i will fax this to the doctor in the morning.

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hi.

so, the short of this is that i'm requesting a reversal of the switch to spiro that we did yesterday and an increase in cyproterone to 200 mg/day, instead. while i tentatively consented, i didn't expect the order to come in so quickly, and didn't have time to do any kind of research of my own before i picked it up yesterday. after reviewing some research, i've decided that the switch to spiro would not be consistent with my transition goals, at this time. further, i would like to reiterate that i really should be looking at an orchiectomy, and not an increase in cyproterone, but my testosterone levels have been doubling yearly since they were at 0.1 (from 0.1 to 0.2 to 0.4 to 0.8), so it is past time to increase my dosage. i would appreciate it if you could send that request to the shopper's at university mall and contact me to let me know about it.

the long of it is...

i first came in and asked to get my testicles out in 2017, when my t-levels were still almost zero. however, i was noticing an unwanted increase in male libido (no reason boners) that, after so many years of absolutely no male sexual activity, came in as exceedingly unwanted. i'd been on t-blockers for eight years at that point and had experienced almost no male libido for essentially that entire period. i had entirely stopped masturbating, even - i just had no penis at all, sexually speaking. so, after many years without it, i had absolutely no interest in a return of a male libido at all and wanted to stop it from happening before it started. after looking into it, i decided the orchiectomy was a better option than an increase in t-blockers, due to concerns about liver functions with high levels of cyproterone. while that seemed a long ways off, i decided that fighting an arms race with my testicles was pointless and it was time to go to the next step, instead. 

within a few months, i saw a specialist in windsor, who denied my request for an orchiectomy. he was not explicit about it, but it seemed to be a rejection on religious grounds. while i found this deeply disappointing, the reality is that my t-levels were still so low as to be almost undetectable. further, i found myself in a fight with my landlord over the space of 2017 that was mostly about second hand smoke and made it impossible to put aside money for things like trips to toronto. i ended up moving at the end of 2017, and came back for my yearly in 2018.

i was in an even bigger fight with my new landlord, at that time. i was told the building was moving to nonsmoking, but i ended up directly on top of a 10 g/day "medical" marijuana user, in an old building with no flooring. i was experiencing frequent contact highs and a general level of unpleasantness that i associated with the second-hand marijuana smoke. but, i was also experiencing a range of symptoms that included random bouts of anger, frustration and anxiety - what are, in hindsight, "male emotions" that could be associated with an increase in testosterone. i also found myself sleeping more and having difficulty concentrating and focusing on day-to-day tasks. on a hunch, i had myself tested for meth, thinking maybe i was inhaling fumes from downstairs, and that came back negative. however, i tested positive for thc, apparently from the neighbour's habit - a reflection of the sheer bulk of smoke coming into my apartment. i did not, in the end, get tested for increased cortisol levels from the marijuana smoke (something that is a well understood consequence of marijuana use), but i was tested for heavy metal poisoning, which also came back negative. when my t-levels came back at .2, it didn't click that that was twice as much as .1 - it was still so low that it could just be error. however, given that my living situation was so unstable, i requested that we put off the issue for another year, until i could figure out what was going on. empirically speaking, .2 is still very low; i realize that. but, it seemed to be moving in the wrong direction.

over 2018, i also started to notice that my skin was getting rougher, that my facial hair was getting thicker and that my hair was knotting up more easily. i actually initially assigned most of this to the second-hand marijuana smoke, but when it didn't get better i became more suspicious. my male libido was also incrementally, if slowly, continuing to return, which remained deeply unwanted.

when i came back for my yearly tests in 2019, my living situation had stabilized enough that i was willing to look at booking an appointment in toronto for the orchiectomy, so we went through the process. we also increased my estrogen a second time from 6 mg/day to 8 mg/day, after noticing it was a little low. we also noticed that my testosterone had increased again to 0.4, which was still low, but twice as much. i still decided it was better to have a surgical than a chemical solution at this point, so i waited on the dose increase. but, i've been experiencing many of the same symptoms over the last year, and it's really just been getting worse and worse, even as the increase in estrogen has led to renewed breast growth, which had stopped for a while. are the creeping t-levels adversely affecting the estrogen levels?

