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Anti-androgens (i.e. spironolactone, bicalutamide, flutamide, finasteride) are also commonly used in trans women who have not had an orchiectomy. These medications block the effects of testosterone, resulting in decreased erectile function and allowing estrogen to develop typical female secondary sex characteristics. Finasteride, however, specifically targets dihydrotestosterone (DHT), not testosterone, so it is not as effective at lowering total testosterone levels.

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