So I think, given everything, if you’re not happy with how the finasteride is working for you your best bet is an orchie if that fits within your long-term goals. If you wanted to keep your gonads that’d be something else…. but if you want them to go, why not now? Definitely realistic, and your doctor can probably make a very good case with your insurance if the company is reluctant (., this is the *only* option left for suppressing your T effectively now, and suppression is necessary for treatment of your dysphoria which is a medical condition). Since you’re in California your insurance canNOT have a transgender exclusion clause in their policy. They can’t deny you surgery just because you’re trans — if they cover orchies for some, they have to cover them for all. CA is pretty awesome that way.
Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.
Information from the Nurses' Health Study indicated that the combination of estrogen and androgen used to treat hypoandrogenism could increase breast cancer risk. However, other studies indicated androgens may decrease breast cancer risk. Follow-up studies on the Women's Health Initiative found women who received estrogen and no progestogen showed a significant decrease in cardiovascular disease (CVD) and breast cancer. This has caused a reconsideration of androgens added to estrogens. Still, the FDA requires demonstration of CVD and breast cancer safety for any product containing androgens or estrogen plus an androgen; that has not been done.