I have been on estrogen patches to lower testosterone. Very effective. Undetectable T and PSAs are 0. No depression. But zero libido, loss of strength, and lower RBC (I think that 0 T is going to cause those regardless of how you get there).
So I am going on a combo of casodex and dutasteride. Casodex blocks androgen receptors and dutasteride stops T to DHT conversion (about 90% effective).
If and when PSAs rise I'm going to go back on estrogen until PSAs go back to zero (or until I'm dead or the cancer is definitely castrate resistant).
I ran this by my naturopath and my oncologist and they are both okay with it.
It sounds like what you're doing is working with regards to holding down the cancer. I hope it works for years and years.
With regard to the side effects, I think it is possible to combat them. Loss of strength can be at least partially repaired by exercise. Be sure to do a lot of it, and get a little extra sleep every day if you can manage it. The sexual side effects are daunting but they too can be mitigated. Even though you have zero desire for sex, I suggest that you engage in it with your spouse or partner. Your purpose in doing this would initially be to satisfy her (or whoever), after all, she hasn't lost any of her hormones and may still crave some affection and intimacy. In fact, if she hasn't had any sex in a long time, she may be in real need. You don't need an erection or an ejaculation to satisfy a partner and you can do the job with just the parts of you that are still working well.
I said that your purpose in doing this would "initially" be to satisfy her. I say that because, when you get into it and she gets aroused, you may feel some unexpected arousal yourself. I did when I was in your situation. Every time I tried this I had to force myself to do it, and yet every time It turned out to be a surprise and a delight.
Thanks! I exercise a lot. I shoot for 4-7 hours a week (I don't think it's good to do more than that or I would). I do satisfy my wife with toys and stuff.
It doesn't make sense to me, but it's probably not a problem. As you say, your symptoms are caused by lack of androgens, which stimulate your androgen receptors (AR). Estrogen blocks androgen production. Stimulation of androgen receptors is what produces libido, erythrocyte production, and muscle growth. It doesn't matter how you stop AR stimulation (estrogen, Lupron, Casodex, Avodart) whether by stopping all T production, blocking T at the AR, or blocking DHT - you are still doing the same thing. Serum T can't increase libido, etc. if the ARs are blocked. In fact, there's a connection between estrogen and libido - men taking estrogen inhibitors have decreased libido.
I think it's a good idea to take tamoxifen while taking estrogen or Casodex. It specifically blocks estrogen in breast tissue and prevents gynecomastia.
I was taking tamoxifen but my oncologist wanted me to stop (cardio risk). Estrogen was conventional 40-80 years ago but was dumped when lupron came along because of cardio risks. Works fantastic. I think it lowers T to zero because some of T converts to E and the body is trying to regulate E.
I'm hoping that some of the muscle wasting and lack of libido goes away. I'd be happy if I get slightly aroused once a month. Beats what I have now (zero per century). Anyway, I would like to give this a shot and if nothing changes I'll go back on the patches. I think that they're more effective than blocking DHT and AR.
Pardon my brevity here as I'm a very slow typist. But two points:
1. Data from the PATCH study in the UK show that ADT can raise sexual interest above the level observed in patients on LHRH agonist drugs (like Lupron, but called Lucrin over there). Once again, Dr. Wibowo (now in New Zealand) has published preclinical data showing that estradiol can significantly raise sexual interest in castrated male rates, though not to the level of uncastrated male rats.
2. Tall Allen is the brightest, most informed, guy that I know of on this HealthUnlocked forum.. However I am not convinced that taking tamoxifen with transdermal estradiol is without some risk. There really hasn't been the proper, long term study on this with androgen-deprived men. But for women with breast cancer tamoxifen increases the risk of bone fractures. See:
Incidence of fractures in young women with breast cancer - a retrospective cohort study.
Stumpf U, Kostev K, Kyvernitakis J, Böcker W, Hadji P. J Bone Oncol. 2019 Jul 26;18:100254
Once again, the full paper is freely available on the internet.
I admit though that for some men gynecomastia is intolerable. However, as far as I know, it has led to very little (if any) dropout from the PATCH study in the UK.
I assume that my age (76) is a major factor regarding the loss of libido. Even prior to the use of tE2 gel (the only ADT that I have ever been subjected to) I was experiencing a decline. Fortunately I have not experienced the "muscle wasting and weight loss" YET.
J-o-h-n, I now understand why you have an ex-wife. You can't admit things like that and not create a marital problem. I can help you be a little more discreet and help you get to third base, home base is probably out of the question now.🤠🍸🍸
Snuffy Myers had me start using estradiol patches about 5 years ago for ADT SE’s and bone health, I’ve been on them ever since. I also remain on on triple ADT (Lupron, Xtandi, Avodart). I was dx Stage 4, G9, my PSA has been undetectable for about four and a half years now. I imagine the estradiol has something to do with that. I’m curious - what dose are you on?
I was on 0.5mg/day the first few weeks to get the T down. Then 0.3, then 02, then 0.1. Last few weeks I was hovering 0.1 to 0.2. I'd monitor T each week and when I was on 0.1 for more than a week or so it would go up a bit - 20ish range. Then I'd titrate up.
If you were on Zytiga and tE2 at the same time, you can credit the Zytiga with the major depression in your libido. I'm not sure though what you mean when you ask "am I closer to a premenopausal woman or post?". Closer in what way?
Two unrelated add-ons:
1. I'm not an MD, so I request that folks following this thread avoid putting "Dr." before my name. I make that general request as I do not want anyone following this thread to think I'm qualified to give out medical advise.
2. I have published on some gecko behaviour as part of another life I have as a herpetologist. As such, Gecko09, I would like to know if you also do research with those lizards. If so, what have you worked on?
MY experience on casodex (50 mg, not 150mg daily) and dutasteride 1.0 mg kept my PSA at 0.02 to 0.04 for 4+ years. Then the bicalutamide stopped blocking the ARs (and may have stimulated them) and PSA rose steadily. So now I am off that regimen. My experience was that androgen deprivation symptoms were not as bad as on LHRHa (much milder hot flushes), felt more "like myself" and my libido was not zero, even though well below normal. So my QOL satisfaction was significantly better. I also plan go on E2 when needed again. The bicalutamide/dutasteride can lead to gynecomastia also. I had pretreatment radiation to the breast tissue (3 treatments) and had only a little. Hopefully this will carry over for the E2.
in any discussion of estrogen, I always like to throw in the work of our Argentinian Dr (whose name now escapes me!) who found or believed that application of the gel to the scrotum increased the absorption significantly.
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Casodex + Lupron (Blockers v Killers)
Told to discontinue Casodex (Bicalutamide)
Casodex cross-resistes Zytiga?
A month of Casodex monotherapy
Casodex after castration resistance?
