I have an appoint with my latest Kaiser MO in October. I have lobbied 3 MO's and my PCP for transdermal estrogen patches, but with no luck. I have sent my MO the latest info I can find (thanks to this support group for their help), but I am pretty sure he hasn't done anything besides scan it in my presence.
Do any of you have a Kaiser MO who has prescribed estrogen? If so, would you please send me their name and location so I can attempt to get my MO to reach out to them?
Thank you
Do you need to get it from your MO? Just a question. Some will only do things that their MO allows. Some will go outside if they need to.
If you don't need your MO to get it for you, you could ask him whether TRANSDERMAL estrogen is contraindicated for PCa/ADT and if so, why.
Thanks warrior. So far my mo has expressed no interest in doing anything other than SOC. I am using an external estriol cream, but it’s difficult to judge the dosage.
Where have you gotten that cream? And what brand/type? Thanks
Thanks for your request. I am not confident in the product I bought, so I am reluctant to promote it here.
Thanks. Haven't decided whether to use it but will need a source if I do.
At least you have something and I too am curious how you came by it.
Eddie, see my response above. Thanks
Are you looking to use that as your primary treatment or just to help alleviate ADT side effects?
Just to help with SEs
It is like that here in OZ, any MO is afraid to prescribe it.
I remember someone on this site recomending Estradiol Gel 17B, reduces PSA with no SE at all. It might be same as the cream you use?
The estradoil gel comes with a paddle measurement to apply.
Thanks Aries, I will check it out
Also in Australia. My MO won't prescribe Estradiol as a PCa treatment but when Gabopentin had no effect on hot flushes was happy to put me on Estradiol 0.1% (1mg). Took about 20 days to have an effect and after some months I had tender man boobs. Horses for courses. Simple sachet, tear it open and rub on inner thigh.
Also in Australia.
MO's and General Practitioners look at you with amazement that you would even contemplate taking Estradiol to combat symptoms or instead of Lupron.
You could always befriend a 50 year old plus women and ask them to get some for you. Works for me.
You might bring this abstract to the attention of your MDs:
Eur J Endocrinol. 2022 Nov 1;187(5):617-627.
Effects of oestradiol treatment on hot flushes in men undergoing androgen deprivation therapy for prostate cancer: a randomised placebo-controlled trial
by Nicholas Russell et al.
PMID: 36806623 DOI: 10.1530/EJE-22-0318
Abstract
Objective: Most men undergoing androgen deprivation therapy (ADT) for prostate cancer experience hot flushes. Current treatments have low or limited evidence of efficacy. It is likely that oestradiol depletion is the mediator of these hot flushes, and transdermal oestradiol might be an effective treatment.
Design: This is a 6-month randomised, placebo-controlled trial with the hypothesis that oestradiol would reduce hot flush frequency and intensity and improve quality of life (QoL).
Methods: Seventy-eight participants receiving ADT were randomised to 0.9 mg of 0.1% oestradiol gel per day or matched placebo. Hot flush frequency and severity were assessed by 7-day diary at baseline, month 1, month 3, and month 6. QoL was assessed by validated questionnaire.
Results: Oestradiol reduced daily hot flush frequency, with a mean adjusted difference (MAD) of -1.6 hot flushes per day (95% CI: -2.7 to -0.5; P = 0.04). The effect on weekly hot flush score was non-significant, with a MAD -19.6 (95% CI: -35.5 to -3.8; P = 0.11). On per protocol analysis, E2 significantly reduced daily hot flush frequency, with a MAD of -2.2 hot flushes per day (95% CI: -3.2 to -1.1; P = 0.001), and weekly hot flush score, with a MAD of -27.0 (-44.7 to -9.3; P = 0.02). Oestradiol had no significant effect on QoL.
Conclusion: We confirmed our hypothesis of a clinical effect of assignment to oestradiol to reduce hot flush frequency in men with castrate testosterone due to ADT. Transdermal oestradiol could be considered for men with burdensome hot flushes in whom other treatments have failed as long as the risk of breast effects and fat gain are considered.
-----------------
That might help.
Richard Wassersug
Thank you. I will pass this onto my team
Thank you for taking the time to reply
What do you mean by "fat gain," Richard?
That is in Russell et al. abstract; not my words. Transdermal E2 may not prevent the increase in weight gained as fat associated with the LHRH drugs. I believe that that is what Dr. Russell et al. are suggesting from their study of tE2 and hot flashes.
See if your GP will write you a script, pretty ridiculous that they won’t give you a script for it. They’re very safe, I’ve been using them 9+ years. First prescribed by Snuffy Myers, my current MO Dr. Sartor is very much in favor of their use.
