Just received the results of my blood work drawn on 5/14/2020 and needless to say I am quite pleased. I am self medicating with E2 gel only and haven't seen a doctor since 7/2017. The ONLY side effect is gynecomastia (man boobs) which I don't perceive as a big deal. I apply an amount as pictured twice daily to my inner thighs and abdomen.
Update: 25 months on transdermal estr... - Advanced Prostate...
Update: 25 months on transdermal estradiol (tE2) and counting.
Written by
E2-Guy
To view profiles and participate in discussions please or .
Read more about...
47 Replies
•
Nice! Refresh my memory... you are in Thailand, and buy your gel online w/o a scrip, correct? What is the cost?
Richard W. was kind enough to reach out when I was considering E2, and we had a nice long chat. While he was very helpful, I couldn't find an MO in New England willing to go near this therapy w/ a ten-foot pole (not that I tried all that hard). Too much of a headache for them trying squeeze it (no pun intended) into an established SOC with definitive dosing. So I ended up on bicalutimide instead.
Yes I live in Thailand and I buy the gel w/o a "script" at a local pharmacy for about $13/tube. One tube lasts me a little over three weeks. Richard Wassersug and I have had numerous discussions regarding most doctors' reluctance to prescribe this natural hormone which is made from yams and soy.
a) There is no money in prescribing an inexpensive gel that a patient applies himself.
b) Most doctors are afraid to put patients on any form of estrogen since there were so many DES (Diethylstilbestrol) lawsuits prior to it being discontinued in the mid eighties. I imagine that many of the younger doctors are not even aware that transdermal estrogens are far safer than oral estrogens such as DES since they are absorbed directly into the bloodstream thereby bypassing the liver which is where the CV events were generated.
c) I think that estrogen therapy for PCa is no longer approved in many countries including the US.
I have sent this gel to some of my friends in the States who WERE on Lupron and they are having great results. I last time I shipped 24 tubes to Florida via DHL the shipping alone was $130 and I had to tell them that it was a cream since they refuse to ship gels. I have brought some back with me in the past; however, I'm in no hurry to spend time in the States anytime soon. We appear to be doing far better here than much of the World since our COVID death toll is currently only 56 with a population of 65,000,000.
Great numbers RonRon. Congrats . You are my hero . “ No Dr since 2017” fantastic ... I’d like to follow your path . We had wanted to visit you there this year , but all travel halted for now . Hope that you enjoying much . Scott & Sherry, now in Prescott 😎🌵 My recent psa was .014 and I’m happy yours is great🕺🥳
E2-Guy• in reply to
Bro, With a PSA of .014 it appears that you are doing great...sounds like Prescott agrees with you! My guest room is still waiting for you guys.
• in reply toE2-Guy
We are raring to go. The world says different right now.. This is one time that being low on the totem pole is in our favor. How low can we go? Hang in there Ron . Peace be with you .🤙🏽
Nice. Why don't you use tamoxifen with it? I know Richard doesn't, but I've never asked him why.
Allen,
Since I already have boobs (about the size of a well endowed 11 year old girl) do you think that they would shrink with tamoxifen? They appear to have reached a plateau. Richard still is not convinced that tamoxifen will not interfere with the efficacy of the E2.
• in reply toE2-Guy
I’m the same pre-pubescent 11 year old 😳
There really is no data that I've seen about tamoxifen when estrogen is the only hormone therapy. But I'm sure Richard knows more about this than I do.
If one already has gynecomastia, 20mg/day has been found to reverse it, 10 mg/day to prevent it. But I think that if connective tissue has formed already, only cortisone shots or surgery can reverse it.
pubmed.ncbi.nlm.nih.gov/229...
pubmed.ncbi.nlm.nih.gov/225...
In a pilot study, tamoxifen alone was found to have some anti-prostate cancer activity. Like estrogen, it seems to reduce prolactin levels.
ar.iiarjournals.org/content...
If that is true, it is an estrogen agonist against prostate cancer cells, and an estrogen antagonist in breast cells.
Thank you Allen for your 'always' informative replies.
Congratualtions, Ron.
Any ideas when the PATCH trial will be concluded? Thanks
Please forgive my tardiness in replying to your question. To the best of my understanding, the 'PATCH' trial should be completed in mid 2021. I believe the COVID crap has delayed it somewhat.
Thank you, sir.
Hello Tall_Allen, ronronHU, and anyone else interested in my views on tamoxifen in men.
Let me say at the outset, that tamoxifen appears to be generally safe for men. The data on that are in a review article my colleagues and I published a few years ago. Here's the link to it:
pubmed.ncbi.nlm.nih.gov/271...?
