Spironolactone
Level 2a: This medication has significant evidence for its use in transition but has specific side effects that need monitoring.
Spironolactone is a drug commonly used to suppress testosterone in trans-feminine people, especially in the United States.
Dosing and Monitoring
100mg to 400mg daily doses are typical for trans-feminine people. Spironolactone works both by changing testosterone receptors and also by blocking the production of testosterone, however, its ability to block testosterone in ways significant to transfeminine people is debated (Lachlan Angus, 2020). Blood tests may only show slightly decreased testosterone levels as much of its impact is at the receptor; This makes monitoring through testosterone testing inconsistent. Many trans-feminine people opt to use bicalutamide or cyproterone acetate for testosterone suppression. When adjusting dosages using 50-100mg steps in dose is typical.
Safety and Effects
While anecdotally Spironolactone can cause unwanted side effects its safety profile makes it rather safe to take. Some common safety concerns for the medications are detailed below.
Spironolactone and Dehydration
As a diuretic Spironolactone causes increased urination for most people and care should be taken to increase fluid intake when starting Spironolactone. Spironolactone also can decrease blood pressure and cause hyponatremia (NH Daily Med). Care should be taken to increase hydration while on this medication and check for symptoms of hypotension.
Spironolactone and Anecdotal Reports of Brain Fog
Research on the topic has not been done, however many anecdotal reports in the community have come about of experiencing brain fog while on Spironolactone.
Spironolactone and Hyperkalemia
Many recommend monitoring of potassium levels while on Spironolactone however in practice the risk of hyperkalemia is rather small and likely not worth testing potassium levels. (Millington Kate, 2019) (Fernandez John, 2016).
| Seller | Product | Price | Single $/100mg | Bulk $/100mg | Stock | Notes |
|---|---|---|---|---|---|---|
| United Pharmacies (UK) | Aldactone 100mg x 15 | £9.00 | $0.60 | $0.56 | Yes | |
| DashPCT | Aldactone 100mg x 15 | $7.00 | $0.47 | $0.47 | Yes | |
| RxAisle | Aldactone 100mg x 16 | $32.00 | $2.00 | $1.68 | Unknown | |
| Dragon Ordnance | Aldactone 100mg x 16 | $30.00 | $1.88 | $1.88 | Yes | |
| Silhouette Beauty | Aldactone 100mg x 16 | €14.50 | $0.91 | $0.91 | Unknown | |
| Medicina Mexico | Aldactone 100mg x 30 | $98.00 | $3.27 | $3.27 | Unknown | |
| AllDayChemist | Aldactone 100mg x 30 | $16.50 | $0.55 | $0.55 | Yes | |
| ReliableRx Pharmacy | Aldactone 100mg x 30 | $13.81 | $0.46 | $0.46 | Yes | |
| Aipctshop | Aldactone 100mg x 300 | $165.86 | $0.55 | $0.55 | Unknown | |
| HealthyAreaStore | Aldactone 25mg x 100 | $45.00 | $1.80 | $1.80 | Unknown | |
| Dragon Ordnance | Aldactone 25mg x 15 | $20.00 | $5.33 | $5.33 | Yes | |
| 4NRX Pharmacy | Aldactone 25mg x 15 | £2.55 | £0.68 | £0.68 | No | |
| DashPCT | Aldactone 25mg x 15 | $2.25 | $0.60 | $0.60 | Yes | |
| United Pharmacies (UK) | Aldactone 25mg x 15 | £2.60 | $0.69 | $0.62 | Yes | |
| United Pharmacies (US) | Aldactone 25mg x 15 | $3.16 | $0.84 | $0.76 | Yes | |
| Medicina Mexico | Aldactone 25mg x 20 | $7.00 | $1.40 | $1.40 | Unknown | |
| Bulgarian Online Pharmacy | Aldactone 25mg x 20 | £12.00 | $2.40 | $2.40 | Unknown | |
| RxAisle | Aldactone 25mg x 20 | $27.00 | $5.40 | $4.54 | Unknown | |
| Medicina Mexico | Aldactone 25mg x 30 | $44.00 | $5.87 | $5.87 | Unknown | |
| AllDayChemist | Aldactone 25mg x 30 | $6.50 | $0.87 | $0.87 | Yes | |
| Aipctshop | Aldactone 25mg x 450 | $41.42 | $0.37 | $0.37 | Unknown | |
| PharmaOnline.TV | Aldactone 25mg x 50 | €18.90 | $1.51 | $1.51 | Unknown | |
| DashPCT | Aldactone 50mg x 15 | $2.75 | $0.37 | $0.37 | Yes | |
| Aipctshop | Aldactone 50mg x 450 | $82.65 | $0.37 | $0.37 | Unknown | |
| Inhouse Pharmacy | Aldactone 50mg x 90 | $29.50 | $0.66 | $0.66 | Unknown | |
| Favskinhouse | Hyles 100mg x 10 | $5.00 | $0.50 | $0.50 | Unknown | |
| HealthyAreaStore | Hyles 100mg x 100 | $44.00 | $0.44 | $0.44 | Unknown | |
| Amazing4Health | Hyles 100mg x 100 | $49.99 | $0.50 | $0.50 | Unknown | |
| HealthyAreaStore | Hyles 25mg x 100 | $37.00 | $1.48 | $1.48 | Unknown | |
| Update Link | Hyles 25mg x 200 | $74.00 | $1.48 | $1.48 | Unknown | |
| United Pharmacies (UK) | Spiractin 100mg x 100 | £22.74 | $0.23 | $0.20 | Yes | |
| Inhouse Pharmacy | Spiractin 100mg x 100 | $57.00 | $0.57 | $0.57 | Unknown | |
| United Pharmacies (UK) | Spiractin 25mg x 100 | £10.43 | $0.42 | $0.38 | Yes | |
| 4NRX Pharmacy | Spiractin 25mg x 100 | £10.22 | £0.41 | £0.41 | No | |
| United Pharmacies (US) | Spiractin 25mg x 100 | $12.68 | $0.51 | $0.46 | Yes | |
| Inhouse Pharmacy | Spiractin 25mg x 100 | $29.00 | $1.16 | $1.16 | Unknown | |
| Japan Health Center (Bio-Japan) | Spironolactone 25mg x 100 | $29.00 | $1.16 | $1.16 | No | |
| Bulgarian Online Pharmacy | Spironolactone Actavis 25mg x 30 | £9.00 | $1.20 | $1.20 | Unknown | |
| Bulgarian Online Pharmacy | Spironolactone-Chaikafarma 100mg x 30 | £22.00 | $0.73 | $0.73 | Unknown | |
| ShapeShifter | Spylacton 25mg x 20 | Enquire with Supplier | Enquire with Supplier | Enquire with Supplier | Unknown | |
| Pilloid | Verospiron 100mg x 30 | $22.81 | $0.76 | $0.76 | Unknown | |
| Pilloid | Verospiron 25mg x 30 | $14.94 | $1.99 | $1.99 | Unknown | |
| Pilloid | Verospiron 50mg x 30 | $14.94 | $1.00 | $1.00 | Unknown | |
| Pharmacy-House | Verospiron 50mg x 30 | $10.53 | $0.70 | $0.68 | Yes | |
| Pharmacy-House | Verospiron 50mg x 30 | $9.54 | $0.64 | $0.62 | Yes |