Spironolactone Misinformation

euryale-dreams:

So Tumblr is broken and for whatever reason I can’t directly reblog some pertinent stuff even though I ought to be able to but…

There is a link circulating around Tumblr that is claiming that spironolactone is not only ineffective at suppressing testosterone in trans women but that it is counterproductive in a feminizing hormone regimen.

THIS INFORMATION IS FALSE AND MISLEADING!

Spironolactone works. The woman who wrote the linked article doesn’t seem to have a clue about how to evaluate research and she has a very tenuous grasp of medicine. To put it bluntly, she uses preliminary evidence of a primary effect to then imagine second (or third) order effects on the human body. This, regardless of how powerful some of those effects might be expected to be.

At one point in her article she cites a non-peer-reviewed paper that compares trans women who refused spironolactone treatment with trans women who were given spironolactone treatment. The paper shows no effect with regards to treatment. Nobody stopped to realize that trans women who initially refused spironolactone could be expected to change their mind when estradiol alone proved ineffective at lowering testosterone.

… especially since those women likely initially refused spironolactone because their doctor might have suggested that some women achieve success at lowering testosterone on estradiol alone.

That is the kind of thing that will instantly get a paper rejected during the peer review process but… open access journals are a thing now, I guess.

Her only other paper supporting her assertion that spironolactone doesn’t suppress testosterone doesn’t even investigate whether or not spironolactone suppressed testosterone. It simply examined whether or not the end result, as measured by serum testosterone assay, was satisfactory in a given clinical population. That’s a completely different question.

By the way, their answer also does not agree with the preponderance of evidence and there are some pretty serious weaknesses in the paper’s statistical analysis so make with that what you will.

Oh, and if that’s not bad enough she also completely ignores the fact that spironolactone doesn’t even need to lower the level of serum testosterone to be antiandrogenic. Like… at all. Spironolactone, in addition to lowering testosterone production, also directly blocades testosterone receptors. In other words, it helps prevent whatever testosterone happens to be in your body from doing anything.

I’m going to stop now because I could honestly go on for hours. I hope I’ve made my point sufficiently clear. The woman who wrote that article is a dangerous crackpot.