But newer data suggests that it may increase the risk of a bone fracture and I don't want that. Here is the reference, but note that the patient population is breast cancer patients and not prostate cancer.
pubmed.ncbi.nlm.nih.gov/300...?
What needs to be recognized is that men vary greatly in how bothered they are b gynecomastia. I had one patient say to me that he would refuse to take ADT if it could cause breast development. And I also have a coauthor, who got a mastectomy after the fact to reduce his gynecomastia.
At the other extreme, many men don't care about it. A sociologist and I wrote a paper about a decade ago speculated about the social determinants of men's attitude toward gynecomastia. Again, here is the URL:
pubmed.ncbi.nlm.nih.gov/191...?
I think we need to recognize and accept the variation here in how tolerant men are for gynecomastia. We should not assume that how we individually feel about it is necessarily the way other men should feel about it.
If anyone wants copies of papers that I authored, they can always write me private. I do not hide my email address.
Richard W.
Richard,
I suspected you could add some interesting perspectives. Thanks for that.
I would very much like to read your paper where you found that the aversion to male breasts is linked to the objectification of women. I don't believe it's my or a doctor's business to tell anyone how they should feel about it. But I note that in studies of Casodex monotherapy, gynecomastia is evaluated by patients as the biggest detriment to QOL, and the biggest reason for discontinuation of therapy. Isn't it more respectful to patients to give them a choice?
I note in the abstract about bone fracture risk that the effect disappears in older women. Since almost all men with prostate cancer are in that age range, is it really a risk? And does any risk completely disappear in men taking estrogen, which is known to strengthen bones?
Given that there is a suggestion in that pilot study that tamoxifen provides an oncological benefit for prostate cancer, I would love to see more studies using it. I don't know whether the PATCH/STAMPEDE trial precluded its use - hopefully there was a subset who used it.
-Allen
(PS- there are 3 copies of your post- you may wish to delete 2 of them)
Hello Tall_Allen, ronronHU, and anyone else interested in my views on tamoxifen in men.
Let me say at the outset, that tamoxifen appears to be generally safe for men. The data on that are in a review article my colleagues and I published a few years ago. Here's the link to it:
pubmed.ncbi.nlm.nih.gov/271...?
But newer data suggests that it may increase the risk of a bone fracture and I don't want that. Here is the reference, but note that the patient population is breast cancer patients and not prostate cancer.
pubmed.ncbi.nlm.nih.gov/300...?
What needs to be recognized is that men vary greatly in how bothered they are b gynecomastia. I had one patient say to me that he would refuse to take ADT if it could cause breast development. And I also have a coauthor, who got a mastectomy after the fact to reduce his gynecomastia.
At the other extreme, many men don't care about it. A sociologist and I wrote a paper about a decade ago speculated about the social determinants of men's attitude toward gynecomastia. Again, here is the URL:
pubmed.ncbi.nlm.nih.gov/191...?
I think we need to recognize and accept the variation here in how tolerant men are for gynecomastia. We should not assume that how we individually feel about it is necessarily the way other men should feel about it.
If anyone wants copies of papers that I authored, they can always write me private. I do not hide my email address.
Richard W.
Hello Tall_Allen, ronronHU, and anyone else interested in my views on tamoxifen in men.
Let me say at the outset, that tamoxifen appears to be generally safe for men. The data on that are in a review article my colleagues and I published a few years ago. Here's the link to it:
pubmed.ncbi.nlm.nih.gov/271...?
But newer data suggests that it may increase the risk of a bone fracture and I don't want that. Here is the reference, but note that the patient population is breast cancer patients and not prostate cancer.
pubmed.ncbi.nlm.nih.gov/300...?
What needs to be recognized is that men vary greatly in how bothered they are b gynecomastia. I had one patient say to me that he would refuse to take ADT if it could cause breast development. And I also have a coauthor, who got a mastectomy after the fact to reduce his gynecomastia.
At the other extreme, many men don't care about it. A sociologist and I wrote a paper about a decade ago speculated about the social determinants of men's attitude toward gynecomastia. Again, here is the URL:
pubmed.ncbi.nlm.nih.gov/191...?
I think we need to recognize and accept the variation here in how tolerant men are for gynecomastia. We should not assume that how we individually feel about it is necessarily the way other men should feel about it.
If anyone wants copies of papers that I authored, they can always write me private. I do not hide my email address.
Richard W.
Dear Professor Wassersug, pls kindly send me your e-mail address so that I could consult with you my problems. My e-mail: drakovci@gmail.com. By the way I am in touch with Ron, who helped me very much. Jerry.
