February 7, 2023

Full Lecture:

All right it’s not about blockers so sometimes it’s necessary to use blockers the testosterone sometimes will just go down on its own when you give somebody estrogen or progesterone but sometimes you really got to beat it as a result you use blockers and the historical way of doing this is stuff like finasteride and spironolactone which i despise and i’m going to

Talk to you about why but the crux of what i do is to use bioidentical hormones and on very rare occasion an androgen receptor inhibitor called bik elude amide to do this job so i don’t prescribe spiro if you come to me on spiro i will take you off of it i will not write it it is the standard of care according to every major medical group everywhere except for me

I’m gonna let you know they’re gonna tell you to write spyro why we think of potassium sparing diuretic that causes and this is known depression fatigue visceral adiposity like it increases serum cortisol levels which is probably the reason why people get visceral adiposity we know that it has issues with breast development so this was a really cool study that took

Every single transgender woman from like europe and this whole distribution like thousands of people and they looked at what they had used in terms of hormones up to that point and when they stratified out four different examples and different things they found that the spiro group was significantly more likely to seek breast augmentation than every other group there

Is a theory that spironolactone causes premature nipple bleed fusion meaning that basically the breasts are not able to achieve the full size they would have otherwise because you have cooked them with spiro early on and development so i have also seen this in some patients who took high-dose spiro who that almost no matter what i do and we’re talking i even have

One patient that i’m currently doing something i said i would never do i’m putting topical estrogen on the breast and which is like i and the reason i’m doing it is that they have failed transdermal injectable oral i’ve had their dose their estradiol level like 900 where they’re living at near like what would be considered crazy dose and still no breast development

So i said okay well and they said i’m gonna go get breast augmentation surgery and i said okay i’d rather you not because i always think of kanye west’s mom who went in for routine breast augmentation and died it’s not without complications or surgical problems or capsular contracture or other issues so let’s try one more thing i can screen for breast cancer but i

Don’t have a crystal ball to say whether my patient reacts to anesthesia and dies under the knife so that’s what we’re doing right now and with that patient i’ve had modest growth so far but i think that they may be a person who is fused prematurely with spironolactone so i get testosterone levels on people with the intent of erectile function if you don’t want it

And most of my transgender women do not they say no no no make it go away i don’t want to get morning erections i don’t want anything like they hate it they call it a dysphoria worm i mean there’s the what does the other one that i was always saying oh god trying to member now sadness noodle i mean it’s just like there’s so many funny things that my patients have

Said to me before that i like to try to store in my head but regardless if they don’t want it to function i keep it about 15 which is the adrenal levels that are produced when you shut somebody down using the powers method which we’re going to talk about if they want to hire them now to keep around 50 anecdotally african-american trans women want erectile function

White’s don’t i don’t know why that is it’s just the thing culturally that i have noted overwhelmingly to be true in a fact of like ninety ten when it comes to white transgender women they usually are either apathetic or they like they don’t want it very rarely or like it needs to keep working whereas with my african-american trans woman almost every single one of

Them would like to preserve their erectile function it’s like critically important i know if it’s a cultural difference or what but it’s something that i’m aware of and i cater to by helping them do this depending on what testosterone and i keep them pegged at all right so there are other blockers that i don’t use because they’re terrible 5 alpha reductase inhibitors

So there’s a brand new drug out right now that is injectable and it treats post menopause re postpartum depression so women that are like severely severely depressed right the problem with this drug is it have to be infused and has to be infused slowly over a 48-hour period so you have to be in the hospital with the severe depression and then they hook you up to it

Nathan fuse it into you and it’s a low pregnenolone which is a neuro of steroid that is involved in depression we find that it is heavily depleted in women with postpartum depression giving it to them makes them feel better do you know what else depletes naropa general own 5 alpha reductase inhibitors it blocks the synthesis of it i wonder why there’s such severe

Depression associated with the usage of finasteride but yet we hand it out like candy so if some hair of problems here have some finasteride oh you’ve got prostate cancer finasteride meanwhile these people are severely depressed because we’re literally depleting a neuro corticoid which is super important to their general functioning i don’t write these like almost

