Transfem

Nice, I don't know doses well for patches but I've heard it's not a bad method. The main problems I hear are that they can come off and be expensive to replace, they can cause rashes and irritated skin, and sometimes there can be poor absorption / lower-than-ideal blood levels from patches (better than oral, though!).

I never considered patches because my skin is very sensitive and I am often rough on my body and I think I would lose patches due to daily activities (exercising, soaking in hot baths, brushing up against things when doing manual labor, etc.).

Cypro sounds better than spiro, but reading about it I don't like the idea of taking a synthetic progestogen, since it causes increased risk of blood clots and breast cancer:

https://transfemscience.org/articles/transfem-intro/#cyproterone-acetate

As CPA is a progestogen, it is associated with increased risks of breast cancer (Fournier, Berrino, & Clavel-Chapelon, 2008; CGHFBC, 2019; de Blok et al., 2019; Aly, 2020; Wiki) and blood clots (Seaman et al., 2007; Connors & Middeldorp, 2019; Aly, 2020; Wiki) even at very low doses (e.g., 2 mg/day). Higher doses of CPA, likewise presumed to be due to its progestogenic activity, are additionally associated with elevated prolactin levels (Sofer et al., 2020; Wilson et al., 2020; Wiki) as well as with certain generally non-cancerous brain tumors including prolactinomas (McFarlane, Zajac, & Cheung, 2018; Nota et al., 2018; Wiki) and meningiomas (McFarlane, Zajac, & Cheung, 2018; Nota et al., 2018; Millward et al., 2021; Weill et al., 2021; Aly, 2020; Wiki). These risks appear to be dose-dependent, and thus are likely to be minimized with lower doses of CPA. Besides risks related to its progestogenic activity, CPA at high doses has shown weak but significant androgenic effects in the liver and has been associated with an unfavorable influence on lipid profile, for instance decreased HDL (“good”) cholesterol levels (Coleman et al., 2022; Wiki). Long-term, this could result in an increase in the risk of coronary heart disease. Other potential adverse effects of CPA at high doses with unclear mechanisms may include increased blood pressure and heightened insulin resistance (Martinez-Martin et al., 2022). Additionally, CPA has been associated with abnormal liver function tests and rare cases of liver toxicity, including at doses used in transfeminine people of 25 to 50 mg/day (Heinemann et al., 1997; Bessone et al., 2016; Kumar et al., 2021; Wiki; Table). The likelihood of abnormal liver function tests with CPA, and probably of liver toxicity, appears to be much lower at doses of less than 20 mg/day (Wiki). More than 100 cases of clinically significant liver toxicity have been reported with CPA, but only two cases have been reported with CPA at doses of 50 mg/day or less (Wiki; Table). Monitoring of prolactin levels to detect prolactinomas, and monitoring of liver function to detect liver toxicity, may both be advisable in people taking CPA. Regular magnetic resonance imaging (MRI) scans have also been recommended to monitor for meningiomas in people taking CPA (at ≥10 mg/day) (Aly, 2020).

I wouldn't be too worried about it, but I'm just glad I can avoid that risk entirely with estrogen monotherapy (and in the long term with surgery).