Good to hear Ron. Take care buddy.
Hey ron!
I’m very happy with my estradiol patches after 15 months . I use (3) .1 mg Sandoz patches weekly . MyE2 is high ( 174) but psa has continued to be <.1 . I’ve gotten used to man boobs ; I see guys my age with them all the time ! Lol
Bob
Bro,
That is great news! Don't worry about your E2 level since most of us that are using this regimen are experiencing large fluctuations. Mine has been between 123 and 380 and my PSA continues to stay down despite the fluctuations. I don't notice any changes in the (great) way that I still feel regardless of the level. For me, this stuff has been a 'wonder hormone' (I prefer not to call it a drug) since to the best of my knowledge it is synthesized from yams and soy.
I hear ya regarding the boobs...many guys who are probably not on hormones have bigger ones than mine! Here in Thailand the average temperature in my condo is between 80 and 84° so I never wear a shirt while at home and none of my friends ever even mention my new endowment.
I find it difficult to understand how few men are even willing to try this therapy which has basically ONLY the boobs as a side effect, requires no doctor visits, and is a small fraction of the cost of other types of ADT. After my PSA continued to rise despite my RP and subsequent pelvic lymph node excision I refused to subject myself to the all too common side effects of lupron, plus the fact that my Medicare Ins pays for nothing outside the States. Consequently, I did a tremendous amount of reading on DES and decided to pursue some form of estrogen therapy as an alternative to the modern nasty drugs. Thanks to a Thai ladyboy who showed me the Oestrogel that he/she was using, I photographed and posted it on this site which caught Richard Wassersug's attention who subsequently has become my tE2 mentor.
Hi RonronHU
Don’t want to seem dumb but is there a difference between estrogel and Oestrogel. Ive been on .5mg of DES which has worked fine for 5 years. Recently I’ve had to increase it to 1mg as my PSA started to increase a bit. I’d like to give the oestrogel a try.........also can you get it at a regular pharmacy or compounding pharmacy.......sorry for the lack of knowledge
Joe D’agati
Hi Joe,
Oestrogel and estrogel are the same. Oestrogel is produced in France hence the spelling.
I'm surprised that you have been doing so well on only .5mg of DES. The original dosage was 5mg; however, more recent research has found that 2mg is equally as effective. Even 1mg is still quite low. It is great news to hear that you have just recently (after5 years) increased your dosage. Where are you finding DES? My dad and his two brothers lived well into their late 80s with the help of DES. They all had RP's in their early 60's, experienced BCF and were put on DES.
I buy the Oestrogel here in Thailand, but I hear that it is difficult to find in most other countries. Some of my friends have tried to buy it on Ebay and have gotten screwed by the people advertising it...they are hoping Ebay will refund their money.
Hi
Thanks for responding so quickly....getting the DES is also another major problem. Seems like availability in the USA is dwindling. I’ve gone to 3 compounding pharmacies who stated they can no longer get it. As far as obtaining the oestrogel I have no problem getting the prescription. I did find an online international pharmacy that you can obtain it for $10 a tube .06%. I’m thinking of trying it but I’m not sure how to use it
I did see it on eBay for an astonishing $180....walgreen and other local pharmacies sell estrogel for around $125
I believe that many of the "online international pharmacies" are con jobs. I failed to mention them when I stated that my friends have gotten screwed. I find it difficult to believe that they can sell it for $10. A doctor friend of mine who is an administrator at a major government hospital said that the hospital pays $10 for the gel. You can try ordering it from them; however, I hope you don't lose your money. I would like to hear from you if you do decide to order it from them...please send the link so that I can check to see if they are the same ones that my friends ordered it from.
It’s IVFphamacy.com......let me know what you think, there based in Israel
If you use them...PLEASE PLEASE ...share your experience with us! They seem to have good reviews.
google "IVFphamacy.com reviews"
Will do Glen
I checked the website and it looks to be legit. They state that shipping to the US is only $25. Please keep us apprised if you or anyone on the forum orders it from them. I checked many of the reviews and they all have 5 stars which is a bit strange; however, they all appear to be reviews posted only by 'IVF Pharmacy'. I will be pleasantly surprised if everything works out as stated. Richard W. has been buying it for years in Canada @ $55/tube...I will ask him if he is familiar with IVF.
Thanks........let us know when you here from him, maybe a good find hopefully. Seems cheap enough to take a shot........good conversation ronronHu and nice meeting you
Joe
Congratulations ronronHU you are leading the way on this and I have benefited from it too.
