Could the men here who use estrogen patches at "just to feel good" levels comment on your experience? Mr. Spouse21 will be getting spot radiation to a single spinal tumor very soon. Thanks to everyone who encouraged that instead of Pluvicto at this time. His two oncologists agreed as did a radiation oncologist. Here's the link where I asked about spot radiation. It has all the medical history of the last ten years. He's 79.
Mr. S21 is about to see his PCP for his annual checkup. This seems like it might be a good time to consider adding an estrogen patch (or gel?) to help build muscles since Mr. S 21would like to continue being very active--some bone strengthening, and just to feel better in general. Does the patch at low doses do some of this? He's been on Xgeva for five years, every three months for the last two and every six months going forward. Lupron is now a lifelong companion, so a patch wouldn't be a theraputic substitute for that but something to help with some of Lupron's side effects.
Have you found low level estrogen patches (or gel) improved your quality of life? Also where do you get them and in what dosage? Should we be concerned about estrogen interactions with Lupron/Xgeva/Flomax/Losartin? Thanks if you have personal experience to share to bring us up to speed.
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spouse21
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I don't believe estrogen does much if anything to aid muscle development, but it does demonstrably reduce bone mineral loss. Having said that, the fatigue-reducing effects of estradiol/estrogen WOULD enhance one's ability to exercise and THAT would help the muscles.
Check out a research paper titled "Transdermal oestradiol and exercise in androgen deprivation therapy (ESTRACISE): protocol "
The "results" section reads: (Boldface is my editing of their text)
Results: The primary outcome is assessed according to the efficacy of E2 in mitigating the deterioration of Expanded Prostate Cancer Index Composite sexual function domain scores. Secondary outcomes are assessed according to the occurrence of ADT-induced adverse effects, safety and tolerability of E2, impact of E2 with or without exercise on physical performance, body composition, bone mineral density, muscle size, systematic biomarkers, and quality of life.
Edited per the advice of farmanerd (lthank you): This trial is still recruiting and has no results to publish yet, I find it encouraging that this aspect of ADT (using estradiol/estrogen instead of or in addition to other ADT treatments) is being studied.
I’ve used the patches for several years mainly for relief of hot flashes and for bone health, the may even contribute to treating PCa. I have a prescription for them and use a 0.1mg patch twice a week (the patch gets changed and replaced with a new one every 3-4 days). I used to get numerous severe hot flashes, up to 15 times a day (I counted) now I rarely if ever get one. These were originally prescribed by Snuffy Myers, he probably has some videos on YouTube discussing their use.
We are seeing hubs MO in two weeks and this is something we will be asking about. His hot flashes on the Lupron aren’t too bad but the positive effect on bone health this could have seems worthwhile. They do have him taking calcium supplements and he gets bone density checked regularly. Will report back.
I can not tolerate the SE of ADT but found Firmagon to have the least SE & the PSA would not go below 1.6.
Then started using Estradoil gel & PSA went down to 0.6 with no SE. I will see MO in a month to know the latest result. I might add I would use the patches if available.
Okay Aries your reply is super interesting. I've been really interested in estradiol as add back therapy against especially important side effects of ADT such as osteoporosis and cardiovascular deterioration.
But I've kind of given up in Canada because my doctors are good at scaring me. I understand there's all kinds of weird and complex feedbacks. Your note however implies that it also has a cancer suppression effect, even though you are just one anecdote.
We know of course that previously estradiol has been used as the primary ADT for PCA suppression, but it much higher doses. But now between say Abiraterone ARPI and an ADT (either agonist or antagonist) etc. etc. the use of estradiol, in part because of its side effects and risks, has disappeared.
I don't think we have the last word on this yet. I still think that low dose estradiol gel could be really worthwhile along with modern therapies.
All I can say JohninTheMiddle is it works for me & some days I forget to apply the gel. I tried the usual ADT the MO was prescribing but why feal like crap at the wrong end of life? So, so far so good & will know more next blood test soon.
Transdermal estrogen (patches, gels, creams) are a great way to treat not only prostate cancer, but also to reduce the side effects of Lupron (etc.) ADT. Oral estrogen was used in the 60's-80's to chemically castrate men, but it was discontinued due to blood clots. Transdermal estrogen doesn't take a first -pass through the liver, and consequently it doesn't have the increased risk of blood clots compared to Oral Estrogen. Older docs who remember the problem with blood clots won't prescribe estrogen in any form, but that has since been debunked. Younger docs don't prescribe it as primary therapy because it's not currently a "Standard of Care".
I couldn't get my MO to prescribe estrogen therapy, but my PCP did. I will be talking 1 large patch (0.1 mg/24hr) at a time, increasing that to 3 patches at a time as a substitute for doing Lupron ADT.
Lupron and high-dose estradiol both chemically castrate men to very low testosterone levels (T < 20 ng/dl) by the exact same mechanism, by suppressing the production of LH and FSH signaling hormones, which suppresses production of testosterone by the testes. That's why high-dose estradiol ADT can be used as a substitute for Lupron ADT.
Because both medications castrate men, the very low testosterone in both cases causes muscle loss and weakness. Taking estrogen won't prevent that.
Other bad side effects of estrogen therapy include: gynecomastia (enlarged breasts) in some men, and an increased risk of breast cancer (particularly for men who have BRCA 1/2 gene mutations). I would suggesting getting a free gene test kit from prostatecancerpromise.org before starting estrogen therapy.
Estrogen is made by converting testosterone to estrogen by the enzyme "aromatase". Dropping T to essentially zero with Lupron ADT will also cause estrogen to drop to zero.
Low estrogen is a primary cause of osteoporosis, as PM women know all to well. The same is true for men.
Estrogen therapy can be done as low-dose "add-back" to existing Lupron ADT. That will help prevent hot flashes and will fight osteoporosis by increasing bone mineral density. The word "add-back" means that you are replacing estrogen lost by stopping the production of its source (testosterone).
Alternatively, high-dose estrogen therapy can be used as a replacement for Lupron ADT.
I've attached a slide summarizing the pros and cons of transdermal estrogen therapy, compared to Lupron ADT.
I you send me a private chat message with your email address, I will send you a few of the best papers about estrogen therapy.
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How did you have access to estrogen patches if outside trial?
Alternate hormone treatment
Estrogen therapy rediscovered
Cost comparison between Lupron and Oestrogel
