Spironolactone is commonly used to treat conditions such as hypertension and heart failure. Spironolactone also produces feminising effects. These include suppression of testosterone production, promotion of oestrogen production, stimulation of oestrogen receptors, and stimulation of progesterone receptors.
How is spironolactone used in gender affirming medical treatment?
Spironolactone has a long history of use as an antiandrogen for transfeminine adults (Prior et al., 1989). It's effective at suppressing testosterone levels and enhancing feminising bodily changes. It's tolerated well, despite being associated with potential risks of low blood pressure and raised potassium levels.
Is spironolactone safe?
As with all medicines, spironolactone has side effects. The most significant side effects are hypotension (low blood pressure) and hyperkalaemia (high serum potassium).
Spironolactone can decrease blood pressure. We recommend having a blood pressure check before starting spironolactone, as well as regular blood pressure monitoring. The systolic pressure must be higher than 90mmHg to proceed with spironolactone.
Spironolactone can increase potassium levels, which can affect the rhythm of the heart. Before starting spironolactone, we recommend having potassium levels checked, along with regular monitoring. Potassium concentration must be in the range of 3.5–5.0mmol/l to take spironolactone.
New symptoms of headache, dizziness, fatigue, confusion, drowsiness, fainting, or decreased urination after starting spironolactone requires urgent medical attention. Anyone taking spironolactone with these symptoms should stop taking it immediately, as these indicate dangerously low blood pressure.
Spironolactone is not recommended in people with moderate to severe kidney disease without agreement by a renal specialist.