He has previously spoken about very low dose estradiol [E2] (when on Lupron) for preserving bone health. Here he is speaking of high E2 doses to suppress testosterone [T].
In essence, since male E2 is largely a result of the aromatization of T, the male body responds to elevated E2, by cutting back on T production. Rather than use a fixed E2 dose, Dr. Myers monitors T & adjusts E2 accordingly.
Myers preferentially uses E2 in older men who might do very badly on Lupron, & on men who cannot tolerate the Lupron class of drugs, but he doesn't answer the question of E2 effectiveness versus Lupron. The Phase III PATCH UK clinical trial is expected to do that, although accrual is apparently slow.
I was on Firmagon, switching to Lupron for more than three years, with Xtandi added.
The testosterone-suppressing drugs didn't manage to bring my testosterone level down to the >20 therapeutic level, so finally my uro and medical oncologist concurred that a bilateral orchiectomy might be successful.
In spite of the orchiectomy, my T-level remains higher than the therapeutic level, and has been as high as 98, but currently is about 44. My body just won't stop producing testosterone---the adrenals produce testosterone, and the cancer cells themselves can also synthesize testosterone.
In the Journal of the American Medical Association, a few months ago, there was an article about the advantages of an orchiectomy over Lupron. There seems to be less risk of fracture and less cardiovascular complications with the surgical castration as opposed to the testosterone-suppressing drugs.
Even though my orchiectomy wasn't as successful as I'd hoped, I don't regret it, as I told my uro, "they're no longer functional, just decorative." ---it gave him a good laugh.
But seriously, I have a very odd metabolism; despite three and a half years of androgen deprivation therapy and a surgical castration, I still have some libido, and retain some erectile function.
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