Estradiol is stimulatory/excitatory, progesterone has a calming effect thus the former may exacerbate epilepsy, the latter reduce it. The important thing is stable levels. In your case, taking both may be beneficial. Other than bio-identical progesterone, other relatively safe progestins (according to the literature) to take are dydrogesterone and hydroxyprogesterone caproate. Bio progesterone is especially beneficial due to its sedative effects (on top of its anti-estrogenic actions). This is because of the actions of its metabolite called allopregnanolone. Provera (medroxyprogesterone acetate) may exacerbate epilepsy.
Apparently, some forms of epilepsy are estrogen (sex hormone)-dependent (catamenial), some aren't so that those that are dependent would likely benefit from a good balance between estrogen and progesterone.
Some drugs for epilepsy may increase metabolization of estrogen and progesterone taken orally (like carbamazepine), hence it could be preferable to take non-orally BUT progesterone taken orally produces much higher levels of allopregnanolone, responsible for sedative (positive) effects. Finasteride/dutasteride reduce allopregnanolone concentrations and as such, should perhaps be avoided in your case. I'm not a doctor so please discuss this with an expert before doing anything.
I read of one transwoman whose epilepsy stopped after her sex reassignment surgery.
Doctors concluded epilepsy was due to trauma of being a "man", not feeling right in her body.
Also, it has been known for a century, almost, that a ketogenic diet can improve seizures where drugs fail. You can watch the movie "First Do No Harm" (1997), it features the well-known actress Meryl Streep.
Front Pharmacol. 2012 Apr 9;3:59."The most notable example of a dietary treatment with proven efficacy against a neurological condition is the high-fat, low-carbohydrate ketogenic diet (KD) used in patients with medically intractable epilepsy. While the mechanisms through which the KD works remain unclear, there is now compelling evidence that its efficacy is likely related to the normalization of aberrant energy metabolism."
"The ketogenic diet (KD) is now a proven therapy for drug-resistant epilepsy (Vining et al., 1998; Neal et al., 2008), and while the mechanisms underlying its anticonvulsant effects remain incompletely understood (Hartman et al., 2007; Bough and Stafstrom, 2010; Rho and Stafstrom, 2011), there is mounting experimental evidence for its broad neuroprotective properties and in turn, emerging data supporting its use in multiple neurological disease states (Baranano and Hartman, 2008). Even in patients with medically refractory epilepsy who have remained seizure-free on the KD for 2 years or more, it is not uncommon for clinicians to observe that both anticonvulsant medications and the diet can be successfully discontinued without recrudescence of seizures (Freeman et al., 2007). This intriguing clinical observation forms the basis of the hypothesis that the KD may possess anti-epileptogenic properties."
"There is no longer any doubt that the KD is effective in ameliorating seizures in patients, especially children, with medically refractory epilepsy (Vining, 1999; Neal et al., 2008; Freeman et al., 2009). After its introduction in 1920, the KD was used as a first or second-line treatment for severe childhood epilepsy."
"The KD has now become an integral part of the armamentarium of most major epilepsy centers throughout the world (Kossoff and McGrogan, 2005)."
"Kang et al. (2007) reported that the KD was both safe and effective in 14 pediatric patients with established mitochondrial defects in complexes I, II, and IV, all of whom had medically intractable epilepsy. These authors observed that half of these patients became seizure-free on the KD, and only four patients failed to respond."
Neurology. 2014 Jul 22;83(4):345-8."To determine whether allopregnanolone (AP) may mediate seizure reduction in progesterone-treated women with epilepsy."
"The findings support AP as a mediator of seizure reduction in progesterone-treated women who have a substantial level of perimenstrually exacerbated seizures."
Horm Behav. 2013 Feb;63(2):267-77."Epilepsy is the third most common chronic neurological disorder. Clinical and experimental evidence supports the role of sex and influence of sex hormones on seizures and epilepsy as well as alterations of the endocrine system and levels of sex hormones by epileptiform activity. Conversely, seizures are sensitive to changes in sex hormone levels, which in turn may affect the seizure-induced neuronal damage. The effects of reproductive hormones on neuronal excitability and seizure-induced damage are complex to contradictory and depend on different mechanisms, which have to be accounted for in data interpretation. Both estradiol and progesterone/allopregnanolone may have beneficial effects for patients with epilepsy. Individualized hormonal therapy should be considered as adjunctive treatment in patients with epilepsy to improve seizure control as well as quality of life." (full article is FREE).
