Estradiol 0.39 mg patch for hot flushes

[positive-thinking]

My husband is on week 2 of the Estradiol 0.39 mg patch for hot flushes. I'm wondering how long it takes for them to work ( if they do ) . He had terrible hot flushes last night and we are curious how long it can take to notice if these are doing anything ? Thanks for any info on this , it is hard to find anything online in regards to this

[GP24]

In the patch trial they used 100 μg oestradiol patches and changed them twice weekly. So against hot flushes I recommend a 100 μg oestradiol patch changed twice a week.

[positive-thinking in reply to GP24]

He is going to try something else I think as he is freaked about increasing dose due to the possible side effects . Also he is prone to breast cancer because of the BRCA2 gene he carries. We just wondered if after a week and a half if others on the low dose had already noticed it was working? His are worse

[GP24 in reply to positive-thinking]

I have a friend who is very happy with the patches against hot flushes. But if you use a dose too low, it cannot work.

[JohnInTheMiddle in reply to GP24]

I'll try to be positive. Can we all work a little harder at being accurate? Even given stressful situations, and also good news. I think there's good news about alleviation of low estrogen in the context of ADT.

1. PT's husband seems to be on doublet therapy. Bravo doublet therapy! (By the way I know that you are on a GnRH agonist as part of your triplet therapy recipe. Consider the possibility that switching to a GnRH antagonist might relieve some of the hot flashes.) And bravo transdermal estradiol patches to deal with hot flashes! (If I have misunderstood your situation, I'd be grateful to be corrected.)

2. Transdermal estradiol patches are being revealed in research as anl full-on alternative, a replacement, to today's primary therapy regimes against metastatic prostate cancer.

3. The results of the marvelous PATCH trial suggests multiple transdermal 100 μg estradiol patches every week as a primary therapy for metastatic prostate cancer. Note that this is a complete replacement therapy. You get rid of your current doublet or triplet therapy.

4. Low dose transdermal estradiol patches can also be used as estrogen "add-back" - as an enhancement to an ongoing regular doublet therapy regime. There are people using this and there is growing evidence that replacing the lost estrogen, suppressed in the normal course of events for regular metastatic prostate cancer, can be worthwhile.

5. The exciting thing here is that low-dose transdermal estradiol patches may be a very effective solution against a debilitating hot flashes and other side effects of low estrogen. This includes reducing the risk of osteoporosis for example, and also cardiovascular risk.

6. Low-dose estradiol patches have their own dosing. I don't know what those doses are. Maybe they are 100 μg estradiol patches, but not the larger number of patches for the high dose replacement. The dosages are completely different.

7. As for PT, may I ask if there's any reason your husband is not on triplet therapy? That means adding chemo, usually Docetaxel. Something to consider. Maybe there's reasons to exclude this.

The casual reference to 100 μg estradiol patches here, in circumstances of different therapy regimes, needs to be made more clear. Are we talking about high dose replacement of current therapies? Or are we talking about alleviation of hot flashes etc, in this case using low dose?

[positive-thinking in reply to JohnInTheMiddle]

My husband already did the chemo with Nubeqa and Zoladex . He was done chemo on April 18th /2024 and continues with Zoladex every 3 months and Nubeqa . He has a high gleason score of 9 and is on this forever. He is thinking of trying megastrol acetate as these low dose patches dont seem to work and he does not want the hurting/swollen breasts he reads is very common . I just wondered if others on the low dose patches found it took a long time for anything to be noticed. He had tried Effexor in the past and it worked within days but eventually even with increasing the does it stopped helping with the hot flushes . He has not tried the megastol and is considering it . Thanks for your reply.

[JohnInTheMiddle in reply to positive-thinking]

Thanks PT. And fantastic your husband received the chemo (Docetaxel 6 sessions?). I was moved by your husband's young age. As for estradiol patches, my understanding is what you have done is very uncommon. Bravo. And success going forward!

[positive-thinking in reply to JohnInTheMiddle]

Not sure what you mean by " what you have done is uncommon " ? He had 6 sessions of Doctaxel ( He is on triple treatment ) . He will always be on Zoladex and is on the nubeqa till it does not work. He is trying to get some relief from hot flushes and the urologist has him trying the low dose patches but he does not think they are working? It has only been 2 weeks though and I wondered if it takes longer to know if it works. He is not the most patient man and switches off ( I keep telling him there may be no 100 % ) . Not sure what you mean by uncommon ?

