Brief Answer:
Information

Detailed Answer:

Hello,

Progestin is the class of hormone and includes naturally occurring progesterone as well as synthetic versions. Commonly when we say progestin we are referring to the synthetic versions.

Estrogens will suppress androgen production (testosterone) but using two avenues by taking one hormone/med that suppresses testosterone while the other supplies estrogen is more effective.

As an anti androgen some use spironolactone (used in the US) or cyproterone acetate [CPA] (used in Europe) or gonadotropin-releasing hormone (GnRH) agonist therapy, combined with estrogen therapy (transdermal or oral 17-beta estradiol). In general ethinyl estradiol is often avoided because of an increased risk of deep vein clots.

GnRH agonists work by suppressing the pituitary secretion of the hormone that tells the testes to make testosterone. These work pretty good, but are usually prescribed as a second line treatment because they are expensive.

Spironolactone, is the most widely used drug in the United States for transgender women. If you would like technical information, it competes with testosterone at the receptors, and also decreases the testes' production of testosterone. The recommended dose of spironolactone is 100 to 400 mg/day.

CPA is both a progestin (which suppresses gonadotropins) and an androgen receptor blocker but it's not available in the US yet.

Now about progestins. While progestins such as medroxyprogesterone acetate are sometimes used as to decrease the pituitary's production of the hormone that tells the testes to make testosterone, it's generally avoided in care for trans women and those who want to be gender neutral, because of some of it's risks that have been seen in postmenopausal women.

Finasteride, which is a med used for treatment of hair loss and enlarged prostates has been used to prevent testosterone from it's more active potent form (DHT), but if testosterone levels are already low, it doesn't work too well basically because it doesn't have anything to work on.

People who have intact testis usually need high doses of estrogen to suppress testosterone into the female range.

Typical regimens include:

●Transdermally, 100 to 200 mcg twice a week.

●Orally, 2 to 4 mg/day, occasionally as high as 6 mg (17-beta estradiol most commonly but also conjugated estrogens).

●In Europe, oral 17-beta estradiol valerate 2 to 4 mg per day is also used.

●Parenteral estrogens as shots or I think you call them jabs (estradiol valerate or cypionate) are sometimes used if target serum estradiol (E2) levels can't be reached with oral or transdermal forms.

So regarding the best progestin - that isn't the mainstay of treatment for what you are trying to achieve. Not sure if that answers your question. You can try again and ask in your first line to have your question addressed by an endocrinologist who is knowledgeable about hormonal gender manipulation.

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Brief Answer:
Thoughts on this

Detailed Answer:
This is interesting. I looked up what you sent me as well as searched for newer information on using progestins as a male contraceptive.

It is still in trials. So there aren't specific recommendations on dosage and form of progestin yet.

You asked if a progestin like Provera causes secretions in males. Do you mean production of semen? The idea is that progestin will feedback on the pituitary, telling the pituitary to not make the hormones that cause the testes to make testosterone and sperm.

Are you looking for a contraceptive to stop sperm production or are you looking for something to help feminize your body?

Regarding whether medroxyprogesterone totally shuts down semen production, I don't know unfortunately. This article from over a decade ago suggests that it would shut down sperm production and that's why it's being researched.

Regarding whether there are GnRH antagonist implants, I couldn't find anything on that. I could only find information on GnRH agonist implants.

But an endocrinologist might be more knowledgeable about that.

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Brief Answer:
Thoughts on this

Detailed Answer:
I didn't mean to out you - hope you are ok with that I asked.

I did some more looking into GnRH agonists and I see that there are some implantable ones such as Supprelin LA (histrelin acetate) which is approved to prevent precocious puberty. Trans adolescents use it to prevent cis-puberty too. I imagine it might just be a matter of time until a dose is figured out for what you are looking for, if it hasn't been done already, but it isn't in the medical literature yet.

If you haven't done so already, connect with any trans mtf community you might have in your area or online to discuss what people are doing and if there is a doctor in your area who has expertise in this area.

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Brief Answer:
Suggestion

Detailed Answer:

Hello,

I don't have colleagues/friends that have expertise in this area for adults. I know that on this website we do have endocrinologists that respond to some of the Ask A Doctor questions. If you are willing to repost your question the way to have one of them answer would be to write in the first line of your question:

FOR ENDOCRINOLOGIST SPECIALIZING IN GENDER DYSPHORIA ONLY. [And then rewrite the rest of your question.] Your question will go on the general list but when family doctors like me see that first sentence, they will leave it for an endocrinologist who has expertise in this area. Most of the doctors on this site are based in XXXXXXX (I happen to be one of the few XXXXXXX doctors) so it will likely be an endocrinologist from XXXXXXX You may need to be a bit patient once you put your question out there because we don't always have endocrinologists on the general site. So it may be a few hours. But someone should answer.

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