Enarei

Spironolactone

Spironolactone is an antiandrogen (testosterone blocker). It works by both lowering the body’s production of testosterone (and other androgens like DHT), and by rendering existing testosterone hormonally inactive. Spironolactone is a relatively weak, but safe antiandrogen that is widely prescribed in the United States (Loriaux et al., 1976; Deutsch, 2016).

Key points

  • Lowers production of testosterone and also renders it inactive
  • Often incorrectly believed to be unsafe
  • May cause a number of unpleasant but harmless side effects
  • Ideally taken twice daily

Dosing

Spironolactone is a pill (or rarely liquid) that is swallowed. Trans people most commonly take a total daily dose of 50 - 200 mg daily. Rarely, some people have taken both lower and higher dosages ranging from 25 mg daily to 400 mg daily (Aly, 2018).

Spironolactone only stays in the body for a short time. Because of that, it is ideally taken at least twice daily (for example as 100 mg twice daily instead of 200 mg once daily) to maintain stable levels (Reiter et al., 2010).

Risks & management

In the past, spironolactone was widely believed to be dangerous and require frequent blood tests because it may increase potassium levels. We now know this does not present a real danger for most people, with studies showing that spironolactone does not normally meaningfully increase potassium levels, and advising that such blood tests are not needed for people who aren't already at risk for other health reasons like end-stage kidney disease, Addison's disease, or old age (Plovanich, Weng, & Mostaghimi, 2015; Zaenglein et al., 2016; Layton et al., 2017; Millington, Liu, & Chan, 2019; Wang & Lipner, 2020; Gupta et al., 2022; Hayes et al., 2022).

Despite this, routine potassium testing is still widely used, and online trans spaces often incorrectly recommend unnecessary dietary changes when taking spironolactone, such as avoiding bananas and multivitamins, neither of which contain consequential amounts of potassium (Barbieri, Margolis & Mostaghimi, 2021; National Institute of Health, 2022).

Many trans who take spironolactone do report safe but unpleasant side effects like frequent urination and thirst (Deutsch, 2016).

Interactions

Most people do not need to take multiple antiandrogens at once.

Medications that significantly increase potassium levels may be unsafe to combine with spironolactone. Examples of this could include prescription potassium supplements, certain blood pressure medications, the antibiotic Trimethoprim/sulfamethoxazole (Bactrim), and the cholesterol medication cholestyramine. Care is advised when combining spironolactone and lithium. (Pfizer, 2022).

Other information

Spironolactone is also called "Aldactone", "Spiractin", "Spylacton", "Verospiron", or simply "Spiro".

See also

References

  • Aly. (2018). A Review of Studies on Spironolactone and Testosterone Suppression in Cisgender Men, Cisgender Women, and Transfeminine People. Transfeminine Science. [URL]
  • Barbieri, J. S., Margolis, D. J., & Mostaghimi, A. (2021). Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone. JAMA dermatology, 157(3), 296–300. [DOI:10.1517/14656566.5.4.933]
  • Deutsch, M. B. (Ed.). (2016). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People, 2nd Edition. San Francisco: University of California, San Francisco/UCSF Transgender Care. [URL] PDF]
  • Gupta, P., Suppakitjanusant, P., Stevenson, M., Goodman, M., & Tangpricha, V. (2022). Potassium Concentrations in Transgender Women Using Spironolactone: A Retrospective Chart Review. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 28(11), 1113–1117. [DOI:10.1016/j.eprac.2022.08.007]
  • Hayes, H., Russell, R., Haugen, A., Nagavally, S., & Sarvaideo, J. (2022). The Utility of Monitoring Potassium in Transgender, Gender Diverse, and Nonbinary Individuals on Spironolactone. Journal of the Endocrine Society, 6(11), bvac133. [DOI:10.1210/jendso/bvac133]
  • Layton, A. M., Eady, E. A., Whitehouse, H., Del Rosso, J. Q., Fedorowicz, Z., & van Zuuren, E. J. (2017). Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. American journal of clinical dermatology, 18(2), 169–191. [DOI:10.1007/s40257-016-0245-x]
  • D. Lynn Loriaux, M.D., Ph.D., Raymond Menard, Ph.D., Addison Taylor, M.D., Ph.D., Julio C. Pita, M.D., & Richard Santen, M.D. (1976). Spironolactone and endocrine dysfunction. Annals of internal medicine, 85(5), 630–636. [DOI:10.7326/0003-4819-85-5-630]
  • Millington, K., Liu, E., & Chan, Y. M. (2019). The Utility of Potassium Monitoring in Gender-Diverse Adolescents Taking Spironolactone. Journal of the Endocrine Society, 3(5), 1031–1038. [DOI:10.1210/js.2019-00030]
  • Pfizer. (2022). Aldactone: Highlights of prescribing information. [PDF]
  • Plovanich, M., Weng, Q. Y., & Mostaghimi, A. (2015). Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA dermatology, 151(9), 941–944. [DOI:10.1001/jamadermatol.2015.34]
  • Reiter, E. O., Mauras, N., McCormick, K., Kulshreshtha, B., Amrhein, J., De Luca, F., O'Brien, S., Armstrong, J., & Melezinkova, H. (2010). Bicalutamide plus anastrozole for the treatment of gonadotropin-independent precocious puberty in boys with testotoxicosis: a phase II, open-label pilot study (BATT). Journal of pediatric endocrinology & metabolism : JPEM, 23(10), 999–1009. [DOI:10.1515/jpem.2010.161]
  • Wang, Y., & Lipner, S. R. (2020). Retrospective analysis of adverse events with spironolactone in females reported to the United States Food and Drug Administration. International journal of women's dermatology, 6(4), 272–276. [DOI:10.1016/j.ijwd.2020.05.002]
  • Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., Bowe, W. P., Graber, E. M., Harper, J. C., Kang, S., Keri, J. E., Leyden, J. J., Reynolds, R. V., Silverberg, N. B., Stein Gold, L. F., Tollefson, M. M., Weiss, J. S., Dolan, N. C., Sagan, A. A., Stern, M., … Bhushan, R. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945–73.e33. [DOI:10.1016/j.jaad.2015.12.037]