I am under treatment for Prostrate Cancer since mid 2019. Gleason 9-10 when detected with 250 PSA. Pet CT showed all contained in prostrate but with one ECE and seminal vesicles involvement. No spread visible to lymph nodes or anywhere in the body. Treatment was conventional ADT using Firmagon for 4 months before RT using IMRT @78Gy over 39 sessions in Dec 2019.
By Sep 2021 PSA started rising. Was advised Nubeqa as there was no spread visible on PSMA Pet CT scan. Preceding Nubeqa I had an orchidectomy.
I have been on Ibandronic Acid for bone health on a 150g monthly dose. Now I want to use low dose Estrogen based patches instead of Ibandronic Acid. I do the usual weights, exercises, and walking etc as well.
I asked my MO but he is reluctant - silly reasons and recently he said you will get gynacomastia. As if I haven't already.
Would be obliged if someone can reply to this or DM me the dosage based on patches, which patches and the lab tests if any to be done regularly. Of course I will Dexa scan annually to check on adequacy of treatment.
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binati
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Binati - I'm so happy you posted this. I have been researching this for a long time. I have not been successful in moving forward. I have one friend who has a gel prescription from his personal position.
My oncologists are all against it. In fact I gave up for a while because I was worried about feedback loops and that perhaps I would be making a terrible mistake. However I have such fatigue and I'm beginning to think brain fog as well. So far my bones are okay and I don't take any of those bone drugs - and I really really hoping to avoid them.
Here are some links to some of the discussions I've been involved with here on the topic. I don't have the time or energy to update them or edit them or anything. But they might give you some ideas. (Some of them may have duplicate references between them.)
My overall sense is that low-dose estradiol transdermal patches as estrogen add-back are a good idea. And it's possible that your doctors may be confusing this with high dose for ADT replacement.
(Here are links to my own comments - you can scroll up and down to see great insights by other posters.)
Yes gel and patches are available. How much should the dosage be? How many patches of say 0.025 mg per week. I understand that the optimum level of estradiol is around 20 pg/ml. So one should target 15-20 maybe.
I've been using two 0.025 mg patches per week for about 14 months and my levels have been between 35-48. I'm feeling better on this treatment and have been on Orgovyx over 2.5 years.
The instructions for the Estradoil Gel is 1.25g to 2.5g every day applied to skin & it comes with a paddle to measure gel. Patches can not be prescribed here but there is plenty info here.
A lot of info out there and posted on here very recently. Dose varies but seems to generally be 0.01mg 2 patches per week so use a patch for 3 or 4 days then change for the other new patch. I'm not a Dr so double check because I am only repeating what I have read and I'm sure they were no Dr either. Seems they work well for hot flashes but man boobs are a side effect of prolonged use.
The only way to correctly determine the amount of Estradiol gel or patches you will need is to get your estradiol level tested shortly after starting to use it. Then adjust accordingly.
SOC seems to be the driving force behind Doctors not prescribing estradiol to mitigate the effects of low testosterone. Perhaps if they experienced a few sweeping hot flushes they would be more concerned.
Husband starting the .1mg patch this week. We will be monitor levels with regular blood tests. His Mayo MO dismissed out of hand but we read a lot of info (here and related studies) and his urologist who also does hormone replacement therapy was open to this. Main interest is to mitigate hot flashes and help with bone loss. Some man boobs already appeared with the Lupron so that’s not a concern. Looking forward to the PATCH trial study results coming out this fall to see if estrogen could be an alternative to ADT. It sure seems better for the bones. We will report back to see how he does on this.
I have been researching transdermal estrogen therapy for quite a while, and have reviewed all of the papers that discuss dosages of estrogen (estradiol, E2) patches and gels.
There are two regimes, as previously mentioned:
(1) Low-dose estrogen "Add-Back", which is done in conjunction with standard ADT to replace the estrogen lost by having very low testosterone. Here, the dose that is recommended is one "large" E2 patch per week @ 0.1 mg E2/24hr strength. This should raise your serum estradiol level to about 100 pg/ml. That should be sufficient to reduce hot flashes and stop osteoporosis, among other beneficial changes.
