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
DashPCT Aldactone 100mg x 15 $7.00 $0.47 $0.47 Yes
United Pharmacies (UK) Aldactone 100mg x 15 £9.00 $0.60 $0.56 Yes
RxAisle Aldactone 100mg x 16 $29.00 $1.81 $1.52 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
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
Medicina Mexico Aldactone 100mg x 30 $98.00 $3.27 $3.27 Unknown
Aipctshop Aldactone 100mg x 300 $165.86 $0.55 $0.55 Unknown
HealthyAreaStore Aldactone 25mg x 100 $45.00 $1.80 $1.80 Unknown
United Pharmacies (US) Aldactone 25mg x 15 $3.16 $0.84 $0.76 52 days ago
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
Dragon Ordnance Aldactone 25mg x 15 $20.00 $5.33 $5.33 Yes
United Pharmacies (UK) Aldactone 25mg x 15 £2.60 $0.69 $0.62 52 days ago
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 20 $7.00 $1.40 $1.40 Unknown
AllDayChemist Aldactone 25mg x 30 $6.50 $0.87 $0.87 Yes
Medicina Mexico Aldactone 25mg x 30 $44.00 $5.87 $5.87 Unknown
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 (US) Spiractin 25mg x 100 $12.68 $0.51 $0.46 Yes
4NRX Pharmacy Spiractin 25mg x 100 £10.22 £0.41 £0.41 No
Inhouse Pharmacy Spiractin 25mg x 100 $29.00 $1.16 $1.16 Unknown
United Pharmacies (UK) Spiractin 25mg x 100 £10.43 $0.42 $0.38 Yes
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
Pharmacy-House Verospiron 50mg x 30 $9.54 $0.64 $0.62 Yes
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