I'm familiar with both bicalutamide and prometrium. Took them both pre-op and prometrium post-op.
Prometrium (micronized progesterone) is identical to the progesterone that our bodies naturally produce. It doesn't have all the negative side-effects of Provera (medroxyprogesterone acetate) like androgenic activity, mood disturbances, negative cardiovascular effects. It is also not associated with an increased breast cancer incidence amongst natal women. It is recommended to take Prometrium at bedtime because it will make you drowsy, sleepy at first until the body adjusts weeks later. Taking it with food increases its bioavailability (concentration/levels in blood) but may also increase its sedative effects so watch out for that. It has a short-half life so is advised to take twice daily BUT at lower doses, you can still take it once daily before bedtime. It may perhaps be taken rectally as well since it is similar to Utrogestan and the latter has been found to be effective that way. Taking it rectally will bypass the liver to a large degree and reduce the sedative effects associated with progesterone as it is metabolized much less and as a result, there is a much lower concentration of its metabolites, namely allopregnanolone which is known to also reduce anxiety. If taken with finasteride or dutasteride, the sedative effect can also be much reduced and even eliminated as both drugs inhibit metabolization of progesterone to allopregnanolone. Progesterone is mildly anti-estrogenic, as are all progestins, since it increases conversion of estradiol to weaker forms such as estrone and downregulates (decreases) estrogen receptors. Estrogen, on the other hand, upregulates progesterone receptors. Progesterone is not androgenic or anti-androgenic but has antimineralocorticoid activity similar to Spiro which means it reduces water retention, much more if taken non-orally as some of its metabolites (i.e. deoxycorticosterone) when taken orally, have the opposite effect. Progesterone may improve sleep, may make you depressed and lethargic if too much is taken relative to estrogen, may increase skin/hair oiliness, may strengthen your nails and make your hair/skin softer. It is known to increase fat accumulation. It also stimulates lobuloalveolar growth in breasts, makes them fuller, rounder, stimulates nipple growth, if I'm not mistaken and may assist estrogen in further developing areola and darkening it.
As far as bicalutamide is concerned, very few transsexual women take it but I personally like it a lot because its side-effects, especially at lower doses, is low as compared to some of the other anti-androgens, especially cyproterone acetate (Androcur). Liver complications may arise at much higher doses typically prescribed for prostate cancer patients but we don't need that much. I hope your doctor realizes this and the fact that it is a VERY powerful anti-androgen with much more blocking potency at androgen receptors vs spiro or androcur. It's half life is between 5 and 6 days and thus, can be taken every 2 or 3 days. It does not reduce androgen production and taken alone, actually increases it, thereby increasing estrogen concentration in the process as androgen converts to estrogen. But, its blocking power is so strong that anti-androgenic effects are still observed, so much so, that in males, bicalutamide monotherapy results in high rates of breast tenderness/gynecomastia (breast growth) up to 60%. Bicalutamide does not cross the blood-brain barrier. Sex drive, libido is usually not affected, nor are spontaneous erections but these will be affected if estrogen is added, of course. It's useless to measure testosterone levels while on bicalutamide since this anti-androgen does not reduce it, ONLY BLOCKS IT. Beware, it can make some quite lethargic and tired at first, even at lower doses, increasing sleep time significantly. This is probably because androgen is inhibited so strongly.
