Instructions for Taking Oral Anti-Androgens
(This information is based on the information and practise for Spironolactone.¹ Other medications will vary somewhat in usage/recommendations)
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Read the Patient Information Leaflet.
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Dosage:
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Your prescribed dosage will be stated on your prescription and in the UK will be printed on the label stuck to your medication box.
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Starting doses typically fall within a standardised range, and then your dose may be adjusted in accordance with blood test results and the effects you are experiencing.
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Timing:
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Take your dose at the same time each day to maintain consistent hormone levels.
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If you miss a dose, take it as soon as you remember until 6pm. After then, skip that day’s dose and start afresh with the next day’s regular dose.
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Take the pill after eating.
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Swallowing the Pill:
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Swallow the pill whole with a glass of water. Do not crush, chew, or break the tablet, unless instructed by your healthcare provider.
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Can I stop taking my anti-androgen if my testosterone levels are stable and I think it’s no longer needed?
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Generally, as a short answer: it’s not recommended and may negatively impact your hormone levels going forward.
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Once your testosterone levels are suppressed and you’re on a steady prescription of oestrogen, occasionally some healthcare providers will suggest trying coming off your anti-androgens and seeing if your oestrogen dose alone is enough to suppress your testosterone.
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This will largely depend on the strength of your oestrogen dose, and it seems to differ between countries and providers whether they are aiming for oestrogen mono-therapy by prescribing larger doses of oestrogen, in order for this to be sufficient to suppress your testosterone alone.
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Most other providers will encourage you to continue to keep taking an anti-androgen alongside oestrogen together indefinitely.
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You may find that stopping anti-androgens results in effects such as increased facial hair growth, as the anti-androgen would typically suppress this.
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This may mean, for example, weighing up any side effects you are experiencing from your anti-androgen, versus the benefits they offer such as reduced facial hair growth and the resulting reduction in dysphoria.
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We will always support individuals must deciding what is best for them or experimenting to find out.
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So we are firmly against advising you not to experiment with stopping your anti-androgens if you feel that's what's best for you.
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What Forms Do Anti-Androgens Come In?
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In the UK, most blockers come as pills or are given by injection, either monthly or three-monthly.
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However, in other countries, other methods of delivery are used – such as implants (a small pellet placed under the skin), and nasal sprays.
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The use of nasal sprays in conditions such as endometriosis is well-known and evaluated, but their use in the suppression of puberty in trans patients is less well tested. However, there is no evidence to suggest that they are not a viable alternative to injections.
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The spray is given twice a day.
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A blood test is carried out after four weeks to ensure that hormones are being suppressed effectively.
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Three-monthly blood testing then continues to check your hormone levels to ensure that they are working effectively.
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It is extremely unlikely these new forms would be available via NHS prescription, but some private services such as Gender GP are willing to prescribe this new option.¹