I'm really thankful I found your website as I'm really confused on what to do next... I'm planning to undergo sexual reassignment surgery within the next two or three years and I'm currently taking spironolactone to decrease my androgen level... is it okay if I take progesterone pills together with spironolactone? And can you suggest other estrogen/progesterone supplements that I can take during the process... Thanks.

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Oct 03, 2010
by: Wray

Hi there I'm pleased you found the site useful. I've had a few going through SRS who've written to me. The surgery can be a success, but the drugs needed to affect the change can be fraught with danger. Please opt for natural hormones whenever you can. Orchiectomy is to my mind a better option for reducing androgens. This is an excellent site Transgender Care Spironolactone is called an anti-androgen, but it is in fact androgenic, please see here. It also comes with potential adverse side effects, please see here and here. Spironolactone also causes an increase in prostatic weight, see here. This last paper also lists other 'anti-androgen' drugs used, one of which is a progestin contraceptive commonly prescribed to women, medoxyprogesterone acetate. It has one of the highest androgen affects, the other progestins are not far behind. They attach to the androgen receptor preventing endogenous androgens from binding, but they still have androgenic effects. So I can't recommend any other 'progesterone', only progesterone itself, which has no adverse side effects. Progesterone if used in high enough amounts, ie 200mg/day, suppresses testosterone, without suppressing libido. In fact there's evidence it's progesterone responsible for libido and not testosterone, see here. Progesterone also suppresses LH and 5-alpha reductase, which prevents testosterone converting to DHT. For more info on progesterone delivery systems see here. The oestrogens you will be given are also dangerous, oestrogen is a mitogen. It?s also a known initiator of inflammation, clots, water retention, increased cholesterol and more. Please don't let them give you 6.5mg as one woman who wrote to me was given, she landed up in hospital with a clot and high cholesterol. Far safer to use a transdermal delivery system. If they want to give you HRT, please read this page on HRT first. Take care Wray

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