How many estrogen patches should I use?

[janebob99]

I had a nice breakthrough today. 😀

I collected all of the available data on the number of estrogen patches that the studies have used, and plotted the measured serum estradiol level versus total milligrams of estrogen used every week.

I was pleasantly surprised when all five of the data points fell almost perfectly on a straight line! That rarely happens in prostate cancer research.

It makes sense, though, that the concentration of serum estradiol should increase proportionately as the dose of estrogen increases...you're feeding the body with estrogen. There is no sign of leveling off or non-linear behavior at these high-doses.

This plot will help doctors and clinicians to easily pick the right estrogen dose ( # of patches) for their patients. Some men may need to titrate (adjust) the number of patches in order to reach a desired amount of castration (for example, T < 10 ng/dL). I hope to be able to generate a similar plot for men who use estrogen gel, although that is less standardized.

Low-dose estrogen (2 patches per week) can help manage hot flashes in men on ADT, while high-dose estrogen (4 patches, changed twice a week) can be used to chemically castrate men without having the bad side effects of Lupron ADT.

In this latter case, men should be able to simply replace Lupron ADT with high-dose transdermal estrogen (patches, gels, or IM shots).

Or, they can combine Lupron ADT + transdermal estrogen (either low-dose or high-dose). There would likely be a synergistic effect of combining the two, although this remains to be studied in the high-dose setting. This option may be more favorable to doctors who are concerned that estrogen therapy is not current Standard of Care.

The ultimate goal for castrate-sensitive men is to get their testosterone down to < 10 ng/dL, and preferably less than 5 ng/dL. Some men on estrogen have reported getting their T down to 3 ng/dL, which is a fantastic number!

[pj1121]

Janebob99”/

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I know nothing about estrogen patches but am interested. Oligometastatic lymph nodes I’ve had 8 mo lupron and 6 month aberaterone, 28 radiation 70 g to all psma detected tumors. Psa undetectable Dr stopped testing T at 20, said it will probably just keep going down. Im going to ask for another test. I have very few side effects other than occasional hot flashes. Why would I want to supplement with estrogen?

thanks for any comments

[lancer82801 in reply to pj1121]

The continuous use of the Lupron like ADT's suppress not only Testosterone but also Estradiol. Normal Men have and need some Estradiol to maintain bone health. Lack of Estradiol can, over time cause osteoporosis, which is a side effect to avoid! The standard treatment for osteoporosis is one of the Bisphosphonates like Prolia , Fosamax etc. In fact some Dr's Rx these drugs to act as a osteoporosis preventative when on ADT. These drugs have some serious side effects as well, (osteomalcia of the jaw) which affect a small percentage of patients and are best avoided if possible

Lancer

[janebob99 in reply to pj1121]

I would suggest that you keep testing your T. Sub-castrate levels of T < 10 ng/dL are highly beneficial.

You may want to start estrogen patch therapy. There are two regimes: low-dose for getting rid of hot flashes, or high-dose E2 to do chemical castration to get T < 5 ng/dL. You can add E2 patches to your current treatment scheme and reduce, or eliminate, most of the bad side effects of Lupron ADT. It's really a QoL question...do you want to feel better, prevent osteoporosis, reduce fatigue, eliminate hot flashes, etc?

The goal for estradiol level should be 50-100 ng/dL for low-dose estrogen "add-back" or from 250 to 400 ng/dL for high-dose E2.

The phase-III PATVCH trial in the UK will be published this Fall, and will compare 10-year survival outcomes for Lupron ADT vs high-dose transdermal estrogen (TDE). Stay tuned!

Estrogen Pros/Cons

[dhccpa]

What should one's target amount of estradiol (in blood test) be during transdermal E2 use instead of Lupron (not just to ease ADT side effects)?

[janebob99 in reply to dhccpa]

The goal for estradiol level should be 50-100 ng/dL for low-dose estrogen "add-back", or from 250 to 400 ng/dL for high-dose E2. The PATCH trial achieved a median Estradiol level of 250 pg/ml, but they said they didn't reach their target E2 level.