1. < Prostate Cancer
Profile picture for carlsbadguy

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

Posted by carlsbadguy @carlsbadguy, 2 days ago

I've been on Orgovyx now for 6 weeks, and thought I was tolerating it pretty well. Eating well, doing resistance training, cardio work and impact work. I had pre SpaceOAR procedure blood work done yesterday. PSA has dropped from 5.91 to .82, testosterone has dropped from 909 (yes,909 not a typo!) to 18.73, and CMP showed everything in the green. However my CBC shows a significant drop in my WBC and neutrophils, well below the normal range. Apparently this is a rare SA with Orgovyx. As I said I am tolerating all of the other SAs of Orgovyx pretty well, I really don't want to switch to Lupron, Firmagon or Eligard. I wasn't able to talk to the Dr who is supposed to perform the SpaceOAR procedure on Tuesday 8/5 or my MO who prescribed the Orgovyx as the results came in late Friday afternoon after they had all left for the weekend. My MO originally suggested Lupron, I talked him into Orgovyx after reading the benefits of Orgovyx over Lupron. I'm supposed to start radiation on 8/19, hopefully that won't be affected. I have messaged my MO and have an appointment with him on 8/11, after SpaceOAR but before radiation. If he decides to take me off of Orgovyx, which of the three remaining options should I be asking for? I understand they are all injections, and all seem to have worse SAs than Orgovyx.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | 1 day ago
In reply to @climateguy "I've been on Orgovyx for more than 7 months. Although I seem to be tolerating the..." + (show)
Profile picture for climateguy @climateguy

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.

Jump to this post

@climateguy

Here is a conversation with Paul F. Schellhammer, MD, FACS and Richard Wassersug, PhD—two respected leaders who speak not only as experts, but as men living with prostate cancer.
They take a straightforward look at transdermal estradiol for androgen deprivation therapy (ADT), discussing the clinical evidence, quality-of-life considerations, and the importance of making informed treatment decisions with your healthcare team.

REPLY
1 reply
Profile picture for carlsbadguy
carlsbadguy | @carlsbadguy | 22 hours ago

I have spoken with my RO nurse this morning and my RO and the urologist who is performing my SpaceOAR procedure have given the go ahead for both the SpaceOAR as well as radiation as scheduled. This is great news after over 48 hours of angst. Since I am having proton radiation there should be little to no further effect on my WBC and neutrophils from the radiation. My MO is out of the office until Friday, I have a scheduled appointment with him on 8/11. His nurse responded to my portal message saying they had never had a patient with lowered neutrophils while on Orgovyx. It is not a listed SE on their website or anywhere else that I have found, and I have read countless websites about ADT meds and specifically Orgovyx. @jim18 is the only person who has indicated a loss of WBCs and lower neutrophils while on Orgovyx on this thread. However if you ask a search engine it responds that it is a rare and uncommon SE. Thank you to everyone who responded to my original post.

REPLY
Profile picture for climateguy
climateguy | @climateguy | 5 hours ago
In reply to @jeffmarc "@climateguy Here is a conversation with Paul F. Schellhammer, MD, FACS and Richard Wassersug, PhD—two respected..." + (show)
Profile picture for Jeff Marchi @jeffmarc

@climateguy

Here is a conversation with Paul F. Schellhammer, MD, FACS and Richard Wassersug, PhD—two respected leaders who speak not only as experts, but as men living with prostate cancer.
They take a straightforward look at transdermal estradiol for androgen deprivation therapy (ADT), discussing the clinical evidence, quality-of-life considerations, and the importance of making informed treatment decisions with your healthcare team.

Jump to this post

@jeffmarc I've listened to everything I could find with Wassersug, and lately, Schellhammer but this is new. Thanks.

REPLY
Profile picture for surftohealth88
surftohealth88 | @surftohealth88 | 1 hour ago
In reply to @climateguy "I've been on Orgovyx for more than 7 months. Although I seem to be tolerating the..." + (show)
Profile picture for climateguy @climateguy

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.

Jump to this post

@climateguy
Thanks so much for sharing information about Webinar 👍 : ))) . My husband is also open to the idea of switching to Estradiol patch after a year, maybe even sooner.

REPLY
Please sign in or register to post a reply.