Estrogen Replacement & Androgen Antagonists

[Tiffanie]

Hello everyone,

I have been on estrogen replacement medications for 25 years.

I am wondering if anyone might have information pertaining to:

1. the long-term health effects of estrogen supplements, and

2. the use of androgen antagonists like spironolactone or drospirenone for reducing the effects of elevated testosterone.

In recent years I have experienced increased acne and facial hair and some scalp hair loss. These symptoms are typical of elevated testosterone. Blood work confirmed I have a high free testosterone level, so I'm considering taking medication with an anti-androgenetic effect.

Thank you for any information you can share,

Tiffanie

[Dana Gold]

Hi Tiffanie,

Here is a website that has indepth info on prescription drugs:

http://www.rxlist.com/

Although this website is for TS and not applicable to your situation, it nevertheless, gives a good overview of both estrogens and anti-androgens available on the market. Clicking on each highlighted drug gives pharmacological profile for each.

http://www.nalifien.servehttp.com/transgender/exactly.htm

Also medical dictionary:

http://www.medic8.com/MedicalDictionary.htm

I would discuss the options for anti-androgen therapy with your doctor first. My own "choices" would be spironolactone as an anti-androgen, due to its traditional use for hirsutism and other androgenic manifestations, including alopecia in females......it is also safer than flutamide (possible liver effects) and the progestins. Usual dosage: appx 200 mg/day divided into 2 equal doses (AM and PM). If you are taking any blood pressure meds in the clas of ACE-inhibitors and/or angio-tension receptor blockers (ARBs); then spironolactone may not be an option, since there is a good chance of hyperkalemia (high plasma potassium). Anti-gonadotropins (GnRH Agonists) such as Lupron are expensive and may not be indicated in your case.

Optimal dosing of estrogens with the least of side effects can be achieved with estradiol patches or (Estrace) sublingual (under-the-tongue) administration. Avoid Premarin and medroxyprogesterone acetate combos; these have been the 'culprits" in the latest studies of negative effects of HRT therapy.

Talk with your doctor. Using the knowledge you get from the sites I've provided, make a mutually agreed upon choice for what's best for you and in consideration of your own personal physiological profile.



PS: that'll be $300 for "consultation:eek: due immediately:eek: .........just kidding;)

Take care.

Dana:D

[Dana Gold]

More things you might need to know:

Different products may have somewhat different effects and side effects. Oral estrogens seem to have more side effects than estrogens delivered through the skin or the vagina, apparently due to the "first pass" through the liver that occurs when drugs are taken by mouth. Lower doses of estrogens generally have fewer side effects than higher doses and may be effective for treating symptoms of menopause.
The differences between oral and transdermal estrogens

Oral estrogens are quickly broken down by the liver, and this "first pass" through the liver seems to be responsible for certain side effects as well as for the positive effects of oral estrogen on cholesterol levels, lowering LDL (the "bad" cholesterol) and raising HDL (the "good" cholesterol). Oral estrogen sometimes raises triglycerides (another type of blood fat) and women who have high triglyceride levels should be aware of this.

Transdermal estrogen does not raise HDL and usually does not lower LDL cholesterol as much as oral estrogen, and it does not affect triglycerides, so it may be a better choice in women with elevated triglyceride levels. Avoiding the first pass through the liver also may prevent the increased risk of blood clots and gallbladder problems associated with oral estrogens.

UPDATE: Results of a study reported in the Journal of the American College of Cardiology (April 2003) show that Premarin pills, a form of oral estrogen, increase C-reactive protein (CRP) in the blood, while Climara, an estrogen skin patch, does not. CRP is a marker of inflammation in the blood that has been found to be a heart disease risk factor. Read Could Heart Risks of Estrogen Replacement Be "Patched" Up? for more information. The study confirms earlier research showing that transdermal estrogen does not raise CRP levels in the blood, while estrogen pills do (Vehkavaara S et al., 2001).

Transdermal estrogen and oral estrogen have differing effects on androgens in the body. Oral estrogen lowers free testosterone and can lead to androgen deficiency (affecting libido among other things), while transdermal estrogen has little effect on testosterone levels. Transdermal estrogen may offer other advantages over oral estrogens, although more research is needed.

I have been taking for 2 years my estrogen as 17-B estradiol (sublingual 1 mg AM; 1 mg PM) (generic for Estrace, which is molecularly/pharmacologically the same as that secreted by the ovaries). I have had no need for anti-androgens, so I have no personal experience with those. My CRP levels have been consistently normal, as well as triglycerides.

[Tiffanie]

Dana,

Thank you so very much for so much excellent information. I am actively working with my endocrinologist, and she was really impressed with the information you brought to my attention.

I have used estrogen patches in the past with good results. I was not aware of the differences in possible effects between oral and transdermal administration.

I was also fascinated to hear about sub-lingual administration. None of my doctors have ever mentioned this to me. Did a doctor recommend sub-lingual medication to you or did you find out about it yourself?

Sometimes I get tired of thinking about drugs but now you've made it interesting again. And thanks for the links to the very informative websites.

Tiffanie

[Dana Gold]

" Did a doctor recommend sub-lingual medication to you or did you find out about it yourself?"

Hi Tiffanie,

Sorry it took a couple of days to answer back; I don't have PC at home, only at my office (I didn't stop by as usual this weekend). I did a lot of research before starting estrogen. Initially I got the idea from how some people take nitroglycerin for their angina (sublingual) and verified that it would work with estrogen from a TS website. One person was putting halved Premarin tablets under the tongue....YEEECCCCHHH:rolleyes: I had determined that sublingual Estrace was best for me because it was actually the least expensive (and more natural) of the estrogen drugs AND it would go directly into the bloodstream as 17-B estradiol. As well as for the patch, this method would simulate what actually takes place in the human body. Oral (swallowing) gets metabolized first ( stomach to liver) and goes into the bloodstream as estrone, which is not a natural process.
Anyway, I'm glad to hear that you and your endo are working together to establish a viable treatment regimen for you. It's always good when our doctors actually listen to us.

Take care:)