Hi Janey. Can I ask you a question? Do you think that taking 12.5 mg bicalutamide orally each day and estrogel (1.5 mg estradiol) topically on my head will be effective? People say that I need 50 mg bica and also dutasteride. I don't realize why I need dutasteride if I already use aa like bica.
TL/DR We just don't have firm answers related to dosages and even the necessity of bica or duta. We know that estradiol is needed for both health reasons, to avoid bone loss and other issues, and because estradiol appears to have a healing effect on follicles that AA's don't have. So AA's might halt hair loss and some of the hair still in cycle might remain viable, spoofing a regrowth of sorts but I don't think that full recoveries are possible without estradiol. MtF's need full recoveries because white female hair balds differently and they don't get receding hairlines. I would venture that 95% of the non-MtF's would be satisfied with my current hairline for life if it were in reach. For a guy, the recession still filling in is only in the corners of the temples and this type of recession impacts far less on looks. Look at Sting. He had significant recession on the temples but the rest of his hair was unaffected by baldness and he could grow it to female lengths easily. I think that is where I am now.
Those are good questions. I have gone back and forth on the dutasteride but I continue to take it because the actions of DHT are so unpredictable. Unlike regular testosterone, DHT can be fabricated in the face and scalp. My face issues only went away after beard removal removed the active follicles. Before that, even with HRT, I had constant dermatitis. Even some folks after castration, continue to have issues with DHT from the adrenals and possibly scalp assuming the beard is gone. I continue to take .5 mg. I would recommend it because it will usually at least keep you where you are even if you don't see much of a recovery. I have been planning to go through the DHT entry on wikipedia and essentially comment on the key points in a future post because DHT, and its back-door pathway are so mysterious and unpredictable. Maybe I can get to it this weekend.
Now I am a non-binary MtF. Looking at your proposed protocol, I am not sure if you are trans or cis because your estrogen intake is a little low for the cis-guys that I have seen have the best results but you aren't far off. All I do is scan the various boards and see what folks say on here and the reddit forums and differentiate mentally between cis-folks and transfolks but generally 12.5 mg bicalutamide, even every other day, and 2-4 mg of estradiol work for hair restoration and feminization. However, I have used Estrogel off and on during my several years of very slow incremental transition and I think Estrogel might work at lower dosages on the scalp where it might be more efficient and less feminizing and also provide slight improvement, i.e. marginal effects on regrowth or hair quality.
For folks who take a lot of estrogen and reach adult female levels of 200 to 300 pg/ml, or pico-grams per milliliter, they don't or shouldn't need an AA theoretically because there is no T any longer for reductase to act upon. Yet, I see questions from MtF's alleging re-masculinization even after regular or chemical castration. But you aren't there yet so your question is more complicated because bica isn't straightforward as an AA. It doesn't actually lower testosterone; it increases it but it spoofs lower T and higher E by occupying androgen receptors so you still have T but a large part of it has nowhere to go essentially, no receptors to attach to. For MtF's, I strongly advise against AA's because they are on meds for life and there's usually no hurry but for cis-guys, things are less straightforward and use of an AA might get you to the hair recovery stage quicker before you get discouraged and give up as often seems to happen. For cis-guys, it's important to do this for six months to a year before evaluating because hair cycles are slow and most meds take that long when new growth is the goal.
I know that none of this is very clear and that's one of the main reasons I started the thread. On a similar thread in the past, guys using AA's would keep switching because either they didn't see results in three months or less or because of the heavy sides. AA's are side-ladened and often more stereotypically feminizing than estrogen alone and they seem to cause sheds if not used carefully. I had a massive shed to baldness on spironolactone early last fall or rather the fall of 2019, followed by an all-but-complete hair recovery. It's taken 16 months but the spironolactone was working for my hair. It just put it all into catagen in three weeks. I call it a benevolent shed but for many cis-guys, it coud be cataclysmic if they don't stay on meds long-term. I quit spironolactone because long-term use of AA's especially by MtF's who stay on meds for life are problematic. spironolactone is pretty safe in the long-run but it has so many pernicious and stereotypical feminizing sides on things like strength, endurance, libido and potency that I quit using it and spironolactone is by far the number one complaint on MtF boards among Americans. It isn't used elsewhere for the most part.
