Estradiol =11.9 pg/mL ... 11.0 - 52.5 pg/mL normal range

[Scout4answers]

Estradoil is on low side of normal.

thoughts?

[Scout4answers]

No 5-AR Inhibitors yet.

Is Patch best way to get to 18-20?

any studies that I can give to my MO to help him along? Or is this something I am going to have to figure out on my own.

[noahware in reply to Scout4answers]

Many docs resist E2 patches because they are not SOC, but there are a ton of studies suggesting low-dose tE2 as an add-back is a safe and effective way to get levels up, if needed. I am not sure if 1) your levels are low enough to worry about, or 2) if you are currently suffering any effects of lower E2 that need to be addressed immediately.

[Some of these studies will point out that E2 add-back may help with things besides just bone density, such as hot flashes, brain fog, etc.]

[Scout4answers]

PSA 0.03,

T < 7

waiting for DHT report from blood draw on Friday

Lupron + Zytiga + prednisone for 7 months

No radiation or surgery yet.

[Scout4answers]

What arrow would you fire at this point? E2 patch or gel?

[Hidden in reply to Scout4answers]

I shoot for 13-22. I don't have any good data to support this range. It is mostly a guess and was arrived at by looking at small studies, papers, and opinions.

If you don't have any issues that estrogen could cause (bone loss, hot flashes, depression) I wouldn't add exogenous estrogen. If you do have issues I would add a little - perhaps 0.025 mg/day and see how my E2 level reacts.

Also, make sure you are doing the women's test (ultrasensitive LC/MS).

[pjoshea13]

Well, this is awkward. I am on record as saying that E2 should not be below 12 pg/mL, and here you are at 11.9 - lol.

I think you are safe, but you have the option of a low-dose E2 patch to get a bit higher in the 12-20 pg/mL range.

My number was based on a review of osteoporosis/osteopenia in aging men that I did about a dozen years ago. There must have been important studies since then. As I recall, some of the studies found single digit E2 to be a problem, with rapid bone loss.

Unfortunately, since low E2 is often because T is low, some older studies assumed that T - not E2 - is required for male bone health.

Here is a study from five years back., involving men from "United States, Sweden, and Hong Kong". "Men ≥65 yrs old were recruited from local communities. Those who could not ambulate independently, had bilateral hip prostheses, were not expected to survive 6 months or who could not consent were not enrolled." i.e. it isn't a PCa study.

"Although minor improvements in NRI {net reclassification improvement} were observed for the dichotomous parameters ...

... low bioavailable E2 (BioE2) (<11.4 pg/mL) ...

... and high SHBG (>59.1 nM), neither sex steroids nor SHBG provided clinically useful improvement in fracture risk discrimination."

Sadly, the conclusion was that "there is limited clinical utility of serum E2, T, and SHBG measures for the evaluation of osteoporosis risk in elderly men."

but I'm sticking to the 12-20 pg/mL range for now.

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

There are many factors that affect bone health - minerals (not just calcium) - vitamins (D & K, preferably K2-7) - hormones - physical activity.

Many men with PCa start out with healthy bones. When ADT leads to osteoporosis, the smoking gun is the loss of E2. It is illogical to throw minerals & vitamins at the problem if bone loss only began with ADT. IMO

-Patrick

[cesces]

Are you taking Estradiol ???

Oops looks like you aren't.

Some people use Estradiol as a treatment on its own. I'm not certain what the research is on that. It may be off label.

But I think it is well established to use it to prevent side effects of ADT such as hot flashes.

Vivelle patches worked well for me. And are probably simpler and more accurate doing than the gel.

[Scout4answers in reply to cesces]

no

[cesces in reply to Scout4answers]

see my edited supplementation to the question

[Tall_Allen]

If you are taking Lupron, it should be low. Lupron prevents your body from manufacturing testosterone. Testosterone is the source of most of men's estradiol. No T-> low E2.

[LowT]

Some thoughts with my experience with Tgel.

Would assume some of this will apply to E2 gel/patches.

There was marked variation of absorption (as measured by serum T - total and free- of the T depending upon several variables such as:

Site of application (Chest upper arms>Abd>thighs

Brand - vehicle used to transport the T

Climate/environment - warmer climates greater absorption

Skin covered or not

Level of physical activity

[PhilipSZacarias]

Hello Scott,

According to Russell, et al (researcher in Australia), in a review of the literature, the minimum E2 to maintain bone health is 11 pg/ml. I would aim for a slightly higher target. See recommendations by the honorable Sir PJOShea. Cheers, Phil

Russell N, Cheung A, Grossmann M. Estradiol for the mitigation of adverse effects of androgen deprivation therapy. Endocr Relat Cancer. 2017 Aug;24(8):R297-R313. doi: 10.1530/ERC-17-0153. Epub 2017 Jun 30. PMID: 28667081.