An alternative to standard hormone therapy (ADT) using luteinizing hormone-releasing hormone (LHRH) analogs like leuprolide (Lupron®, Eligard®), goserelin (Zoladex®), triptorelin (Trelstar®), and histrelin (Vantas®) for men with advanced prostate cancer, but often not used is estradiol (a form of estrogen).
When estrogens were first used as a therapy for men with advanced prostate cancer they were administered orally and caused significant issues including primarily cardiovascular toxicity associated with the therapy.
There has been renewed interest in using estrogen therapy, but instead of oral administration the use of timed release patches is the preferred method of administration.
The problem is that different brands of patches release different quantities of estradiol at different rates. Additionally, their release of estradiol is not consistent over time. Confusing the dosing issue even more is that different men require different levels of estrogen to accomplish the desired goal, stopping the production of testosterone so that a man is castrate.
If you decide to use estrogen patches you will have to work at taking the treatment properly. The goal is to work out a patch application regime that works for you.
To do this you will need to regularly test your testosterone (T) level when starting patch therapy to assure that it is being maintained at a castrate level while also avoiding excess estradiol levels. An optimal serum level of around 270 pg/ml is a good goal, but some doctors do believe that a considerable variance on either side of this level is alright.
Besides testosterone and estrogen levels, issues surrounding the development of rashes and patch adherence can become problematic for many men.
Some men deal with this by wearing the patches for relatively shorter periods of time as well as rotating the area of application between each side of their abdomen and buttocks. It is recommended that prior to the application of a patch the area is cleaned with alcohol. Not only does this insure a clean field, but it also seems to aid in the adherence of the patches.
One man I know who does use estrogen patches reports that he uses three different brands of patches, all of them are labeled as being 0.1 mg patches. He uses Climara, Vivelle Dot, and Mylan (generic) brands.
He has reported that the Climara patches, which are considered to be a seven day patch, release about half as much estradiol by the seventh day as they do in the first couple of days. The Vivelle Dot patches are considered to be a four day patch, but his experience with them was that the initial release rate is modest, and drops off sharply after the second day. His experience with Mylan patches which are supposed to have release rates similar to the Climara patches release huge amounts during the first couple of days, and this drops off sharply in the back number of days.
For these reasons a man needs to settle on one brand and create a rotation. Usually the rotation will consist of four to five patches with one changed out every day. However, to find your ideal dosing will take time, experimentation and constant monitoring of your testosterone level.
For men on Medicare the Mylan generic patches might be the best choice as they have excellent Medicare Part D coverage. The man I mentioned earlier reports using the Mylan patches, wearing two patches at a time, changing one patch daily. His testosterone levels have been maintaining themselves at 14 ng/dL, an excellent castrate level.
There have been several reviews written both in the U.S. and U.K. about the use of non-oral estrogen. You can find these reviews at:
Okrim, Abel, et al (UK):
Tomasz Beer et al (US):
A 2008 report on a transdermal estradiol trial in progress, conducted by the UK group:
Joel T Nowak, M.A., M.S.W.