Estrogen

[Knittingque]

DOES ESTROGEN FEED CANCER ?

Thanks

[Tall_Allen]

ER-positive breast cancer.

[ARIES29]

I have been using Estradiol Gel to keep the PSA level down & it reduced it to 0.5 from 9 & Tamoxifen for the possibility of having breast cancer. It has however started thrombosis in my legs which is bad circulation, so no more & back to Firmagon.

[Lost_Sheep in reply to ARIES29]

ARIES29, I was under the impression that transdermal estrogen/estradiol (TDE) applied to the skin instead of pills by mouth bypassed the digestive system and did not have the thrombosis problems of oral administration. What was your dosage, please?

I have been lobbying my oncologist to let me take TDE treatment instead of Orgovyx (I have diabetes and worry about the metabolic side effects). He objected because of blood clotting problems, but I countered with a bunch of medical journal papers and studies putting that objection to rest. Yours is the first report that I may be wrong. Can you please share with me any more details (here or by private message) that might suggest contraindications for trans-dermal estrogen therapy? Like, what was your dosage, etc?

Thanks in advance.

[janebob99 in reply to Lost_Sheep]

One anecdotal report does not prove a strong causation. The link between his estrogen use and thrombosis may simply be a coincidence (although serious for him).

I had a pulmonary embolism (of unknown cause) before I had prostate cancer. There is a link between high prolactin level (which I had back then) and embolisms. Other hormones can cause thrombosis. One could Google "estrogen" and "thrombosis" to see what is written about that.

Many papers have been published with 100-1000 numbers of men that, overall, transdermal estrogen does not cause thrombosis. There are always a small percentage of men that will have thrombosis in these studies, as in any study.

I'm sure the final PATCH study will address this issue, when it publishes this Fall.

Stick to your guns!

[Lost_Sheep in reply to janebob99]

Thanks for the reality check Bob. I thought the same thing but was unhappy that even one thrombosis was even suspected of being related to estrogen.

Larry

[bcnulater in reply to janebob99]

As Richard Wassersug previously pointed out, those with BRCA 1 /2 gene mutations should be cautious.

[janebob99 in reply to bcnulater]

Yes, you are correct.

Fortunately, those mutations are relatively rare, 1 in 400 to 1 in 800 men have it (I have read).

The gene test is free from the PROMISE registry (a saliva test).

Bob

[ARIES29 in reply to Lost_Sheep]

My dosage as per the instructions was 2 to 2.5 g once day applied on skin around groin area. I have stopped using it to see if Thrombosis subsides but will no doubt have a rise in PSA again. Mr google said it can cause thrombosis or blood clotting. Maybe my thrombosis was going to happen anyway? We will see.

[Lost_Sheep in reply to ARIES29]

Aries29, please read the reports from Dr Google critically. Oral E2 (estrogen) therapy produces alarming rates of CVT (CardioVascular Thrombosis), but that is because it passes through the digestive system (resulting in the liver producting a blood clotting factor). This occurs in men being treated for prostate cancer, leading to the conventional ADT therapies once they were invented and in women taking high-dose birth control pills which were eventually reduced down to reduce the death rate but still produce the anti-pregnancy effects. Absorbing E2 through the skin bypasses that mechanism.

As I have posted before, I am lobbying my oncologist to use transdermal estrogen (TDE) as a monotherapy. TDE is developing a track record around the world, but the U.S. is slow to change protocols.

Adding low-dose estrogen to standard ADT is FDA approved. You might want to mention that to your oncologist while adjusting your medications.

[ARIES29 in reply to Lost_Sheep]

Thank you for the reminder that it is not oral & therefore goes through the liver, so I will start the Estradoil Gel again . My Thrombosis is not going away anyway.

I am not on any ADT yet & relying on this to reduce PSA levels which is 3.6 lately & my MO does not or can not prescribe the ET patch or the gel because we live in the dark ages down here in OZ & is not approved.