A new question about this now is: Will E2 down regulate TMPRSS2 expression in the same way as other forms of ADT and afford the same possible COVID-19 protection?
That women have increased TMPRSS2 expression from ADT regimens throws this into greater uncertainty. Can of worms.
Hi Doc,
Great hearing from a Cabo guy! I just scanned over your previous posts and noticed that you have been taking tamoxifen along with using E2 patches. I have been reluctant to take it even though Tall_Allen has recommended that I start. The gynecomastia appears to have reached a plateau and the nipple tenderness has subsided. Richard Wassersug just replied to my post with some interesting info on tamoxifen.
Regarding "E2 down regulating TMPRSS2 expression" I'm sure you are far more qualified to shed light on this topic than I am. I wonder if Richard W. has read any studies pertaining to this query?
Are you still using the patch and if so, how are you doing?
I am off it now to let my T recover for the purpose of hopefully increasing PSMA expression preparatory for 177Lu-PSMA treatment in Australia. Not sure now if that is my optimal strategy!
The tamoxifen at 10mg kept gynecomastia away but it sounds like you do not need it. It is good to avoid unnecessary extra medicines as a general principle. Best regards. Paul
Thanks for the reply Paul. I had gone down to Peter MacCallum in Melbourne in 2017 for the 68 Ga-PSMA-11 scan which was available at UCLA for $2650; however, I was told that Medicare would not cover it at that time. Peter Mac was a no-brainer for me since it was only a nine hour flight from Bangkok as opposed to 21 hours to LAX. The entire trip ended up costing far less than the UCLA scan alone. Airfare was $725, accommodations were $550, a fun one day 'Great Ocean Road' tour was $105, misc $150, and the scan was $600 for a grand total of US$2130.
Wishing you great results with the 177Lu-PSMA treatment.
Cheers,
Ron
I was in a clinical trial using estrogel for a year in 2017. I had great results and was constantly tested for negative side effects which were none. I had radiation prior to treatment to help prevent the man boobs. It was great but the results of the trial were
never released. The point being i was under close supervision for negative side effects and there were none. I applied a small portion to each shoulder every morning. After the test i took a year off from treatment and because of some other issues i never used estrogel again. But i would recommend trying it: controlled my T and PSA, NO SIDE EFFECTS!!!!!
I was never part of any trial. I just read the PATCH trial , talked to my urologist who had used Des pills in the past (but stopped due to CV events ) and he gave me a script for estradiol after reading the PATCH trial . He said he took all his patients off Lupron and put them on estradiol after he saw the results. No man should have to live with the side effects of lhrh agonists . I’m convinced that they are prescribed because they are more profitable for big pharmaceuticals and for urologists and oncologists.
That’s a good doctor. Takes action based on new (sufficient) evidence. So many do not.
Great testimonial Joe! As you and I have stated, "No side effects" (other than the boobs since I did not have any radiation). If I'm not being overly intrusive, can you tell us why you didn't continue with the tE2 since you were doing well while in the trial?
Greetings Ron, Joeym1040, Break60 & Everyone! I'm also having great results applying transdermal estradiol E2 cream/gel level currently at 187 pg/mL and my T below <3 ng/dL with a declining PSA currently at 1.9 ng/mL which I will try to explain further down.
As the Lupron level slowly left my system a few months after my last shot about one year ago. Thus, I had to discover how much of the E2 cream/gel to actually apply each day to reach the proper balance. I started low applying the E2 and the PSA back then was less than <1. To date I have been doing this for about 10-months now and had to increase my E2 dose accordingly. The side-effects other than slight man-boobs for me is a better QOL. Yes, for a younger lad it might be more of a mental challenge to his ego since you do lose most of your dippy-do-da with sex.
I have provided a link in this post that will visually compare the Standard of Care ADT to tE2. It's one of the best that I have seen which pretty much summaries it accurately. As a side note, the loss of muscle mass/strength stated can be countered by proper diet, exercise and supplements as needed.
Most of the other gents applying estradiol E2 that I'm aware of had an RP. Afterward in time their PSA started to raise again even with an RP. I would assume/estimate their PSA levels should be/usually are <1.0 if successful and their T almost non-existent applying E3 gel as needed or an E2 patch which I have no personal experience with.
Dosing E2 cream/gel for me has been different than their experience since I still have my prostate. By the way I've had, no chemo, no radiation. Three years ago diagnosed Gleason-8 stage-4 PCa with a PSA of 55 and starting double every three months before any treatment was started.
My observations only and specific to the E2 gel/cream (never tried the E2 patch). I've learned quickly that I had to to apply more estradiol per/day to "move the needle" and find the sweet spot as the Lupron wore off and it had less of impact during the start of my Lupron Holiday (break) transition to transdermal E2.
