E2 gel to fight prostate cancer.

[E2-Guy]

All I ever did was to apply Oestrogel to my inner thighs, which I stopped doing years ago since my PSAs have been undetectable. I don't know if Dr. Richard Wassersug is still on this forum? He was my mentor, and introduced me to the E2 gel.

[Hidden]

hmmmm

[Tommyj2]

yeah for you. Without a ton of other information this standalone declaration is meaningless.

[JohnInTheMiddle]

💥 NEW NOTE - E2-GUY'S STORY 💥NEW PERSPECTIVE ON THE SITUATION See bio and discussion further below.

I've been researching low-dose transdermal estradiol add-back. The whole business of estrogen in the context of metastatic prostate cancer is a big deal. And currently the UK-Based PATCH trial is revealing amazing things about the use of estradiol, and estrogen, as an alternative to fighting prostate cancer.

Let's clear up the confusion. The patch trial is using transdermal estradiol patches as the primary or even only prostate cancer therapy. And it's very high dose. And there seems to be very interesting and exciting results.

On the other hand, the use of low dose transdermal estradiol patches is a completely different thing - even though both are dealing with estradiol.

Many or even most of the worst side effects of prostate cancer therapy, especially but not only from the primary therapy of ADT, is that estrogen is also suppressed. Because estrogen in a man's body is made from testosterone. And osteoporosis and cardiovascular disease risks increase when we don't have estrogen anymore.

And if you think about it every human being relies on hormones to function. And for a man to have both testosterone and estrogen suppressed in order to defeat for a while prostate cancer - it's crazy. Your life in a body as you have known it is upended. One has to fight to go forward.

So from what I can see, the whole business of adding back a little bit of estrogen to get rid of the side effects of the prostate cancer therapies could be a really big deal. For a while I was thinking it would be good to try the estradiol gel patches myself. And of course my regular doublet therapy would not change. I know several people who are doing this.

However even low-dose estrogen replacement is still really complex. And I decided not to try the gel for now. There're all kinds of weird feedback loops in terms of how hormones and hormone receptors interact. And I wouldn't want to inadvertently stimulate my prostate cancer progression. That would be very sad.

I'm still researching this. And I'm not going to disagree with one of the first responders that such and such bold statement with no context is more or less meaningless.

Nevertheless, bravo for your success! Continued good health and long life!

💥 NEW NOTE - E2-GUY'S STORY 💥NEW PERSPECTIVE ON THE SITUATION See bio and discussion further below.

[E2-Guy in reply to JohnInTheMiddle]

The only therapy I used after my prostate was removed was Estradiol gel, and it ended my battle with prostate cancer years ago. I totally forgot that I even had PCa. I'm 81 and doing great. Never had a nasty Lupron injection! I haven't done anything for many years since I assume my PCa is sleeping!

[JohnInTheMiddle in reply to E2-Guy]

Bravo E2 Guy! I just read your intriguing bio. You switch to transdermal high-dose estradiol only - if I understand that correctly - is a whole different world. Also the amazing Richard Wassersug is very active out of the Canadian BC-based national advanced PC group 😃

So many implications for alternative paths, cost, success, QoL. Do you or anyone know how all this in fact relates, or not, to the PATCH RCT?

[E2-Guy in reply to JohnInTheMiddle]

I'm not sure if the E2 gel that I was using is considered "high", or "low" dose?

[dhccpa in reply to E2-Guy]

Always good to neatly define terms. PCa has a number of slippery ones.

[VHRguy in reply to JohnInTheMiddle]

When my G9 5+4, Stage 3 case was recurring a few years after primary radiation and 3 years of ADT, I chose permanent ADT to manage it. Having been on ADT already for 3 years, I knew permanent ADT would be rather unbearable. I also lost a LOT of bone density the first time, and knew that was a substantial risk after orchiectomy.

So I'm on estradiol backfill. My research suggested that parenteral (non-oral) administered estradiol presented acceptably-low risk, and could greatly improve quality-of-life. Over five years after my orchiectomy, and almost as long on estradiol, my PSA has remained undetectable ever since.

I think eventually estradiol therapy will dominate this field. There are a lot of doctors living with old information based on oral and non-bioidentical forms of estradiol and side effects that happened during trials many years ago. Modern patches, bioidentical estradiol, are a completely different situation. Doctors don't make much money from this approach, nor do the pharmaceutical companies. This will greatly slow adoption!

