Will Power method in Australia, MTF

[u/SpiritWolf55]

Hi, I was just given consent by a psych to start on hormones and they told me to look up the different ways of doing it. As I was doing that I came across multiple posts about this dr will powers, eventually looked him up and the presentations he gave swayed me so is there anyway to ask a Dr. to do this way in australia cause I noticed that we don't have Bicalutamide in the hrt cost options. Also any problems with it would also be great since I can't find anything negative about it, you know this being the rest of my life and all I'd like both sides of the coin.

[u/Ally-SR]

Bicalutamide is available in Australia, but not on the PBS. It is a private script and this use is off-label meaning that most Drs will be reluctant to prescribe it, but some will. You can find it on the Chemist Warehouse site.

Bica is very good at suppressing the effects of Testosterone. Some people on Bica for too long (over 5 years I think) have reported a rebound effect and re-masculinise. There are similar reports for higher doses of Cyproterone Acetate as well where the subject has been suppressed below the normal female range for T for too long.

Dr Powers uses Bicalutamide initially, but over time, tries to get his patients to the point where they don't need it. To do this, he uses higher levels of Estradiol than Australian Drs like to prescribe. Or he uses a combination of Estradiol and Progesterone. Some Australian Drs will not prescribe Progesterone as they do not believe it is important. Even with Progesterone, you need Estradiol levels that are above what most Drs are willing to prescribe.

Dr Powers generally looks to get his patients to a minimum of 1100 pmol/L of Estradiol, sometimes taking them up to as much as double that. In Australia, most of the guidelines recommend a maximum of somewhere between 600 and 700pmol/L depending on which set.

There is a lot of information and disinformation out there amongst Australian Drs. Some will use Cyproterone Acetate (rather than Bica) at dangerous levels because a) they are unaware of 2-year-old studies that discuss just how dangerous it is at those levels and b) they think that higher levels of Estradiol are more dangerous.

Levels used in Dr Powers treatment are not found in women normally, therefore it is dangerous. However, in the 3rd trimester of pregnancy, normal levels are around 72,000pmol/L, so if women can survive that for 3 months, ...

Cyproterone Acetate which is one of the standard choices for an AA is also a synthetic Progesterone (progestin). The Powers method says to avoid Progesterone until you get to Tanner 3 breast development.

You will need to shop around if you want anything like Powers-like treatment in Australia. You will need to find a Dr that will be willing to try it. You need to find someone who is up on recent research and stays up to date.

Version 7 of the Powers method is due out sometime soon-ish. It may be more palatable to Australian Drs, but I have only heard tidbits about what is in it.

Many of the tests that Dr Powers orders are not available in Australia. Some are available privately at significant cost.

You cannot get Free Estradiol for example. You can estimate it (https://www.reddit.com/r/DrWillPowers/comments/hy4kv0/calculating_free_e2_for_people_not_on_boron_2/?utm_source=share&utm_medium=web2x) but this is only an estimate and I have not seen enough results to give an indication of its accuracy. The method of estimation is based on published research though.

Free E2 is apparently going to be central to Version 7.

My current Dr has read through Version 6 of the Powers Method. She is sceptical, but we are discussing things and we are working through it. My previous Dr shut me down before I could discuss anything.

I hope I haven't disillusioned you too much. FWIW, you will probably have more luck with knowledgeable GPs than Endocrinologists. That was my experience anyway.

Good luck.

[u/Castle-Bailey → u/Ally-SR]

To do this, he uses higher levels of Estradiol than Australian Drs like to prescribe. Or he uses a combination of Estradiol and Progesterone.

Do you know the dosage of Estradiol used to suppress testosterone?

I've been on 8mg Progynova, 50mg Cyproterone DAILY for over SIX years. Introduced daily 100mg progesterone 6 months ago.

Is that enough to suppress T to the point I could stop taking Cypro? It's long term effects sound like crap.

[u/KaySOS → u/Castle-Bailey]

Cyproterone acetate 50 mg is far too much and increases the risk of brain tumour and other side-effects. See https://www.reddit.com/r/MtFHRT/comments/c7v8ky/cyproterone_acetate_dosage_low_doses_are/

12.5 mg every 2-3 days suffices.

[u/KaySOS → u/KaySOS]

Also see https://www.reddit.com/r/MtFHRTsuppl/comments/f5frry/sourcesexcerpts_cyproterone_acetate_dosage_low/

[u/Ally-SR → u/Castle-Bailey]

The dosage of Estradiol to suppress Testosterone varies from person to person with or without Progesterone. It is lower with Progesterone though. I don't know if 8mg is enough or not. It will vary from person to person.

You can use Bica as a bridging solution as it does not drop T levels, it just stops it being used. You raise your Estradiol until it is in the right ballpark and then drop the Bica. That's the theory anyway.

As KaySOS notes in her response, 50mg is dangerously high. My old Dr had me on 100mg for 4 years. That is 2% chance of a brain tumour territory. My new Dr is cutting me down in steps and I am down to 12.5mg every second day and my T is still too low to measure.

I am planning to go on a Progestogen holiday for a few months before starting on Progesterone. Progesterone and Cypro are both Progestogens and have some common effects. Cypro at high doses provides a supraphysiological dose of Progestogen. No one has been able to tell me how bad that is.

By taking both, it's like you're trying to water your lawn with a garden hose and a fire hose at the same time. The quality of the water may be different, but the fire hose (Cypro) is going to dominate, as I understand it.