From the Guidelines
Estradiol therapy is a beneficial treatment option for men on androgen deprivation therapy (ADT), as it can help alleviate hot flashes and preserve bone mineral density, with transdermal estradiol potentially providing similar cancer control with fewer side effects compared to other estrogen therapies, as suggested by the ongoing PATCH study 1. The benefits of estradiol therapy for men on ADT include reduction in hot flashes, which are a common and distressing side effect of ADT, as well as preservation of bone mineral density, as ADT often leads to accelerated bone loss and increased fracture risk, with the risk of fragility fracture in men on long-term ADT exceeding accepted intervention thresholds 1. Some key points to consider when using estradiol therapy in men on ADT include:
- Estradiol can be administered as a transdermal patch or oral estradiol, with typical doses ranging from 0.025-0.05 mg/day for transdermal patches and 0.5-2 mg daily for oral estradiol
- Estradiol therapy may also improve energy levels and mood in some men
- Potential risks of estradiol therapy include gynecomastia, nipple tenderness, and increased cardiovascular risk in some patients
- Regular monitoring of estradiol levels and side effects is recommended, with individualized treatment based on symptom severity, bone health status, and cardiovascular risk factors
- The use of estradiol therapy in men on ADT should be considered in the context of overall bone health, as men with prostate cancer are at increased risk of osteoporosis and fragility fractures, particularly when treated with ADT and other therapies such as abiraterone, enzalutamide, and steroids 1.
From the Research
Benefits of Estradiol Therapy for Men on Androgen Deprivation Therapy
The benefits of estradiol therapy for men on androgen deprivation therapy (ADT) include:
- Reduction in hot flush frequency and intensity 2
- Potential improvement in sexual interest and performance, as estrogen receptors are present in tissues involved in sexual behavior 3
- Prevention of bone mineral loss, which commonly occurs with ADT 4, 3
- Relief from other side effects of ADT, such as osteoporosis 3
Estradiol Therapy and Quality of Life
While estradiol therapy has been shown to reduce hot flush frequency and intensity, its effect on quality of life (QoL) is less clear. One study found that estradiol had no significant effect on QoL 2, although another study suggested that estrogen may help improve QoL by reducing side effects such as hot flashes and bone mineral loss 3.
Considerations for Estradiol Therapy
Estradiol therapy may not be suitable for all men on ADT, as it can cause side effects such as gynecomastia and increase the risk of breast cancer 3. Therefore, patients should be informed about the pros and cons of estrogen therapy before starting ADT. Additionally, the optimal dosing and administration schedule for estradiol therapy in men on ADT is not yet established, although cyclic administration may be beneficial 3.
Comparison with Other Therapies
Other therapies, such as gabapentin, denosumab, and metformin, have also been shown to be effective in managing side effects of ADT 5, 4. However, estradiol therapy may offer a unique benefit in terms of its potential to improve sexual interest and performance, and its ability to prevent bone mineral loss.