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In the Transgender Hormone Therapy section it's mentioned that CPA has "an advantage over spironolactone as an antiandrogen in transgender people, as the combination of estrogen and CPA consistently suppresses testosterone levels into the normal female range whereas estrogen with spironolactone does not.". Unless I've got this wrong, this is technically both a true and false statement: CPA does reduce androgen production far more than Spiro, however it is not an advantage because their respective modes of operation are completely different (in the context of transgender hormone therapy): Spiro works to block the androgen receptors throughout the body, whereas CPA stops the production of the androgens to begin with. Therefore naturally you would see differing androgen levels in people taking CPA vs Spiro, but that's not helpful; you need a different metric to compare the feminizing capability of these medications. Aspenpaw (talk) 06:35, 19 November 2024 (UTC)[reply]
25 fold increase in brain cancers requiring surgery w/prolonged use.
Seems strange that there's no clear warning that (per several studies) there's a very high excess risk with long term use of CPA of meningiomas requiring surgery. An increase of nearly 25 times per a 2024 study of all French medical records - (OR, 95%CI: 24.54 (20.85 to 28.88)) (4.9% of 18k on CPA vs 0.3% of 90k not on it). https://www.bmj.com/content/384/bmj-2023-078078 (cites 3 other studies) I guess regulators are slow to respond.
A 4.6% excess risk makes it a common side effect, not a rare one, yet the article lists it as a rare side effect. A 6-fold increased risk of meningioma is seen with low (3-36 g) doses. RememberOrwell (talk) 02:38, 8 December 2024 (UTC)[reply]
Common, deadly side effects don't deserve less prominence than rare, non-serious ones. Deleting content isn't moving it. Brain tumors merit more prominence, and merit plain English; reverted to 'brain tumor'. RememberOrwell (talk) 08:49, 8 December 2024 (UTC)[reply]
Hi, it seems you are referring to my edit that you reverted regarding this issue. Let me explain my reasoning for my changes and hopefully we can come to an amicable solution on this.
Firstly, I wanted to remove your inclusion of specific percentages & at what dosages these rates occur. I did this because it is worded very awkwardly right now, no other side effects have this specificity, and there is a dedicated section further down the article where such detail would be much more appreciated - including a full table (This is a very well-crafted article imo). It is my understanding that such details isn't warranted in the lede here.
Secondly, I specified what kind of tumour is being referred to. You say it merits 'plain English' however in the interest of being informative, particularly about a medication where potential patients may be researching, I think specificity is very important here. If they are not familiar with intracranial meningioma, we are providing them with the oppurtunity to click the link to the relevant article to learn more. Obfuscating the exact side effects here isn't helpful, and if it deserves prominence it also deserves clarity.
Your edits are well-meaning and so are mine, I hope you can see my edits are also well-reasoned and I fully believe the lede is strengthened with these small edits to your edit. NameName-Me (talk) 02:45, 9 December 2024 (UTC)[reply]
I see lots of common ground. Perhaps we agree on :
1.It would make sense and is typical to mention minor side effects in the body, not the lede.
2.The lack of specificity of side effect frequency is a deficiency.
3.Mention of breast development and feminization should be in the lead because they are often desired effects when it's used for transgender hormone therapy not because they are side effects when it's used on-label.
4. Use both, thus: "meningioma(a brain tumor)." This provides the clarity of plain English and specificity we each champion.
5. You said of the %ages that they are a "detail more suited to the body of the article as opposed to the lede" yet you didn't move them. Your deletion was severely obfuscating the exact side effects...an effect which, as you've pointed out, isn't helpful. As I noted, twice, "Deleting content isn't moving it." Yet I see no explanation of your reasoning for that outright deletion.
6. It's worth mentioning in the lede that about <<blink>> 1 in 20 to 50 users will need brain surgery, or something to that effect? Notably, death is a common side effect of meningioma surgery.
