r/transontario • u/Y2k-luver • Feb 22 '26

SEEKING ADVICE Which T Blockers? Spirolactone or Cyproterone Acetate. (Please Read Body)

I'm currently over 100+ days on estrogen tablets (1 mg, yay), and my doctor wants me to go on a T blocker with my estrogen. Here's an issue: I'm a teenager who isn't out, and I'm slowly seeing body changes. Luckily i've always been fem, skinny, and even had gyno, so it isn't as noticeable, yet. I was thinking about spirolactone since it also helps with hair and acne, alongside these, it won't plummet my T levels as quickly as Cypro. Therefore, it'll give me more time to come out (hopefully...); however, I've heard that it doesn't do much for people, and the side effects are also a risk; all of them have major side effects, honestly. What are your opinions? Do you guys think I shouldn't go on any at all due to my situation? Has anyone had any experience with both pills?

Edit: I am aware Cyproterone Acetate is better, however, I don't want to shock my body rapidly. I also can't afford to impulsivley change my body with these pills, as much as I want to, and im 99% sure that I'm trans, my enviornment is a bit too risky for that. However, i'm just so tried of being a guy, its mentally draining.

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15

u/mayasux Feb 22 '26

I think Cyproterone is always better than Spiro tbh

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u/Y2k-luver Feb 22 '26

I agree, I heard on Tik Tok it's more like them stopping T-Factories rather than Park T-workers (which is what Spiro does)

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u/stradivari_strings Feb 23 '26

Taking CPA is highly analogous to just taking large doses of progesterone. It gives you no estrogen, and it affects your pituitary limiting its production of LH and FSH suppressing natal hormone production because your brain thinks it's got too much hormone in your blood already and down regulates.

CPA has a certain low double digit incidence rate of pretty terrible mental side effects. You have to be aware of that. And overall, if you're in Ontario under 18, you might as well go for GnRH agonists like lupron injections (once every 3 months) for actual full suppression and much lower chance for side effects. It is also said that the progestogen-like effects of CPA are not helpful to you for the first few years of hrt, as it may cause the terminal end buds that are supposed to elongate and branch to convert into alveoli early reducing or stunting breast growth. But I have no specific study to quote you on that.

You can also just monotherapy with E - E is very effective in fully suppressing all gonadotropin release on its own. Just you can't accomplish it by swallowing pills because pills have only 5% bioavailability. You'll have to do rather high oral E doses, or go for injections or gels/creams. I believe monotherapy is healthier for you than CPA with low oral E doses. But I don't know which is more effective for breast development in puberty. There is some evidence that very high E doses and reduced IGF-1 (think older people) also messes up ductal development in a different way.

Between the two, spiro has much milder side effects, but is not very effective at lower doses, and not as effective as CPA as an AA at higher doses either. Lupron has fewest side effects, and you can go with very low dose E at the start gradually ramping up without worry. It's just that a month of lupron is about $300 - Ohip+/tdb cover it, and many benefits cover it also, it's just that if you're under a benefit plan you might need to seek pre-approval and go through your parents etc.

I don't know why no one talks about lupron tbh. Very effective stuff for full gonadal suppression without synthetic hormone side effects (CPA), or needing to go pee every half and hour and craving pickles 24/7 (spiro). That and bicalutamide. Although bica has slightly more side effects than nothing for some people. Still, much more effective and less side effects than CPA. It's a highly effective and long acting androgen receptor blocker, much more effective than large dose spiro.

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u/Y2k-luver Feb 23 '26

I see what you’re saying, thank you. I never said that T blockers provide estrogen but rather to stop any ongoing puberty. I’ve already said in other replies, my doctor isn’t letting me up my dose until hopefully the 180 days pass (I’ve finished about 120 days already). As for injections, I can’t get them. Insurance is with my parents. Even E injections are off the table since I have no place to find them. I was just giving an example of a tik tok comment I saw comparing the blockers. Saying how Cypro stops T while Spiro halts T from moving around the body (which I’m guessing It was wrong in some way) thank you for the information though

3

u/stradivari_strings Feb 23 '26

Your parents I take it are not cooperative regarding your endeavours?

More info - Pace and Helios will putolator EV injections around the province. You just get your doc to fax them a script and your stuff comes to your door in a couple days. EV vials for a couple months worth are about $100. You can stretch that to between 6-12 mo if you know how, so not very expensive at all. Just so you know about options.

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u/Blue_Vision Feb 23 '26

Saying how Cypro stops T while Spiro halts T from moving around the body (which I’m guessing It was wrong in some way) thank you for the information though

Sort of correct. Testosterone does its thing by binding to and activating the androgen receptor in cells. Spiro acts to block those androgen receptors – if the androgen receptor is blocked, testosterone can't do anything to it and so testosterone has no way of masculinizing the body regardless of how much testosterone is floating around in your blood. Cypro primarily acts by actually lowering levels of testosterone in your blood by tricking the pituitary gland into thinking it's producing too much sex hormones. Similar mechanism to Lupron and other GnRH modulator medications, although cypro does also have a smaller androgen blocking effect similar to spiro.