I am completely pleased with my therapy and my situation. I'm over 11 years out from a rather dire diagnosis, and 5 years out from recurrence, with no evidence of disease.

[Wassersug]

Yes "E2-Guy", I am still on this list. [I owe you a letter and hope to get it out tomorrow.]

I still follow the literature on transdermal estradiol used at both high and low dose respectively for T suppression (high dose) and to replace estradiol lost with standard ADT (low dose).

Richard Wassersug

[addicted2cycling in reply to Wassersug]

👍👍 2 U 4 still being around

[Pcnmyy in reply to Wassersug]

Hello Richard,What is the recommended dosage for transdermal estradiol to take with standard ADT. I'm currently on Zytiga+ Prednisone and Orgovyx. Thank you for your help.

Bill

[janebob99 in reply to Pcnmyy]

I'm currently taking Orgovyx, which has reduced my PSA and T considerably. I also take Estradiol gel to prevent hot flashes and osteoporosis. I get the gel from a local compounding pharmacy, using a prescription from my PCP/GP. I do have some gynecomastia and mastalgia.

There are no standards that defines what "low dose" estradiol is for men.

In practice, one should adjust the amount of estradiol (E2) gel used until there is a noticeable reduction in number and severity of hot flashes and osteoporosis (to name a few).

At higher doses, E2 gel could be used to replace Lupron/Orgovyx ADT (based on extrapolating preliminary PATCH study results using E2 patches). The PATCH study used 3-4, large, E2 patches per week, with a nominal patch strength = 0.1 mg E2 absorbed over a 24 hr period. The 5-yr and 10-yr survival results should be published this Fall.

The PATCH study didn't use E2 Gel...just patches. Some men prefer E2 gel over patches, because the patch's adhesive can irritate the skin. Also, E2 gel is generally less expensive than patches, especially for higher E2 concentrations.

Other forms of transdermal E2 include sprays, implanted pellets, and IM injections.

Oral E2 is not recommended because of increased risk of blood clots, due to the oral E2 being initially processed by the liver.

Anyone considering transdermal E2 should get a genetic test done to determine their BRCA 1/2 gene status (using the free test at prostatecancerpromise.org). Men with BRCA 1/2 gene mutations have a much greater risk of breast cancer.

Bob in New Mexico

[Pcnmyy in reply to janebob99]

Bob, Thank you very much for the valuable information.

[Wassersug in reply to Pcnmyy]

Bill,

jannbob covers your question in the email below. But any use of tE2 for prostate cancer is an "off label" use so should be discussed with your oncologist. I am not an MD and would not feel comfortable making dose recommendations to other patients in the absence of published data.

Richard W.

[Pcnmyy in reply to Wassersug]

I understand. Thank you.

[Gabby643 in reply to Wassersug]

Richard, you say “low dose ADT,” you would saying low dose Lupron?

[janebob99]

Do you have a specific question that we can try to answer?

[cam123]

Glad to see a new posting from E2-Guy and Richard along with the excellent clarifications and responses of JohnInTheMiddle and Bob. There may be many more on this forum who may have an interest in transdermal estrogen as an additive or as monotherapy for PCA. I have been successful using tE2 monotherapy for 4 years following the PATCH trial protocol with excellent QOL benefits and there may be several more here doing the same.

I would encourage those who are interested to research the PATCH trial and related information currently available - certainly worth a discussion with your Doctor(s). I along with others are very interested in the additional results that should be available soon with the hope that the use of transdermal estrogen will be added to SOC

[JohnInTheMiddle]

📖📑 Here is all about the Richard Wassersug et. al. amazing book "Life on ADT":

lifeonadt.com/abouttheauthors

Note this is the third edition, from 2023.

[JohnInTheMiddle]

I'm very interested and even eager to do low-dose transdermal Estradiol patches. And it's odd that the strategic importance of the elimination of estrogen from the body in circumstances of metastatic prostate cancer therapy is not more talked about my physicians and oncologists.

So why haven't I gone ahead? Because as I mentioned in my post above, the body's hormone relationships are so utterly complex. And I'm not satisfied yet that low-dose estradiol is not also a risk. So let's explore the risk. And maybe this is why physicians and doctors don't talk about this.

