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I've seen up to 400 mg (for people taking it as a diuretic, not for HRT). I guess you just have to be more careful about your potassium
Spironolactone is a potassium-sparing diuretic that works by telling your kidneys to excrete more water, it works on a specific part of the little tubes in your kidneys that reabsorbs potassium (I dunno why they're so ridiculous, you got parts that toss out electrolytes, parts that absorb some of them, parts that throw it out again, all along the same tube lol). Spiro ALSO has a nice amti-androgen effect that we take advantage of off-lable for feminizing HRT, it's mainly used by cis people for the diuretic effect. Just a nice side discovery that when cis men were on it for a while to help manage blood pressure they ended up getting boobs lol.
You have to be mindful of your potassium because your body is retaining more potassium than usual when you're on spiro, the more spiro the more it'll retain. So long as you eat healthy and your otherwise pretty healthy, taking spiro shouldn't do anything harmful - you should still get a lytes panel after getting spiro increased just to make sure your still in the right zone for potassium levels. Potassium is used for a bunch of cell signaling stuff all over your body, one of the big ones is in your heart - too high potassium can lead to heart issues (but it usually has to be really super high before anything noticeable).
i'm not an expert but i'm on 300 (blech) at the suggestion of my doctor, too afraid to change it, of course body weight/height/individual tolerances probably matter a lot
When you're playing Skylanders: Spyroβs Adventure. /j
Anyways, from my understanding, spiro doesn't lower T. It prevents T from binding to receptors (so T levels are less relevant). E is what lowers T if you are going the spiro route, but idk if sublingal/oral is that effective at it.
https://transfemscience.org/articles/spiro-testosterone/
subcutaneous injections, nsfw
I'm doing subcutaneous injections without an antiandrogen.
Within a week my ejaculation was clear.
Seven weeks in my testicles are back to pre-puberty size. This may have happened sooner but I noticed just last week.
Libido is much less frustrating. Aggression in check. Boobs growing.
I haven't had my levels checked but so far the results are way better than I expected.
Other people's timelines will of course be differet. But if you can handle injections it might be another option rather than bumping or switching antiandrogens.
A lady I know was having issues and so she had her testicles removed. That helped her a lot too.
Its an annoy game of small tweaks and hoping things work while waiting months between tests and lots of YMMV. Feels like the science could be better too, but I don't read primary literature in the field, so idk.