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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by iforgotmypassword on November 2, 2005, at 21:07:50
(also goes by trade name ANDROCUR sometimes)
hi, i was just wondering if anyone knows much about cyproterone acetate, and if any specific mental health related problems or fatigue, malaise, or neurological health problems that may be associated it with its use.
i have severe gender identity issues and have lot of trouble with masculine aspects of my body and stuff, and i use the cyproterone to help with it, and really i couldn't do without it or something like it (not too much in existence) to deal with things. but now i really worry if it could be doing harm. for one thing, it's an extremely old progestin and is now famous for devouring B12 somehow. which is really kind of funny because, my B12 is almost always very low unless extremely supplemented (it has been this way for years, i was getting weekly B12 shots less than 2 months ago while an inpatient... i should prolly learn how to inject them myself and continue things.) this is probably an extra risk becuase i am mostly vegan (except when i get very dragged down and start making exceptions for chocolate, like now)... but also it seems like provera (medroxyprogesterone) a lot of people seem to have trouble tolerating it. this may be less due to any progestogenic (or whatever the word would be) effects as while it is in fact a progestin, it is much weaker than provera, but im not certain if this is relevant.
anyways, it's hard to find relevant info as i gather it's not a very popular med anymore (not even dispensed in the US). its mostly used as a (presumably less popular) treatment for prostate cancer, for sex offenders, in the Diane 35 and Dianette 50 birth control pills, and of course for transgender-related HRT.
i'm thinking i may just be much safer getting an orchidectomy (the surgical castration procedure) to deal with excess testosterone, then not only would i not have to take a antiandrogen at all but i would also get to take less estrogen for appropriate levels (another thing i gathered was that CES (basically canadian generic chemically identical non-equine PREMARIN) is probably not all that good for you either. i bought some estrace (pure estradiol oral preparation). now i am very having a lot of trouble keeping up with doses and everything just as with personal hygeine. :( god i am such a mess...
i am still very suspicious that the changes in my HRT have become noticably less effective in reducing visible masculinization, which is something i inside panic over, and if i werent so numb and apathetic and actually caring about anything in the world id actually be going crazy. the fat on my face seems to have changed, my voice sounds much more male, my body shape as well... ugh.
anyways, if anyone knows anything about hormonal drugs and mental health and has any advice to offer that would be really really awesome. i understand though, if this is just too out of left field for any one to be able to help with though.
thanx! xo
Posted by TamaraJ on November 2, 2005, at 21:37:09
In reply to cyproterone acetate, transgender HRT+mental health, posted by iforgotmypassword on November 2, 2005, at 21:07:50
I don't know about the drug that you have been taking, but, with regard to progestins, I had a debilitating reaction to Depo Provera last year. Not only did it make me physically ill (throwing up every day for over 2 months, exhausted), but it made me emotionally ill (threw me into a severe depression). I have read that synthetic hormones can exacerbate depression in those with or prone to depression. Perhaps the progestin is the root of your problems, or exacerbating your condition.
Posted by iforgotmypassword on November 2, 2005, at 21:49:32
In reply to Re: cyproterone acetate, transgender HRT+mental health » iforgotmypassword, posted by TamaraJ on November 2, 2005, at 21:37:09
well i actually think my symptoms of depression were technically worse beforehand, that is as if i was much less numb and could feel them. but it almost seems that that was much healthier...
my friend is getting the orchidectomy procedure done for them, if it works out, i think i'm really going to look into it...
Posted by iforgotmypassword on November 2, 2005, at 23:51:16
In reply to Re: cyproterone acetate, transgender HRT+mental he, posted by iforgotmypassword on November 2, 2005, at 21:49:32
thank you for responding, BTW; that must have been such a terrible experience. i've heard depo can be really nasty from other people, thats so sh*tty that they didn't give you a trial on low-dose pills first.
Posted by Iansf on November 3, 2005, at 0:41:07
In reply to cyproterone acetate, transgender HRT+mental health, posted by iforgotmypassword on November 2, 2005, at 21:07:50
> (also goes by trade name ANDROCUR sometimes)
>
> hi, i was just wondering if anyone knows much about cyproterone acetate, and if any specific mental health related problems or fatigue, malaise, or neurological health problems that may be associated it with its use.