Without going into too many details, apparently prostate cancer cells have two kinds of estrogen receptors: ERα and ERβ. So far so good. A little estradiol will trigger both receptors and you will get, with management, the nice little bit of estrogen you need in your body to significantly or even totally reduce the risk of some of the nasty side effects of ADT, especially osteoporosis and CVD risk.

And from what I read, and very interestingly, not only do these two receptors merely enable estrogen production, but they also have a direct impact on prostate cancer!

For example, apparently receptor ERβ helps fight prostate cancer! Sadly however, receptor ERα promotes prostate cancer!

Now we get into just a little bit more detail. Because different substances have different affinities for various kinds of receptors. Apparently estradiol has roughly equal affinities for these two receptors. It stimulates both the good receptor and the bad receptor.

Maybe this is okay - because what I have heard in passing is that there are many more ERβ than ERα receptors. Although apparently the risk is this receptor population ratio may change over time - in favor of the bad receptor. (I am sharing this in the hope of clarification - not from any understanding.)

Interesting side note: the supplement Genistein, which is claimed to be good for prostate cancer, apparently also works to activate estrogen receptors - however apparently it has a very high (10X) preferential affinity for ERβ over ERα - a good thing. (I'm not taking this supplement either.)

If someone can specify that low-dose transdermal estradiol for estrogen add-back is in fact safe, then the benefit is not only estrogen recovery, but also a significant anti prostate cancer effect as well.

Again a warning - hormone processes in the body are really weird (at least for the lay person - if one is a research scientist then maybe not so weird!) and have feedback loops and all sorts of complexities. So maybe sometimes you think you're doing one thing and you end up doing another.

(I look for correction and clarification for these notes!)

[E2-Guy in reply to JohnInTheMiddle]

John, You obviously have done much more research on this subject than I have!

[JohnInTheMiddle in reply to E2-Guy]

But you have really good results! Research is okay but results are better!

[garyjp9 in reply to JohnInTheMiddle]

John, I am using the patches as add-back to try and get my E2 back to normal after ADT and Zytiga lowered it to 3. My MO is pretty conservative, but he said that he had no objection if the endocrinologist I was also seeing approved it. She did, after some back and forth, since she had not done so with any PC patient before. I do have man-boobs now, but non-binary is supposed to be cool now, right? I would not experiment on your own though. Only do it with a doc's OK and supervision.

[janebob99 in reply to JohnInTheMiddle]

Hi, John.

I may have said this before, but it's worth repeating. The UK Patch study has been going on, in three different phases, for over 15 years. If supplemental estrogen to bring E2 levels back to their normal, natural levels (i.e. low-dose E2) was dangerous, the PATCH study would have been stopped a decade ago. But, it hasn't. Food for thought.

[MateoBeach]

it is a good standalone alternative to other ADT or as an add back at lower dose for bone and brain protection. John in the Middle provides a good summary.

[j-o-h-n]

From good old A i

E2 gel, also known as 17β-estradiol gel, is a form of estrogen therapy that has been investigated for various applications, including its potential role in prostate cancer treatment. The idea behind using estrogen in prostate cancer therapy stems from the fact that prostate cancer growth can be influenced by hormones. Traditional treatments often focus on androgen deprivation to counteract the effects of testosterone and related hormones, which fuel the growth of prostate cancer cells.

However, the use of estrogen, including E2 gel, is somewhat unconventional in this context. Estrogen has been shown to have anti-androgenic effects and might counteract some of the pathways involved in prostate cancer progression. Clinical studies and research into this approach are ongoing, and while there may be some promise, it's not yet a standard or widely accepted treatment.

If you or someone you know is considering this treatment, it's crucial to consult with a healthcare provider who specializes in oncology. They can provide guidance based on the latest research, clinical guidelines, and individual health needs.

Good Luck, Good Health and Good Humor.

j-o-h-n

[dhccpa in reply to j-o-h-n]

I guess we have to make our docs aware of the PATCH trial. I wonder if anyone's doc brings it up without prompting.

[E2-Guy in reply to dhccpa]

Probably not since there is no money in it for them! Lupron injections are far more lucrative!

[street-air]

This video is a recent good summary of the world of estrodil patches/gels yes?

youtube.com/watch?app=deskt...