy, but he said e only was not his office's typical practice. He said spiro side effects were minimal though he admitted the drug has a bad reputation...

 

I have one big medical issue I need to deal with (unrelated to all of this) in the short term and that will give me time to sort through all of this more ... part of me was ready to start yesterday ... part of me still struggles with the impact of this on the people around me (and of course some of the potential side effects scare me)...

 

Anyways, here I am ... one step at a time ... 

[Keera]

Hi EasyE I was wondering if this action means you are no longer 'questioning'?I can preasume that I'd say! I wish you all the best with this process and one I would love to take but not just yet!

Love Keera

[Susan R]

3 hours ago, EasyE said:

he gave me the green light to go when I am ready. He recommended starting with spiro, then adding e after that ... though he said I could start both together ...

Congratulations on being able to move forward with HRT if you decide to do so. I can only speak of my personal experiences with Spironolactone and I believe your concerns are well founded.

 

There are side effects that if not monitored properly can be detrimental to one’s health. I was originally put on too large of a dose by my first primary care doctor and after only 2 months, my eGFR started dropping. The comparisons between labs tell the doctor how well your kidney function is adapting to a new medication. After 3 months and another drop, my original Primary Care Physician took me off Spiro completely.

 

Immediately, I switched my PCP. The new PCP would not prescribe Spiro for the next 3 months after reviewing my chart. After that, I was put on the very lowest dose possible after labs showed that my eGFR had returned to normal. I stayed on that same dose for several years until GRS and had no issues with it. The right dose is critical. One thing to note…you may need to urinate a little more often as it is in essence a diuretic.

 

My Best To You,

Susan R🌷

[KatieSC]

I may be the odd ball. I actually found that the spironolactone was wonderful for my blood pressure. It is an incredible drug for hypertension, and it is very useful for congestive heart failure. One other big thing if you wind up on spiro, watch you potassium level. Spironolactone is a potassium sparing diuretic which means it reabsorbs potassium in the urine and helps to excrete sodium (you pee out the salt and the water goes with it). You can also get dehydrated, have constipation with it, and sometimes leg cramping from the dehydration.

[EasyE]

So the endo seemed to suggest that E only wouldn't really be effective for feminizing, hence why he wanted me to start on spiro then add the E later. But I've read otherwise in multiple places, that E alone can be effective ... Any thoughts from those experienced in these areas? Thanks!

[Audrey]

@EasyE I share your concerns about side effects as @Susan R describes. I am curious if the bloodwork you have already shows your testosterone level right now at baseline? When I started, I wanted to know this information to make an informed choice, and I was assuming I would need both the estrogen and the blocker at the same time. So glad I asked! The labs came back and both my prescriber and I were surprised to see my baseline testosterone level was already below [male] range!.So we decided on the estrogen alone and watched the labs closely every few months for the first year. Forum rules do not allow me to say the dose, but I can share it is still the same as it was when I started HRT - that is more than three years ago now. Estrogen level is where it should be (200-250 range), and the testosterone has been suppressed to below 50 (and often below 30). And I feel great!

 

All the best as you consider starting HRT... and I hope you can get your other medical concerns resolved too!

 

Love,

~Audrey.

[KatieSC]

To keep this simple, the Spironolactone has an anti-androgen effect. It reduces the testosterone level. Strangely, this particular side effect is why so many men do not like to take Spironolactone as they will develop some mild gynecomastia in some cases, and erectile dysfunction. Of course, for those of us making the path to trans womanhood, we usually like to have the testosterone levels go lower. The estrogen will provide a much more robust level of feminizing activity, and is enhanced by the reduction of testosterone. You should have medical guidance for your gender affirming hormone therapy. I hope that helps.

 

Many of us have been down the pathway using Spironolactone and Estrogen (oral, patch, or injection). Good luck!

[Louise B]

While Spiro may help hypertension, it can cause notable problems if you have hypotension (low blood pressure).  If you notice an increase in dizziness with Spiro, discuss with your doc immediately.  And should you actually faint (syncope), immediately cease all use until you speak with your doc.  But fair warning:  In some American states, reporting a fainting to the doc requires them to inform DMV, and it could jeopardize your driving license.

[KayC]

Congratulations @EasyE on getting Green Lighted!  I'm sure you're feeling Wonderful about that.

I think you are getting a broad spectrum of experiences and pros/cons about Spiro & E, so I will just add mine. 

My doctor started me on Spiro first (mostly because I wasn't ready for social transition yet).  When I was ready (about 8 mo later) he started my on Estradiol.  It took him about 4 months to ramp me up to my current dosage.  It's been 6 months of the E.  My most recent labs showed T coming down and E going into the normal female range.  Target achieved.

I have not had big problems on Spiro - and it replaced my normal blood pressures meds, and as @KatieSCmentioned - it was GREAT for my BP (even better than my previous BP med).  Not sure if that is the case for you. 
The other cautions about dehydration, and frequent urination (once or twice a night for me) are true for me also.  But I've become used to those.  Someday (maybe with an orchiectomy?) if I can get off Spiro that would be good.  But for now I am just happy with my HRT results.

My best experience is to stay engaged in the conversation with your Dr and Endo, research about lab results and different HRT options, and mostly take care of yourself and ENJOY THE RIDE!!!

[MirandaB]

I can only respond about starting spiro and estradiol at the same time, I had the urination/dehydration issues too, so nothing else to add other than my usual posting of what the endo said to me at this point:

 

"Let's get this party started!"

 

[Ivy]

12 hours ago, EasyE said:

Any thoughts from those experienced in these areas? Thanks!

In my experience Spiro caused low sodium for me - but I have a tendency for that already.  I am on Estradiol.  Started with low doses and increased over a couple years, and a few months ago added Progesterone.  My recent blood work showed low T levels and E levels on track.

The monotherapy has worked for me.  But I wanted the Progesterone to give the girls a boost.  For me The Estradiol has suppressed the T pretty well.  I have a lot less body hair now.  It's a pity it doesn't help with facial fur.  But we're all different.

[EasyE]

After much reading, studying and listening to others' real life experiences, I feel much more comfortable going the monotherapy route (E only). Can I go back to my doc and see what he thinks? 

[Audrey]

Hi there @EasyE, I think your doctor should honor your choice even if it is not "typical" of the practice, assuming it is not medically contraindicated - I cannot imagine why it would be if you have the okay to start HRT. Your involvement in the decision-making is the heart of the informed consent model. It is impossible to know how your body will react to HRT until after you start and it can take some time to notice the effects. You can monitor how you feel as well and check labs in a few months time to see where your hormone levels are.

 

@Ivy Did the progesterone help?

 

Love,

~Audrey.

[emeraldmountain2]

On 12/27/2023 at 9:43 PM, KatieSC said:

I actually found that the spironolactone was wonderful for my blood pressure.

I think it has also helped control my high blood pressure.

 

11 hours ago, EasyE said:

Can I go back to my doc and see what he thinks? 

Why not ask? For your own safety and health, you should get the doctor's blessing and not rely on strangers on this forum to help answer this question.