[Sailameme in reply to ARIES29]

Hello. Where are you purchasing you Estradiol Gel please? Thank you.

[janebob99 in reply to ARIES29]

Hello, Aries29.

Here is a paper by Dr. Ruth Langley of the PATCH trial in the UK using transdermal estrogen. They have been running these Phase I, II, and III trials since 2005, and will be publishing their final 10-year survival data this Fall.

pubmed.ncbi.nlm.nih.gov/234...

This paper reports that the incidence of thrombosis and CVE's is approximately the same for men on estrogen patches compared to men who took Lupron ADT. This means that the same fraction of men on either treatment will get thrombosis and/or CVE's. Transdermal estrogen doesn't prevent clots. It's just no worse than Lupron ADT.

You can draw your own conclusions.

If you send me a request for the .pdf of this paper to [e-mail], I will send it to you.

Bob

[ARIES29 in reply to janebob99]

Thankyou Janebob, looking forward to next blood test to see if it is still keeping the PSA down.

Still undecided about cause of thrombosis. Doctor put me on fluid tablets which can not be good for kidneys.

[janebob99 in reply to ARIES29]

Are you back on taking estradiol gel?

[ARIES29 in reply to janebob99]

Never stopped, I hardly miss a day but the application times vary. They say to apply same time & amount every day.

[janebob99 in reply to ARIES29]

Thanks!

I hope to start E-patches in about two weeks.

[ARIES29 in reply to janebob99]

Good luck with the patch, it is probably more safe than just smearing the gel on because it is administering it in the correct dose & times.

[janebob99 in reply to ARIES29]

Yes, I agree.

One downside to patches, however. is that some people react badly to the adhesive used in the patch. It's not a large percentage, though.

Given the slow time for decreasing testosterone after applying an estrogen patch, on the order of 1-2 weeks, I don't think the time of day that the patch is applied is very important. Nevertheless, there is a circadian rhythm to levels of estradiol in the blood. So, drawing blood at the same time during a day may give more consistent measurements. Also, drawing blood at the "trough" part of the long cycle (e.g., the afternoon of day #7 of a 7-day patch cycle) may also give more consistent blood levels.

One report of serum estradiol levels in a man using estrogen patches has shown wide cycles in serum estradiol over a period of 1-2 months, which may be caused by a cyclic over/under-expression of the two different types of estrogen receptors (alpha and beta) in response to supplemental estrogen.

Regarding gels, there has been one, recently-reported instance of a man developing a blood clot in his leg (thrombosis) a few days after applying a too-large amount of gel directly to his scrotum, which inadvertently caused a very large, transient spike in the serum estradiol level. Clotting factors naturally react very quickly to cuts, nose bleeds, etc...on the order of 1-3 minutes). I call this fast spike a hypothetical "estrogen shock",.

Such a hypothetical estrogen shock (i.e., rapid overdosing) appears to be a real concern only when estradiol is applied scrotally (not so for the other traditional sites, such as: forearm, shoulder, abdomen, thigh, hip, and buttock that have much thicker stratum layers (epidermis) of the skin, as compared to the scrotum).

BTW, for estradiol molecules, scrotal application has been reported to result in a 3-4 times higher absorption rate than forearm application. For testosterone molecules, scrotal application results in a 5-8 times higher absorption rate than forearm.

Interesting factoids that aren't well known.

[ARIES29 in reply to janebob99]

That is interesting, I apply it to inside of legs & occasionaly touching the scrotum & the other night I had pain in left calf muscle like a cramp but could have been a clot? However I was wearing those compression socks & had gym work earlier that day.

Applying the gel on legs & inside of arms might b better option?

[janebob99 in reply to ARIES29]

Great discussion. I sometimes get a really bad leg cramp that goes from my ankle up to the top of the groin, on the inside facing surface. It just started this year (I'm 69). Quite painful. But, then it lets up after a few minutes. The relief wouldn't happen if there was a blood clot sitting there. I do take 4 (400 mg ) capsules (1.6 g) of magnesium every night to prevent leg cramps, and another pill to treat restless leg syndrome (which my Dad had). Did you pain in the left calf muscle go away after a few minutes?

