Transdermal Estrogen + ADT {was Zometa}

[pjoshea13]

Just about to shut down & a new vblog post from Dr. Myers comes in. Very timely, considering my mention of estradiol [E2] patches as an alternative to Zometa for ADT-related osteoporosis.

I was a bit cautious in the Zometa post, because I'm not aware of a study that showed that an estradiol patch could eliminate the risk of osteoporosis while on ADT. Some think that male bone health requires testosterone too. Myers quashes that idea in the video. He mentions patients that arrive with osteopenia & gain bone mineral density while on ADT - because of the E2 patch.

I have an issue with how he deals with E2 & clotting risk. The aim of the E2 patch when used with Lupron, say, is to restore E2 to a normal level for bone health. Normal male E2 levels do not cause clots.

The patch he uses is the Vivelle-Dot 0.025 mg estradiol patch. He does not mention a target, but E2 = 20 pg/mL is ideal IMO. E2 should not go below 12 or above 30 pg/mL. Life Extension has long touted 20-30 pg/mL as optimal, but aging men not on ADT often have sub-optimal testosterone [T], & my personal view is that the E2:T ratio matters. In any case, there seems to be no advantage in having E2 above 20 pg/mL.

Dr Myers deals with E2-clotting concerns by denying that estrogen causes abnormal coagulation in men. E2 is associated with clots in women, but men are not women, he says(!) OK, but before Lupon (1985), the synthetic estrogen Diethylstilbestrol [DES] had been used since 1941. High doses (5 mg or higher) were associated with thromboembolic events. Today, there is interest in DES at 1 mg or thereabouts, which is considered to be less risky.

There is a 1996 study [1]:

"The association of hyperestrogenemia with coronary thrombosis in men."

"Estradiol was the only variable measured that showed a significant relationship to {myocardial infarction} ... These findings suggest that hyperestrogenemia may be related to the thrombosis of {myocardial infarction}."

Anyway, here is Dr Myers:

askdrmyers.wordpress.com (May 27, 2016 post)

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/891...

[DenDoc]

I have been on Lupron continuously for the past 7 years. I get Zometa every 6 months and had a good baseline Bone Density with no osteoporosis. My understanding is that the Zometa is to prevent BRE (Borne Related Events). So far no mets in my bones. Mine presented in soft tissue(lungs).

I am on a .25mg estrogen patch once weekly for prevention of hot flashes. My understanding is that the risk of clots drops significantly with transdermal estrogen since it does not pass through the liver. Diethylstilbestrol was well known to cause clots in men and women. That is why it lost favor. I don't follow the science of estrogen therapy. A good resource is Dr. Richard Wassersug, a researcher who studies and writes about estrogen therapy. Has a book for patients in print. [e-mail]

[pjoshea13 in reply to DenDoc]

DenDoc,

Very interesting. My understanding is that Zometa is used in (i) non-bone-metastatic disease when ADT has caused osteopenia/osteoporosis) or (ii) when there are bone mets - and (a) osteopenia/osteoporosis &/or (b) bone pain. None of the above in your case.

Studies I cited suggest that Zometa has no prophylactic benefit. Perhaps this is not generally accepted by doctors? At least not 7 years back.

You must be a rare case - to be on Zometa & estradiol!

-Patrick

[WendyL]

It's not common, but if there is a family history of particularly estrogen mediated breast cancer or of male breast cancer, or if you are BRCA positive, be very careful with estrogen.

[pjoshea13 in reply to WendyL]

Wendy,

A 0.025 mg patch to bring estradiol up to 12 pg/mL should not be a problem, since that is a very low E2 level.

If E2 is a threat to BRCA men, Arimidex can be used to bring E2 down to, say, 20 pg/mL.

DenDoc mentions Dr. Richard Wassersug, who uses E2 to drive down testosterone to castrate levels (obviously, at a much higher dose than the 0.025 mg dose used to restore minimal levels). You would consider this not an option for BRCA men, I suppose?

-Patrick

[herb1 in reply to WendyL]

Wendy,

That's a very good, and not frequently noted "side effect" of E patches. thanks.

herb

[Bluebird11]

Patrick, I only know from our personal choice. We used the vivelle dot for 3 1/2 years. Great quality of life. He was not on Lupron during this time. And, yes, we used it to keep the T and PSA down. We used cardiokinase and baby aspirin, helping to prevent clotting. My husband does not eat fast foods, nor a lot of meat. His diet is quite healthy, with lots of good organic foods.

If, and when, we go on zoladex or Lupron again, we will certainly use the vivelle dot added to it.

genie..

[Neal-Snyder]

Patrick, thank you very much for all your efforts to let us know about important research findings. Any chance you'd be willing to share with us what supplements you take, along with details such as dosage & frequency? I think that would be enormously helpful.

Thank you,

Neal