LADASTEN ® is very different from typical psycostimulants in that it does not work on any particular receptor in the brain but acts on the expression of 1116 genes, all of which affect the central nervous system. Its unique mild psycostimulating effect can be attributed particularly to an increase in the expression of tyrosine hydroxylase - the key ferment responsible for dopamine synthesis. In other words, bromantane indirectly stimulates the expression of dopamine, unlike typical stimulants, which simply release dopamine already stored in the synaptic cleft. As a result, Ladasten has a weaker stimulating effect and does not cause dopamine depletion.
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.