EV + Bicalutamide Pathway
Estradiol valerate with bicalutamide non-steroidal anti-androgen. Bicalutamide blocks androgen receptors without affecting LH/FSH or testosterone production — testosterone remains high but its effects are blocked. Liver monitoring required. Growing in popularity as a spironolactone and CPA alternative.
Duration
—
Steps
3
Total Weeks
—
Route
IM
Protocols
3
Source
clinical practice
Protocol Timeline
| Step | Weeks | Dose | Compound | Note |
|---|---|---|---|---|
| 1 | 0 | 4 mg | Estradiol Valerate | Most common starting dose. E2 target: 100-200 pg/mL. Every 5-7 days. |
| 1 | 0 | 50 mg | Bicalutamide | 50 mg daily. Full prostate cancer dose. Very long half-life (~5.8 days). Monitor liver function. |
| 1 | 0 | 100 mg | Progesterone (Oral) | 100-200 mg at bedtime. Sedating — allopregnanolone metabolite. Added at Tanner stage 3-4 for breast maturation. |
Rationale
Monitor liver function (AST/ALT) at baseline, 3 months, 6 months, then annually. Bicalutamide 25–50mg/day. Testosterone levels remain elevated on bloods — this is expected and not a sign of treatment failure.
Compounds Used
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