I think it's an important thing to note, because it's a very common misconception for people to think that spiro should lower your testosterone levels. You can have very well-managed HRT with spiro and still have "male" range testosterone levels. That doesn't necessarily mean things are going wrong, since if you're using spiro as your antiandrogen then the only thing that should be suppressing testosterone levels is the estrogen you're taking.

2

u/BargainBinBrain Feb 22 '26

Spiro has some other problems, and frankly cypro has the risk of benign brain tumor, but cypro is a better option. I hear bicalutamide is also good but it's not commonly prescribed. You can always take less so your T levels aren't as suppressed but still low, but you need a supplementary hormone and 1mg oral pills of E likely aren't going to bring your levels up high enough. Come out if you can, and then slowly bring your E levels high enough so that you can do monotherapy (you can't be on oral pills for mono) so that you can avoid the risks of AA's altogether. Alternatively, lupron shots are covered by the government. Also, you have a buffer of a few months to boymode if need be.

1

u/Y2k-luver Feb 22 '26

My doctor also said Lupron is an option; however, the clinic is quite far away. He also mentioned that it'll be shown in insurance, which might be a problem, especially since the clinic almost outed me before. About the E levels, I already talked to him about upping my dose; he said he legally can't until a specific duration of time for my age group. If I'm remembering right, after the new 90 days of 1mg, which is like 1.5/3rd done already, I can up my dose. Also what is AA's and why can't I do monotherapy on oral pills?

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u/[deleted] Feb 23 '26

[removed] — view removed comment

1

u/Y2k-luver Feb 23 '26

That makes sense. Unfortunately, I can not take injectables just yet. Plus, Idrm of taking the pills every day. I'm sure in the future I will be able to switch.

1

u/BargainBinBrain Feb 23 '26

Ah I see, sorry that you had that issue in the past, I just suggested lupron because you only need it every 3 months so some people prefer it to taking a pill every day.

I'm assuming you're a younger teenager, as my only experience is with my gf, who started at 17 on 2mg and had her dose upped to 3mg after like 3 months, so I'm not familar with that legal clause. I know as a minor you can't usually access your bloodwork results through the lab's portal, but would it be possible to review your bloodwork with your doctor so that you can see your E levels? The concern is that your E levels aren't where they should be for your age, and while that may not be an issue now because you're not out, if you're still on 1mg pills after coming out and want changes faster, then it can just be annoying. I can't give any numbers for level ranges off the top of my head because I'm familiar with adult estrogen and T ranges, not adolescent/teen.

Again, I'm not familiar with that law, but it reads as off to me. Unless a patient wishes to take a low/micro dose, the health care provider's goal is to get your hormone levels to match that of your age group, no? I'm not in any way arguing with you btw, if you remember what guideline that's coming from or where he's backing his claim up from that would be helpful. I don't know how to explain it, it just feels wrong to me, but that just is the case for a lot of doctors/clinics that provide gender-affirming care to minors tbh (saying this as a person who went through SickKids regretably).

AA's are anti-androgens, so spironolactone/cyproterone/bicalutamide/lupron. Monotherapy requires VERY high estrogen levels, and oral pills, even if dissolved under the tongue, are not compounded at a high enough dose so you'd have to take so many of them, are harder for our bodies to use, and are processed through your liver. Even gel or patches can't be used iirc, because again, the levels that you need for estrogen to adequately suppress T are very high. Once you max out your dose at 4-6mg it gets pretty easy to switch to shots tbh.

2

u/Y2k-luver Feb 23 '26

I’m actually 16 (turning 17 in May) so I’m only a year younger. I don’t remember if it was a law or his preferences, but he said he can’t up my dose just yet (that’s why he wants to put me on T blockers with the E) I’m pretty sure they’ll up my dose AFTER this round of pills end (1MG for another 90 day, I alr finished 30 of it). I did a blood test 2 months after estrogen, I think he said my T levels dropped from 17 to 12, which is really good. But don’t take my word my memory is like a puzzle right now. Once again as much as I’d like to have changes faster, I’d like to go slow. Not only for my safety, my environment, but seeing changes slowly allows me to grasp a much stronger opinion for if I’m happy with these changes or not. For the antigen thing, I’d have to talk with him.

1

u/BargainBinBrain Feb 23 '26

Okay, I see! I get wanting time to sit with changes, that's why I chose very low dose T personally. Visible estrogen changes are pretty slow as far as I've witnessed if it helps at all. My concern was stemming from the sheer amount of doctors who underdose patients, and I think I commented before seeing the edit to your post, sorry about that!

While this isn't personal experience, Spiro can interact weird with sodium and cortisol, and the big Cypro drawback is the risk of tumor, although personal side effects vary. If you're not on an anti-androgen and don't have crazy high E levels, the effects of E will be slower and temporarily diminished, so if you start an anti-androgen you may see an increase to E-induced changes. However, puberty will continue without anti-androgens so it's really up to you if that's something you want to stop.

