HRT_FEM clinical practice

EV + CPA (European Pathway)

Estradiol valerate injections with low-dose cyproterone acetate (CPA) anti-androgen. Standard in Germany, Netherlands, and much of Europe. CPA at low dose (6.25–12.5mg/day alternate days) provides potent androgen suppression with significantly lower meningioma risk than legacy high doses.

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 12.5 mg Cyproterone Acetate Low-dose maintenance — evidence supports equal efficacy to higher doses with lower meningioma risk
1 0 100 mg Progesterone (Oral) 100-200 mg at bedtime. Sedating — allopregnanolone metabolite. Added at Tanner stage 3-4 for breast maturation.

Rationale

Modern low-dose CPA protocol (6.25–12.5mg/day) has substantially reduced meningioma signal vs legacy 50–100mg/day. Do not exceed 12.5mg/day long-term. Monitor liver function annually. Prolactin monitoring recommended.

Compounds Used

Estradiol Valerate

estradiol_valerate · primary

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Cyproterone Acetate

cyproterone_acetate · ancillary

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Progesterone (Oral)

progesterone_oral · support

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Related Tools

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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.