Until the ‘Patch” trial is completed sometime next year there seems to be a lot of unanswered questions regarding the use of tE2. Some warriors on this site maintain that E2 levels should remain in the 20 pg/mL range while many of us including myself appear to be doing quite well using tE2 (patches, gels and creams) as our only form of ADT. Use of these agents ultimately has the effect of suppressing testosterone levels similar to GnRH agonists such as Lupron; however, unlike Lupron E2 levels are generally increased to well above the normal male range of ~10 to 40. To the best of my understanding E2 levels should approach normal female premenopausal levels for the E2 to effectively reduce T to the castrate level. Since E2 is aromatized from T, GnRH agonists pretty much wipe out any E2 which we all agree is necessary to maintain bone density. The majority of us that are using tE2 are experiencing Only gynecomastia as a side effect.
If any of you are considering trying tE2 you may be interested in a cost comparison between Lupron and the gel. I don’t know what the patches cost or how well E2 creams work so I can only speak about the gel. Not being familiar with Lupron, I have been ‘told that a three month injection can cost over $5000. I found this price online which may or may not be the average:
7.5 mg/month: Lupron Depot-PED intramuscular kit from $1,763.53 per kit
Obviously insurance plans will greatly affect what the patient actually pays.
One tube of Oestrogel lasts me about three weeks which here in Thailand would equate to less than $20/month. Even in Canada where the price is ~$55/tube, a month's supply will cost about $70. I don’t think the gel is available in America; however; E2 creams are advertised on Amazon. Here is one example (which I know nothing about):
Estrogen - All Natural Bioidentical Estrogen Bi-EST 2.5 - Estriol & Estradiol - Age Management for Women - Professional Grade - Two Month Supply - 3oz. (Unscented) $30.00. by BIOLABS PRO
Oestrogel is advertised online; however, some people have reported many of them to be scams.
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E2-Guy
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Good point about cost! Is the dose you are using bioequivalent to the dose in the PATCH trial? (i.e., does it result in the same serum level of E2?) Also, I was wondering which other monitoring tests you use (e.g., T, DHT, SHBG, prolactin, liver enzymes, DEXA (BMD), prothrombin time?) Also, is there any libido?
From what I've read, in the PATCH trial receive Oestradiol 100mcg (4 patches changed twice weekly = 8 patches of at total 800mcg or 0.8mg ) for 4 weeks and then the estradiol (E2) and testosterone is checked with the blood test.
1. During that first 4-weeks if the testosterone level is less than or equal to 1.7 nmol/L they are given only 3 patches changed twice weekly (6 patches total of 600 mcg or 0.6mg) for at least 3-years. Not too difficult to do.
2. During that first 4-weeks if the testosterone level is greater than 1.7 nmol/L they are they are given 4 patches changed twice weekly (8 patches total of 800 mcg or 0.8mg) and the E2 and T are checked at 6 and 8 weeks until they reach chemical castration. Basically their T drops and their E2 increases as the PSA drops. Once they are castrate, they are reduced to only 3 patches changed twice weekly (6 patches total of 600 mcg or 0.6mg).
Applying the transdermal Oestrogel is a much more potent dose. Which if you wish it could speed up the reduction in T and thus your PSA. The tube comes with a measuring "ruler" as you see in Ron's picture. You squeeze it out into the groove in the plastic ruler that you measure out your dose. Yes, you will sometimes squeeze a fat bead of Oestrogel and therefore each dose could vary somewhat. Each bead/application of Estrogel is about 1.5mg of estradiol according to the documentation. Total content is in the tube is approx. 60mg. of estradiol. You therefore you adjust your application as needed.
You can drop your testosterone down to castrate levels provided you have not prior reached ADT resistance levels. Once you do reach your desired T and PSA levels you simply reduce your daily application(s) of transdermal estradiol.
Compared to SOC ADT there are virtually no major side-effects (lose some of your sex drive). You may notice your T and PSA drop faster because of the increased E2 dose compared to PATCH. Perhaps compared time-wise to Lupron/Casodex combo. Yes, you will get some man boobs eventually. There is more libido remaining than Lupron ADT. But, you may only have the appetite of a 65-year old. In other words, it depends on you and your partner to get creative.
The Estrogen - All Natural Bioidentical Estrogen Bi-EST 2.5 - Estriol & Estradiol cream that you pump from a can and you can buy at Amazon online. That made in America over the counter estradiol cream delivers 500 mcg per pump press application on your skin. It drys within 4 minutes. You can apply some on one of your forearms and then use the inside of your other forearm to rub/spread on both sides of your arms. Keeps your hands clean just using your arms. Easy and it dries quick. Again, it is more estradiol E2 per application than PATCH. So, getting faster results is to be expected. It works quite well!
One of my friends recently started using the Bi-EST 2.5 and his PSA dropped from 33 to 22 in two weeks and it kept on going lower along with his T as well. His T was in the 600s when he started. He applied the E2 cream twice per day. After that two weeks he had an previously appt. with his urologist and he was just amazed at the "sudden drop" in his PSA. He told his doctor he was changing his diet and making lifestyle changes. Doc replies keep it up!
His target PSA is less than 2.0 and T of less than 1.7 which is a heck of a drop in T for him. He still lifts weights and still has the energy level to do so. He's in his 60s and said he was not going to get man boobs. We'll see!
Not much libido anymore; however, I'm 77 and it has been slowly decreasing since my RP 15 years ago. I've noticed the biggest decline in the last five years, even before I started using the gel 27 months ago. Erections are pretty much a thing in my past life...don't really miss them anymore due to the lack of libido. I'm able to accomplish more today since the 'little guy' rarely disrupts!
E2 purchased online is not likely to be suitable for castration purposes. LOL
In one PATCH paper, median E2 was 685 pmol/L, which is 186 pg/mL.
The target E2 range for healthy men is 20-30 pg/mL.
You say that you are doing well at 146 pg/mL with T at 23 ng/dL, but I wouldn't use that to question the relevance of the 20 pg/mL target some use. &, although I aim for 20 pg/mL, I by no means feel that it is crazy to be at 200 pg/mL or higher for the purposes of ADT.
We know the downside of zero T. We know less about the effects of supraphysiological E2.
It's encouraging to note that the PATCH trial trundles on. I am looking forward to the full paper.
Great and practical info on topical E2 for ADT here. Thank you. Works for me too and I heartily endorse. Don’t forget about Tamoxifen to control the man boobs. Or pretreatment with radiation. If you have even a tiny amount of gynecomastia before starting estradiol (or bicalutamide monotherapy) Medicare may pay for it as they did for me.
Hi Ron thanks for the thought provoking and informative piece. Just to add my tuppence worth - as you may know I was on 3 monthly Lupron injections for 2 years before switching to the very gel captured in your image. I have used it successfully for 1 year now (only monitoring Psa). In future I will ask for testosterone and E2 levels to be checked. The cost in the USA sounds pretty pricey. Here in Malaysia I pay 1300 ringgit for a 3 monthly Lupron depot shot and in Thailand 11600 bhat last time I had I one a year back at Lampang Cancer Hospital (a normal goverment hospital and not a fancy Bangkok Hospital type where expats normally go).
Therefore it would be safe to say that the injections are a bit cheaper here than stateside. Nevertheless, over a year I do save quite a bit of cash despite the lower cost. 3 tubes of gel gets me through 3 months therefore 900 bhat as opposed to 11600 for the Lupron depot injection.
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Lupron Cost Increase?