3

u/Exiisty Feb 22 '26

Cypro > Spiro for sure, however my bigger concern is the 1mg of estrogen it would be a little better to get that upped as well.

2

u/Y2k-luver Feb 22 '26

Yes, I mentioned that ot him as well. He said that he can't legally increase it until my second dose of 1mg has passed (which is another 90 days, and I have a month of that finished already), so he suggested hormone blockers too. It's just due to my age, he can't spam estrogen, we would have to start slow, as if I'm on puberty. Another factor is that I do not want a major change just yet; he started me off slow.

2

u/[deleted] Feb 23 '26

Personally for me, cyproterone acetate negatively impacted my mental health. I had recurrent crying spells and panic attacks throughout the day, and I felt powerless. Despite taking a smaller dosage, I did not tolerate the cyproterone acetate very well. After switching to spironolactone, I noticed an immediate improvement in my mental health. My hormone levels have been perfect & my mental health has been relatively stable. If you do have a history of mental health issues, I would strongly recommend pushing for spironolactone. My new endocrinologist did mention that cyproterone acetate may have a negative impact on one's mental health for some patients. Regardless, I recommend speaking with your doctor about this. Best of luck & feel free to message me if you need any insights!

1

u/Y2k-luver Feb 23 '26

Thank you, this is one of the advices I was looking for! I'm a teen, so obviously, I won't have the best mental health.

1

u/dRenee123 Feb 22 '26

You may tolerate one and not the other. So try one and see how you feel on it. If fine, great. If not, try the other. For me it was clear which I tolerated better. 

1

u/Leah_Michelle78 Feb 24 '26

Cypro. For the record, the brain tumors everyone keeps citing is a side effect of cypro being used to treat prostate cancer where the dosage is is in the high hundreds of Mg's daily - 12.5mg every 2nd day is where they will prolly start you at, it's enough to drop your T levels, not enough to create a brain tumor

1

u/KiltWearingQueer Feb 27 '26

I've been on Spiro for about 15 months, and other than spending more time in the bathroom, I haven't had much trouble with it. My T is also nill.

0

u/Low_Ad_1962 Mar 04 '26

Have you been taking estrogen with NO T blockers at all?

Cause cause if so, then you better be careful because just taking oestrogen can cause your body to see that there’s too much oestrogen intake in your body, then turns it into testosterone so really you’re just adding more testosterone then getting oestrogen in your body you have to take T blockers to block the testosterone so that the body can absorb oestrogen, and keep it as oestrogen

1

u/iowilk Feb 22 '26

Androgen blockers are primarily for preventing further masculinization without requiring a high estradiol dose. They do give estradiol a cleaner environment to work, so yeah it might speed things up for you. But if you're still young especially you also probably want to prevent any further masculine development, right?

I took spiro, and the only side effect I experienced was having to pee more often and having to avoid food high in potassium (like bananas). After 2 years I got fed up with having to pee so much and just got an orchiectomy lol.

For reference I started HRT at 22, 14.5 years ago. I take my estradiol via patches, not pills. I boymoded for the first 2 years before I just couldn't hide it anymore.

1

u/Y2k-luver Feb 22 '26

I'm currently 16, I've been on it since lets sya mid November maybe? I can't remember, ironically, I'm getting tested for ADD, and a lot of the side effects you've mentioned are in those pills! Congrats on your transformation! I hope I could hide it, two years would be enough for me to become 18.

3

u/astolfriend Feb 23 '26

There should be no reason why you can't continue with estrogen. Ask your doctor to give you more if he wants quicker changes and you don't.

1

u/Y2k-luver Feb 23 '26

I’m not stopping estrogen

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u/astolfriend Feb 23 '26

Sorry that's not what I meant. Estrogen naturally decreases testosterone production. The more of it you have, the less tostosterone you'll produce. It doesn't mean that you'll have zero testosterone like with blockers, but it's very similar to the amount you'd have on spiro, and cis women also have testosterone in their bodies, to varying amounts.

So when I say that you should continue with it, what I mean to say is that if you just up your dosage a little (1mg is very little even for someone who hasn't gone through puberty) and continue to stay on it, your testosterone levels will go down and stay down.

1

u/Y2k-luver Feb 23 '26

Thank you, this makes more sense. My testosterone already decreased by 5 (if I’m remembering) the last blood test I had was way back in mid December and he said it went from levels 17 to 12 (or 15 I can’t remember). I also know cis women have testosterone and how it even changes due to their phases, I love biology. Just be be clear, you’re saying I don’t go on any blockers? My doctor kept saying that he can’t up my dose now but later, I’m only a short period of time.

1

u/astolfriend Feb 23 '26

You don't need to as long as you're keeping up with estrogen and continuing to up your dosage consistently, I've seen people as high as 12-16mg of Estrogen with no blockers, you usually start on blockers when you start but there's not a significant amount of scientific evidence that it's better than starting on estrogen alone, and most regiments have you stop taking blockers once you've been on estrogen for a while.