[JohnInTheMiddle in reply to positive-thinking]

Super thanks PT for your reply. And congratulations that your husband started on triplet therapy and has completed their Docetaxel part. You mentioned your urologist; do you also have a medical oncologist may I ask?

What is not common is a prescription for low-dose transdermal estradiol as estrogen add-back therapy. I would like to do this myself, but supported by a proper doctor. Mine have refused so far. There is research coming out now though validating the approach that you are taking.. And there's been a lot of discussion in this forum. There are people who do this on their own and who have also figured out how to monitor there blood estrogen levels. But from everything I've read and from people I've talked to this is not standard of care and it's not even common early adoption.

Because you mentioned it, I looked up to see if there's any thing that says how fast transdermal estradiol should work to alleviate hot flashes. I couldn't find anything with a short search. I do know that being on Firmagon/Degarelix (a GNRH antagonist, a different category than the ADT your husband is on with agonist Zoladex/Goserelin), I don't have hot flashes.

[positive-thinking in reply to JohnInTheMiddle]

Thanks so much for the reply. My husband when diagnosed had a very short period that we had some guidance ( 2 phone calls ) about treatment from an oncologist . We did have to insist and argue to be able to have nubeqa and not Enzalutamide ( we thought from research there would be less side effects ) . He was dead against chemo and triple therapy treatment , but did agree as this was something we strongly wanted. Shortly after my husband started treatment he went golfing ( he is off work for a few years ) and his care went back to the urologist . We have asked quite a few times if we could please have an oncologist for care and told this is common practice to have the urologist till PSA or something else happens that leads to a decline in my husbands health. We live in The Yukon and have no urologist or oncologists here. We have just our regular doctor and myself doing research, this has been quite stressful putting this on me as I'm not a doctor. We have found that if I was not researching things would have gotten missed and we would be more in the dark than we are now. I have seen that some people are lucky and do not have hot flushes from the Firmagon you are on and some do , the same for Zoladex. I'm not sure if that would make a difference as they both work to lower the Testosterone so I think my husband is just getting them from that. He started the patch awhile back and went off of it right away and than recently started it again due to the hot flushes. He put one patch on and is told to change every week, he changed the path and a few days later decided he is too scared of the breast issues he may get. He is trying to find the best quality of life with the least side effects and the hot flushes are not letting him have great quality of life . It was the urologist that wrote the prescription for the estradiol patches . I wish he would stick to one thing long enough to see if it works, I keep telling him that I dont think anything will take them away 100% . Thanks god for this site and all the knowledge everyone has. I was just hopful for anyone else that's on the low dose to see if it takes longer than he thinks to work and if some meant dont get the breast issues he is scared of. Wishing you well

[JohnInTheMiddle in reply to positive-thinking]

Good morning PT! The Yukon! (Whitehorse?) A few phone calls with an oncologist. And you got triplet therapy! And you got Nubeqa/Darolutamide! This is an astonishing story! And you're the best coach ... even if it's a game one wouldn't choose voluntarily.

As for golf, I worked one summer in Yellowknife, I'm thinking your husband's golf season doesn't last very long 😂

As for ADT, you mentioned that the different drugs do the same thing, which is true. But as I mentioned earlier the two ADT drugs we were talking about - one is an agonist, and one is that antagonist. So they're not completely the same.

And also regarding the patches, are you having your husband's blood tested regularly to figure out the target blood level for the restored estrogen you need? Apparently has to be fine-tuned? Or even estradiol dosing has to be grossly tuned! I hope you are able to obtain the benefit your husband needs and that he can stay the course maybe a little bit more until results kick in? As long as it's not bad for his health of course.

Thank you PT so much for sharing all this with us. And outstanding research too!

[positive-thinking in reply to JohnInTheMiddle]

I will let you know how the patches are working for my husband as he let me read what you put on another post about these patches and is very interested to give them a long time as the benefit of replacing the missing estrogen you mention makes so much sense to us both. Bone loss is also a huge concern he has .

