Agree Alison – I treat male GCT and there is a distinction between risk categories where 4 x EP and 3 x BEP are valid alternatives and where 4 x BEP is considered necessary.    Also because the cumulative risk of long term Bleo toxicity really goes up (in everyone) after 9 doses we need to be very specific about anything that could result in women receiving unnecessarily 12 x Bleomycin.   We were lucky enough to be have a visit from and present some GCT cases to Prof Larry Einhorn some years ago.  Among the many unwritten pearls from that; he said he is so convinced of accelerated Bleo toxicity in girls with OGCT he never gives them more than 9 BEP ie 3 x BEP and 1 x EP.   I am not necessarily say that is a basis for a clinical trial protocol! – just to illustrate why there is a real difference