i had a doctor's appointment today after getting my blood taken a few weeks ago.

my vitals are, as usual, outstanding. but, the t-blockers are decreasing their effectiveness in an increasingly worrying direction, and i found out that he didn't even send the fucking letter to the surgeon, yet.

i noticed this intuitively, to start with, and i actually think it's at the root cause of the problems i'm having with drowsiness and focus. i was feeling anxious and angry and frustrated, and thought i was dealing with cortisol issues or even lead poisoning. but, then i realized my testosterone was going up.

it was at 0.1 four years ago, .2 two years ago, .4 last year and .8 this year. this is the wrong direction!

but, it's not surprising, either. i'm developing a tolerance to the cyproterone acetate, which is a well understood reality of it.

so, if i'm developing a tolerance to the drug, i can either increase the dosage or i can just cut my testicles out. i desperately want my testicles to be put through a fucking incinerator. i want them gone. forever. but, i can't get a doctor to do it.

it's covered. it's simple. it's fast. but, they won't do it.

i was concerned about increasing the cyproterone due to eventual strain on my liver.

so, the doctor suggested i switch to spironolactone instead, and i said "ok", and i even filled a prescription today, but i'm looking into it and i think this was a stupid suggestion.

to begin with, clinical studies seem to suggest that the spironolactone is less effective than the cyproterone acetate, at the dosages i've been prescribed - with the spiro only reducing levels to 2.0, and the cyproterone generally coming in around the 0.8 i'm currently at. so, if i'm trying to get my testosterone back down to .1, the spiro seems unlikely to do it. it's probably going to actually increase it, from what i can see.

second, the spiro seems to reduce hdl, whereas the cyproterone seems to increase it. the doctor is consistently amazed at my cholesterol levels. the cyproterone - which he doesn't usually prescribe - may have something to do with it.

worse, the spiro is often prescribed for heart conditions, which is something i'm not sure i want to fuck with. the cyproterone is simply a safer drug at high concentrations. so, if i'm concerned about complications from high concentrations, moving me to spiro is backwards.

i'm going to do some more research, but i'm leaning heavily towards tossing the spiro and asking him to just boost my cyproterone instead. i'm only taking 100, which is usually considered a maximum dose for trans patients, but appears to be substantively below levels where liver complications are a serious problem.