[JohnInTheMiddle in reply to positive-thinking]

My new note this morning above asks about how often your husband is getting his estrogen blood level tested. I'm assuming this is happening. You want to get the dosing correct of course.

And I can't remember if you have already raised the question of exercise, but in terms of bone loss exercise is super super important for us. Both weightlifting and aerobic.

[positive-thinking in reply to JohnInTheMiddle]

He is not getting the blood work at this time for this and as I have stated we are having issues with getting to talk to any oncologist or urologist about our questions. We will seek out having this addressed and hope to get answers and results. My husband does exercise and is striving to keep this a big part of his life. Appreciate your answers and input

[JohnInTheMiddle in reply to positive-thinking]

One of the things that took me awhile to learn was the division of labor between different kinds of doctors.

For example insofar as cancer therapy can have implications for cardiovascular health, the right person to work with for cardiovascular situations is your family physician or general practitioner.

The urologist or medical oncologist will deal with the answer therapy medications themselves and that particular treatments that may be causing any issues. But your GP is the person who orders blood tests and stress tests etc etc.

In this case it crosses my mind that insofar as you husband is using estradiol patches for estrogen recovery to normal levels, that a GP would be the person to order blood tests - until you figure out the dosage correct. And then as a periodic double check.

And from people I've talked to (as you know from my notes I would like to start low-dose transdermal estradiol for estrogen add-back myself), it's very important to have blood tests to measure the effect of the patches on one's recovered estrogen blood level. It easily could be too high or too low.

It has been suggested to me that such a question would be something like "I'd like to ensure that my estrogen is at the right level for a man". And you could get other markers checked at the same time. Urologist and medical oncologists are super-focused. But the GP's purview is the whole body and person.

I apologize if my question is irrelevant or unwelcome or if I misunderstood your husband's situation.

[positive-thinking in reply to JohnInTheMiddle]

Quite the opposite , I find your knowledge very helpful and thank you for this . My husband was just diagnosed last October , I see that the 18th of October it will be 1 year since his biopsy confirmed cancer gleason 4+5. It seems like it has been one thing aft another and so much to take in since that day . We are trying to learn who to push to talk to living in an area without specialists . It was though our family doctor that missed this , that kept saying that my husbands peesing issues were normal . That he never felt anything with the rectal exam. He was gone on a holiday and I made my husband go see the Doctor replacing him and have an exam. He immediately referred him to a Urologist because he felt something and did my husbands PSA . This was the first time it was ever above 4 ( 4.13) . He is the only one currently to go to , is hard to swollow but there is not other doctors and these days you have to be thankful you have a doctor. My husband is going to consult and have him check his levels with blood test and he is also able to increase the dose if needed. I have read some of your posts and love the way you are so positive and the way you look at things. Attitude I'm learning is a huge thing with this dreadful disease.

[Islandboy2021]

I am using Estradoll gel every day rubbing on my inner thighs. Was prescribed by a bone specialist. He also prescribed Exgeva for my bone loss.

I am very advanced just completed 17 rounds of chemo not counting the six rounds I had in 2017/2018 at the beginning of this reality.

[positive-thinking in reply to Islandboy2021]

Do you find that the gel is helping? My husband was prescribed the patches by the urologist but has been unable to even talk to him about his concerns or ask if it should work right away?? He is scared about the breast issues that men have faced with the patches so unsure if he wants to continue with the patch as it does not seem to be working for the hot flushes. Hope you are do good

[janebob99 in reply to positive-thinking]

Hello, Positive-Thinking.

I am an estradiol gel user. I also am on Orgovyx ADT. I get the E2 gel from my local compounding pharmacy. It costs about $60 for a 2 month supply. You can also get pre-packaged gel from Estrogel.com (0.06% concentration) or Divigel.com (0.1% concentration), but it costs more. His patch dose is too small to get a good effect for reducing hot flashes. Plus, it takes 3 weeks for the patches to reach a "steady-state" level.

I recommend switching to one, 0.1 mg/24hr "large" estradiol patch. If the hot flashes don't disappear in 3 weeks, go to 2 patches per week, and so on. The higher estradiol serum levels will also prevent osteoporosis, and grow bone (see Langley et al 2016).

