Orchiectomy vs Spiro: Weighing the Risks in Heart Patients

[MelisssTN]

I have a question on the risks associated with HRT and  anti-androgen therapy and those of us with cardiac history.    I was diagnosed with paroxysmal atrial fibrillation in 2015. Shortly after my diagnosis I had a catheter ablation that successfully kept me in normal sinus rhythm for nearly two years. I had an episode of AF last summer that resulted in my cardiologist putting me back on a blood thinner and anti-arrhythmia meds.  Other than the AF my heart health is otherwise excellent.  My echocardiograms, stress tests,  24 hour holter, and 24 hour blood pressure monitors are within normal limits,  my blood lipids are normal and I have no evidence of coronary artery disease. I was a marathoner and endurance athlete for many years which my cardiologist states helped protect my cardiovascular system but paradoxically may also have triggered the electrophysiological imbalance that result in paroxysmal AF.  Based on the research that I've conducted it appears that the greatest risks associated with HRT in transgender women is associated with the possible side effects and toxicity from anti-androgen therapy.  I'm scheduled to see an endocrinologist later this month and I want to be as informed as possible when I see him for my consultation.  I've reviewed the WPATH standards and my interpretation is that the criteria for an orchiectomy is for the patient to have been on HRT and Spiro for a year prior to the procedure.  Of course once the orchiectomy has been completed the Spiro can be discontinued and the dose of estrogen be reduced.  Is anyone aware of instances where a patient could consent to an orchiectomy with taking anti-androgen therapy and then commence a safer low dose of estrogen for the desired result?  I'm 59 and have no interest using my testicles for reproduction. I'm well aware that once I have an orchiectomy there is no turning back and I'll be obliged to take HRT for the remainder of my  life.  I'm just attempting to determine if based on my age and medical history an orchiectomy is a safer alternative to anti-androgen therapy .  Obviously,  my cardiologist and endocrinologists medical opinions will influence this decision.  I just want to be as informed as possible when I meet with them.  Any insight and recommendations that any of you can provide me would be appreciated.  Thanks!

 

Melissa

[Charlize]

I have severe cardio vascular disease.  Simply getting a cardiologist to sign off on HRT took what seemed ages.  I found that Spiro was difficult for me to handle so i started to move towards an orchiectomy.  I got clearance from two therapists and pushed on.  Unfortunately after i stopped taking my normal aspirin prior to surgery i had a second heart attack.  After some time i did another stress test.  My cardiologist said i had to do 10 minutes and i did.  As a competitive bile racer i am used to pain and  without that ability i wouldn't have made it.  I did have issues but was still allowed to proceed with local anesthetic.  I'm so much happier now with simply a single spray of a topical E each night.  I wrote quite a number of posts during this time.  It was difficult but the last years have been great and so far so good as far as my coronary health is concerned.

Here is one of those posts:    If you look in the surgery forum you will read more posts about orchiectomy. 

 

Hugs,

 

Charlize

[Carolyn Marie]

My issue wasn't coronary disease, its Type II Diabetes.  The Spiro played havoc with my water retention, which  was already messed up with my diabetes drugs.  So side effects were a real problem.  On top of that, I just didn't want to put my body through GCS at my age (61 at the time), and my wife would not have liked it, either.

 

For all those reasons I went ahead with an orchi, and have not regretted it.  I'm very happy to be done with the Spiro and its effects, and while some of my junk is still present, it doesn't cause me much concern.  I'm happy, and that's what counts.

 

But that's me, and everyone is different and has different needs and comfort levels.  I think you should do whatever is best for you.  Good luck!

 

Carolyn Marie

[TessaOKC]

Hi Melissa,

 

I read all three posts on this subject from you, Charlize and Carolyn. I get AFIB occasionally and its usually from something I ate or from drinking alcohol (I have since stopped all alcohol intake) . I do however get regular PVC's. I just quit using salt and it helped to reduce them by about 90 percent. I am on a large aspirin per day for thinning my blood. 

 

I'm on the typical dose of Spironolactone and a higher than normal dose of estradiol. I have asked and asked and asked some more any of my doctors about the dangers of hrt and none of them say it's a problem. I have had four episodes of passing out within the last three years and all since starting hrt. Every episode involved very small amounts of alcohol.

 

So, I just don't know what to think. Salt and alcohol seemed to be my culprit. All recent studies of hrt utilizing Sprio and estradiol point to it being very safe. Don't know if I'm sold on that yet......

 

Sorry I can't offer any advice Melissa. Please keep us posted.

 

Tess

[MelisssTN]

Good morning ladies,

 

Thank you all so much for your feedback.  Knowing that others have trod a similar path before me is very reassuring.  The endocrinologist that I'm seeing is well versed in transgender health needs but I want to make certain before meeting with him that I'm as informed as possible about my options.  If I can forgo taking Spiro and proceed with the orchiectomy it seems like that might be a safer option for me given my AF history.  I'll see what he recommends and keep you informed.

 

Thanks again!

 

Melissa