Never and when i do i write them topically and that’s it i have a compounded finasteride urdu task to ride with minoxidil at 10% that i put on the head but i won’t use them orally on people because there’s just no reason to do it the other reason it’s stupid is that the overwhelming majority of transgender women have a very low testosterone to begin with 5 alpha

Reductase inhibitors don’t block testosterone at all all they do is prevent the conversion of testosterone to dihydrotestosterone 3 times stronger testosterone it’s a more potent form so if your total testosterone is 10 why do you have the patient on finasteride you cannot imagine how often i have people come to me that have a testosterone of zero 1015 that are on

Finasteride this and that and i’m like what if your doctor doing because there’s you just expose them to the side effects for no reason so don’t do that deut asteroid it can also be used topically like i talked about i have a compound that does that never prescribe any of these things to somebody who basically has a loti you’re just you’re giving them side-effects

For no reason so there was a drug called flute amide ever still is actually and it is a incredibly potent anti androgen receptor inhibitor the best way to describe how it works and i love this drug class is here’s a testosterone receptor spiro all these other things block or reduce tea levels but flute amide bit collude amide and enzalutamide do this they’re like

A bowl that sits over top of the receptor they prevent the binding of the ligand so it just sits here and inhibits the ability for testosterone to do anything about 50 milligrams a day of bik aleut amide is enough to inhibit about 400 nanograms per deciliter so pretty solid amount of tea you can just wipe out by using the collude amide now the reason i use bik

Elute amide instead of flute amide is that flute amide has a horrible reputation it is like the angry mean cousin of pickle ood amide that causes liver failure bikal ood amide causes hepatic irritation in about one in 500 people i’ve seen it once ever and it was very mild we’re talking like their ast and alt went to like 60 compared to the other things are on

I generally also use bit collude of mine for another really cool reason if i took it it sad prostate cancer and i take it no estrogen no nothing just pick a loot amide i’ll grow breasts it causes gynecomastia the reason it does this is that when you inhibit the binding of testosterone the body recognizes that it’s not getting sex hormone signaling and so it up

Regulates the expression of the estrogen receptor on the cell surface membrane thereby sensitizing the cell to estrogen why are we giving people a testosterone poison that literally causes visceral adiposity and makes them feel like crap when this exists because people are afraid they’re afraid of this drug but i’m not and i write it constantly you can get it like

16 bucks a month at kroger with a good rx coupon i only use this drug temporarily right at the start of hormone therapy until i’m able to achieve what i call capture captures the point one i own your endocrine system it does what i tell it it basically has stopped doing what it wants to do on its own and it does what i tell it to do you know explain you how i do

That a little bit i’ve felt edit the slide i’ve never seen a hepatic transaminase elevation once two weeks ago i actually saw for the first time like i said ast and alt went to 60 alright so in not the united states there is seifer to your own omegis exists here we have majesté all but cyber tear on acetate cpa is a blocker that’s used in europe constantly it’s

What everybody uses in europe it causes prolactin oma’s and meningioma i don’t use it because i can’t but even if i could i still wouldn’t but you need to be aware of it cuz if somebody comes in having taken it and they have you know their peripheral field loss or whatever you need to be aware that literally this thing can cause a brain tumor i once saw a patient

Abusing cimetidine apparently cimetidine can cause gynecomastia probably via its p450 inhibition it screws with the cytochrome p450 system a lot and so subsequently people try and take it to get gynecomastia along with a thing called poor rem errific a– which is a plant that one of the most powerful phytoestrogens you can get that is an app right estrogen without

A prescription i have a lot of people who are ex diy meaning they like used to do this on their own from the street ordering it from like all day chemists in india and getting a chip to them and now they’ve come legit they come to see me because i offer the opportunity to inform consent

Transcribed from video
Anti-Androgens and Spironolactone issues in MTF HRT | Dr Will Powers @ OUWB By Transgender Info