HRT_FEM clinical practice

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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Doseline provides informational tools only. It is not a medical device and does not provide medical advice. Always consult a qualified healthcare provider.