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Spironolactone, a synthetic 17-lactone steroid, is a potassium-sparing diuretic that also antagonizes androgen and progesterone receptors
.
It is approved by the U.
Spironolactone is also frequently used as part of gender therapy, and it is included in Endocrine Society guidelines as part of a hormone regimen for transgender women (male-to-female)
.
For transgender women seeking female physical characteristics, anti-androgens, such as spironolactone, can reduce muscle hypertrophy and male body hair growth, induce skin softening, alter body fat distribution, and cause testicular contractions
However, spironolactone carries an official FDA warning about possible carcinogenicity
.
The warning is largely based on animal studies using doses up to 150 times the human dose and has been found in the development of liver, testicular and breast adenomas
PubMed, Cochrane Library, Embase and Web of Science were searched from inception to 11 June 2021
.
Includes studies reporting cancer in men and women 18 years of age and older exposed to spironolactone
Seven studies met the eligibility criteria, with sample sizes ranging from 18,035 to 2.
3 million, and a total population of 4,528,332 (mean age 62.
6-72.
0 years; 17.
2%-54.
4% women in studies not stratified by sex)
.
All studies were considered to have a low risk of bias
Studies have shown that spironolactone use is not associated with a significant increase in cancer risk, but is associated with a reduction in prostate cancer risk, i.
e.
spironolactone is an important treatment for patients with acne, hidradenitis, androgenetic alopecia and hirsutism, and is unlikely to be associated with cancer risk significantly increased correlation
.
However, the confidence of the evidence is low and very low
Source: Bommareddy K, Hamade H, Lopez-Olivo MA, Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-analysis.
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