@jacqueline i'm not sure if "doesn't do shit" is quite accurate even if snappy, but i will fully stand behind "there is no reason to use spironolactone whatsoever as an AA"
bicalutamide is essentially as cheap, infinitely more effective, and has only one real downside (you can't infer effectiveness from T levels which don't decrease) which isn't a problem because it's so effective at suppressing the effects of T
@whitequark@jacqueline bica has another downside - it's not safe to take if you don't have access to regular blood testing for liver function as some people develop acute liver toxicity and without blood tests you can't tell until it's too late. of course you're still better off not taking any AAs in that situation than taking spiro, so it's not a downside relative to spiro
@p2502@jacqueline what is the actual incidence of that? transfem care has a rich history of having overblown concerns (there's some about GnRHAs too, though there I at least know it's essentially unfounded)
(and by "actual incidence" i mean "at transfem care doses, not cancer treatment doses")
@whitequark@jacqueline transfemscience says "10 published case reports", all of elderly men being treated for prostate cancer, but there is one unpublished case of a death of a young transfeminine person. though compared to CPA that's still nothing (how badly prescribed that is would be another rant), main difference is the sudden nature compared to CPA. it's a fair point that there is bias because of the typical lack of data, but i don't think it's the same fearmongering as with GnRHAs?
@p2502@jacqueline i think the risk you should be comparing this to is that of death due to not being on AAs, which is clearly considerably higher than "one unpublished case"
@whitequark@jacqueline that depends what form of estradiol you have access to. you don't need to take AAs if you can suppress testosterone with estradiol alone. i might be a little biased how easy it is, from experience here doctors often prescribe Neofollin (EV 5mg/7days) in combination with 50mg/day CPA. the CPA dose is very excessive and we have to convince people to disregard their doctor and take much less (<=10mg/day) and in most cases people are able to stop taking CPA altogether
@p2502@jacqueline yes, this tracks. for most of my life I haven't had easy access to injectables (and had no one to teach me inject); I've actually not started on those before getting orchi
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