>
>
I can't answer your question, but I know there are more recent androgen suppressors. One was recommended to me when I had prostate cancer. Unfortunately I can't recall the name. Perhaps a newer one might have fewer side effects.On the other hand, low testosterone in males is often associated with depression, and when it drops below a certain threshold it's also correlated with low energy. But surely when someone has gender reassignment, the infusion of additional hormones of the opposite gender must compensate. I mean, almost all women have very low testosterone levels, but they're not all depressed and tired. Presumably, higher levels of estrogen are the reason.
Aren't there others who have completed the process you can turn to for advice? I think they would be the best source of information. Or your doctor. For something like gender reassignment, you definitely need a doctor you trust. If he or she is unable, or unwilling, to address your questions about the drugs you're taking, you probably should consider changing doctors if at all possible.
Posted by ed_uk on November 3, 2005, at 14:37:47
In reply to Re: cyproterone acetate, transgender HRT+mental health » iforgotmypassword, posted by Iansf on November 3, 2005, at 0:41:07
>I can't answer your question, but I know there are more recent androgen suppressors. One was recommended to me when I had prostate cancer. Unfortunately I can't recall the name
Was it a tablet? Perhaps it was bicalutamide (Casodex).
Ed
Posted by ed_uk on November 3, 2005, at 16:20:36
In reply to cyproterone acetate, transgender HRT+mental health, posted by iforgotmypassword on November 2, 2005, at 21:07:50
Hi IFMP,
>also goes by trade name ANDROCUR sometimes
........and Cyprostat
>i was just wondering if anyone knows much about cyproterone acetate
Yes, what would you like to know?
>if any specific mental health related problems or fatigue, malaise, or neurological health problems that may be associated it with its use
Cyproterone is associated with depression (can be severe), fatigue (can be severe), breathlessness and thromboembolism. High doses can cause liver damage.
>anyways, it's hard to find relevant info as i gather it's not a very popular med anymore (not even dispensed in the US). its mostly used as a (presumably less popular) treatment for prostate cancer, for sex offenders, in the Diane 35 and Dianette 50 birth control pills, and of course for transgender-related HRT.
It's dispensed quite a lot in the UK. Androcur is used as a treatment for pedophilia because it suppresses the libido. Cyprostat is used to treat advanced prostate cancer. Dianette is widely used to treat hirsutism and severe acne in women.
>HRT and other drugs
Estrogens.......
Ethinylestradiol, a synthetic estrogen, is very potent. It is found in most oral contraceptives. Tablets containing ethinylestradiol *alone* are also available. Such tablets allow the dose to be optimised, without the risk of ODing on the progestin. Ethinylestradiol is very feminising, and is particularly suitable for young pre-op transexuals. In patients who have not had an orchidectomy, ethinylestradiol is used in combination with an anti-androgen such as cyproterone.
Estradiol (the main human estrogen) is particularly suitable for post-op transexuals. When used alone, it may be less feminising than ethinylestradiol. In combination with anti-androgens, its effects are enhanced. After an orchidectomy, estradiol can be effective in the absense of anti-androgens. Estradiol is available both as tablets and as a patch. The patch is particularly suitable for older post-op transexuals.
Conjugated equine estrogens - seriously, who wants to take horse estrogen when you can take estradiol? I don't recommend it.
Progestins.............
The synthetic estrogens found in most oral contraceptives can be masculinising eg. norethisterone, norgestrel and levonorgestrel. Cyproterone and drospirenone (found in Yasmin and Angeliq) are both progestins and anti-androgens. Dydrogesterone (Duphaston) and medroxyprogesterone (Provera) resemble natural progesterone in their actions.
Anti-androgens.............
Cyproterone is widely used in Europe. It is a progestin and a powerful anti-androgen. In combination with an estrogen, it is very effective.
Drugs are available which 'shut down' the testes temporarily. Nafarelin, leuprorelin and goserelin are examples. Nafarelin is available as a nasal spray - it is used to treat prostate cancer. Similar drugs are available as implants. These drugs are very expensive. In addition, they are not well studied in transsexuals.
Spironolactone is a diuretic and weak androgen antagonist. It is used to treat fluid retention and hypertension caused by HRT.
As you know, anti-androgens are no longer necessary following an orchidectomy.
What do I think?
Ethinylestradiol tablets are very effective. The usual dose is 50mcg twice daily. Nevertheless, the risk of blood clots is a concern. The estradiol patch may be safer. Since you're very young (I think), ethinylestradiol might be acceptable. As you get older, the risks of ethinylestradiol increase, and the estradiol patch would be a better option. ........Btw, Estradiol is also available as a nasal spray!
