this post was submitted on 02 Mar 2026
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Hai everybody! :3
We haven't been around much lately, but we've missed you all <3
As much as we enjoy talking about electromagnetism and the like, we're really feeling trans joy as the theme for this mega post. And we'd love to hear some of the things that have brought you all some joy lately (without doxxing yourselves of course).
Something that is bringing us a lot of joy right now is seeing the local trans community finding each other and making joy for ourselves. They're planning events, going out, finding love and friendship, and refusing to allow our circumstances prevent us from enjoying life and having fun as much as possible. And we're part of it! We've been doing the same! And it doesn't just make this life tolerable in the face of all the bad stuff happening, it's making this life beautiful and filled with love and happiness.
In order to try to get back in the habit of participating here, we're going to try to at least post one bit of trans joy every day here this week.
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What are everyone's thoughts about spironolactone vs cyproterone?
I've been on spiro for years, and while I never noticed brain fog I have to pee constantly and now I don't really sleep through the night. I sleep as long as I can before I wake up to pee (6 hours MAX), then I'm up for 4ish hours, and then I have a 90 minute siesta. It kinda works for me since I'm 2nd shift, so this way I actually get to be up in the morning while also getting enough sleep.
Maybe you don't remember because it's been years, but did the increase in peeing start relatively soon when you went on spiro? I have only been on it two months and I haven't noticed it, but I don't know if it's because it hasn't hit me yet or if because I have lucked out and am not getting that problem
Oh it was right away for me. I guess you lucked out!
hated spiro so much! i had a severe reaction to the brain fog cropping up suddenly and it almost got me in a car crash. switched to monotherapy the next week and thankfully that served me well.
I think if I ever noticed brain fog from a medication I would want to change it for sure, brain fog is like a top-tier covid fear of mine, I really rely on that sucker as an educator; I can't have it fogging up!
I've been on spiro for over half a decade now and I both understand and don't understand the hate towards it. Its definitely had its diuretic effects but I did not experience the side effect of brain fog. Taking Cypro (and Bicalutamide) makes one inelligible for blood donation (at least where I am) and since I genuinely enjoy doing that I'm not all that eager to switch.
Oh the blood donation thing isn't something I've seen mentioned before, interesting
You haven't heard of it because it isn't true. I got cypro mixed up with finasteride and/or dutasteride. My apologies.
I started with Spiro. I didnt mind it. I got used to the change in BP pretty quick and voiding more often. It didnt work as good for suppressing T after about 6 to 8 months or so? No idea why. I got switched to cypro which was convenient because it was once evey other day and eventually once every few days. Then I got bottom surgery so I dont have to worry about T suppression anymore lol.
Cyproterone is known to be able to cause prolactinoma as a side effect. If youre taking it, make sure youre getting your prolactin checked. You do not want things with -oma at the end of their name - but usually its benign. While on cypro, I developed hyperprolactinemia (prolactin level went up) but I was pretty sure it was from stress and my shitty romantic life before breaking up with my ex ๐คทโโ๏ธ
I was on spiro and it sucked. Had to pee like all the time. Then I switched to cypro and I could immediately tell that it was working better and didn't have as obvious side effects for me.
Interesting, I haven't had any side-effects on spiro (but it's only been a couple months). Just nervous about changing when I'm on something that works for me, but hearing anecdotes about cypro working well may help ease the nervousness, thank you
Spiro is kinda the worst AA (maybe fin but I don't even know if that should count), heard much better things about cypro. I'd start with cypro if you need an AA.
Firstly, thanks so much for responding!
I have been on spiro for about two months, and it has more or less suppressed my testosterone (from 14+ down to 1.4 in two months), but there is a shortage of spiro so my doctor is asking if I would switch to cypro. Spiro has been associated with HDL production, whereas CPA has been associated with prolactin production but also higher health risks (like increased risk of meningioma, which is scary to me), so I am feeling very iffy about how to proceed.