I have been using medroxyprogesterone acetate, which is a type of AA, like reductaste inhibitors but not one of the "Big Three" AA's. For me, MPA has no sides or even has good ones. I noticed I was sleeping much less when I started MPA which gives me more time to devote to my labor of love, here. MPA, for short, also reduces T levels in a straightforward way. They just go down by somewhere between five percent and 20 percent at normal dosages of 2mg and 10mg. I had been taking 10 mg but my P.A. had a conniption upon receiving my very recent testing results (posted a couple of pages back) because I was at estrogen levels of the very highest encountered by cis-females during the first trimester of pregnancy, i.e. I was at ten times the levels needed for effective feminization. So, she stopped my MPA dosage temporarily. I will have to check the half-life because some meds like dutasteride and bica, I think, stay in the system for 40 to 60 days. I continue on one patch and she doesn't know about the Estrogel which I continue to use copious, unmeasured amounts of but I don't want my levels to plummet overnight because that can cause depression and it might negatively impact my incredible hair progress.
Even though cyproterone acetate and medroxy are similar chemically, cyproterone or CPA is one of the three AA's generally referenced, meaning it impacts on receptor binding not on general T levels like MPA. I recommend MPA before the three main AA's as it is very inexpensive compared to bica and for me, it seemed to lack jarring sides. AA's, for lack of a better term, can be jarring to the system by working too quickly perhaps and trigger hair sides If you pick one, barring sides, you really want to give it six months to a year. Also strangely enough, cis-guys probably want to test more than MtF's. We can just look in the mirror to evaluate because we have a life-time but you will want information on the precise E2 and T levels that either work or don't work for you, followed by titration, upwards or downwards.
There was an influential fellow,
@bridgeburn who did this for a couple of years without testing, purportedly to see what works for cis-guys but it didn't really work out for his cis-guy followers because he used essentially strong MtF dosing and there was no way for the cis-guys to do that in emulation without feminizing completely. He was influential still though because he provided two years of pics of an all but full hair recovery that allowed him to grow his hair to female lengths and that was rare and still is rare. That's why I try to emphasize incremental picture taking and posting for those confident enough. And when I say this about
@bridgeburn, I mean that his hair looked really good long, not just letting ragged male hair grow on the sides and back where it is mullety (my term) and in my case with my dermatitis made me look sort of like a hobo. I have five years of recovery pics and transition pics here, if anyone wants to see what the whole process from balding to bald to recovery can look like, together with beard removal here:
https://inpursuitoffeminity.blogspot.com/
Finally, we aren't sure necessarily if these meds work incrementally or if you have to get your estrogen levels up to adult female levels first, almost like a light switch where high levels of estrogen turn hair recovery
on meaning that you have to reach those adult female levels first before any substantial recovery. For me, I saw both types of meager improvement as my estrogen levels stayed middling but the hair really started coming in copiously when I pushed my estrogen levels above 200 pg/ml. Clear as mud? That's one of goals here to anecdotally compare among ourselves to see what is working. If you don't mind, I will paste your question on the main thread without identifying information because this is to me, the key question on the site, or three questions if you split it into a dutasteride, estradiol and an an AA question.
But the protocol that you mention sounds excellent and I think that it has plenty of bica. If you need more estradiol at some point, you can titrate upwards to somewhere between 2mg and 4mg. 2 mg is enough to reach target levels of E2 and T if used consistently although it might take you a year to get there. MtF's who don't care about breast growth can sort of flood their systems and throw the kitchen sink at it like
@bridgeburn did. (although pretty much completely feminized, he maintained male pronouns). In my opinion, most cis-guys are willing to accept some gyno for a full head of hair but they don't want full-blown breasts that can be noticed through clothes. The guys on here who have used bica, please chime in because I haven't used this med and am more familiar with spironolactone dosaging.