Neurol Sci. 2011 May;32 Suppl 1:S31-5."Oestrogen and progesterone have specific receptors in the central nervous system and are able to regulate neuronal development and plasticity, neuronal excitability, mitochondrial energy production, and neurotransmitter synthesis, release, and transport. On neuronal excitability, estradiol and progesterone seem to have an opposite effect, with estradiol being excitatory and progesterone and its derivative allopregnanolone being inhibitory. Estradiol augments N-methyl-D-aspartate-mediated glutamate receptor activity, while progesterone enhances gamma-aminobutyric acid-mediated chloride conductance. Sex steroid regulation of the balance of neuroexcitatory and neuroinhibitory activities may have a role in modulating clinical susceptibility to different neurological conditions such as migraine, catamenial epilepsy, premenstrual dysphoric disorder, and premenstrual syndrome."
Curr Neurol Neurosci Rep. 2011 Aug;11(4):435-42."Reproductive hormones have been found to have a role in the pathogenesis and treatment of seizures by also altering neuronal excitability, especially in women with catamenial epilepsy. The female reproductive hormones have in general opposing effects on neuronal excitability; estrogens generally impart a proconvulsant neurophysiologic tone, whereas the progestogens have anticonvulsant effects. It follows then that fluctuations in the levels of serum progesterone and estrogen throughout a normal reproductive cycle bring about an increased or decreased risk of seizure occurrence based upon the serum estradiol/progesterone ratio. Therefore, using progesterone, its metabolite allopregnanolone, or other hormonal therapies have been explored in the treatment of patients with epilepsy."
Epilepsy Behav. 2008 Jul;13(1):12-24.
"Although sex steroids such as estradiol, progesterone, and the progesterone derivative allopregnanolone (ALLO) influence numerous neurotransmitter systems, it is their potent effect on the brain's primary inhibitory and excitatory neurotransmitters gamma-aminobutyric acid (GABA) and glutamate that links the study of premenstrual dysphoric disorder (PMDD) and catamenial epilepsy (CE). After providing an overview of these menstrual cycle-linked disorders, this article focuses on the preclinical and clinical research investigating the role of estradiol and progesterone (via ALLO) in the etiology of PMDD and CE."
Methods Find Exp Clin Pharmacol. 2004 Sep;26(7):547-61.
"Generally, progesterone has antiseizure effects, while estrogens facilitate seizure susceptibility. The progesterone metabolite allopregnanolone has been identified as a key endogenous neurosteroid with powerful antiseizure activity. Allopregnanolone is a potent, positive allosteric modulator of GABA(A) receptors. Progesterone and allopregnanolone exposure and withdrawal affects GABA(A) receptor plasticity. In animal models, withdrawal from chronic progesterone and, consequently, of allopregnanolone levels in brain, has been shown to increase seizure susceptibility. Natural progesterone therapy is proven to be effective in women with epilepsy."
Epilepsia. 2001 Feb;42(2):216-9."These data are consistent with a role for allopregnanolone in the control of neuronal excitability and seizures."
J Pharmacol Exp Ther. 1999 Feb;288(2):679-84.
Finasteride, a 5alpha-reductase inhibitor, blocks the anticonvulsant activity of progesterone in mice."Progesterone is an effective anticonvulsant against pentylenetetrazol (PTZ) seizures. This action is hypothesized to require the metabolic conversion of progesterone to the gamma-aminobutyric acidA receptor potentiating neuroactive steroid allopregnanolone by 5alpha-reductase isoenzymes followed by 3alpha-hydroxy oxidoreduction."
"The anticonvulsant activity of progesterone against PTZ-induced seizures can be blocked by 5alpha-reductase inhibition, providing strong evidence that the anticonvulsant effect of the steroid in this model is mediated by its active metabolite allopregnanolone."
Hopefully, this is helpful.
