The following protocol emerged: (credit
/r/estrogen)
Each step should be separated by a few weeks to find the minimal set of changes needed:
- [1] Stop progesterone to starve the backdoor pathway
- [2a] If not on bicalutamide, replace your current AA by just bicalutamide
- [2b] If already on bicalutamide, try to raise bicalutamide dose (given the binding affinity)
- [3] Add dutasteride to bicalutamide. do not use finasteride as an alternative to dutasteride as it doesn't block all isoforms of 5AR
- [4] If the problem persist, check DHEA levels or the androsterone to etiocholanolone ratio to confirm the adrenal origin through the frontdoor pathway which shouldn't be operating
- [5] WORK IN PROGRESS
At step 5, if the adrenal origin is confirmed, adding spironolactone or low dose dexamethosone are being investigated as alternatives to abiraterone. Nothing of that can be recommended yet as a step 5. We will know more after the literature review
Still, if you suffer from high DHT or signs of remasculinization, please try this.