Another approach is to apply multiple ones of the small patches at a time.

The phase-III PATCH study used 3-4 of the large patches per week (each patch = 0.1 mg/24hr strength). (see Langley et al 2024)

He needs to apply the E2 patch(s) to his upper buttocks or hips, for best absorption. Stay away from applying to the forearm or shoulder, the absorption there is too low.

I do have some small breast growth and some small breast tenderness/nipple sensitivity that I only notice when I push on my breasts. My wife doesn't care what I look like. I'm used to the change and it's OK. It's not worth having hot flashes or osteoporosis.

It's a tradeoff. But, hot flashes at night ruin good sleep, which is so essential to good health. Even worse is osteoporosis. They will put you on bisphosphonates, which don't grow bone (they do stop the loss of bone density, however). Those drugs also have their own side effects and risks. Fracturing a hip from osteoporosis is a very serious thing...to be avoided if at all possible. Using medium to high-dose estradiol will increase the bone mineral density. (see Langley et al 2016, Russell et al 2017).

He should get a baseline DEXA bone density scan at least once a year, and one now.

Regarding breast cancer, the rate of incidence for healthy men is less than 1 % of the general healthy population (men and women) per year. For men that are BRCA 1/2 positive, however, the rate of incidence goes up to 5-14%, depending on which study you read. So, it is a concern for those men. He may want to get a mammogram every year, if he continues on estradiol therapy. I plan on getting a mammogram this year, even though I'm BRCA 1/2 negative.

Remember that estradiol therapy for ADT replacement is not a current Standard of Care. and it does require frequent monitoring of PSA, T, and E2.

I used my PCP to prescribe the estradiol. My MO was very interested, but didn't know anything about it.

There is a new drug for fighting hot flashes in PM women, called Veozah. But, it has side effects, including increased liver enzyme levels. It may be expensive, too.

I know of a three men that have been using estradiol gel/patches for over 20 years, with no other drug therapy, and their PCa is well-controlled. But, each person's response is different and highly individual.

Bob in New Mexico

[Mgtd in reply to janebob99]

Bob that was an excellent write up. Thanks for taking the time to do that. Much appreciated!

[janebob99 in reply to Mgtd]

You're welcome !

[positive-thinking in reply to janebob99]

Thanks for all the info, it is a huge concern having BRCA2 and I have researched this as much as I can. He does get a mammogram every year now and is starting the 0.39 mg patch 1 weekly. He will give this patch at least 3 weeks and if it does not help the hot flushes he will add 2 of these patches a week. At that point we will reach out to his urologist to see if he should increase the dose of the patch and talk about the BRCA2 and risks with this. Our problem is trying to talk to the urologist even with a phone call. Thanks for all the info . This site is awesome

[DrawingSnowmen in reply to positive-thinking]

Here's an article that might be helpful if you haven't seen it yet:

erc.bioscientifica.com/view...

The bloodtest is the Ultrasensitive E2, try to get that. If the dosage isn't correct it's not going to have the desired effect. Make sure it's the "ultrasensitive" test, the regular E2 doesn't have a great enough range for this use.

[positive-thinking in reply to DrawingSnowmen]

Thanks ever so much !

[j-o-h-n]

Yukon for you, Mekon not for me, that's for sure....

Good Luck, Good Health and Good Humor.

j-o-h-n

[7OaksTom]

I'm taking Eligard (9 months) and Xtandi (3 months). I have been taking a tablespoon of flax seed powder daily for the last 8 months. While I still get hot flashes, they are tolerable and easily treated with a fan for about a minute. They do disturb my sleep, but I quickly fall back to sleep after tossing the sheet off.

[positive-thinking in reply to 7OaksTom]

My hot flushes are worse than my husbands , I have had them for 11 years now and now have osteoporosis. Unfortunately I know ho he feels and dont want him to suffer like I have aloud myself to. I wish I had researched about my loss of estrogen 11 years ago or someone doctor would have been watching out for me. I'm more scared of bone issues and want him to avoid that if possible , but hot flushes can really wreck quality of life sometimes. I wish you well