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.

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.

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.

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.

Spiro is the classic, but be warned: if you drink anything you will pee it back out within about 2 hours.

thanks for your advice @AcidSmiley@hexbear.net and @kristina@hexbear.net, i’ve decided to do mono with injections after discussing it with some other trans hexbear users i know

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.

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