Anyone Ever Opt For Transdermal Estradiol Over Conventional ADT Meds?

I'm not on any form of ADT...currently active surveillance...so I can't relate any personal experience.

However, a few months ago I posted a thread regarding physicians, who had been diagnosed with prostate cancer, and the various approaches they decided upon. https://connect.mayoclinic.org/discussion/physicians-with-prostate-cancer/

In that thread, I posted an article/video interview by Richard Wassersug, PhD, and Paul F. Schellhammer, MD, FACS, who discuss the Estradiol Initiative; which is a movement advocating for transdermal estradiol as a standard-of-care option for androgen deprivation therapy (ADT) in men with advanced prostate cancer.

If you haven't seen it, it's quite informative.
https://www.urologytimes.com/view/estradiol-and-adt-lessons-from-lived-experience

@handera Thank you for the posting and the references you've provided here, and yes, I have become familiar with both the relevant mayoconnect thread and the Estradiol Initiative. In fact, I have viewed several of the estradiol-based videos (available on ANCAn and on YouTube), and I recently spoke directly with Richard Wassersug about the subject. As a result, I am beginning to feel as though I've become sort of 'semi-informed' on the topic, but I am always looking for more, and that includes the Urology Times videos, which I do not believe I've yet seen. So again, my thanks to you. 👍

Been on the "Patches" for thee weeks. Two weeks in it had dropped my testosterone from 535 to 117 and Estradiol increased from 21 to 405. My wife and I both feel like I have MORE energy and no change in an active sex life. Slight soreness in nipples but this may be from the prophylactic RT (two sessions, 6 Gy each).

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.

@marko49 Whew! Thank you very much for responding.

As I said in my opening post, I am strongly considering this approach, and I have physicians willing to prescribe it for me here, but there is an absolute 'dirth' (absence) of patient-based, direct-use information on the subject available out there, other than those directly or indirectly associated with the Estradiol-Initiative and/or the Patch/Stampede/Pact trials. So at this point, 'any' feedback on tE2 (positive or negative), is fantastic, and I am most grateful to you for sharing your experience here. Its very helpful, and I wish you the very best going forward with it. 👊

@climateguy My sincere thanks to you as-well, and everything I said moments ago to @marko49 applies equally to you. I am most grateful to you both.

As I have indicated in previous postings here (but in different threads), I have been experiencing considerable difficulty in the way of delays and outright insurance denials for conventional ADT meds (other than age-old Lupron, which I am fully and painfully familiar with from earlier treatments). So I am, by necessity or otherwise, deeply intrigued by the tE2 option.

In the course of my research, I have spoken to (or otherwise communicated) directly with a number of physicians and other proponents of tE2 ADT treatment, and while supportive, they are nonetheless, few in their apparent numbers. So once again, the information that you've provided me and others with here, is invaluable.

This is especially true, since you have personally experienced prior use of other alternative (but 'conventional', non-Lupron) forms of ADT (i.e., Orgovyx). Why? Because whether paid-for by insurance or not, this is precisely what the experts are all proposing for me and most others in my high-risk/advanced/localized situation (e.g., Lupron, Orgovyx, Firmagon, Eligard, Xtandi, etc.).

So again, my very sincere thanks, and my best wishes to you as-well. 👍

Thanks for posting. I had MR-Linac SBRT in Dec 2024 and 12 months Lupron Depot starting Nov 2025. I won't bore you with how much I detest standard GnRH agonists or antagonists (I had 6-months of Firmagon previously). Twenty-one months post-SBRT, my T and PSA have started rising. Nothing particularly concerning yet. For my quarterly Zoom telehealth call at Duke in Durham, NC with my medical oncologist, I forwarded a reference to the NEJM article and other information on the use of estradiol, and stated that at age 79, I don't think I can tolerate additional rounds of standard GnRH agonists or antagonists, and would like him to consider use of estradiol patches if I end up with BCR or metastatic disease. To my shock, he said he could support doing that, stating the NEJM article added a high degree of credibility. Now hopefully, I won't ever be diagnosed with BCR or metastatic disease, but I feel a wee bit better just knowing that estradiol is not off the table. For those that are interested in using estradiol, I would encourage you to start discussing that with your prostate cancer care team when appropriate.

@willdon Bingo! Good on him (your doctor) and good-on-you! The data appears to be literally "unassailable", and I would truly love to know, what are the "legitimate" arguments by the trained medical opposition, who are against the alternative use of tE2 (other than the associated gynecomastia and nipple soreness)?? What is it?

And I'm being quite serious here (not confrontational or argumentative)! Please just bring-it! Someone out there, whether you're a researcher, a general practitioner, or an esteemed and highly published/highly acclaimed urologist or oncologist . . . where and what is the pure "evidence" to underpin and support your opposition to tE2 for such patients?

Absent that information, I would suggest that the answer lies precisely where most everyone believes it lies . . . "money", plain and simple, full-stop!

@toomany Wassersug is an incredible resource. I sent in a question via the Estradiol Initiative website, he answered with a few questions, I answered, and the next thing I knew he was calling me on the phone to make sure I understood everything I wanted to know about tE2. He's an inspiring guy. So much so I volunteered to do some research for the Estradiol Initiative which takes up most of my time these days.

@climateguy Yessir! I couldn't agree more. I sent a message to the Initiative website a few days ago, and Richard contacted me within hours to schedule an extended video chat, which occurred the very next morning. He has been most helpful, and incredibly patient with any and all of my questions. A tremendous resource indeed.