Are there gestagens similar to CPA?

Not all progestins are created equal. See the table on the pharmacodynamics of progestogens for on- and off-target effects.

CPA is used because it has absolutely excellent antiandrogenic (AA) effects (that ++ in the AA column). It does has glucocorticoidal effects but I suppose it's a compromise with being an excellent AA.

MPA I wouldn't recommend, it has androgenic effects and glucocorticoidal effects, both not good. Glucucorticoidal effects are especially worrisome long-term has they carry all kinds of nasty systemic side-effects.

Three progestins of note are

  • Drospirenone, both AA and and antimineralocorticoidal (AM) effects.

  • Dienogest, moderate AA effects and little else

  • Nomegestrol acetate, moderate AA effects

The problem will be to find those as standalone medicine. I don't even think they exist in this form. They are almost always combined with ethinylestradiol(bad) or estradiol/estradiol acetate (ok). They are certainly not as good AAs as CPA.

I mostly reiterate the same comments I made a while ago in this thread.

/r/AskMtFHRT Thread