when i came back in 2020, my t-levels had skyrocketed to 0.8, which is confirming to me that all of these symptoms i've been having are a result of unwanted testosterone levels. more frustrating, my estrogen levels are still low, after having been doubled over the last few years. and, there has been no progress on the preferred surgical solution.

if we were to plot the curve of t-levels since 2017, we would realize they've been doubling every year since. so, should i expect them to be 1.6 this time next year? that would be a 16 fold increase in four years, and i will no doubt have a list of terrible symptoms to look forward to. while i understand that 1.6 is still low, it is these symptoms that i am tying to the creeping testosterone that i want to reverse. this is, after all, ultimately a quality of life issue, right?

while what i want is the surgery, it doesn't seem likely that this will be available in the next 12-24 months. so, we decided to make a treatment option to move to spiro.

my research into the topic indicates that if i want to get my t-levels back under .5 and pushing towards .1 - or even an absolute 0 - then spiro would be the wrong decision, as spiro is less effective at blocking testosterone than cyproterone. a recent study is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612061/.

while spiro may have comparable feminizing effects overall, it would seem that a reasonable expectation of t-levels would be around 2.0, which would actually be an increase. as my goal is very specifically to reduce the side effects associated with creeping t-levels, this would appear to be counter-productive. i've seen no research anywhere that suggests that i should expect the spiro to take me to the t-levels i want, which i admit is perhaps lower than most transfemales experience or even want.

i am also concerned about what spiro may do to my heart health. i eat a very large number of bananas and an unusually low level of processed foods (so i don't get much salt), so i would be a bad candidate for a drug that increases potassium levels. i survive largely on fresh fruits and vegetables. i would expect that my potassium levels are already high, as it is, and that my sodium levels are probably a little low. i also have low blood pressure, as it is, from diet and exercise, so i probably shouldn't be taking drugs that are likely to decrease my blood pressure - it could lead to dangerous hypotension, which is what i need to actually be concerned about.

this study also suggests that spiro may reduce my hdl, while cyproterone may increase it:

https://www.jsm.jsexmed.org/article/S1743-6095(16)30421-0/pdf

i know that it's easy enough to look at my cholesterol levels and tell me i have nothing to worry about, but i need to dissent. my father died of a brain tumour in his mid-50s, but he had already had several heart attacks by the time he turned 40, which i will do in january. his youngest brother died of a heart attack in his early 30s, and his father died of a heart attack in his early 50s. my cholesterol levels are low due to great amounts of effort on my behalf to keep them low with diet and lifestyle, which seems to be working. my genetic risk factors are so frightening, that i am very adverse to doing anything at all that might increase them. if my cholesterol is so great, maybe the cyproterone & estrogen is actually helping, and maybe i should keep at it.

lastly, i'm also dealing with an unwanted change in my estrogen delivery systems over the upcoming months that i want to isolate for testing. if i switch from cyproterone to spiro and my estrogen comes way down, i won't know if it's the switch to generics or the switch to spiro that's at fault. i'm also looking at switching back to prometrium, soon. i want to do one thing at a time to ensure that i can properly isolate and understand the effects.

my concern with cyproterone and liver functions was less immediate and more long term. i fully understand that i can't win an arms race with my testicles, in the long run, and that i'm not supposed to be in this situation, in the first place. 11 years on t-blockers is bizarre. my testicles should have been removed ages ago, and i shouldn't be in this mess. however, cancer patients can take up to 300 mg/day of cyproterone before they begin to suffer adverse effects and there is apparently essentially no risk of actual overdose:

https://pdf.hres.ca/dpd_pm/00022190.PDF

this isn't the right answer in the end, and it didn't seem necessary before, but it does now and it's not all that scary for the short term.

so, for all of these reasons, i am proposing that we go to 200 mg of cyproterone instead of switching to the spiro.

however, what i really want is to get them out and, while i understand that elective surgeries are not available right now, i would request some urgency be attached to the matter, as much as is possible. i think i've laid out my case, here.