Beware of estrogen patches in the TST recovery phase

[giorgioc]

Dear Friends,

I finished the ADT in August 2024 (last injection of Decapeptyl in May 2024) and for fear that the estradiol would hinder the recovery of the TST I almost simultaneously stopped applying extradiol patches (2 per week of 25 mcg) that for almost the duration of the ADT they maintained the level of extradiol between 15 and 35 (depending on when I did the blood test: higher when I did it the first day after the application of the patch and gradually lower day by day of 3-4 days. duration.

So for 3 months I was without adt and without patches and in the third month I did the blood tests and found:

- TST 1.34 ng/ml (During ADT 0.10 ng/ml) Estradiol <10 pg/ml LH 3.70 mUi/ml

Concerned of the level of extradiol and considering that before the ADT I was in osteopenia at the neck of the femur (t -score -1.5) I started again to apply the patch as usual.

A month later I wanted to check some parameters:

- Estradiol 13 pg/ml LH 5.86 mUi/ml

And two months later, at the control of almost 6 months I found:

- TST 1.34 ng/ml Estradiol 30 pg/ml

Concerned this time that the TST was blocked , I stopped applying the patch of estradiol again and a month and a few days after, I made the blood tests again to see the results and they were:

- TST 3,21 ng/ml Estradiol 10 pg/ml LH 10.96 mUi/ml (Normal values: 0.57-12.07)

Before I started any therapy my TST normally was 6.6 ng/ml (now they are halfway from that value 7 months after the end of ADT).

Now I don't want to say that estrogen patches hinder the recovery of the TST also at normal estrogen levels (I had created a post to ask for experiences of other patients).

But with me it worked this way, I think.

I don't think I will use the patches of extradiol anymore and I hope that if my TST levels will increase more , my estrogen will increase through aromatase.

Our body is a damn complicated system!

[PCaWarrior]

Did you have 1, 3 or 6 month shots?

The tE2 patches you used were rather low dose. I haven't seen T inhibition with low level replacement. My tE2 patches were 0.3-0.4 mg/day to push my T down. I tried going 0.2 and my T started going up.

But, like you said, the body is not understood well and we all react a little differently.

[giorgioc in reply to PCaWarrior]

The Decapeptyl was quarterly. The dosage of the estradiol patches was low, but in the blood, it fluctuated from 30 pg/ml (So, very high) on the first day of application to about half that between the third and fourth day. I checked what was happening only once, but I had no doubts: I almost doubled my testosterone level when I was off the patches. That was enough for me to decide to stop. LH received a significant boost, and if my testicles haven't atrophied too much, I hope my testosterone will increase further. I believe each of us has a different sensitivity threshold to various hormones.

My use of estradiol during ADT was to reduce side effects, especially on the bones, and I was afraid that testosterone would recover much more slowly, worsening my T-score.

[PCaWarrior in reply to giorgioc]

It's working for you, that's what matters. I had to take my blood E2 to 500 or so to get my T down. Some guys go much higher than me. 30 won't budge my T.

Trials show that your T might not recover until a year post Decapeptyl. So around August of this year. But that's on the high side. Most guys are recovering by now. I "urged" mine along with T injections.

[giorgioc in reply to PCaWarrior]

I think these are two fundamentally different cases.

[PCaWarrior in reply to giorgioc]

Yes. But I also use tE2 during ADT. Right now I'm using 0.25 mg/day weekly Climara patches to hold my E2 up - fluctuates wildly, 10 to 45. Today I'm on Orgovyx but I've used them with AA, Lupron and briefly with Firmagon.

Anyway, it works for you to remove them. And what works, works.

[janebob99]

One has to be careful to not equate an association with a causation. What you are describing appears to be an association, and not a causation.

The normal range of E2 is 20-40 pg/ml for a healthy male. Your E2 has never exceeded the reference "normal" range. 30 pg/ml is NOT "very high".

The median value of E2 for the PATCH study was 230 pg/ml, approximately 8 times larger than the middle of the normal range. The PATCH study used much stronger E2 patches than you (3-4 patches with 100 mcg E2 strength). Your dose of E2 (2 patches of 25 mcg strength) is likely too low to make your E2 level exceed the normal range.

Attached is a comparison plot I made that shows the association between E2 and T levels. While there is a lot of scatter, one can see that "normal" levels of E2 have little effect on reducing T levels. E2 needs to be > 100 pg/ml to reach castration levels of T < 50 pg/ml.

Hope this is helpful.

Bob

Association between T and E2 serum levels

[giorgioc in reply to janebob99]

Thanks, Bob, for your input, but I don’t think I’ll try 100 more times to distinguish between association and causation—frankly, I’ve had enough. In doubt, I’ll refrain from using estradiol. I hope to recover my testosterone quickly so that aromatase can work properly.

As for estradiol, I’ve sometimes found values as high as 45 pg/mL with the same dosage; it’s very variable, and maybe the testing method plays a role. With 3.2 ng/mL of testosterone, I’m already feeling much better and happy—I didn’t expect to recover so fast after two years of Decapeptyl.

Thanks!

[janebob99 in reply to giorgioc]

I respect your position.

Yes, factors of 2 X are common for an individual. Time of day, and day of the week after applying a patch affects the E2 level.

If you are off of ADT, you really don't need to use E2 anymore, unless your natural E2 level is too low to make good bone.

Bob

[j-o-h-n]

Hello George,

Our body is a damn complicated system! (Until we die, then it's just a piece of meat).

Good Luck, Good Health and Good Humor.

j-o-h-n