(2) The high-dose regime is for replacing standard ADT with Estradiol ADT (E-ADT). Huggins and Hodges discovered in 1941 that estradiol monotherapy was excellent at causing chemical castration. Unfortunately, the oral form (DES) that was given extensively from 1950-1980 caused increased rates of blood clot formation. Lupron was invented in 1980, and it replaced the oral DES. Starting around 1990, estradiol gel was used to treat PCa, and then slow-release patches started to be used in 2005 to treat PCa.
The biggest study of estrogen patches (the PATCH trials I, II, and III) began in 2015 in the UK at 52 different centers, with about 1000 men enrolled. It compared Lupron ADT to Estradiol ADT head-to head. The final long term results from the Phase-III trial will be published this Fall.
The dosage used in the PATCH trial consisted of either 3 or 4 large patches per week. That equates to an absorbed dose of 0.3-0.4 mg/24 hr. The serum estradiol levels achieved ranged from 300-450 pg/ml.
I've attached a graph that I made which plots the serum estradiol levels versus estrogen patch dose.
You can also use estradiol gel in place of patches. Typical doses are 1-2 pumps applied daily to the upper buttocks or hips, using a gel that has an estradiol concentration ranging from 0.06 % to 0.1 % E2. That route is typically cheaper than the patch route, because the gel is cheaper to make than the highly-engineered patches.
Currently, I am personally doing the high-dose E2 regime with estradiol gel made by my local compounding pharmacist. The bottle is made with an E2 concentration of 1.0 %, to save costs. I just started taking it a few weeks ago and my serum Estradiol is only 218 pg/ml. My target E2 level is 350-400 pg/ml, so that I don't have to take Lupron or Orgovyx. That's my goal. I also start SBRT radiation treatment in a couple of weeks.
My impression, based on the study is that it may be promising but has not been studied enough to fully understand the side effects of this treatment. After dealing with hormone imbalances with both my daughters when they were younger, my wife and myself, hormone therapy can have unintended consequences. Hormones effects so many bodily functions, so that when we consider it to be something we can just "supplement" for a specific purpose, it is a bit like playing with fire. The source, type, dosage and interval all need to be considered.
Before being diagnosed, my primary care doctor had me on bioidentical testosterone cream for low testosterone and Avodart for hair loss due to conversion of testosterone to DHT. I believe this may have led ( at least in part) to the aggressive form of PCa I have.
The interplay between hormones and other systems in our bodies is complex. I personally believe our tendency to try to treat individual symptoms and can cause other unforeseen complications.
Whatever way you choose to go. I wish you the best and hope you report back your results.
Most of these studies still give dosages for reduction of T as an ADT equivalent. I am seeking levels of tE2 for bone health only. I have picked up a figure of around 20 to 30 pg/ml. However, need confirmation from someone who has experienced using the low level treatment with estradiol. Thanks for the article.
I was able to get the patch for bone strength only after fracturing a vertebrae. I use a patch from Sandoz, a dose of 0.075/mg/day (one patch per week).
I've seen a recommendation of around 50 pg/mL E2 blood level to protect bone density in menopausal women. That's barely above men's normal E2 level as well, and it's thought it does the same thing for men. But at that level I still didn't feel very good, and with my doctor's suggestion we increased it significantly. I feel great today!
Dr. "Snuffy" Myers used 0.025-0.05 mg/day patches, changed twice weekly, for his patients on long term ADT. You may also search for videos by Dr. Richard Wassersug, a urologist who is on estradiol gel himself. He doses it based on how he feels, an interesting strategy.
I'm on permanent ADT (recurrent G9 stage 3 after radiation and primary ADT), and have been on estradiol for almost 5 years now. I developed some gyno when I first came off of Lupron as my T recovered.
After restarting ADT a couple years later, and going on estradiol (two 0.1mg/day patches changed twice weekly), I do have gyno but I don't care. I feel terrific, full energy, clearest memory I've had in years, peaceful, no hot flashes. Even more importantly, my bone density has actually recovered from just shy of osteoporosis. I'm in the normal bone density range now.
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