I'm in the process of switching from Orgovyx to tE2. I'm being treated at Fred Hutch in Seattle. I wrote my radiation oncologist and medical oncologist to say I would like to do this. They are being very supportive. Fred Hutch has a number of patients on tE2.

I see the medical oncologist in a week. He is going to prescribe the tE2. He recommended prophylactic breast radiation. I've already done a sim for that, with the treatments coming up in a few days.

There is a national shortage of tE2 patches that many are complaining about. I don't know if this affects the availability of gels, and perhaps, whoever is prescribing to you, i.e. if at a large institution, they may have large stocks maintained for times like this.

The NEJM study showed "noninferiority" with Lupron, better quality of life, equivalent safety data. The main difference with standard ADT such as Lupron is the different side effect profile. Much less in the way of hot flashes, instead of bone deterioration there often is improvement, less cognitive issues, etc. The main drawback is increased risk of breast development and nipple pain. There is a study showing 85% of men who wanted breasts (trans men) who took tE2 were disappointed with their A cup or nothing that they got. 15% got B cup or larger. Nipple pain can be addressed with prophylactic radiation or topical cream.

I felt I was doing well on Orgovyx compared to the horror stories I've read. I hit the gym for about an average of an hour, 6 days a week. I have been increasingly concerned about my short term memory loss, and my "warm" flashes have been increasing in severity and frequency lately. Bone loss is also a worry. So after the NEJM study came out, I started heading toward tE2.

The Estradiol Initiative website (E2-I) has a lot of top quality info. https://estradiolinitiative.org/

Dr. Keith Holden, a PCa patient, wrote an extremely well researched webpage about his recent switch to tE2 https://substack.com/home/post/p-214057348

Two of the founders of E2-I were interviewed recently. The recordings are on youtube.

Paul Schellhammer, former President of the AUA, distinguished urologist, has been on tE2 for almost 20 years.

Richard Wassersug, who wrote the book on ADT, https://www.amazon.com/dp/0826183913 was interviewed on the Dr.Geo podcast