Question for TA

[epfj3333]

I'm on Firmagon. What's the science behind the hot flashes? I understand the fatigue as my testosterone is about zero. But I don't understand the hot flashes. I have two or three every hour. Why not sore muscles or head aches or something else? Why does Firmagon make me sweat like a pig for a few minutes every hour?

[noahware]

Men need T to produce estrogen, so ADT means low T and low E2 as well. As with menopausal women, a reduction in E2 in men is associated with hot flashes. There are many possible treatments that might reduce these, but as with women, adding back E2 (via patches) in men is associated with a reduction of hot flashes.

[Hidden in reply to noahware]

If low-dose estrogen patches are used along with the ADT, hot flashes are reduced considerably. Some doctors do this whenever they prescribe ADT. Another reason is cardio issues and another is bone loss. All can be mitigated, eliminated, or reversed using low dose E patches. The purpose of ADT is zero T. Not zero E. So this doesn't affect treatment results.

[spencoid2 in reply to Hidden]

what is low dose? i have tried everything and this was never suggested

[Hidden in reply to spencoid2]

I don't know if there are recommendations. I'm using weekly patches that deliver 0.025 mg/day and adjusting as needed to maintain an estradiol blood test reading of 15-25 pg/ml. I don't have enough lab readings yet to tell me what the ideal dose will be. But whatever I find that I need might not be what you need.

I think that 0.025 mg/day is a safe starting point and you could adjust to target 15-25 pg/ml of estradiol. Note that the government has data suggesting that patches delivering 0.1 mg/day are cytotoxic to prostate cancer. I'm going to research this more and possibly increase mine.

Goodrx has a coupon for 4 weekly patches delivering 0.025 mg/day for $28.

This is not what you are doing but at least I have personal data on this: To use estrogen patches in place of Lupron, I had to use weekly patches to deliver approximately 0.3 mg/day. This held my testosterone to undetectable levels.

[ARIES29]

Glad somebody explains this. I wake up in a lather of sweat 3 or 4 times a night whilst on Firmagon. I am Taking something called Menovair for menopause in women which helps for hours only.It would be a big help if we could have the E patch here in this country. I wonder if Women can buy them for menopause? If so why not men for PC?

[VCinTx in reply to ARIES29]

I get relief from Evening Primrose Oil. It doesn't stop the hot flashes totally but it definitely reduces the severity.

[Christopherg in reply to VCinTx]

Could you please let me know how much and frequency of using Primrose Oil?Thanks so much

Chris

[VCinTx in reply to Christopherg]

I take one capsule with my evening pills.

[Christopherg in reply to VCinTx]

Thank you so much Best wishes and good health

Chris

[Hidden in reply to ARIES29]

I don't know if you could get something like this in your country. OTC in the U.S.We can also get estriol cream.

smile.amazon.com/Estrogen-C...

[ARIES29 in reply to Hidden]

Thanks for the link RSH1. They ship to OZ so will try the cream & hopefully leave the ADT behind.

[Hidden in reply to ARIES29]

You're welcome.

Just to be clear there are two ways to use estrogen for ADT:

1. use Lupron or another androgen inhibitor drug (e.g. Firmagon, Orgovyx) and use a low dose of estrogen to replace your estrogen hormone. So, your testosterone will be zero and I keep my estrogen around 15-25 pg/ml (estradiol - the one tested in common labs). You need to use a sensitive estrogen test for men. The standard one for women isn't accurate enough for men.

2. use a high dose of estrogen in place of an androgen inhibitor. This reduces your testosterone. It should work better if you are on Zytiga. You don't really target estrogen levels. You target testosterone instead. Lower the better. Mine was always undetectable.

I've done both. Both work just fine. It might be hard to use enough cream for #2. I haven't tried using the cream for the second one so I don't know. I have used cream for #1 and it works well.

Please let me know if you find the cream and want to use it. I would like to help if I can.

Good luck! Russ

[cesces]

Get some estrogen patches from your Doc

[Chask]

An interesting question. I have been on ADT for over 6 years and the last 3 with the addition of Zytiga. In the early days I also suffered from frequent hot flushes and got little sympathy from my wife (in a joking way) who has been having the same hot flushes for many years. However it has just made me realise that these have now become very infrequent, maybe only once or twice a week. And I haven’t done anything to minimise them, no oestrogen patches etc. Not sure why they have reduced other than maybe because my ADT is now failing badly. Haven’t measured my testosterone recently. I am about to start Docetaxel.