What about spiro makes it the worst? (I literally do not know, I researched HRT like...not at all. I fully transitioned nearly a decade ago, did the name change/gender marker change, have been living as a woman just fine. But never had a doctor and could never get a clinic to prescribe HRT, so I thought it wouldn't ever happen. Then I got on HRT about two months ago, only to be told the meds I'm on and are working for me may not be available anymore. Sheesh)
You've gotten a lot of responses really fast so hopefully they can be a bit more helpful with side effect stuff. The big reason I've seen is people complaining about side effects, peeing more, mental fog, few others probably. A lot of people start on Spiro and switch to cypro later tbh. Spiro also doesn't work as well, I mean you're getting good results but that can be a factor. Spiro is mostly prescribed in the US, internationally bica/cypro are much more common.
If you need help with diy feel free to message me anytime, that's what I'm on and it's pretty great.
I see somewhere else you asked what a good E dose is, it depends a lot on method, what your levels look like, and how you feel. For pills probably like 4-6mg. Depends on E levels and shgb (if you can get that tested).
Thank you so much, I really appreciate your responses! I've been taking patches because injections are not my thing (and there is a shortage here), and pills can be hard on your liver and harder to get consistent levels (from what my doctor was saying).
The problems with cypro are less likely to happen at the low doses that most trans women require (12.5mg every 2 or 3 days is usually effective for suppressing testosterone, if you're also taking a good dose of estradiol)
People mostly dislike spiro because it's not as powerful as the other options, and having to pee more often is annoying.
What would you consider a "good dose of estradiol?"
I know you said you don't do or can't do injections but this website (made for and by trans femmes) can give you an idea of dosing
https://estrannai.se/
Ooh shoot, I didn't even realize the site had a calculator for patches.
Oh yeah... that might be new lol
It's not the same for everyone, just enough so that your blood level of estradiol is around 100-200 pg/ml. Blood tests are the only reliable way to make sure the dose you're on is working for you.
Our blood tests measure in a different unit than pg/ml, so far as I can tell. My doctor was saying my estrogen was at 140 (of whatever unit, she did not say), but that we were aiming for 300 for the like, average "cis" level. I have some issues with doctors so even though I know I should have investigated more about specifically what this all was, I did not.
If you were seeing other units it may have been pmol/l, in which case the equivalent range would be about 367 to 734 pmol/l. You would have to check the units though, because having numbers without units doesn't really tell you anything.
Did your doctor increase your patch dose after seeing that your estradiol level was below the target? You want your average to be at least as much as the average cis level because it's good for your bone health.
If it is 300pmol/L
god I hate doctors
yeah she doubled my patches from 50 mcg/day to 100 mcg/day. There aren't really doctors where I am, this is a clinic doctor who I get to see for like 5 minutes every quarter now, and she's pretty much the only one in the city who will give anyone HRT. There used to be an informed consent clinic in a nearby city, but they shut it down like a month after I made my first appointment lol.
I super appreciate your responses :)
Ok that's better, although still on the low side for feminizing hrt. Your doctor is giving you a similar dose to what menopausal cis women would get, which is pretty common especially with doctors who lack experience with trans hrt.
Next time you have a blood test, see if you can look at the results so you have a better idea of if anything needs to be changed.
I'm happy to help - sorry to hear about the informed consent clinic closing.
I am trying to get a hold of the actual results today to see what's up specifically. If my dosing is low I would like to figure out a more appropriate level. Obviously it's different for everyone, but do you what an average range of doses for feminizing HRT would be?
As you said it varies a lot, especially with transdermal. I think doses of 150-300ug/day are pretty common for patch users, and some people are higher than that especially if they're doing monotherapy (suppressing testosterone with just a larger amount of estradiol instead of an antiandrogen). However adjusting your dose really has to be based on blood tests.
If your hrt is prescribed, take whichever is available to you. Antiandrogen use requires additional blood tests compared to estrogen monotherapy. Also, antiandrogens are unnecessary for most of the injection crowd. Either way you should get blood tests and sanity check your doses here or with others familliar with hrt.
My dilemma is that I am currently on spiro and there's a shortage, so I don't know if I should pursue trying to find more spiro, or accept a swicth to cypro. It's all being done with a doctor and quarterly bloodwork.
You're fine either way I imagine. If you decide to switch try to taper off of spiro, and a lot of doctors prescribe more cypro than is necessary for transfem usage, so just be aware of that.