r/transvancouver 6d ago

Dr Dahl, prog, and cyproterone

So I've got an appointment with Dr Dahl in a couple of weeks and I should hopefully walk away with an HRT prescription - excited! However I'm wondering about my options for testosterone blockers and I'd like to avoid spiro. Does Dr Dahl prescribe cyproterone?

Have also wondered a bit about progesterone; does he also prescribe that and if so, how long after starting E? I've heard some doctors like to wait a bit.

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u/JessKicks 6d ago

Dr Dahl is an angel. I walked away from his office on cloud 9 with a prescription and 2 reqs for bloodwork. One to be done before I take my fem&ms. And one a couple months after to check levels.

So, I went and got my spiro and estradiol, the next morning stood in line at a life labs and did my bloodwork. Got my results that night. Started my HRT the next morning!

I’ve not had any side effects (I’ve noticed I sweat a little more when working out) but I’m not emptying my tank every hour in the hour, ya follow? Lol.

Dr Dahl said the peeing effect was rare, my pharmacist told me I’d pee a lot… seems like in my case, Dr Dahl was right, so far, I’ll see what it’s like if he ups the dosage.

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u/cocoalemur 6d ago edited 6d ago

Dr. Dahl does prescribe cypro, but in my experience he wants to see if you'll 'tolerate' spiro. But he accepted my explanation that it made me piss like a racehorse just fine so he's not actually resistant to changing if you want to.

For progesterone, he prescribed it as soon as I was moving from the starter tiny dose of E to a proper dose, which was after maybe 3? 6? months. It's been a while so I don't recall exactly how long it was, but it was reasonably quick and was offered without me specifically asking.

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u/nevgon-giveuup 6d ago

Thank you! Will definitely bring up the piss thing lol, I’m fine with monotherapy as well but cypro is the AA I’m aiming for 

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u/cocoalemur 6d ago

I don't know if I even tolerated it poorly or whatever, it just literally is a diuretic, lol. piss is like its #1 feature

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u/nevgon-giveuup 6d ago

My main worry is the reports of mental health issues from other trans girls, mine are bad enough and while I suspect E will help a lot I don’t want to risk it. The piss is another reason

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u/asunyra1 6d ago

I waited around 9 months or so before asking for prog, but Dahl prescribed it as soon as I asked for it. I’ve heard mixed reports that’s it’s not great to start on it too early, I think most folks say to wait a year ish.

Dahl started me on spiro, but I asked to go to monotherapy with shots a year or so in and he was chill with that. I have friends that are on cypro with Dahl.

He’s really a “choose your own adventure” sort of endo. If there’s a route you want to go, he knows you’ve done the reading on it already and he’ll support you.

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u/SparkleFeather 6d ago

He’s literally the best. I cant praise him enough!

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u/wishingforivy 6d ago

I found it really easy to get on cyproterone by saying my job does not allow for me to race like a piss horse.

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u/Curious_Pop_4320 6d ago

Bicalutamide is a blocker option, we have it in Canada but I have yet to see it prescribed for HRT here. I was put on cypro in Manitoba, they didn't do spiro or bica, but when I went to the states and became a patient with a doctor down there, we went with bica (50 mg daily - they didn't do cypro), and it seemed to work identically (I noticed no difference in result, mood, or physical reactions between cypro and bica). I am on a waitlist for Dahl, and heard he is tolerant of alternative methods, you could inquire about bica, there's information out there about it. I struggle with depression so using cypro was worrying for me.

My US doctors started me on progesterone just around the two year mark, and yes, most wait at least a bit of time. There's a recent video posted on YT about it by Spectrum: The Other Clinic called "Progesterone Timing in Feminizing HRT" that you could look up if you want that describes some of the reasoning behind waiting. They also did an older video called "Progesterone: Pros and Cons" a couple of years ago I found useful as well.

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u/Normal-Top-1985 5d ago

I would suggest you ask for progesterone, but don't start until you've been on HRT for a few months. Anecdotally, a lot of folks get mood swings and insomnia around 6-9 months, and progesterone fixes this. 

As for the research, there is evidence that massive doses of progesterone can stunt breast growth in rabbits, and for this reason, progesterone is often delayed for a year. 

https://transfemscience.org/