Good news, bad news on blood work after 6 weeks of Orgovyx.

How low is it? Neutrophils are a subset (about 50%) of WBC so no surprise that both decreased. All of the drugs have this side effect at <0.5% so no guarantee that switching will eliminate the issue. Any injection puts you in for 1 month for Firmagon (same action as Orgovyx). Lupron and Eligard have the same active ingredient with Lupron injected in muscle and Eligard in fat.
FYI: My Neutrophils decreased by 40% and WBC by 30% on Orgovyx but both were still well within their normal ranges.

@jim18
Thanks for sharing your experience. Unfortunately I have a history of low WBC counts and low neutrophils, I was actually under the care of a hematologist who performed a bone marrow biopsy in 2019 when my neutrophils dropped to 1.14. The biopsy didn't show any cause and they eventually rose to low normal. My last CBC in 12/2025 showed my WBC at 4.5, it dropped to 3.1, my neutrophils dropped from 2.16 to 1.15 so similar percentages but I probably started at a much lower count than you. I've been reading everything I can, and now understand all of these drugs have similar effects on WBC and neutrophils. I've also read that ROs are most concerned with neutrophils, and at 1.15 it is borderline for radiation.

Firmagon is a one month shot. You also can get a one month Lupron shot to see how it works.

Both Firmagon and Orgovyx are antagonists.

Lupron and Eligard are agonists.

It would probably make more sense to get a one month Lupron or Eligard shot to see if your problem is still there with Firmagon Since it works like Orgovyx.

Definitely speak to your doctor about this.

I had to discontinue Orgovix after 2 months because it didn't work, no testosterone drop. Very rare, but it happens.
Now in my 6th month of Firmagon and doing very well. Severe fatigue at first, that is letting up, muscle weakness (duh!), hot flashes last 5 minutes or so, 2 or 3 times a day? Injection is no problem at all for me, a tough achy for couple days, at most.

@jeffmarc
Thanks for the clarification on the 3 potential replacements if needed. Does Eligard have the severe side effects that Lupron has, along with the extended length to recover your testosterone?

@datasource
Thank you for the response, I haven't read about anyone who did not respond to Orgovyx, but I also didn't know it would crash my white blood cells. Strange that they are the same class and the Orgovyx didn't work but the Firmagon does. Happy for you that it worked out.

I'll be curious to find what both my MO and RO have to say, I'm ready to start radiation treatments now, hopefully this won't cause them to be put on hold until it's sorted. My MO is also a hematologist, (I think they all are?) so I'm sure he'll listen to me and steer me in the right direction.

@carlsbadguy Not to pile it on, but radiation will lower all your RBC/WBC’s even further; good that your MO is a hematologist.
Phil

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.

@heavyphil
Thanks Phil, yes I am aware that radiation will lower both RBC/WBC's even further. My understanding is they will pause radiation if neutrophils drop below 1.0, and with mine at 1.15 I'm not sure if they'll even allow me to start. The nurse for the Dr who is supposed to do SpaceOAR procedure Tuesday sent me 3 reminders to make sure I had CBC done last week. Now I understand why.

@carlsbadguy
Eligard and Lupron are essentially the same drugs, they both use Leuprolide. A few years ago that was a shortage of Lupron and they just gave us Eligard instead.

You might find that longer use of Orgovyx Will allow your blood counts to rise to normal. We’ve been on ADT for almost 9 years and Orgovyx For three years and my white blood cells and platelets are normal.

@climateguy
Richard Wassersug PhD is Another person that has been on estradiol for over 20 years. He started the estradiol initiative https://estradiolinitiative.org/. He’s actually written a widely read book on ADT.

For more information about using estradiol go to the ancan.org Website and search for Estradiol or Wassersug. He’s done at least three talks about it, at that site, that have been recorded .