Lupron/Eligard side-effects for that one year were not pleasant at age starting at 66-years old. I was still working full-time and wondered back then if I could make it to my 35-year employment retirement target with all of the brain fog and mood swings. So far, the estradiol alternative E2 route has been far less of a disruption and I don't regret it.
Here are some thoughts. Do your own research and take responsibility for your choices:
1. bjui-journals.onlinelibrary... Transdermal oestradiol as a method of androgen suppression for prostate cancer within the STAMPEDE trial. They provide a realistic visual chart of the toxicities for reference.
2. There is no way I would consider oral estradiol E2 pill because it will put an additional load on your liver. A bio-identical E2 gel/cream is absorbed quickly and avoids those early DIM discovered cardiovascular/stroke issues. E2 transdermally goes into your blood stream quite fast. I was surprised how effective a delivery system it is and a new found awareness of how easy it may be to otherwise put toxins in your body with many commercial over the counter products/ingredients. Just my opinion.
3. There are estradiol E2 gels & creams. Some are bio-identical natural and others are synthetics which I avoided. Believe it or not, I have tried some bio-identical cream sold over the counter/online. Bio-identical Estrogen Bi-EST 5.0 by Biolabs Pro is such a brand. The 5.0 is the estimated amount of total estrogen cream released per each pump. of which only 1000mcg or 1mg is Estradiol and the other 4000mcg is Estriol 4mg which is an E1 estrogen. There is more than one estrogen. But, this brand does also work to lower your T and you need to discover how much of it you need to apply for your body. RP folks takes far less than non RP folks like myself.
Note! I do have a friend with his prostate who started with a 33 PSA and two weeks later his PSA dropped down to 22 PSA and he was ecstatic. Try at your own risk. I have used the online brand and so has he andI surmised that it does work and really easy to obtain.
4. The brand Oestrogel E2 gel which is not sold in the USA is perhaps the best transdermal E2 gel for this purpose. One "ruler" measurement (comes with a grooved plastic device to measure) of the gel delivers about 1.5 mg of bio-identical estradiol gel. Two doses/day for the RP folks is an estimate and a larger amount/day for guys like me with a intact functioning prostate. My tumors on my prostate are smooth during the DREs. So, for those that might say your PSA is low, but is it really masking your cancer growth rate. DRE and PSA are two reliable measurements used by urologist, right? How do your numbers look?
5. All of the above efforts/expense is somewhat useless if you can't monitor your progress & make adjustments. Knowing your levels in Estradiol E2, total testosterone, and obviously your PSA are needed at least every three months that first year. I take my test before I go to my urologist on my dime and I have full control of my lab work, returned in three days flat. Why do doctors only check for ONLY PSA which does not cut it if you have advanced prostate cancer? My urologist can't believe how low my PSA has been one year after stopping my Lupron horror shots. Not the norm of what they are use to seeing.
You can get a doctor's blood work script online at Life Extension: lifeextension.com/lab-testi... that you hand to your local LabCorp to draw your blood. The blood lab scripts come to your email. I buy my blood lab scripts during their annual sale (going on as I write this) for the entire year in advance. The scripts are all good for 6-months. But, if you call them and ask them to renew the unused ones for another 6-months, they will take care of it with no hassles. Sweet!
That's enough details for the majority of you guys to consider or not. I'm not selling anything and I'm not a doctor nor studied medicine. You would be surprised how many are stealth on these forums. Solo la mia opinione che non c'è bisogno di seguire.
Very informative post Herm! I just may consider trying some E2 gel...haha! Loving the stuff!
Grazie mille
I like my tits....
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 05/24/2020 10:45 PM DST
Not what you're looking for?
You may also like...
Transdermal Estradiol (tE2) update # 2
Just a quick update on my tE2 gel progress (sample taken on 8/3/2018, 6 weeks after previous......
43 Month Transdermal Estradiol (tE2) Update
Just a brief history:
Robotic RP in 2004. BCR in 2013 (PSA-0.21). 'Failed' lymph node excision in...
Surprising tE2 (transdermal estradiol) results...fifth update
Just received the results from my August 10 blood draw and I am pleasantly surprised. I started...
My 46 Month Transdermal Estradiol (tE2) Update
PSA - 0.006, T - 231, E2 - 162, ALP - 88
Actually I was quite pleased with my trimonthly blood test...
31 month transdermal estradiol (tE2) update
Not sure why my T has gone up to 223 from 23 and my E2 has gone down to 56 from 146 in the last six...
