Hi all.
My endocrinologist gave me Lupron because I wasn't responding with reduction in testosterone with standard oral anti androgens. So far he wants me to stay on both my spiro and finasta (200mg/5mg) even though I'm on the Lupron. Is this still something I should be taking? I've also been advised to drop my estradiol down to 8mg which I've done but the other stuff worries me.
Do I still need a DHT blocker when I'm on Lupron?
>>5921480
you abdl anon
>>5921480
Yes, you should continue taking your other anti-androgens, because when the lupron hits the pituitary gland, you will get a rise in testosterone. That's because lupron is a gonadotropin receptor agonist, and not an antagonist. The same way cypro is a weak agonist in the androgen receptor.
>>5921537
is that constant? or after some period of time should I be good to stop the other anti androgens?
>>5921556
Yes it will stop, and then it will prevent anything else from binding to the receptors for a time, keeping your testosterone level at nihil. However, you should keep taking your other AAs as your doctor has asked until he tells you it's alright to stop.
>>5921512
Bump
>>5921480
Why is your estradiol so high?
>>5922109
I'm on that amount too I didn't think that was high.
>>5922213
I think anything over six is considered high. At least, that's the impression my endo gave me.
>>5922243
Ignore this man.
>>5922109
>>5922213
>>5922224
8mg is considered high only because it's typically the most that insurance will pay out for. The amount you need to take will vary from person to person, and for some people with poor testosterone management [for example, those on oral anti androgens like Androcur and Aldactone] a rather high dose of estradiol (12mg or even 16mg) can be used to properly suppress your male hormones.
>>5922281
I was wondering something, if taking estradiol sublingually results in higher levels of it in the blood over oral, does the same apply to taking CPA sublingually? Or does it not work that way? I never tried it with spironolactone because of its horrendous taste.
>>5922302
You should make sure you're not just taking any old pill sublingually, first and foremost, as some of them have preparations that will cause sores and welts inside the mouth if tried.
There isn't a lot of solid literature on the benefits of sublingual HRT for transwomen at this stage. Yes you'll get a safer [in theory] route to your bloodstream, but you'll significantly reduce the active life of the medication.
In the case of anti androgens, in particular, this is the exact |opposite| of what you'd like.
>>5922281
>man
Fucking rude
My estradiol levels on 250mg spiro, 0.5mg dutasteride and 8mg Progynova aren't fantastic, I can't imagine being on less.
Enjoy having barely any feminisation anyone to takes less than 8mg.
>>5922281
Endo~chan I need help! I have been on 150mg of Spiro and 6mg of Estradiol for about 5 or 6 years, but I'm pretty sure the diuretic effects of Spiro have been the source of chronic butt problems for me. Constipation, fissures, painful and bloody bowel movements (the stool doesn't even have to be dry or compacted to make me bleed), etc. When I had surgery in January I had to cut my mones in half for a month, and by the 3rd and 4th week, I was having regular god tier bowel movements one to two times a day with no pain or issues.
Over the last six years I have had three different health care providers, and none of them ever have any clue what they are doing with me. All medical advice I've been given over this time has been: drink miralax everyday, take metamucil everyday, and drink more water.
I drink an absurd amount of water a day, I eat healthy, I take vitamins and fiber supplements, and I think taking miralax everyday is a horrible idea. The only thing that ever helped me was reducing my HRT dosage for that month. It feels like being on SPiro just makes my intestinal tract completely dry and not-elastic and therefore having even a normal bowel movement becomes a painful ordeal.
What are my options at this point for my HRT? I live in the US. I want an orchie, but that's just not possible for at least another year for me.
>mfw trying to poop on a bad day and feeling my insides shred apart and fill my toilet bowl with blood
>>5922460
Ouch! Yes, chronic constipation can be a pretty awful side-effect of Aldactone, and thankfully you have a few choices.
Casodex [bicalutamide] is seeing high favor in medical circles at the moment for treatment as part of combined HRT therapy. Dosages in excess of 150mg are controversial, but thankfully you can see feminizing effects as low as 12.5mg per dose, and you oughtn't need more than 50mg. It has a very long active life in the body, too, not crossing the blood/brain barrier, and most patients can expect to take it just every other day without issues there.
There are some other options, too, like Lupron Depot injections, but I would recommend you explore the Casodex as your first port of call.
One final thing to mention is that Aldactone is chosen for its high rate of tolerance and comparatively low side effect profile. Switching medications in your case would be advised, but remember that you'll potentially be chancing new side effects, too. Casodex works very differently to Aldactone, you can face resurged activity in your sex drive as well as loss of all body hair, depending on how your body tolerates it.
Finally, you won't be able to reliably use blood test results to directly measure your testosterone once you're on Casodex, as the way this drug works is that it prevents it from binding, and doesn't impact the production itself. You'll need to discuss with your doctor [or even a close friend] some indicators that help you know your testosterone is managed [for example, body hair, body odor, et cetera]
>>5922532
>not crossing the blood/brain barrier
True in rats, but not true in humans.
