Here's a chart showing % of men who have a given condition, comparing Estrogen ADT versus Lupron ADT. There's big reduction in hot flashes, and improvements in libido, when taking supplemental Estrogen. Estrogen increases gynecomastia (enlarged breasts), however.
Bob
I might add comparisons showing that Lupron contributes to brain fog, fatigue, depression, and emotional ability.
Thanks for your comments. I will post a new chart today summarizing those effects. In the meantime, here's a chart that I made with Prof. Wassersug's help of the documented pros/cons of transdermal estrogen vs Lupron therapy.
Dr. Google
Does high estrogen in men cause breast cancer?
Men with the highest levels of estrogen were two and a half times more likely to develop breast cancer than men with the lowest levels of the hormone.May 11, 2015
Men with high estrogen levels could be at greater risk of breast cancer
TAANSTAFL
Good point. I'll check with Prof. Wassersug.
I'd guess, though, that the normal rate of breast cancer in men is relatively low. But, I'll add this to my PROS/CONS chart. Thanks for the info!
Hi, Derf4223.
Thank you for suggesting this topic.
I spent an hour researching breast cancer in men, and found some helpful statistics (which vary, depending on the source).
The rate of breast cancer in men varies from about 1-2 cases per 100,000 men (0.001 % - 0.002 %). The rate increases significantly with age (which makes sense) and men that are 70-80 year old have a much higher rate, about 7 cases per 100,000 (0.007%). Still, it's a pretty low rate overall, compared to women, who have a BC rate of = 125 cases per 100,000 women (0.125 %), (18 X greater than older men).
Of all the total cases of breast cancer, men's BC cases account for < 1% of those total cases.
Another source reported much higher rates of BC : 1 case per 833 men (0.12 %), and 1 case per 8 women (12.5 %). That's the same rate of prostate cancer in men (1 case per 8 men) as BC in women. Interesting comparison!
For men who have a mutation of their BRCA2 gene, the BC rate increases substantially to 7 cases per 100 men (7 %), and those with a BRCA1 gene mutation have a lower rate of 1 case per 100 men (1 %). Still high, though. Men need to get their genes tested for BRCA1/2!
The rates of BRCA 1/2 mutations in men range from 1 out of 400 men, to 1 out of 800 men. So, it's pretty uncommon.
I couldn't find the reference that you mentioned that said high doses of estrogen increases the risk of breast cancer by 2.5 times. Perhaps you could send me the citation for that reference?
I did find a paper (ncbi.nlm.nih.gov/pmc/articl... that compared the rate of BC for men with/without gynecomastia, and they report that the rate of BC increases by 6-10 times, as compared to men without gynecomastia. Overall, the total rate of BC was very low: 642 cases per 4,500,000 men, which translates to a rate of 0.0014%...quite low. So, assuming 10X more BC with gynecomastia (e.g., from high-dose estrogen treatment), that would be a rate of only 0.014%...still quite low.
It's very important for men considering high-dose estrogen treatment to get genetic testing. I used the free PROMISE/Color test (saliva test), which showed that I did not have any BRACA1/2 mutations. Whew!
I'm still going to get annual mammograms after going on high-dose estrogen treatment, just to be safe. I already have gynecomastia from congenitally high estrogen levels, so it's not a problem for me.
It sucks if you are the one of 1000-10,000 men who ends up with breast cancer, though.
Bob
Are there figues on the different levels of fatigue depending on type of ADT taken? I've been on Lupron 10 years and fatigue is currently my worst side effect. I imagine it would be difficult to find enough comparisons of people on different types of ADT for such a long period.
I don't have any figures on fatigue with different types of ADT, unfortunately. There is data, however, supporting significantly reduced hot flashes with estrogen therapy (add-on to Lupron, or as stand-alone High-Dose estrogen). So, if you have hot flashes at night, then that would affect sleep quality, and, hence, cause increased fatigue.
I would start by trying add-on transdermal estrogen while you continue to do Lupron. That should reduce hot flashes, and, perhaps, help with fatigue. Later, if you are bold, you could stop Lupron and do high-dose estrogen (which castrates men as effectively as Lupron), but without the bad side effects of Lupron ADT.
You may want to sent a post to "Wassersug". He's Professor Wassersug and has been on high-dose estrogen gel therapy for 20+ year (after being on Lupron before that). He's an excellent resource, and loves to talk to patients about ADT (he's a PH.D, not an MD).
You can start by ordering estrogen gel from estrogel.com. They will provide a doctor to write a prescription. No need to convince your MO to do this. Just start taking it and see how you feel. Just a thought...
Bob
SRT vs Intermittent ADT Post-RP PSA recurrence 
Gynecomastia from ADT - how much?
