Testosterone and Estradiol Replacement

Has anyone been prescribed testosterone cream and estradiol patches after HT to bring hormones quickly back to normal levels? It appears estradiol patches can possibly cause heart attack, stroke, and blood clots. What a trade off to try to prevent bone loss while on HT.

Below is an article I had wanted to post from the June 2014 issue of Life Extension magazine. The article is about a study at Massachusetts General Hospital where doctors gave men Zoladex to lower testosterone but also gave them a mistaken overdose of anastrozole that lowered estrogen to unacceptable levels. The article also discusses replacement testosterone and the severe consequences of an imbalance of estrogen and low testosterone in aging men.

I'm somewhat confused where they talk about low testosterone causes prostate cancer, but HT, as we know, suppresses it to near zero for months.

(url)http://www.lef.org/magazine/mag2014/jun2014_Misguided-Medicine_01.htm(url)


Robert

Hi Robert,

I doubt you'll find many men whose doctors prescribed testosterone cream, and certainly not estradiol patches, to bring them back to normal levels after HT. (There is a clinical trial now to see whether it's beneficial to alternate testosterone deprivation and augmentation (called Bipolar Androgen Therapy) for some men on intermittent ADT). The reason is because supplementing testosterone will suppress one's natural production, and the first choice would be to let the body produce it naturally. Sometimes, hCG and Clomid can be used to jumpstart natural production if the hypothalamic-pituitary-testicular axis gets stuck in the off position after long-term ADT.

Estradiol patches have been shown to have much lower cardiovascular effects than the pills.

There was no "mistaken" overdose of anastrozole. You can read the full study itself (link below). The researchers were trying to differentiate the effects of testosterone from the concomitant estrogen changes that accompany it. Because estrogen is a metabolic product of testosterone, it is always present when testosterone is present, so they artificially blocked estrogen production in men while they increased their testosterone up from ADT levels. They found that small amounts of estrogen help, along with testosterone, to maintain libido and erectile function in men (small amounts of testosterone are necessary to maintain libido in women), and that it prevents fat accumulation. From other studies, we know that it prevents bone loss and is needed for thermoregulation. The study was only 16 weeks because they wanted to avoid bone loss in the subjects who were depleted of estrogen.

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men

A history of low testosterone (hypogonadism) is associated with increased risk of prostate cancer. Castrate levels of testosterone may sometimes cure it. This has been much written about on this site, so I won't go into it here.

- Allen

(corrected typo)

Post Edited (Tall Allen) : 6/5/2014 11:38:47 AM (GMT-6)

Thanks for catching that -- corrected now.

Hi Allen,

In one of the paragraphs of the Life E. article the writer said "we at Life Extension have no idea why a dose of 7.0 mg of anastrozole a week would be given to men. Perhaps it's sold in 1 mg. tablet so the physicians who designed the study thought the men should take one a day". That was what I thought was the mistake or that's how Life kind of presented it

I asked about estradiol patches too because Dr. Snuffy has said he uses a .025 or .035 patch to prevent bone loss while a man is on HT, if his estrogen is low. I had Lupron for 12 months and no one mentioned checking my estrogen. I now have osteoporosis although I may have had some prior to HT. At my request, my estrodiol is being checked now.

Another subject maybe for another post -- today my GP said with my A1C score of 5.8 this month I am pre-diabetic. I weigh 154 lbs., 6'0", and am on Mediterranean diet plus exercise three days a week at a center. I asked him about low does Metformin, but he says he doesn't think meds are needed yet and to try cutting carbs. Before long I will be on cardboard:). So, are men on HT other than due to weight gain reasons more prone to diabetes?

Peter catches everything...and that's a good thing.

Robert

Robert,
Other than a higher incidence of metabolic syndrome with its risk of hyperglycemia, I haven't seen anything about ADT causing diabetes.

In some interesting studies, Metformin has been associated with lower risk of recurrence of PC, however several studies show no association. None that I have seen show that it isn't safe for PC, so as long as you don't have any contraindications, why not ask your doctor what is the nature of his objection?

- Allen

Ralph, Allen and others, thanks for your input.

I believe that I have beginnings of metabolic syndrome with the osteoporosis diagnosis after 12 mos. Lupron and now pre-diabetes. As I said before, probably had some osteo already but Lupron caused more. Below are some other stats.

I think I am doing things right in diet and exercise, but I have to find a way to stop the rise in blood sugar and resulting A1C level. The urologist here did not test my "T" level before he started ADT in Feb. 2013 and never checked it during the first 9 months. I could have had low testosterone before ADT was started. I just didn't know enough about it all and am still learning. I just don't want to have another issue like diabetes if I can stop the progression now. As I mentioned, the oncologist is okay with starting Metformin, if I want to do it, GP wants to wait 6 mos. and re-check A1C. Not sure Metformin is what I need to control blood sugar quickly. I am waiting on result of testosterone, DHT, and estradiol test from blood draw yesterday. Blood pressure was 104/60 - usually 115 to 120/70. I am 6' and weigh 154 lbs. Lost a lot of muscle on Lupron. "T" was <3 Dec. 2013, and at 12 in March 2014.

So, what can I do to prevent diabetes?

Dr. Myers did a very good video on Hypergonadism back in 2011 that I watched again. Sometimes I think I need to just go see him.

(url)http://askdrmyers.wordpress.com/2011/10/05/male-hypogonadism-pca/(url)

Glucose
10/7/2013 84
12/16/2013 112
5/27/2014 102

A1C
1/4/2013 5.5
5/27/2014 5.8

HDL is 70, LDL 72, and Triglycerides 100 up from 91. Ratio is 2.3.

Robert

Robert,

I seriously doubt that you have metabolic syndrome, given your low BMI. It is associated with lots of excess belly fat, and high blood pressure.

It sounds like you'll want to talk to an Endocrinologist. Some of us are just genetically programmed for things like insulin resistance, high cholesterol, high blood pressure, plaque accumulation, blood clots, etc. no matter how healthy our diet and exercise habits are. I'm not at all saying that diet and exercise and not smoking are unimportant - they are perhaps the most important health-related things that we have control over.

- Allen