Kaiser MO's and Estrogen: I have an... - Advanced Prostate...

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Kaiser MO's and Estrogen

Carlosbach profile image
43 Replies

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

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Carlosbach profile image
Carlosbach
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43 Replies
PCaWarrior profile image
PCaWarrior

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.

Carlosbach profile image
Carlosbach in reply toPCaWarrior

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.

dhccpa profile image
dhccpa in reply toCarlosbach

Where have you gotten that cream? And what brand/type? Thanks

Carlosbach profile image
Carlosbach in reply todhccpa

Thanks for your request. I am not confident in the product I bought, so I am reluctant to promote it here.

dhccpa profile image
dhccpa in reply toCarlosbach

Thanks. Haven't decided whether to use it but will need a source if I do.

fast_eddie profile image
fast_eddie in reply toCarlosbach

At least you have something and I too am curious how you came by it.

Carlosbach profile image
Carlosbach in reply tofast_eddie

Eddie, see my response above. Thanks

GoBucks profile image
GoBucks

Are you looking to use that as your primary treatment or just to help alleviate ADT side effects?

Carlosbach profile image
Carlosbach in reply toGoBucks

Just to help with SEs

ARIES29 profile image
ARIES29

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.

Carlosbach profile image
Carlosbach in reply toARIES29

Thanks Aries, I will check it out

RS265 profile image
RS265 in reply toARIES29

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.

Jac_J profile image
Jac_J in reply toARIES29

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.

ARIES29 profile image
ARIES29 in reply toJac_J

HAHA, 50 yo plus woman? not for me Jac_J. I prefer a slow agonizing death the normal way thanks.

Wassersug profile image
Wassersug

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

Carlosbach profile image
Carlosbach in reply toWassersug

Thank you. I will pass this onto my team

Carlosbach profile image
Carlosbach in reply toCarlosbach

Thank you for taking the time to reply

garyjp9 profile image
garyjp9 in reply toWassersug

What do you mean by "fat gain," Richard?

Wassersug profile image
Wassersug in reply togaryjp9

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.

garyjp9 profile image
garyjp9 in reply toWassersug

Thank you

EdBar profile image
EdBar

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

Carlosbach profile image
Carlosbach in reply toEdBar

I have a great relationship with my PCP. This is the one issue where he's been unwilling to buck the MO.

jjdevin profile image
jjdevin

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?

dhccpa profile image
dhccpa in reply tojjdevin

Do you have a link to that Thailand source? I'll search around if not.

Or a brand name? Thanks.

Sailameme profile image
Sailameme in reply todhccpa

On request. Will you please share your contact with us? Thank you for your time. Take care.

dhccpa profile image
dhccpa in reply toSailameme

did you mean email address?

dhccpa@aol.com

Knittingque profile image
Knittingque in reply tojjdevin

Could you please share your Thailand supplier please, l have searched and am having trouble finding it. Thanks so much

Exrunner profile image
Exrunner

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!

Carlosbach profile image
Carlosbach in reply toExrunner

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.

Bacana profile image
Bacana in reply toExrunner

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?

Carlosbach profile image
Carlosbach in reply toBacana

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.

VHRguy profile image
VHRguy in reply toNewPotatoCaboose

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.

NewPotatoCaboose profile image
NewPotatoCaboose in reply toVHRguy

Yes. 0.025 is the patch dose. Thanks for catching that!

Horse12888 profile image
Horse12888

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.

Carlosbach profile image
Carlosbach in reply toHorse12888

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.

VHRguy profile image
VHRguy

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.

Carlosbach profile image
Carlosbach in reply toVHRguy

Thank you for your suggestions. Yes, I did send him info on the patch trial

j-o-h-n profile image
j-o-h-n

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

Carlosbach profile image
Carlosbach in reply toj-o-h-n

Knock, Knock

MateoBeach profile image
MateoBeach

I would leave Kaiser and find an MO I could work with. Progressively and thoughtfully considering options and available evidence beyond static guidelines.

Carlosbach profile image
Carlosbach in reply toMateoBeach

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.

fast_eddie profile image
fast_eddie in reply toMateoBeach

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.

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