Could you apply your gel to your abdomen or hips? The arms don't have great absorption, compared to other sites. Here's a comparison of estrogen patches applied to three different sites. Hips and buttocks are the best. There have been reports of the gel rubbing off, so applying to the buttocks might not be a good idea.

Bob

E2 Patch Application Site

[ARIES29 in reply to janebob99]

Hi Janebob. To answer your question, yes the pain went after around 4 minutes but I will not wear those compression socks any more.

I will try abdomen & hip area in future & I noticed the gel dissolves on the skin in a matter of minutes so the skin is uptaking it., Estradoil Gel 0.06%.

Try Magnesium L- Threonate 2000mg, they work well for me & I knew a weight lifter that passed away from blood clot going to his heart so I worry about that at 75years on. But he was taking steroids & his father died from same thing.

Thank you for these tips.

[janebob99 in reply to ARIES29]

Thanks!

I take 1600 mg of Magnesium every evening to help prevent leg cramps (which it does).

I might take issue with one thing you said about Estrogel. The alcohol in the gel evaporates quickly, but the liquid estradiol stays on the surface for a long time. It's absorption coefficient is only 0.1, meaning that 90% stays on the surface for a long time, where it can get rubbed or washed off.

I have a paper where they washed the skin of women that applied Divigel (0.1% cestrogen oncentration) to their thighs and then washed the skin after 30 minutes. They found that their serum estradiol level was much lower after washing, compared to no washing. They also measured the effect of lying in bed next to a man, and then they measured the amount of estradiol that was transferred to the man by simple skin-to-skin contact. The man's serum estradiol went up. So, it stays on the skin's surface for a long time.

Prof. Wassersug in Canada has been using Estrogel for over 17 years and prefers it over patches. You just need to titrate the number of pumps to whatever serum estradiol level you are trying to reach.

Bob

[janebob99 in reply to ARIES29]

Here's a different plot that I made from a paper by Jarvinen in 1997, that compares applying 1 mg of DIVIGEL estrogen gel to three different areas on the thigh of post-menopausal women: 200 cm2, 400 cm2, and "as large as possible". The smallest application area gave the highest peak serum E2 concentration, and the largest area gave the lowest peak serum E2 level. The same was relationship was true for the total dose absorbed over a 24 hr period (Area-Under-the-Curve, AUC).

They also looked at the effect of washing the area after 30 minutes, and found that they could wash a lot of it off. Clearly, estradiol sits on the skin and isn't absorbed well. I've seen reports of only 10% absorption for estradiol into skin.

pubmed.ncbi.nlm.nih.gov/938...

Estrogen gel surface area effect

[Kaliber]

I wanted to try it ( gel ) after all the great reports here on the group , a while back. I definitely could use a little SE improving…. Of course I ran it by my oncologist before trying anything ….. Two of my subsequent oncologist ( seperately ) , rebuked my request as wildly dangerous , for me, with my current physical and systemic issues. “ you’ll shoot your eye out. Ala: Christmas Story “. …. Whatever ….yayayaya yayay yaya

❤️❤️❤️

[Lost_Sheep in reply to Kaliber]

Kaliber, side effects of typical ADT therapies are commonly mitigated by low-dose estrogen. You might want to mention that this is an add-on therapy that is approved by the FDA.

[Kaliber in reply to Lost_Sheep]

Yea that’s what I asked for, sounded great … they said that with my cardiac issues , low dose estrogen wasn’t safe for me. They were concerned about clots in my legs too. Since they treat a lot of breast cancers, I’d guess they are well versed in estrogen treatments.

