Dr. Mary Claire Haver

So we're not gonna affect testosterone levels, we're gonna affect DHT levels.

How does spironolactone work?

Great question.

So spironolactone works by blocking production of testosterone and blocking the androgen receptor.

So it will affect your testosterone.

And so it's different.

And so that's why you will sometimes see sexual side effects from spironolactone.

And you will also see menstrual cycle effects from spironolactone in some people because you are now affecting the metabolism of estrogen in the body because you can't make estrogen without making testosterone.

So some people actually stop their menses when they take spironolactone.

Okay.

What about local activity of testosterone in the general urinary system?

So we've learned over the years that the dogma that the genitourinary system, the vulva and the vagina are only sensitive to estrogen is actually untrue.

So remember, I talked about the receptors.

There's estrogen receptors and androgen receptors all over the vulva.

And it actually is going to play a big role similarly to the way that the estrogens do in terms of blood flow.

I actually get really nerded out on this, that it helps to produce glycogen.

So that is a sugar.

That sugar is fed upon by lactobacilli, right?

Anybody who knows anything about the vagina knows lactobacilli.

It's the good bacteria.