for context im in my early 20s and in a decent material condition rn so getting the AA isnt the problem, it's just deciding which to get

CW: mention of alcoholism

so a friend recommended bica and i was pretty much just about to get it until i saw in the warnings section (on this website: https://healor.com/bicalutamide_mtf) that it said "Do not use or use with caution if you drink heavily" and since i'm an alcoholic (and have been for quite a long time, tried to quit a few times but always started drinking again) i think that i probably shouldn't go with it.

so since i'm probably not going to be doing bica because of the alcohol related warning, what type of AA would you people advise i get instead?

edit: also how bad could it be if i just went ahead with getting bica anyway, is it worth just trying that out despite the alcohol risk? because it seems to be the best for what i want out of hrt that isnt ludicrously expensive

  • AcidSmiley [she/her]
    ·
    11 months ago

    I think bica has some risk of liver damage and that's why it is contraindicated in case of alcoholism? The same would also apply to cyproterone acetate. Liver health is monitored during regular blood work and normally that makes the risks to the liver from these medications very manageable, but in your case, i think monotherapy is an option you should definitely look into.

  • MYWNcWR9Rgc31zkhTOsA [they/them, she/her]
    ·
    11 months ago

    If you do decide to try monotherapy, gel is unlikely to give you blood e levels high enough to suppress testosterone production if it's applied as directed (upper arms and thighs) https://transfemscience.org/articles/high-dose-transdermal-e2/ You can get higher levels by applying it to your scrotum, but it's quite irritating https://transfemscience.org/articles/genital-e2-application/

    If you want testosterone suppression without an AA, E injections are generally the best option. Vanna pharma is based in the uk and is reputable (not sure if I can post a link here, but the url is on diyhrt.cafe). Her product has a lower viscosity than Lena's so you can get away with 29g fixed needles (higher gauge = thinner needle = less pain). You might need 27g or even luer syringes with a low gauge needle for drawing and a higher gauge for injecting if you order injectable e from elsewhere.

    Here's the 27g needles I used to use with Lena's EV https://www.exchangesupplies.org/shopdisp_unisharp_fixed_1ml_green_27.php
    Drawing the product from the vial can blunten the tip a little, so occasionally an injection would be a little difficult and painful. It could also take several minutes in winter to draw 0.18ml into the syringe due to the higher viscosity.

    Here's the 29g I use with Vanna's EV https://www.exchangesupplies.org/shopdisp_Unisharp_fixed_1ml_yellow_29.php
    These are thinner and I'm yet to have a painful injection. It takes around 15 seconds to draw 0.18ml at current temperatures (5-15C).

    There are several different esters of estradiol available for injection https://transfemscience.org/articles/injectable-e2-meta-analysis/ , but the most common one is estradiol valerate which is often dosed at 0.18ml of 40mg/ml solution (0.18 x 40 = total dose of 7.2mg) every 5 days. Ideally you'd get a blood test after a couple of months so that you can check your levels and adjust your dosage accordingly.

  • CrimsonSage [any]
    ·
    11 months ago

    If you can stand the needles I would just go straight to monotherapy. I take .125 ml 2x per week of 20mg/ml EV per week and have had good results.

    • AcidSmiley [she/her]
      ·
      11 months ago

      Glad to help and yeah, that sounds like a solid plan. Just avoid taking your e in pill form, that also puts additional strain on the liver that you do not have with injections or gel.

  • kristina [she/her]M
    ·
    11 months ago

    seconding trying estrogen monotherapy and/or spiro if you have a history of alcoholism. bica is generally considered to be the last line of defense if other meds dont work out well for you.

    • HornyOnMain
      ·
      11 months ago

      i was looking at it and it seems fine but it says that its the slowest acting form of AA there is, which is dissappointing

      • kristina [she/her]M
        ·
        11 months ago

        i think this is overthinking it a bit. i had close to zero T within a month of spiro. very much a ymmv especially on dosage

  • die_livster@lemmygrad.ml
    ·
    11 months ago

    hey, when i lived in england i was on bica - you can get it shipped from turkey, india, and russia (tho russia requires ALLEGEDLY circumventing sanctions). bica was pretty good for me because you only have to take 1 pill every 4 days.

    you can get your liver enzymes checked for free by your gp if you do decide to get on it, personally my liver enzymes didn't change one bit on it. and also there are people on reddit claiming that liver toxicity from bica isnt real (https://old.reddit.com/r/MtF/comments/vbv5mg/will_bicalutamide_cause_liver_toxicity/icbzzlc/)

  • What_Religion_R_They [none/use name]
    ·
    11 months ago

    Worth considering Buserelin nasal spray. Russian pharma industry made it relatively inexpensive to get delivered. Although since you're in the UK idk how that would work

  • Targuinia [she/her]
    ·
    11 months ago

    GnRH agonists like triptorelin might be an option as well, they generally have few side effects and they don't have risk of liver damage AFAIK, so they're starting to become the default blockers used in (parts of) mainland Europe. They might run too pricey if you have to pay yourself though.