Since my last post I have been rereading your (Bryony and PansyMae) which I find very interesting and relevant. It does seem that we do need some way of expressing our feminine side but clothing does not do it for me, and my original solution, to resolve the concerns that affected my work to the extent of nearly getting me thrown out of university, was misconceived and dangerous and in retrospect fairly repellent (but quite effective in its way). On another issue, I would be delighted if BS (an unfortunate acronym?) and maca could restore my own male functionality, but it might have an uphill battle against the spiro and other meds. If I get taken off spiro, I might try them down the road. In the meanwhile we are both losing weight but it seems to be more wearing on J. than myself.

Incidentally, when J. went off HRT some years ago and subsequently threw out the remaining pills, I rescued them and although I knew there wasn't enough estradiol left to achieve anything, I tried taking them with a initial dose of eight pills (4mg) and then four pills (2mg) daily until they quickly ran out, to see whether they would make me feel different. They didn't, but it was after that that In had my first go at NBE. The medroxy progesterone seemed on investigation to be a dubious idea so I left it alone.

AP

"Experience is what you have just after you needed it most".

Since my last post I have been rereading your (Bryony and PansyMae) which I find very interesting and relevant. It does seem that we do need some way of expressing our feminine side but clothing does not do it for me, and my original solution, to resolve the concerns that affected my work to the extent of nearly getting me thrown out of university, was misconceived and dangerous and in retrospect fairly repellent (but quite effective in its way). On another issue, I would be delighted if BS (an unfortunate acronym?) and maca could restore my own male functionality, but it might have an uphill battle against the spiro and other meds. If I get taken off spiro, I might try them down the road. In the meanwhile we are both losing weight but it seems to be more wearing on J. than myself.

Incidentally, when J. went off HRT some years ago and subsequently threw out the remaining pills, I rescued them and although I knew there wasn't enough estradiol left to achieve anything, I tried taking them with a initial dose of eight pills (4mg) and then four pills (2mg) daily until they quickly ran out, to see whether they would make me feel different. They didn't, but it was after that that In had my first go at NBE. The medroxy progesterone seemed on investigation to be a dubious idea so I left it alone.

AP


"Experience is what you have just after you needed it most".

Hi Annabel,

I don't know how much estrogen you consumed, but I didn't get my real mental relief until after a 2/3 weeks when I had ramped up to 3g/day of PM. It has to build up in the system to take effect, I think.

I agree, the progesterone isn't a good move to start with, I think.

I'm sure if you manage to come off spiro, you may well see an improvement. Wiki says :

"Because spironolactone reduces the body's production of testosterone and also blocks its testosterone receptors, in men it can cause gynecomastia, impotence, erectile dysfunction, loss of sex drive and other conditions such as reduction of muscle mass, fatigue and physical weakness which are also generally associated with low testosterone levels and hypogonadism in males"

I don't know if it is because PM is a phytoestrogen, but it clearly isn't totally successful at blocking testosterone receptors, as I am still able to function as well as I need.

I also noticed this important rider to the previous quote, which I don't know if you are aware of:

"For this reason, men are not typically prescribed spironolactone for any longer than a short period of time as for acute heart failure. A newer drug, eplerenone has been approved by the U.S. Food and Drug Administration for treatment of heart failure, has no similar anti-androgenic effects and thus is far more suitable for men for whom long term medication is contemplated."

If you are taking spiro for heart failure, maybe you should ask about eplerenone?

Good luck, as ever!

B.

I am prescribed spiro solely for hypertension. Two years ago my blood pressure was out of control, much to the concern of our then doctor since I was already taking about five other antihypertensives. She changed the beta blocker I was taking and repeatedly increased the dose, all without much effect, and sent me to the cardiologist who suggested first trying spiro in case I had a type of hypertension that is responsive only to spiro but not to conventional antihypertensives, and if that didn't work to prescribe a calcium channel blocker. Because spiro is a diuretic it did produce some reduction in blood pressure, but not nearly enough, so she then went on to prescribe the CCB without cancelling the spiro. The CCB worked like a charm without causing the leg swelling that had resulted in my having been previously taken off CCBs, but the day before my next visit to her, she died suddenly. This was not only a tragedy (she was in her early 40s and had school age children) but left her patients in a very difficult position since there is a serious shortage of family physicians in this area (about 10% of the population are on the official waiting list). We were very fortunate to be able to sign up with a new clinic within 20 miles of us run by a nurse-practitioner (in fact two currently, since the second, formerly a cardiac nurse, is doing the equivalent of her residency). I cannot speak too highly of the NPs, but they are understandably hesitant to stop medications originally recommended by a specialist. They have been reducing the dose of four of my antihypertensives one at a time, and have changed another, in order to find out what has been causing brief, almost daily episodes of very low blood pressure and/or pulse rate. The reductions in dosage have eventually reduced the depths of the dips, but paradoxically my average blood pressure has continued to decline to levels approaching hypotension rather than hypertension - hence the further visit to the cardiologist and hence my anticipation that he may cancel the spiro. In favour of the spiro is that it does seem more effective than the terazosin (originally developed as an anti-hypertensive) that my urologist prescribes. He said this could not be so, but the literature seem to back me up. I also found that there is research that digoxin (which I also take) potentiates the action of spiro.

I looked into eplerenone (thanks for the information) but find that it has never been approved in Canada and is not available.

The jury is still out for me on GABA. It seems nearly as effective as valerian as a sleep aid, but whether it increases growth hormone production or does any of the other things that are alleged, I have no idea. No noticeable side effects.

