Spironolactone is frequently used as a component of hormone replacement therapy in transgender women , especially in the United States (where cyproterone acetate is not available), usually in addition to an estrogen .    Spironolactone significantly depresses plasma testosterone levels, reducing them to female/castrate levels at sufficient doses and in combination with estrogen. The clinical response consists of, among other effects, decreased male pattern body hair , the induction of breast development , feminization in general, and lack of spontaneous erections . 
74 Secondly, this case is yet another of those all too frequent cases where, in order to impose a proper sentence on the Respondent, this Court has had to choose between the unfairness of unequal treatment of co-offenders and the injustice to the community of acquiescing in a second manifestly inadequate sentence because the Director of Public Prosecutions, while appealing in the case of the Respondent elected, or was not sufficiently organised, to appeal in the case of a co-offender. As the Respondent and Sayadi were both arrested on the same day and sentenced by the same judge some 2 weeks apart it is inconceivable that the Office of the Director of Public Prosecutions was not aware of the relationship between them. In that situation it is impossible to see any rational explanation for the bringing of an appeal in one case and not in the other.
Maple syrup urine disease, a disorder of branched-chain amino acid catabolism that results in abnormal accumulations of the amino acids and their metabolites, was suspected in a healthy infant born to a mother who ingested a paste prepared from fenugreek seeds early in labor. 30 Fenugreek, maple syrup, and the urine of patients with the disease share a characteristic odor originating from a common ingredient, sotolone. The seeds have been used in traditional medicine to augment milk supply in nursing women. The extent of transmission of fenugreek-derived constituents into breast milk is unknown.