Some recent news via instagram (https://www.instagram.com/p/B9_qW56jegn/) had the internet raising concern around the use of spironolactone during the COVID pandemic. In brief, the theory is that spironolactone may make you more susceptible to coronavirus infection as it increases ACE2 receptor activity. The ACE2 receptor is how COVID gets into our body’s cells.
Sounds scary, right?
But on further review, we also know that spironolactone decreases angiotensin II which is a substance in our body that at high levels may be part of why COVID causes so much damage to our lungs.
So spironolactone may actually help protect your lungs if you were infected!
Clear as mud, right?
Really, what we can say is- we don’t have enough research to know if spironolactone interacts with coronavirus infection in either a harmful or helpful way. And we won’t have enough research to know that for quite some time. Recently, experts recommended continued use of medications similar to spironolactone in patients with heart, vascular, and kidney problems because those medicines help stabilize their conditions. Heart, vascular, and kidney problems put you at higher risk of complications from COVID; if your heart, vascular, or kidney problems are destabilized by a medication change (or anything else), you would be at even higher risk (https://www.nejm.org/doi/full/10.1056/NEJMsr2005760). As gender diverse people on spiro don’t necessarily have the same increased risk of heart, vascular, or kidney disease destabilization if they stop their spiro, each person should make the decision that’s right for them with the help of their healthcare provider.
You have to weigh the risk versus the benefits to you, individually, in light of the current data. For example, will stopping your spiro make your dysphoria so bad you feel horrible, maybe even suicidal? Are the other androgen blocking medications not an option for you? Or does being on a medication with so little knowledge around its interactions with COVID make your anxiety skyrocket and you would rather sit with potential dysphoria? These are all individual experiences that would affect what medical recommendations I would make for each person. Gender care (like all medical care) should be individualized to your specific goals and risk profile, that’s what we do at QueerDoc- expert, individualized gender affirming care!
