It's no so black & white unfortunately. Bica over time seems to bring renasculinazation and all the negative effects that it helped combat in the first place just maybe because all these free T are here, up to twice as much and then AR upregulation brings you downhill? And because blood work provides no indication about what it does at the AR level you are left guessing what's next. Only CPA provides hormonal feedback. This doctor provides many anecdotal facts based on his patients. He also tends to attribute things that were published in the recent literature as its own inventions. Granted his colleagues are even worse by just lazily following WPATH guidelines. His recommendation on P4 is very arbitrary too. I adopted his "method" switching from spironolactone to Bica and got those negative effects a few months later.
I don't believe in monotherapy to fight hairloss. E2 local seems to work well but that's not enough. I am back on spironolactone but contemplating Bica (or Enza) with Eplerenone in combination with E2.
I check my blood levels monthly.
@JaneyElizabeth You sound a responsible person why don't you? I will add DHEA test and figure out if I am getting DHT production from the adrenal gland (backdoor pathway) then experiment by gradually increasing abiraterone acetate dosage (in conjunction with prednisone). Crossing fingers that I don't have to do that but still monitoring.
Topically I am on similar regimen as
@Pegasus2 and this has helped in the neogenesis department.
As for estrogen: E3 topical on scalp. E2 injections subq. E1 E2 E3 P4 on face. Optionally P4 & E1 on breasts.