In gender-affirming care, the goal is to achieve maximum therapeutic benefit with the lowest effective dose of medication. This is to minimise side effects and increase safety.
If you're being recommended a lower dose, this doesn't necessarily mean that your transition will go any slower – it can just mean that you don't need as much to have the same effects but with a reduced risk of side effects. This also means that the treatment can be safer for longer – an important consideration with long-term care.
For people taking higher doses of spironolactone (e.g., 100mg or more) or cyproterone (over 12.5mg), we recommend reducing the dose once testosterone levels are effectively suppressed. This helps to minimising potential side effects while maintaining effectiveness.
Initial Dosing and Adjustment
Higher Initial Doses: Sometimes, higher doses are needed at the beginning to get to the target hormone balance.
Gradual Reduction: Once hormone levels stabilise, it may be possible to reduce doses. This is because your body won't need as much as before. Hormones and their balance are more complicated than just 'more = better and faster', especially as the production of hormones in your body is suppressed so the antagonistic hormones that had to be overcome with higher initial doses aren't as present in your body.
Benefits of Lower Doses
Safety: Lower doses can reduce the risk of side effects and long-term health concerns.
Effectiveness: There shouldn't be a drop in effectiveness with a lower dose. However, we monitor regularly with any new dose introduced in the past 12 months to make sure the dose is right for you and is working properly. If it isn't, it can be easily changed.