When I started medically transitioning, my doctor at the time wasn't too confident about prescribing HRT himself, so he gave me a prescription for spironolactone and referred me to a doctor he worked under who has an interest in trans health.
That doctor gave me estradiol on my first visit, and it's been a series of appointments about 2 months apart since to adjust dosages. A few months in, there was a massive shortage of spiro in my area, so I switched to cyproterone for androgen suppression at one quarter of a 50 mg tablet a day. The tablets are hard to break that small without them turning into powder, so when he mentioned we could up it to a half tablet, I figured, sure that will make it easier, so we upped the dose.
I've had issues with low (nonexistent) libido since starting HRT, and hoped starting progesterone at 6 months would help. It did not. The only other thing I found that could cause it would be having your T be too low, so we talked about adding that to the mix, but T wasn't in my last batch of bloodwork, so he sent me to get more blood drawn and we'd talk at my next appointment.
At this point I finally got my first appointment at the trans health clinic in my city and they pulled up my bloodwork and pointed out that my T being so low it couldn't be detected at all is because when they prescribe cyproterone they start at a quarter tablet a day, and go down from there, often ending up around a quarter tablet a week!
I am so mad at my doctor who, even at the trans health clinic, has a good reputation for knowing about trans health, but also at myself beacause I didn't look into dosages for cypro. I had looked into everything else I've been taking for HRT, and beyond my doctor saying taking progesterone rectally rather than orally doesn't significantly raise bloodstream levels, everything else has lined up. My wife and I aren't super horny people, but if I had looked into this one medication like I did the rest, our sex life wouldn't be on the critically endagered list!
TLDR; My doctor has been giving me a cypro dose 4-14x what most people seem to need and it's killed my sex drive/life for months
I had been on a fairly low dose of spiro for a little over 2 years and recently asked my doctor if I could discontinue it. She said it should be safe since my testosterone levels had been suppressed for so long and estrogen alone should keep it down now; my last labs coming out to 11ng/dL.
I never really had any issues with it, but I started a new medication that also had the chance to interact with my water/salt levels and wanted to avoid potential complications. It's been 2 weeks so far, and I haven't noticed any rebounding effects... though apparently it can take anywhere from 2-12 weeks for anything noticeable. I've also had absolutely zero libido since transitioning (progesterone didn't help), so waiting to see if that returns and how my next routine labs come out!