Spiro should honestly not be recommended for 99% of people. I only use it because most other anti androgens have progestergenic effects, and I had liver concerns with high blood pressure. I would’ve changed by now, but I won’t even need t suppression soon.
Edit: should also mention that I’m injecting e as well. I started spiro first, as I was initially denied HRT for backwards ass reasons. When I finally started, injections were an easy choice.
seriously, it’s insane that spiro is used so much - it’s a weak anti-androgen to start with, and the side effects are so common and potentially dangerous (I feel like everyone I talk to that takes spiro has a horrible time on it - the only person I can think of who had a good experience is Mia Violet).
Meanwhile, injecting bioidentical estrogen with monotherapy doses is relatively harmless (the biggest harm I guess would be from needle injury, infections, etc. - easily mitigated by following standard / best practices, something diabetics have to do as well).