Update: Experience with Estradiol patches for ADT

[MateoBeach]

I have had in the past (2012) what I consider to be quite terrible side effects from ADT with LHRHa (Eligard similar to Lupron). So recently when I needed to start short-term ADT as adjuvant to pelvic lymph node radiation (IMRT with boost to nodes) I chose to try Estradiol patches. Now 7 weeks in and I have learned the following:

1) Estradiol can effectively lower testosterone by depressing GnRH but it is a gradual process requiring about a month to reach castrate levels.

2) The side effects profile is unbelievably better with estradiol! Zero hot flashes. No weight gain (nor loss). Good energy and eagerness to exercise that I haven't had in years. No fatigue (until the RT started producing a little). And no mental fogginess evident.

3) There is much variation in the delivery of supposedly equivalent brands of estradiol patches. I was using 4 patches at a time and changing one daily on a rotating basis (per PATCH trial findings). These are supposed to deliver 0.10 mg/24 hours each and are semi-weekly patches (4 day). I have used 3 different brands due to supply and insurance issues.

The first patches were generic Medicare approved and dropped my testosterone from over 350 to 90 within 2 weeks. When they ran out I had to order some from a (legitimate) Canadian Pharmacy and got Sandoz Estradiol Derm 100. These are very large and un-elegant patches that don't stick well but raised my E2 levels three times higher! Then I went back on another US product: Tamneal DOTTI estradiol transdermal. These are small and adhere well, but my E2 levels dropped by 2/3 on them. So the dosage delivery needs to be titrated and rechecked until stable. If I had to start over I would use Estradiol transdermal gel instead on a daily basis.

4) Because the last patches were not delivering the Estradiol adequately and my radiation was well underway, I decided to punt: To take a shot of degareliz (Firmagon) which drops T levels very rapidly. I feared my old ADT problems would re-emerge but delightfully they did not! With the Estradiol on board I have had no re-emergence of adverse or unpleasant ADT symptoms.

5) When I started the patches I experienced the start of some breast tenderness and glandular swelling within 3 days. So I started the Tamoxifen (I had at the ready) 10mg once daily. Within 24 hours 90% of the breast symptoms resolved and have remained steady (very mild).

[AZjame]

Thank you so much for sharing your experience with estradiol. My husband also had severe side effects from Eligard (given prior to adjuvant RT). If he needs further treatment estradiol gel is first on our list to try.

[StayingOptimistic in reply to AZjame]

Hi

Can you tell me please where you got the estrogen gel? Thanks a lot. I would like to try it

[MateoBeach in reply to StayingOptimistic]

Two available prescription products of estradil topical gel are EstroGel and Elestrin.

See manufacturer's package information below on EstroGel stating that one pump of 1.25 grams of 0.06% estradiol provides .75 mg estradiol. Noting that the amount applied will not be the same as the amount absorbed. If one pump applied per day is equivalent to a 0.10 patch then 4 pumps per day would be equivalent to the 4 patches used in the PATCH trial. But perhaps twice that much may be needed to reach an effective level to bring testosterone to castrate levels.

What % will actually be absorbed I have no idea. So it will require measuring blood levels of estradiol and testosterone after a week or two and adjusting accordingly.

This could get somewhat expensive and messy I would guess. So it may be more reasonable to have a compounding pharmacy prepare a higher concentration estradiol gel such as 0.25% estradiol rather than .06%. Perhaps other HU members who have been using this method already can lend some insight.

"EstroGel 0.06% is an estradiol transdermal gel. One pump depression delivers 1.25 g of gel that contains 0.75 mg estradiol.

EstroGel is a clear, colorless, hydroalcoholic 0.06 percent estradiol gel supplied in a non-aerosol, metered-dose pump. The pump consists of an LDPE inner liner encased in rigid plastic with a resealable polypropylene cap. Two pump sizes are available, a 50-gram (1.75 oz), and a 25-gram (0.88 oz). Each individually packaged 50-gram pump contains 50 grams of gel and is capable of delivering 32 metered 1.25-g doses. Each individually packaged 25-gram pump contains 25 grams of gel and is capable of delivering 14 metered 1.25-g doses. One pump depression (1.25 g EstroGel) contains 0.75 mg estradiol."

[Tall_Allen]

Thanks for your observations. Any comments about bone mineral density? Any liver adverse effects? clotting?

[tango65]

Thank you for posting your experience with the estradiol patches. It is important for many of us who need to be in ADT for the rest of our lives. Bets of luck on your journey.

