I've been on Orgovyx for more than 7 months. Although I seem to be tolerating the drug better than expected at the moment, I have considered what I would do if I concluded I can't keep taking this drug.

I've decided on Estradiol. It makes more sense the more I look into it. Some of its advocates have been on this treatment for more than 20 years. Most clinicians, up to fairly recently don't see it as something they should offer their patients. Things seem to be changing.

The theory is that men require estrogen. If testosterone is present, the body makes the required estrogen out of the testosterone. When testosterone disappears, so does the estrogen, and when estrogen disappears, the side effects of estrogen deficiency set in.

In practice, advocates of using Estradiol instead of today's traditional ADT drugs claim that almost all of the side effects of traditional ADT are reduced or disappear, except that gynecomastia occurs more frequently.

A problem is that no drug company can patent a naturally occurring hormone, so drug companies haven't been anxious to step up to finance the expensive gold plated studies that would prove that this therapy is acceptable as ADT for men in the eyes of most clinicians. No patent, no profit. Since estradiol patches have been approved for use in women, Estradiol as ADT in men advocates have been using it off label.

Now that the New England Journal of Medicine, March 25, 2026, has published 'Transdermal Estradiol Patches in Locally Advanced Prostate Cancer", this situation, i.e. reluctance of most clinicians to consider this therapy, will be changing.

From the NEJM article: "The patches appear to be as effective as standard LHRH agonists against prostate cancer and are associated with a lower incidence of the short-term and long-term deleterious adverse events related to estrogen depletion during treatment with LHRH agonists.".

P.C.R.I. published a discussion between Mark Moyad and a man who has been taking estradiol for more than 20 years, i.e. Paul Schellhammer. https://www.youtube.com/watch

Apparently the big deal breaker many men say when they first consider estradiol, no matter how bad their experience with the commonly prescribed ADT drugs of today has been, is the breast growth issue.

Schellhammer brings up a study of transexual men, i.e. the men who want to grow breasts, that found that when they take estradiol with the intent to grow breasts, they most often are disappointed. ! 85% got nothing or A-cups at most, 10% B-cups, and 5% C.

UCSF Urology is hosting a webinar August 20. The title: "Transdermal estradiol vs traditional ADT – what’s best for you? "

Dr. Cooperberg is moderating. Schellhammer will be a discussant. They will be taking a "deep dive" into the New England Journal article. https://urology.ucsf.edu/education/events/all/202608/6th-urotoday-journal-club-prostate-cancer-patients

At the moment I'm most concerned about Orgovyx caused mental decline and bone deterioration. My RO may reduce his ADT prescription for me from 2 years to 1 year. If he stays with the 2 years, I'm going on estradiol.