Understanding Anti-Androgens
Anti-androgens are an important part of many feminising HRT regimens. They work by reducing the production or effects of testosterone, allowing oestrogen to work more effectively.
Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider before making any changes to your medication.
What Are Anti-Androgens?
Testosterone is the dominant hormone in people assigned male at birth. Even with oestrogen supplementation, testosterone can continue to counteract feminising changes. Anti-androgens help by:
- Blocking testosterone from binding to receptors.
- Reducing the overall production of testosterone.
- Preventing the conversion of testosterone to more potent forms like DHT.
Types of Anti-Androgens
Spironolactone
One of the most widely prescribed anti-androgens worldwide. Originally developed as a blood pressure medication, it also blocks androgen receptors and mildly reduces testosterone production. Common considerations include monitoring potassium levels and kidney function.
Cyproterone Acetate
A potent anti-androgen widely used outside the United States. It directly suppresses testosterone production. Regular monitoring of liver function and prolactin levels is important, especially at higher doses.
Bicalutamide
A non-steroidal anti-androgen that blocks androgen receptors without reducing testosterone levels. Some providers recommend it as an alternative to spironolactone or cyproterone.
Finasteride and Dutasteride
These are 5α-reductase inhibitors. Rather than blocking testosterone directly, they prevent it from converting into dihydrotestosterone (DHT), which drives scalp hair loss and body hair growth. They are sometimes used alongside other anti-androgens.
Monitoring on Anti-Androgens
Different anti-androgens require different monitoring:
- Spironolactone — Kidney function (creatinine, eGFR) and potassium levels.
- Cyproterone Acetate — Liver function (ALT, AST, GGT) and prolactin.
- Bicalutamide — Liver function tests.
- Finasteride/Dutasteride — Generally fewer monitoring requirements.
Use the My Health blood test tracker to log these results and watch trends over time.
Tracking in Gender Journey
Add your anti-androgen to My Medications alongside your oestrogen. You can set independent reminders and doses for each medication, and view your complete medication history at any time.