[Hidden]

Thank you for that detail. I hope it all works out for you. I hope I have just had my "last" 3-month Lupron which will actually take at least 6 months to wear off (my doc says it may take a year before testosterone comes back). The Estradiol alternative is one of the best things to be given publicity on this Forum, and I can see a number of guys are going to take a break from the ADT poisons and get their body back. They will have to fight their doctors though - this is not in the manual, so they will advise against it and prolong the problems until they get to be life-threatening because the manual says it is now "Sledgehammer Time"!

I suspect ADT fails after a while for 2 main reasons - (a) it really hammers the body and causes general debilitation (b) The fat build up in the gut (a side effect so we are all like a Telly-Tubby) causes production of "bad" estrogen (androgen) compounds which feed the cancer and that PSA starts to climb (as does the blood pressure and glucose). Thus the ADT treatment becomes counter-productive after a while (4 years in my case).

Those who have gone the castration route avoid most of these problems. For me, I live in hope I will soon beat this bastard and will die one day as a man.

[Jimhoy in reply to Hidden]

Bravo Dave.......BRAVO!!!!

Jc

[StayingOptimistic in reply to Hidden]

Would you like to share your status and treatment?how will you be cured?

[Hidden in reply to StayingOptimistic]

I do a weekly sodium ascorbate with some Xtandi (to boost the kill) and I experiment a lot to find what works to keep my PSA around 1 or below.

[PhilipSZacarias]

A very good and useful report. Much appreciated. Cheers, Phil

[j-o-h-n]

I guess you now can say "life is a MateoBeach"... Thanks for the info.. Keep on Keeping on.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/26/2019 12:08 PM DST

[Break60]

My profile and previous posts on estradiol patches shows my ADT journey and switch to estradiol patches after reading the UK PATCH trial results. The patches are easy to use , T levels are easy to manage and side effects except for gynecomastia are nil. My latest psa was <.1

[Jimhoy]

Thank you for that info.

I had heard some about this for a while but I kind of disregarded it because of a mind set like, if my x-coworkers & most of my guy friends, would invite me to a blanket party if they knew I was on estrogen (as I would likely join in if it were one of them)!! But mainly, my following my Dr’s advice as gospel, was steering me away.

Now that I have been in ADT “HELL” for......so......so......long, and learned what I can about getting away from that, mostly from my “new friends” here on HU. Posts like yours and the many responding to my questions / rants have supported this QoL friendly option.

I’m finishing a QoL vacation now with testing due in 3 weeks. I’ve so often been under the curse of “Murphy” so with my luck, I see my next challenge is convincing my Dr to prescribe this!! Or find yet another Dr!!!! If not right now, it’s kind of guaranteed to be in the cards for some point!!!

Thanks again and best of luck!

Jc

[MateoBeach]

Print out the clinical studies on the PATCH Trial (and related published peer reviewed research on topical estradiol for ADT) and take it to your doctor.

Such as (and others)

ncbi.nlm.nih.gov/pmc/articl...

[Hidden]

good luck .

[pinejogave]

Would this work for someone who has stoped responding to Lupron? Thanks

[MateoBeach]

Unknown. But I would think that it would not work because the final pathway is the same: The estradiol inhibits GnRh (Gonatotropin Release hormone) which in turn inhibits release of Luteinizing hormone which regulates the testes' production of testosterone. So I would expect that if the cancer is growing independent of castrate testosterone levels from Lupron (and similar) then estradiol will also not be effective and more advanced treatment such as abiraterone or enzalutamide (and similar) may be required.

[D_Alden]

Has anyone compared dosage in the prescribed gels with the OTC Estrodial creams? The one my wife used back in the day says it is 0.25 Estrodial USP and 1 mg Estriol USP in each suggested dose. If the RX gel provides 0.75 daily Estrodial could the OTC be sufficient with a triple application daily? Might have to bathe in it. Asking for a friend. ;^)

Second question: The patches and/or gel look like they have Progesterone as well as Estrodial, is the Prog. important?

Daniel

[MateoBeach]

Estrogens other than estradiol may not be bio-equivalent (estriol and conjugated equine estrogen etc.) So I would not go that direction. And finding equivalent potency would also be difficult. The estradiol topical gels are water and alcohol based that facilitate absorption across the epidermis. Creams have emulsifiers etc. that probably are not helpful in this regard. And combinations that include progestins are appropriate for women with an intact uterus, but not for men with prostate cancer.