Ed
I have a great relationship with my PCP. This is the one issue where he's been unwilling to buck the MO.
I have been on ADT for 20 months and using oestradiol the whole time. I have no SE's at all. I just squirt some on my inner bicept and rub it in. I don't measure it because I'm using very little. I would say I squeeze out less than a half inch once daily. It still causes mild nipple pain and small man boobs, which I could do without, but hey. You can order oestradiol online from Thailand for $25 per tube if you search for it. I bought three tubes for $75 plus $16 shipping and I still have a large amount. Oh, one last thing. My doctors kept pushing Xtandi so I finally gave in and tried it. Within a few days I was sick and stayed that way until I quit taking the crap. It may extend life but I would prefer to not extend life if I'm miserable. So maybe oestradiol doesn't help against Xtandi SE's?
Do you have a link to that Thailand source? I'll search around if not.
Or a brand name? Thanks.
Could you please share your Thailand supplier please, l have searched and am having trouble finding it. Thanks so much
Like you I had no success getting a PCP, VA, Oncologist, Urologist or endocrinologist to prescribe transdermal estrogen patches. SOC and fear of a law suit I am guessing.
I was able to get a bioidentical Bi-EST 5.0 cream from Amazon that help keep my Estradiol level within the range recommended.
Low-dose E2 patches are intended to replace the minimal amount of E2 essential for bone health. Men produce E2 by aromatization of T. ADT can therefore result in E2 defficiency. IMO, the target level for E2 should be 12-20 pg/mL.
E2 is only a threat to male health when >30 pg/mL. Some studies (e.g. cardio) equate the E2:T ratio with risk.
{When massive levels of E2 are used to suppress T, the ratio becomes meaningless.}
My PCP and Oncologist both included Estradiol in lab work to see how the cream was working.
I was able to keep my E2 within the recommended range for about two years. Occasional hot flashes were reduced mainly to during sleeping hours. Bone health improved slightly per DEXA scan. I was taking a supplement for bone health.
I stopped Orgovyx and the cream in March of this year for personal reasons.
Not recommending, just explaining my experience.
Good luck!
Thanks. My primary concern is bone health. Sounds like I've got the same cream as you, just been hesitant to use it too frequently.
My husband’s primary concern is bone health as well. I myself use a 2.0 estradiol cream from Ona’s. So it sounds like it would be safe for him to use as well?
I’m sorry, but I’m not the one to ask. Hopefully, someone more knowledgeable will reply to your question
My long-time primary care physician agreed to write my estradiol script after my RO declined. Doing well on 0.25 nearly 5 months in.
To clarify, I think you may mean 0.025 mg/day, right? The largest dose patch of which I’m aware is 0.100 mg/day.
Yes. 0.025 is the patch dose. Thanks for catching that!
MOs who will prescribe transdermal estradiol are not rare, though I can't speak for Kaiser. My MO remembers well how miserable I was with Eligard, and how close I came to suicide. She would never suggest that I do that again, especially for a long period of time. She'd be happy to prescribe me tE2, as it's called.
Richard Wassersug is a Canadian PhD, who has researched this subject extensively. You may want to contact him.
I had a horible time with Luptron and Eligard. Thought I was close to totally losing my sanity after a couple of years on them. That's why I initially lobbied my MO for estrogen. The answer was still "No", but he did switch me to Firmagon which has helped with the mental SE's.
have you reviewed the PATCH trial results with any of them? Very encouraging.
Also, the purported cardiac risks are generally based on old studies, not using modern transdermal bio identical estradiol.
Thank you for your suggestions. Yes, I did send him info on the patch trial
If Kaiser doesn't want to.....try Frazer.................
Sorry C
I just couldn't resist......I'm like Roger Rabbit who couldn't resist the ending to shave and a haircut, 2 bits...... TWO KNOCKS on the wall and he was like southern pinecone jelly on white bread....
youtube.com/watch?v=6ds6w7S...
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 09/18/2023 8:02 PM DST
Knock, Knock
I would leave Kaiser and find an MO I could work with. Progressively and thoughtfully considering options and available evidence beyond static guidelines.
Thanks Paul. This is my last ditch effort to find a good MO withing Kaiser. Where I live they provide the most care options, but the turnover in MO's in my area (so far one a year) is scary. I'm willing to travel for MO appointments if I could keep all of my other appointments local. If I don't find a Kaiser MO that I can work with and trust, I will have to switch during open enrollment.
Copy that. I don't think I've heard one good thing about Kaiser and I've heard some real nasty knocks against them on this forum.
Kaiser Hospice Care
Kaiser Xtandi follow up post. 
Estetrol for bone density? What estrogen test so I need, anything specific?
Estrogen for BRCA positive patients
