...issue with Spiro is that upping her dose makes her very tired and groggy throughout the day. This week, she's been trying taking 2 one day and then 3 the next,

This is fine. I'm assuming she typically splits the total daily dosage so she's taking it about 12 hours apart? The half life is about 12 hours so this is the way you're supposed to do it. Again, more consistent levels are best for this. She could split the dosage so that she takes 1/3 in the morning and 2/3 at night. This might be more helpful for reducing grogginess.

I actually do personally take Spironolactone as a diuretic and only take it at night which is uhhhhh not what you're supposed to do if you're using it as an antiandrogen.

However, recently it's been making her nauseous, so I suggested that she look into boofing it.

Honestly, go for it. It absolutely works better as a suppository, but it also comes with a higher chance of negative side effects like depression or anxiety. It also typically has a much stronger sedative effect when taken via this route so do it pretty much immediately before bed. Watch out for a lowering of mood and if you do notice that, just switch back to the oral route.

If it's the micronized estradiol capsule that looks like a rugby ball, she can just shove it up there about an inch or two. Like, to the second knuckle of the index finger.

Fuck synthetic progesterones though. These are much more strongly associated with low mood and I'm not sure which if any can be successfully used as a suppository.

I'm really glad she's got a great healthcare org! Having providers that actually give a shit about their patients is so important and upsettingly not universal.