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Ideally we’d like to use an androgen synthesis inhibitor. These stop the production of testosterone, but those drugs are either breathtakingly expensive or still in development. The one that’s approved is fifty thousand a year.”“That’s worse than the histrelin,” Glenn replied.“Exactly. Instead we start with an androgen antagonist. These block the action of the testosterone she produces, and are quite reasonably priced. Our first line is spironolactone. It’s a daily pill, available as a generic and costs only about twenty dollars a month.”“That’s quite a bit more reasonable,” Glenn remarked. “If it’s generic, there’s no co-pay. The insurance will cover it all.”“It’s well tolerated, however the drug’s primary use is to treat congestive heart failure or fluid buildup. Its anti-androgen properties are actually side-effects we exploit.”“So, the drug’s primary purposes become side-effects,” Glenn remarked.“I like to start patients like Jackie with a strong estrogen dosage, to jump-start. As we drove along Denise described the hot night club that wewere going to and how much I would enjoy myself. I found myselfbecoming more and more apprehensive about the night's upcomingevents. Finally I spoke up, "what am I supposed to do foridentification and money at this place"? Victoria smiled broadlyand turned to me, "oh, Hon, you won't have to worry aboutmoney." "And we have already taken care of your identification,so you're just fine," added Denise, both women giggled at thisexchange.The next stop was at a small night club in a seedy part of thecity. By now I was extremely nervous but felt somewhat protectedby the mere presence of these two women. It was about 8:00 PM aswe entered the establishment and I was thrilled to see that itwas virtually empty of customers. We were met by the doormanwhich Victoria seemed to know. She immediately cornered him tothe side in conversation. My tension was rising as the door mankept glancing over at me. Finally we were lead over and seatedat.
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