I did the traditional path, started with Spiro, added E, switched off Spiro for Cyproterone (in my country its the next anti androgen if spiro isnt preferable or not working as mych). I didnt have any issues during that. I suppose I wish I was started on E faster but it wasnt that long either - it took me longer to decide if I wanted hrt at all than the two months from starting anti androgen to taking estrogen.

People will tell you and warn you about underdosing in the official system. My own personal experience, I was very happy with thr ramp up and Ive been happy at my current dose - there were a lot of mental and emotional changes I dont think I would've been ready for at the time and I had actually requested a step back at one point after crying at work a bunch. I also receive an adequate dose now anyway. There is good evidence that trans women should generally be getting higher doses for what its worth. When you go in to get your levels tested they will ask you how youre feeling - when theyre deciding on doseages for HRT, lab values are part of it but so is how you feel inside. If you tell them "oh everything is fine" but you dont mean it, they wont know and you might end up with a lower dose. Do not fawn and tell your doctor you feel fine at your current dose if you do not in fact like the progress, results or feeling at your current dose you have to tell them how you are actually feeling.

Spiro is a dieuretic, its gonna make you pee more. Its potassium sparing (it makes your kidneys change up what electrolytes theyre pushing out and reabsorbing), so you should be mindful of your potassium intake and levels but dont get anxiety over it, youll notice internally something feels off and youll get lab work to make sure everything is in balance. I did feel a little different because my blood pressure was lower than I was used to but I adjusted after about a week.

They will ask you about fertility preservation. I couldnt afford it but I still got tested to see if there was a reason to worry about it anyway. I dont regret not freezing personally, I am way happier.