The dosing regimen for spironolactone as an antiandrogen in transgender adolescents varies and should always be personalised based on individual needs, under the guidance of a team experienced in transgender healthcare. Spironolactone is used to reduce testosterone levels and its effects, contributing to the feminisation process in transgender girls and transfeminine adolescents.

Typical Dosing Regimen for Spironolactone:

1. Initial Dose: The starting dose is often conservative to assess tolerance. It typically ranges from 25 mg to 50 mg daily.
2. Titration and Adjustment: Depending on the individual’s response and tolerance, the dose may be gradually increased. Common therapeutic doses range from 100 mg to 200 mg per day, divided into two doses.
3. Monitoring: Regular monitoring of blood potassium levels and blood pressure is essential.
4. Maximum Dose: The maximum dose generally should not exceed 200 mg per day in adolescents, but the exact limit can vary based on individual factors and healthcare provider discretion.
5. Combination with Other Therapies: Spironolactone is often used in conjunction with estrogen therapy in transgender adolescents. The combined approach aims to decrease testosterone levels while increasing estrogen levels to induce feminising effects.

Important Considerations:

• Age and Tanner Stage: The appropriateness of spironolactone and its dosage highly depend on the age and pubertal stage of the adolescent.
• Informed Consent: It’s crucial for the adolescent to understand the effects, benefits, and potential side effects of spironolactone.
• Side Effects: Common side effects include increased urination, electrolyte imbalances, and potential impact on blood pressure. People should be informed about these and other potential side effects.
• Regular Follow-Up: Continuous follow-up appointments aim to assess efficacy, manage any side effects, and adjust dosing as needed.

Conclusion:

The use of spironolactone in transgender adolescents requires a careful, individualised approach. Regular monitoring and adjustments by a provider experienced in transgender healthcare are essential to ensure safety and effectiveness. As each individual’s response to hormone therapy can differ, ongoing communication and collaboration are crucial for optimal care.