I've heard about this drug before and didn't realize until recently that it was the same as the drug most Transgendered individuals call simply "spiro." The feminizing effects of this drug are not listed here. As a MTF Transgenderist individual my self; that's how I initially found out about what "spiro" is. I did not however know Spironolactone was infact the "spirp" in question. To clarify transgenderist is a term used for individuals who want gender characteristic altering procedures short of Gender/sexual reassignment surgery(also known as a sex change, or "bottom surgery). I'd honestly like to know why; gynecomastia(benign breast enlargement), feminization in general, testicular atrophy, and sexual dysfunction consisting of loss of libido, and erectile dysfunction are not listed as side effects for men. Also why aren't menstrual irregularities and breast tenderness and enlargement listed as side effects for women?
Why is Spironolactone not listed as an Anti-Androgen?
Question posted by PrincessKira on 20 July 2013
Last updated on 5 July 2017
4 Answers
Spironolactone has two roles: it's an aldosterone antagonist and an anti androgen. It blocks the androgen receptor which is the cytoplasmic receptor for dihydrotesterone (DHT) and it also inhibitors androgen biosynthesis. Spironolactone is not only a bonafide anti androgen but it's the most commonly used anti-androgen to treat female genetic hair loss in the United States.
DrDonovan
I have a number of friend, women who are using this as heart patients and are reporting thinning hair. So much for using this for hair lose in women.
Spironolactone is an antiandrogen as it is used to treat hyperaldosteronism a condition in which the adrenal gland produces too much of a hormone called aldosterone. A condition I have that causes the Heart to use all of the potassium in your system. It is not for the purposes of a sex change. I am a congestive heart failure patient. It dose alter the adrenal gland but not in the method you are subjecting.
Using it in transgenders and for hirsutism is an "offlabel" use. It is not FDA approved for this use. That is why this information is not in the descriptions. And some of those side effects are listed under the professional listing:
Adverse Reactions
CNS
Drowsiness; lethargy; headache; mental confusion; ataxia.
Dermatologic
Maculopapular or erythematous cutaneous eruptions; urticaria.
GI
Cramping; diarrhea; gastric bleeding; gastric ulceration; gastritis; vomiting.
Genitourinary
Inability to achieve or maintain erection.
Hematologic
Agranulocytosis.
Hepatic
Hyperchloremic metabolic acidosis in decompensated hepatic cirrhosis.
Miscellaneous
Gynecomastia; irregular menses or amenorrhea; postmenopausal bleeding; hirsutism; deepening of voice; drug fever; carcinoma of breast.
Endocrine
Spironolactone interferes with 17-hydroxylase activity, which causes a decrease in testosterone synthesis. It also inhibits the intracellular binding of dihydrotestosterone to its receptor.
Rare cases of young women with liver disease who developed menarche only after spironolactone was discontinued are reported. Since estradiol synthesis is partially dependenton testosterone synthesis, spironolactone may cause primary or secondary amenorrhea in adolescents.
Endocrinologic side effects have been due to the antiandrogenic properties of spironolactone. Five percent to 30% of male patients complained of gynecomastia, impotence or diminished libido. Female patients reported hirsutism, oligomenorrhea, amenorrhea, menorrhagia, and breast tenderness. These side effects appeared to be dose-related, and were more likely during long-term therapy. Gynecomastia may be more likely in some male patients with liver disease due to the increased conversion of androgens to estrogens in severe liver disease.
https://www.drugs.com/ppa/spironolactone.html
https://www.drugs.com/sfx/spironolactone-side-effects.html
Spironolactone is not listed as a anti-angrogen because it isn't, it is the generic form of Aldactone, a potassium sparing diuretic. It's normal dose is 12.5 to 25mg as as diuretic and to prevent scarring of heart muscle following a heart attack. At larger doses of 100 to 300 mg it is used as a source of potassium. You have broken the drug down the wrong, you want to first look up the medication and find out if it is a brand name or the generic form of another medication.
Spironolactone is a generic, as it's covered by my father's generic drug plan. He is showing erectile dysfunction, loss of libido, general feminization, and gynecomastia as side effects since he began this drug. Spironolactone which is indeed called Spiro in slang is used by endocrinologists as an anti-androgen. Every other resource I've looked at for this drug states that fact. Along with that almost every Male to Female transgendered individual I've ever met, who had hormone replacement therapy, was/is on this drug as an anti-androgen. I checked my facts before I posted the question, in fact connecting Spironolactone to the slang name of spiro used by the transgender community was what prompted the original question.
Slang is used on medications when ever they are not being used in there proper form. In terms of trans gender use I have no idea but after having a massive heart attack which is the purpose of the medication. It stops the forming or scar tissue on dead heart muscles which can throw some one with serve heart damage back into another heart attack. Lots of medications are used for the wrong reason and it your father is having those kind of reactions then you should contact his doctor as the are adverse reactions to the medication, a bad side effect. Not all medications are meant for all patients.
My father is on the lowest dose, but he's had seven heart attacks, and suffers from congestive heart failure. That's the reason he's on the drug. But the anti-androgenic effects are more common than generally stated, because so many MTF transgendered individuals are prescribed this drug by their endocrinologists. That being said these side effects aren't listed which I find really strange.
The effects are normally for those taking more then 100mg and closer to the 600mg amounts. If your father is having those effects at the lowest dose of 12.5mg his cardiologist needs to know this as soon as possible. I was kept on the lowest dose because of massive heart damage and I am diuretic resistant (allergic to diuretic). But I was kept on a low dose because I won't survive another heart attack, less then 40% of my heart is working.
Your doctor will call it a "potassium sparing diuretic", because it can have that effect, but it has other serious effects on androgenic hormones. See DzooBaby's answer below: "Spironolactone interferes with 17-hydroxylase activity, which causes a decrease in testosterone synthesis. It also inhibits the intracellular binding of dihydrotestosterone to its receptor." This causes female loss of libido and response, but the doctors won't tell you that when they prescribe it. Our US health care system is completely broken. "Side effects" ARE effects. They are what happens, regardless of names and labels.
Its not classified as it, because it isn't one. Its a potassium sparing diuretic. It antagonizes aldosterone specific corticoid receptors.
Except as far as I've read on the drug that has an anti-androgen effect. I stated in a previous comment, that almost all the Male to Female transgendered individuals who are on hormone replacement therapy are on this drug as an anti-androgen. That as is prescribed as by their endocrinologists.
Why ask the question if you don't want to believe what you're told. It may be used for a side effect of the medication, but it is not the purpose of the medication.
Drugs may well be developed for one use but get marketed for something else as well if they can used and sold for different applications. Doesn't matter what you name it. Sometimes, it just is what it is. And it is what it does.
Related topics
heart failure, spironolactone, congestive heart failure, edema, gender dysphoria, gynecomastia
Further information
- Spironolactone uses and safety info
- Spironolactone information for Healthcare Professionals (includes dosage details)
- Side effects of Spironolactone (detailed)
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