[Hidden in reply to Chask]

I was on a 180 degree opposite hormone therapy for two years. Super high testosterone. I injected 400 mg of cypionate a week. My BP went up a lot. Nalakrats helped me take care of it. But then it started coming down and wasn't an issue so I didn't use anything to help. I speculated that my body eventually adapted to the high testosterone environment. Problem is that my cancer eventually adapted too. So after 2 years my PSA finally started increasing and now I'm doing BAT (bipolar androgen therapy - testosterone high with Androgel and then low like ADT - I use 1-3 month cycles). By the way, I can easily dose Androgel to get my testosterone up to 2300+ ng/dl. Cernos gel does the same thing. I mix and match. I had read a lot of speculation that Androgel couldn't be dosed high enough. My NMD and I never understood why so I tried it.

[London441]

The estrogen patches work well for the hot flashes. So does vigorous exercise, both cardiovascular and resistance training. Kills the fatigue and muscle loss also.

What is your weight, how much fat are you carrying? What are your fitness habits?

[epfj3333 in reply to London441]

6'6", 215. Cardio & weights 4 days per week. Golf 3 days. Yard work in between. I can tolerate the hot flashes which I get about three times per hour. It's the fatigue that comes along with them that really bothers me on the golf course. I know that doesn't sound that important but I'm a professional golfer. In my day, I played on the PGA Tour. Even though I'm retired now, I'd hate to give up playing.

[London441 in reply to epfj3333]

Don’t stop playing. I don’t have to tell you how envious guys are of your ilk. Not me of course, I’m terrible and play only when my friends insist on it, and I only enjoy the game because I don’t work at it anymore😀

I can’t know what your routines are like, I can only encourage you to do more if you’re able, especially the weights. Sometimes shorter sessions with greater intensity can be transformative.

Another solution for hot flashes is the Embr Wave, a cooling device you wear like a wristwatch. I know personally a good number of guys who swear by it for the hot flashes. Details at embrlabs.com

[Muffin2019]

I have embraced them for the past 4 years, worse in the summer less in winter, I joke about the female curse, adjust the temperature at work when they hit. It could be worse like being dead, kero me knowing I am still here and kicking.

[Hidden in reply to Muffin2019]

I used estrogen. Zero testosterone for 6 months. No hot flashes despite living in 120+ Phoenix and doing estrogen ADT from April-Sept. My MO told me it wouldn't work. But after seeing a dozen or so lab tests with zero T she had to agree that it does work. High School biology still rules! Go Washington Rams!

[meowlicious99]

I know couple of men here in india on adt. Suprisingly none of them suffer from hot flashes. My dad started adt 4 months ago and never had hot flashes.

Perhaps something to do with Indian genetics?

[j-o-h-n]

I'll let T_A respond.........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/28/2021 7:03 PM EST

[Exrunner]

I have yet to find a doctor that will prescribe estrogen patches to try and control hot flash or to prevent bone loss while on ADT. I am currently on Orgovyx and have elected to purchase a bioidentical estrogen cream off Amazon. It is a hit and miss proposition to get the right amount to bring your E2 level up 12 to 30 pg/ml to help reduce hot flashes and bone loss. The hot flashes hasve been reduced. I will find out about bone loss the next time I have a DEXA scan.

[Hidden in reply to Exrunner]

Awesome! We need to go out on a limb at times. I tested and tested to get it right. And then I monitored and monitored. I truly enjoy figuring out my own body and how to manipulate it.

[Hidden]

Some good info: cancerresearchuk.org/about-...

I used estrogen for my ADT. No flashes. Then I used bicalutamide with dutasteride. No flashes. Now I use bicalutamide for certain time periods with a hormonal cycling program. No hot flashes. I'm a white guy in Phoenix, Az and it frequently gets to 120 F.

Also, my bone density in the femoral neck of my hip increased during estrogen ADT. I have osteopenia and this is the first time in decades that my bone density increased instead of doing down (but the bone density in two other locations went down a little - overall a slight decrease in bone but less than a third of the "normal" rate).

Muscle loss was big. But I also lost fat. Just had to diet and exercise. My bodyfat got down to single digits. I went off of ADT over 2 years ago and since then I've gained almost 100 lbs but that includes over 20 lbs of fat!