Hi. I will be trying to convince a sceptical MO of the potential value of low dose transdermal E2 tomorrow. I have some papers, but can someone please remind me of the typical dosage in this context? Thanks
Estradiol add back dose?: Hi. I will be... - Advanced Prostate...
Estradiol add back dose?
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Proflac
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In this thread healthunlocked.com/advanced... EdBar wrote: "I'm on 0.1mg patch, I keep 2 on and change one daily. Myers had me wearing 3 patches at one time, changing one each day for a while, Sartor thought it would be fine to go with 2. "
Dr. Charles "Snuffy" Myers recommended 0.025 mg/day, to 0.05 mg/day transdermal skin patches. They are commonly changed twice weekly.
From my reading, a blood estradiol (E2) level of around 50 pg/mL is considered sufficient to protect bone density in post-menopausal women, one of the primary targets of these patches. That seems reasonable for guys on ADT as well, but that's just my speculation. I can't point to a study supporting that specifically.
Higher levels can help one "feel" better - improved mood, energy, and so on. I'm on a higher dose, and feel terrific. No hot flashes, better memory than I've had in years, enough energy to keep up with my 6 yr old grandson! I know what I felt like for 3 years on Lupron, and it is very difficult. Our body needs some minimum level of sex hormones, and either male or female types will work.
I think a target, measurable, response level, specifically the blood estradiol, E2 is important. People vary a lot in how they absorb estradiol from skin patches. (estradiol is the 'active' part of "estrogen" which is a composite mainly of E2 and E1 which is 'estrone')
This is a link to a video by Dr. Myers talking about this treatment support. [Edit to add, the link redirects to YouTube, which is why there's a site-posted remark about the link. It does work just fine.]
youtube.com/watch?v=KBpg_SE...
Men who have E2 <12 pg/mL have rapid bone loss according to old studies.
Life Extension advises men to aim for the 20-30 pg/mL range.
I used to aim for 20 rather than 30, & was happy if in the 12-20 range.
Now that I use DES (Diethylstilbestrol) daily, my E2 comes back as <5 pg/mL (which could be close to zero. However, DES is a synthetic estrogen that is not associated with bone loss.
-Patrick
Patrick, Im surprised that your E2 is that low while taking DES? Obviously it doesn't have the same effect as tE2. My grandfather, dad, and his two brother did very well while on DES. Dad and my uncles never complained about any Side effects until the DES was replaced with Lupron in 85.
With DES apparently being accepted as an E2 substitute by the bones, I would not have expected your kin to have had suffered bone weakness.
Even so, I wonder if there is some bodily function that would perform better if I added a little E2. I will discuss with my integrative guy later this month.
-Patrick
I have numerous posts on this site regarding my use of transdermal estradiol (tE2) for the last 41 months. If you can't view them, please apprise.
I would love to have them and possibly share with my MO. Thank you
Can you not view my posts? I have even posted my blood test results.
sorry am new to computer things, thinking click on your profile and go from there. Thanks for understanding
This may help from a search in HU for "transdermal estradiol":This will take you to the partial post, you have to go to the whole post based upon the titles of the post.
Boob Pic!
After 40 months of successful ADT using transdermal estradiol gel (tE2) my ONLY side effect is a bit of gynecomastia. I took this pic today and I'm not embarrassed to wear pullover shirts.
ronronHUin Advanced Prostate Cancer
2 months ago
High-Dose Transdermal Estradiol as ADT
Tall_Allen: Most of what I've read on tE2 is on castrate resistant patients. How can that be? How does it work at all if they're castrate resistant, meaning that their PSA is rising despite castrate levels of T? Does it delay castrate resistance in castrate sensitive men? ADT author and patient
Horse12888in Advanced Prostate Cancer
6 months ago
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 months? My E2 gel usage has stayed the same. Perhaps Richard
Wassersug or Tall_Allen may have some input. Still no side effects other than the boobs! No complaints...many of the poorly endowed girls
ronronHUin Advanced Prostate Cancer
11 months ago
tE2 – History, Sourcing, and obstacles in the US
Transdermal estradiol gel was developed and marketed beginning in the early 1980s. For a complete discussion of this development history, read the Wikipedia entries.
ragnar2020in Advanced Prostate Cancer
7 months ago
Estradiol add back dose?
Hi. I will be trying to convince a sceptical MO of the potential value of low dose transdermal E2 tomorrow. I have some papers, but can someone please remind me of the typical dosage in this context? Thanks
Proflacin Advanced Prostate Cancer
1 day ago
DC’s bone scan results are in!
Hi All, DC’s bone scan results came back with “very small” lesions on 4 areas in his body. The Dr said they will go away with the medication he is taking
(Zytiga+Prednisone+Lupron 3 mo). Dr. rejected the estradiol patch but I’ll find a way to get some. His PSA is 24.5 from 243 & 66. Dr added Potassium
jcoilin Advanced Prostate Cancer
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 11/01/2021 11:03 PM DST
Thank you!!!!!!!
