Sending good vibes to all of my trans comrades 
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HRT
my wife is geting fucked around by the NHS with her HRT. she moved here from anoher country while on HRT, got an NHS script for cyrpo and estradiol. then hey phone her up the other day and said 'sorry we have to cancel the cypro because a specialist has to prescribe this in britain'. now I know that high doses of cypro, of which stuff like 25mg or 50mg which most trans people take is a high dose, do have adverse long term side effects of spinal cancer and stuff like that, so that might be why? gut reacion ofc says institutional transphobia, but they didn't do anything abou the estradiol which is also ofc anti androgenising; so if it was just a transpobia thing they'd surely cancel the estradiol?
anyways, I told her to get her former doctor to forward relivant diagnoses and stuff, so we'll see. she has a doctors appoinment set up about this to plead her case. I am hoping the NHS is reasonable, because just denying somebody a medication they have been prescribed by a doctor is actually kind of fucked up regardless of transness or not
HRT
we both have stockpiles of HRT, so it's not like this is a pressing concern. it's just fucking annoying. immgration has enough paperwork as is
25 to 50mg are only a common dose for cypro if your endocrinologist is a fucking asshole who doesn't know what they're doing, which admittedly applies to most of them, but usually not to that degree. A common starter dose is 10-12,5mg, depending on the brand that you get, and it's usually no problem to halve that, at least after a few months in. I know a girl who takes 2,5mg per week (cypro has a half-life of several days) without problems and she's as high femme looking as girls get.
That said, cypro is also really good at quickly knocking down your testo, so denying it to her is absolutely awful. If you can't get it, monotherapy is a very valid alternative, but that requires fairly high estradiol blood levels to work well. Other options would be switching to spironolactone, leuproreline or bicatulamide (leuproreline has the least side effects out of all commonly used anti-androgens, but it's usually only used as a puberty blocker, for what are purely economic reasons - it's the most expensive out of all these medications).
As far as the science behind "only prescribing it through specialists" go, a fucking NHS gender clinic should be specialists in prescribing anti androgens, and the side effects are only a common issue with really long term use. If it isn't made unnecessary by bottom surgery, you can often taper off the CPA after a few years on HRT without elevating T again, as long as you get enough estradiol. If you regularly monitor how well your liver is taking the stuff, which is a normal thing to do if you're prescribed HRT anyway, it really shouldn't be a big deal. That said, it is kinda fucky in regards to depression in many people, and it just steamrolls people's libido. I'm glad i can soon get off the stuff for these reasons alone, but they should absolutely offer reasonable alternatives instead of just cutting out a central part of her medication without doing anything else. Just an all around awful decision, sorry she has to go through this.