Since you're taking cyproterone, you do not need to take medroxyprogesterone or dydrogesterone.
I think you have some difficult decisions ahead. Although effective, the side effects of cyproterone are unacceptable. The fatigue and depression can be too much to bear. You NEED to see a specialist in transsexualism. Don't attempt to self medicate.
I hope I've been of some help.
Feel free to email me if you like
[xxx]
Kind regards
Ed
PS. No, I'm not a transsexual!!!
Posted by iforgotmypassword on November 3, 2005, at 19:51:56
In reply to Re: cyproterone acetate, transgender HRT+mental health » iforgotmypassword, posted by ed_uk on November 3, 2005, at 16:20:36
sorry, i'm trying to respond but having trouble... i will be replying again soon. thank you both for your posts. (holy crap ed_uk that's a wealth of info!! :P)
Posted by iforgotmypassword on November 3, 2005, at 20:00:20
In reply to transgender HRT; Iansf, ed_uk, posted by iforgotmypassword on November 3, 2005, at 19:51:56
it didn't let me mimic the double chevron thingie to mark this post as a reply to both of you... oh well. i'm guessing you'll both still find this. i'm guessing no one actually relies solely that find reply button anyway...
again i really value input on this, so again thank you, i don't mean to leave the thread hanging... i'll brb as soon as i make sense.
Posted by ed_uk on November 5, 2005, at 11:42:08
In reply to ugh., posted by iforgotmypassword on November 3, 2005, at 20:00:20
Hi IFMP
I've been thinking about cost issues and about the side effects of cyproterone.
What dose of cyproterone are you taking? Your depression might improve if you were able to take a lower dose.
I was thinking you could try Dianette, 3 tablets per day eg. one in the morning and two at night. Dianette contains ethinylestradiol 35mcg and a low dose (2mg) of cyproterone. Due to its exceptional potency as an estrogen, the ethinylestradiol might allow you to take a lower dose of cyproterone while maintaining an adequate level of feminisation. Since Dianette only contains a low dose of cyproterone, I expect you'd have to take a daily cyproterone tablet alongside the Dianette, although a much lower dose ought to be sufficient.
Although effective, tablets containing ethinylestradiol as the sole ingredient are expensive. Dianette tablets are relative cheap in comparison and contains an adequate dose of estrogen if you take three tablets per day.
Unfortunately, the risk of deep vein thrombosis is relatively high with ethinylestradiol. Pulmonary embolism may occur. It's important that you are fully aware of the symptoms so that you can gain immediate medical treatment if necessary. (DVT/PE is treated with anticoagulants).
Since you're young, the risk of DVT is *much* less that it would be if you were older. Nevertheless, it is a definate concern. Estradiol (as a skin patch) is the safest form of estrogen but it's potency is lower than that of ethyinylestradiol and you'd need a higher dose of cyproterone to suppress your testosterone levels. At the moment, since the side effects of cyproterone are a major concern, this would be undesirable. If you had an orchidectomy, you could ditch the cyproterone completely and use transdermal estradiol as your sole HRT. Of course, orchidectomy is permanent and needs very careful consideration. In addition, orhidectomy itself can cause side effects.
Kind regards
Ed
Posted by ed_uk on November 7, 2005, at 14:37:32
In reply to ugh., posted by iforgotmypassword on November 3, 2005, at 20:00:20
Hi
Did you read my posts? They took a long time to write. I was trying to help you. No one is responding to my posts lately.
Ed
Posted by iforgotmypassword on November 7, 2005, at 23:19:55
In reply to Re: ugh. » iforgotmypassword, posted by ed_uk on November 7, 2005, at 14:37:32
i'm really sorry, i did read them. i am having a lot of trouble contemplating everything right now. i really am extremely appreiciative, or at least i am trying to feel that way... i can't care about anything other than my frustrated outbursts. i can't even remember to take my hormones now. it feels like i am just going to a homeless bum soon. i really don't care about anything. my landlord is giving me a lot of leeway, but he can only do so much. i have no idea what is going to happen to my cat, and he is really my best friend... now it feels like all i can do is hope my dad will take him...
Posted by ed_uk on November 8, 2005, at 15:33:20
In reply to Re: ugh., posted by iforgotmypassword on November 7, 2005, at 23:19:55
(((((((IFMP))))))))))
Sorry, I do apologise. I was having a bad day.
Love
Ed
This is the end of the thread.
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