❤️❤️❤️

[Lost_Sheep in reply to Kaliber]

My medical oncologist disagreed with my request to use transdermal estrogen as a monotherapy (TDE) because of "blood clotting problems". I countered with several studies I have found which attribute the blood clot problems to the lever reacting to oral estrogen (DES, primarily) the same as the early high-dose birth-control pills killed a lot of women. But current transdermal administration bypasses the liver.

Thankfully he agreed to read what I submitted. I have not heard back from him directly of his thoughts but a meeting with his assistant seemed to me to be productive in the directions I seek. (Tumor review board, gene testing on the cancer and TDE).

Two out of three ain't bad. But I am getting anxious to start therapy.

So, my first sentence is meant to say that your oncologists may not be sufficiently up to date on the latest information (many doctors adhere to whatever protocols were taught to them in medical school). Without insulting their Continuing Professional Education (CPE), you might consider submitting relevant research for their consideration. Diplomatically. Or find an oncologist who practices a naturopathic, holistic approach. I asked my radiation oncologist for a referral to such a doctor and Dr L is who I got.

I went in armed with my research and think I convinced him to accept my inputs.

[Kaliber in reply to Lost_Sheep]

I don’t get to talk about cancer treatments with my oncologists much. Basically , my first offer of care was inpatient hospice and that’s what went into my records. I’m just a patient that they are trying to keep comfortable while my time runs out. Talk with my oncologist is : ( turn off their computer screen, put their arm around my shoulders ) “ how is your pain management doing, are we keeping you comfortable ( no ) ….. are you trying to do your bucket list, did you get estate papers in order , do we have a current Life Care Planning documents on you ? Are you having QOL time with the family ? Etc. . I’ve already been told no more scans, surgery, or radiation too. The talk with my last (5th ) oncologist ( that left first of the year ) was her saying ; 3 different times , how incredibly lucky I’ve been ( I’m miraculously 64 months past my expected death date ).

Sounds like you and I are in different universes when it comes to our cancer situations and treatment yayayayay yayay. I’m planning on blowing their minds even more than I already have. My eye on the prize. You sound like you are actively involved in your cancer with a lot of hope and expectations …. Good for you brother and more power to you , maybe you can take that a long way. I hope you do.

❤️❤️❤️

[Lost_Sheep in reply to Kaliber]

{Insert curse word here} Kaliber, you have nothing to lose if you are receiving only palliative care. At this point in my research, I would get some estrogen gel and slather 5-10 mg on my inner arms and thighs daily and just see what happens. Unless I run across an even more promising therapy. That one is my (layman's) choice right now.

Also, look up the experience of St Peregrine. I am not Catholic, but his story was recommended to me by another support group member.

[Kaliber in reply to Lost_Sheep]

Yayahahahaya …. I’ll keep that in mind brother …appreciate it.

😁😁😁

[edfriedman]

Initially, almost all of the estrogen receptors (ERs) consist of ER-beta, which helps kill prostate cancer (PCa). However, as PCa evolves and becomes more aggressive, more and more ER-alpha is expressed until it is found in 94% of CRPC (or in the words of the authors, "Recurrent adenocarcinoma after hormonal therapy expressed the nuclear ER in 94% of cases"). See: ncbi.nlm.nih.gov/pmc/articl...

[32Percenter]

I believe this is a myth spread around on the Internet, often expressed as something like this:

"Testosterone doesn't fuel prostate cancer, estrogen does. Doctors in Japan treat prostate cancer by blocking estrogen and it works much better"

I have yet to find any scientific evidence to support this, although I can't read Japanese so maybe there is a Japanese study or two out there offering some support to this. That begs the question though, if Japanese oncologists are having so much success treating PCa by blocking estrogen in men, why hasn't this approach caught on over on this side of the planet?

Maybe the confusion is between estrogen vs. prolactin. There's been research around since the 70s showing that blocking prolactin improves outcomes in advanced prostate cancer patients:

sciencedirect.com/science/a...

But prolactin, while a "female" hormone, isn't estrogen.