Yes, Click on my photo and you can see all of my posts.
I’ve used estradiol patches for about 7 years now to relieve hot flashes etc. associated with ADT. The dose I use is 0.1mg and I use 2 patches per week changing the patch every 3/4 days to a new one. Originally prescribed by Snuffy Myers, they work like a charm. They also have the approval of Dr. Sartor who I’ve been seeing since Snuffy’s replacement. Snuffy has several videos on YouTube discussing the use of estradiol patches.
Ed
Following the guidelines in the PATCH trial , I started out with 4 .1 mg patches and after T went to castrate I dropped down to 3. They use .1 mg patches changed twice weekly. Finding that a nuisance, I use the weekly patches. If that’s not appropriate maybe someone will correct me. I’ve been using them since February 2019 after stopping trelstar.
What do you have against them?
The dosing for using estradiol patches exclusively instead of Lupron type AST uses much higher dosing per PATCH trial, 3-4 patches at once of 0.10 mg/day. For adding E2 back into ADT, just one 0.10 patch changed twice weekly works very well. Tell the reluctant MO that while on ADT you have the physiology of a post-menopausal woman, so this is appropriate to prescribe. And no increase in cardiovascular risk was shown in the PATCH trial for transdermal estradiol.
Helpful. Thanks. Oncologist has at least agreed to ask Prof Langley who lead the PATCH trial for an opinion.
👍.
See this link ncbi.nlm.nih.gov/pmc/articl...
When I was on Lupron I used one .1mg estradiol patch changed twice weekly to stop hot flashes. Totally worked.
How big are these patches? What is the cost? Does insurance cover this for PC?
The patches I use by Sandoz are about 2 1/2 X 1 1/2 inches oval shaped and translucent. They are covered by my Medicare Part D plan. I get three packs of 4 patches per month since I use 3 .1 mg patches changed weekly. My copay varies but gradually decreases as the year goes by. It’s now just $35 a month. You need a prescription from your doctor.
With support of my Oncologist when my PSA was 5.3 and rising I started with four 100mg Estradot patches and changed two each day. A year later PSA had dropped to .038 and after another six months to <.008 or technical remission with no adverse effects apart from Man Boobs and slight loss of energy.
After discussion with Oncologist we decreased to four .75Mg patches patches still changing two a day and PSA has remained at <.008. Expect to gradually decrease patch concentration to 50mg to 25mg so long as PSA remains at <.008.
I get quarterly bloodwork for PSA, testosterone, estradiol as well as Alkaline Phosphatase and DHT to confirm cancer is not finding alternative metabolites to create testosterone to feed the cancer.
It seems everyone has different very different dosage regimes and also different reasons for using Estrogen from reducing night sweats to virtually eliminating testosterone that feeds the cancer. In an imperfect world I am very happy with the benefits of estrogen patches and should the cancer ever become resistant to estrogen therapy there are still all of the standard ADT therapies available for Plan B.
Hope this helps and best of luck.
Peter
Thanks for replying. So glad this works well for you. I think if we were 3 years back and knowing the PATCH results this may well have been our choice. It's good that these options are opening up for men.
100mg. Can’t be correct . You mean .1mg? What’s the reason given for changing patches so frequently?
Sorry and yes your are correct. Estradot 100 patch is actually 1.56mg of estradiol and Estradot 75 patch is 1.17mg of estradiol. The confusion is in product nomenclature which is misleading.
However what is unequivocal is high blood estrogen averaging 1000 pg/ml has reduced PSA and testosterone to levels which are steady and below measurable values with PSA <.008 and Testosterone < .4 from regular bloodwork at LifeLabs in Canada.
There is a lot of research showing low T and high estradiol are the perfect environment for prostate cancer to grow and flourish. I’m actively looking for SupraT treatment. Forget ADT, hormones matter!!!
That is because in the typical environment of "low-T and high E2" the T is not sufficiently low, and/or the E2 is not sufficiently high. To be clear, we should distinguish between the NON-castrate-level "low T" of normal aging and the castrate-level "no T" of successful ADT.
It would be difficult if not impossible for a man to achieve a "no T" and high estradiol environment without being on a high-dose E2 program of ADT... which has proven for many men to NOT be the perfect environment for prostate cancer to grow and flourish. Rather, it delays progression for them, because T is sufficiently low.
When I attempted ADT with E2 patches I failed to reach castrate levels of T, and T hung around 80-160. Based on my ALP numbers spiking for months, that indeed WAS evidence that low T (NOT castrate) and high estradiol really ARE the perfect environment for prostate cancer to grow and flourish! [Now I am on ADT with undetectable T and, obviously, very low E2. Numbers are great so far in that "low-low" environment.]
Chemically castrating otherwise healthy men can’t be good. Personally I refuse any further ADT. It was never the standard of care. There is a s research showing bio-identical testosterone therapy, while using aromatase inhibitors can cure PCa. I’ve been down the castration route, at 52, I’m not about to follow palliative and damaging ADT.