AP

"Experience is what you have just after you needed it most"

Hi A,

gosh you've had some serious problems! I wish you well in your recovery!

I looked into eplerenone (thanks for the information) but find that it has never been approved in Canada and is not available.

Who told you that? It seems to conflict with this:
http://www.newswire.ca/en/story/555361/inspra-approved-as-adjunct-to-standard-therapy-to-reduce-risk-of-death-following-a-heart-attack

and this:
www.pfizer.ca/en/our_products/products/patient_infosheet/172

Although this seems to imply it was not listed...
http://www.cadth.ca/media/cdr/complete/cdr_complete_Inspra_November-27-2009.pdf

And purely for economic reasons, too... it seems that the lessened chance of gynocomastia (and by implication, E.D.) wasn't considered worth the cost!

I don't know the legal status of CEDAC recommendations, but that was November 2009. This is 28 Jul 2010:

www.gov.ns.ca/health/Pharmacare/info_pro/pharmacists_bulletins/pharma_bulletins/Pharmacists%20Bulletin%2010-09.pdf


So it looks like it is approved, but not for Canadian insurance (?) purposes, and you may have to pay the full economic cost of it yourself. From the description, it looks safer, and may help with the ED, but I have no qualification to make any judgement - just trying to help.

Good luck!

B.
PS Looks like your CEDAC has all the ethical standards of our oxymoronically named NICE committee...

Bryony,

I should have used the word ’listed’ rather than ’approved’ for eplerenone.

CEPAC. Constitutionally, health services in Canada are the responsibility of the provinces, but since the Federal government provides a lot of the financing, it has a fair amount of clout and requires the provinces to provide primary medical and hospital care (as well as to see that people are not provided privately with these primary services outside those provide by their provincial health services). “Pharmacare” is not one of the required services. It is open to the provinces to provide additional services and most if not all do provide some drug coverage to elderly, disabled and low income people. The drugs covered seem generally follow the CEPAC list or a subset of it, but sometime additions are made in response to public outcry. In my province, all that is provided to seniors other than those with very low incomes is effectively a membership in a group policy with a commercial insurance company with a high monthly premium and a substantial co-pay. Even for me, it is simply not worth the money.

I had looked up some Canadian on-line pharmacies, but all that I checked said that eplerenone was “not available”. I suspect that in view of the narrow application for which it is approved in Canada, it is used mainly in hospital cardiac wards, and that there is little or no retail market. It is interesting that the CEPAC document gives the relative costs per day of spiro and eplerenone as 7c and $2.49 respectively, a mind boggling difference particularly since prices in a retail pharmacy would be significantly higher.

I have been trying to persuade my medical advisors that the excessive number of prescription medications I take each day should be reduced. As I see it, both the spiro and the beta blocker could probably be dispensed with. Even if my blood pressures rise, I have nearly 20mm in hand below the top of the ideal range. For the first two years after my heart failure episode I was not on a beta blocker at all while under the care of a highly regarded cardiologist, and I believe that it was the exponential 16 fold escalation of my initial beta blocker dosage after moving here that put paid to my erectile function, so I didn’t then object to the spiro although I knew it was used for chemical castration and by transitioning transexuals. The beta blocker has already been reduced 75% by the NP, and I am now inclined to think that the long term continuance of the spiro was simply an error.

Sorry to ramble on, but thanks again for your interest. I would never have heard of eplerenone if it hadn’t been for you, and it could have been important.

BTW, I forgot to mention that I don’t think I can have taken E2 for more than ten days at most.

I really hope it all works out for you. Let's hope the dieting improves your B.P. as much as it did for me!

Good luck,

B.

I was a little surprised to find this thread moved here, in that, unlike people who have moved on from herbs to synthetics, I have gone the other way and have since relied essentially on PM for NBE, once drugs prescribed for other purposes got my breast development off the ground (or onto my chest) after an initial lack of success with conventional NBE. I suppose it does paint the other side of the picture, and also I am it appears still relying on the very low T levels caused by the synthetics to support my further (hopefully) development and femininisation. That is not to say that I would turn down bio-identical E2 were it to be offered.

I was a little surprised to find this thread moved here, in that, unlike people who have moved on from herbs to synthetics, I have gone the other way and have since relied essentially on PM for NBE, once drugs prescribed for other purposes got my breast development off the ground (or onto my chest) after an initial lack of success with conventional NBE. I suppose it does paint the other side of the picture, and also I am it appears still relying on the very low T levels caused by the synthetics to support my further (hopefully) development and femininisation. That is not to say that I would turn down bio-identical E2 were it to be offered.

Well, early this morning (I woke at 5am to make the appointment) I got to see the endocrinologist again: he looked at me and said 'You are on the way, aren't you' and on the basis of the psychological assessment I had obtained, gave me my first prescription HRT. Initially only 2mg per day micronized estradiol-17, plus 100mg per day spiro split into two doses, pending review I hope at the next appointment (not fixed yet). Interestingly, he is referring me to a speech therapist, which apparently will be covered by New Brunswick medicare. I read this as indicating that he has taken possession of my case, which is reassuring given that we do not have a family doctor, and our NP admits that she has little experience in this area. The E2 was brand name Estrace which worked out about 60c (US) per pill from our usual pharmacy. Is this expensive?

Congrats Annie, the E will work better to feminize with your spiro than the PM will... I bet your unable to wipe that smile off your face

Congratulations Annie on starting on estradiol.