>>5921512
Not OP but am trans abdl if anyone wants to talk about that
>>5922532
Thank you so much for your advice! Do you have any idea how expensive Casodex is? I have read that Lupron is like $2,000 per injection. I have insurance, but it has a really high deductible (almost $7,000) and it won't help at all with my prescriptions until that deductible is met.
>>5922532
>loss of all body hair
how common is this?
>>5922652
It's quite affordable in the US. Around $20 for a monthly supply from Kroger and Target and that's without insurance at all and assuming you take one per day. You can ask for the 50mg preparation and take one every second day to make it even more affordable.
Lupron is quite expensive, yes. Ironically it's covered under US Medicaid now, so I have had two patients resign from their jobs to take lower paying roles so they'll qualify for Medicaid simply for getting Lupron covered.
>>5922532
endo-chan does casodex prevent dht from binding to androgen receptors or is it necessary to take a dht inhibitor with it?
>>5922680
I've documented it in around about 1 in 3 patients on 50mg. I have one patient who is on 100mg that also experienced it [and is my only patient on that dose as monotherapy] but that might be statistically insignificant.
>>5922691
It does have a minor impact to this effect yes. But there are some potential cardiac issues with having high natal levels of testosterone in the bloodstream and so I usually prescribe Finasteride or Durasteride along with Casodex as a preventative measure. The former of which is around $11 at Walmart pharmacies.
>>5922683
OMG thank you so much for your help! Really, thank you. I am totally going to ask my provider for this when I see her next month. Until then, can I just reduce my Spiro to 100mg? After the ordeal I had in the bathroom the other day I am just sooooo done with this pain.
>>5922683
Also, are you sure about Casodex being cheap? This website says it's over $500 for 30 pills of 50mg.
https://onerx.com/prices/?drugId=3693&dosage=50mg&form=Tablet&quantity=30&latitude=38.4901072&longitude=-121.5255815&withInsurance=false&forceInsurance=false&excludeDiscount=false&withRetail=true&location=Current%20Location&requestId=495737
>>5922729
I would recommend leaving it as it is until you see your doctor, but if you are worried about that to the point of causing an anxious response, reduce your Spironolactone to 100mg [50mg twice daily, with meals or high hydration].
If you're worried about or experience any minor androgenic effects as a result, you can go up to 8mg of estradiol [4mg twice daily, with your Aldactone] to help suppress your free testosterone levels.
But do please see your practitioner sooner rather than later!
>>5922749
It's important to remember that different pharmacies often price drastically differently!
>>5922712
Sorry if this is a dumb question but, do I really need a dht inhibitor if I'm on cypro?
>>5922751
Thank you so much for your patients and
I would see her sooner, but she only works 2 days a week and a month out is the soonest she can see me.
I feel guilty for taking so much of your time, but just out of curiosity, what are your thoughts on also using micronized progesterone with an AA and estradiol? My practitioner says it's dangerous and adds nothing of value, but everything I have read says otherwise.
>>5922762
Wow, such a huge difference. Again, thank you so much!
>>5922792
Not a dumb question at all!
But a complicated one. Generally speaking, Androcur manages both testosterone and DHT, but at doses typically prescribed to be safe for transwomen, it won't be sufficient as a monotherapy for DHT if you are predisposed to DHT issues pre transition.
Always best to let your blood work do the talking!
>>5922794
No problem at all.
There isn't any concrete evidence that progestins help with feminization of a transwomans body, but at the same time I've had enough anecdotal evidence to prescribe it if someone is dead set on wanting it. Make are you only pursue the bio identical micronized form (Microgest) as the alternative, Provera, is a one way ticket to breast cancer on your shiny new boobs.
>>5922712
would micronised progesterone suffice as an alternative to a 5-ar inhibitor? Iread online that progesterone is more effective than finasteride at reducing dht
>>5922848
Yes and no. It'll do the job, but has associated mood issues and a broader range of side effects [and no long term journals on use for XY patients] to the point where I wouldn't recommend it.
>>5922826
>Always best to let your blood work do the talking
my physician does not test for dht levels should I request it? I'm mostly worried because my family has a history of mpb
>>5922281
So how would you rank the GnRH analogs you have prescribed, and what are their typical dosages?
>>5922683
is it alright to take bica every other day rather than each day? wouldn't that make it less effective?
>>5921480
>"oh that's a cute pic"
>click thumbnail
>fucking diaper fetishist shit
>>5925783
join the diaper master race, muggle
>>5921480
similar situation...
>>5922375
>you'll significantly reduce the active life of the medication.
Why? They should have the same pk decay constant regardless of administration route
>>5922451
shut up snowflake
>>5925905
no such fucking thing, you guys are a a literal shitstain