I am not arguing that ADT is good for men, or that you should pursue ADT, or that supra-T cannot be beneficial. I am simply clarifying your statement about a "low T and high estradiol environment." It would typically apply to men NOT doing standard hormonal therapy.
Such an environment is not really relevant to the OP's thread, as he is asking about moving from a "no-T and no-E2" regime to a "no-T and low-E2" regime. The add-back of estradiol via low-dose patch does not move one to high levels of the hormone, but gives just enough to mitigate problems associated with a lack of SUFFICIENT estrogen.
And it is of course not relevant to most men on ADT, as how would they ever have "high estradiol" without having the T from which it is derived?
Simply stating…..there are other options and we don’t have to buy into the dated and dangerous science of ADT. That’s all.
That's fine, but then why the initial post about high levels of E2? Men who "buy into the dated and dangerous science of ADT" have absolutely no worries about being in a "high estradiol environment."
Standard ADT brings about a very, very LOW estradiol environment. That is one of the things that makes it dangerous, and what the OP is trying to address. The add-back dose does not bring one into a "high estradiol environment."
Be aware that regardless of stated dose, there may be some variation in delivery with different brands. This was found to be the case in the two brands used in the PATCH trial in the UK.
My use of the generic Dotti brand failed me in both high-dose (ADT initiation) and low-dose (hot flash) applications, but I don't know if that was because of the patches or because of me. I do know that Dotti gets horrible reviews from many women who are switched over to it from other brands.
Good post Peter! There are many of us who are suppressing the proliferation of our PCa with tE2 mono therapy. Richard Wassersug (the tE2 guru) has been using the gel for 20 years and his PSA is still undetectable. I have been using the gel for 42 months now and my most recent PSA was 0.003. The only SE is small boobs. I had an RP in 2004, BCF nine years later, lymph node excision in 2017, and my PSA continued rising until I started using the gel. I view it as a miracle hormone since I have been on this journey for 17 years and at 78 I still feel great! I'm in the gym six nights a week, 'still finishing' out and remodeling condos, driving motorcycles, playing in the sea on my waverunner, and doing everything I did before being inflicted with this crap, only a moving a bit slower.
Obviously everyone is different and what works for some may not work for others. Nal is having success with ADT vacations from 'whatever' he is using; however, others haven't been that fortunate.
Unfortunately the majority of doctors would rather inject their patients with nasty, outrageously expensive ADT drugs every three months as opposed to allowing them to apply an inexpensive natural hormone!
My best to everyone on this site,
Ron
Wow Ron that's a good run on the mono therapy. Really pleased you are keeping so well. Long may it last!
RonHi it’s Bob. What’s the brand of gel and is it available here in the US? I don’t like peeling off the funky adhesive used on the patches .
My last psa was .6 after being nil for a year then .2, .2 and I dropped down to two patches and psa went to .5 so added patch back and two months later it was .6. T is 3.0 so seriously castrate. E2 has been over 100 all along . I’m now considering what to do if psa continues to increase. In the past, I’ve gotten a scan when psa was between 1.0 and 2.0 ( axumin or psma ct pet ) to find mets which have been in bones albeit only one or two which I hit with SBRT. The thought of going back on standard ADT or second level hormone therapy is not something I want to do. And certainly not docataxel! The fact that I’m oligometastatic gives me some comfort given I’m Gleason 9 and 8 1/2 years out from diagnosis.
Bob
My husband was on estrogen patches without ADT for 5 at years and did very well... then psa became unstable and went to Honvan. That worked another 4 or so years... he was diagnosed in 2007 stage IV.. he died this past April which is 14 years.
I wish we had begun to work again with the patches along with more 4-1 CBD to THC.
I can't look back- though as we went more deeply into being tired, dealing with a botched radiation, and bone biopsy... he had more difficulty..We also we getting to the end of the expensive alternative route with docs charging 350 and hour and more. Overall, I have no idea of timing for my beloved, just that I know our path was right for us. I wish I had more help that wasn't so expensive. It got to be difficult to comprehend what I needed to do and I was his main caregiver.
The only thing I would change is we followed a closer standard of care in the last two years.
This is PERSONAL to us and our situation, to my husband's personality and our philosophy.
I have a lot to say about our journey. I can't look back. Diagnosed stage 4, living 12 of 14 years very active, I must accept.
Estrogen patches worked well for him.
Thank you for replying. So sorry for your loss. I appreciate you sharing this. It's hard for us wives to help sometimes, but sounds like you did a great job. X
What is your PSA level when you go on ADT vacation and how high do you allow your PSA to go before you start ADT again?Thanks
NalYour psa is so low it’s amazing. Obviously your doubling time when on vacation indicates you’re at very low risk of death from Pca! Congrats!
Your PSA is definitely amazing. Mine after an RP never went below .09. This month is ten years out from my surgery, salvage radiation and SBRT. I am currently at .4 after six months on Orgovyx. I guess it will be awhile before I go on a vacation.
Thanks
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