Estradiol as HRT after castration

[JesusA (imported)]

I sent the question of estradiol, which has come up several times in different threads, to Dr. Richard Wassersug, who is an expert on treatment after (mostly chemical) castration as treatment for prostate cancer. Here is his response:

Estradiol as HRT after castration

There is quite a bit of confusion about what effects one might expect from exogenous estradiol in a male who is otherwise androgen-deprived. We know a fair bit about this from the literature on men who are androgen-deprived as a treatment for prostate cancer and are also taking estradiol. We know, for example, that the estradiol can help block hot flashes and also help preserve bone mineral density. These are both important because severe hot flashes that occur at night can disrupt sleep leading to daytime fatigue. That can become dangerous, increasing the risk of, for example, of a fall or a car accident.

We also know that loss of bone mineral density can lead to increased risk of bone fractures. A broken hip is serious business.

There is some evidence to suggest that the estradiol may reduce the "brain fog" that some men complain of when androgen-deprived. But such a benefit is not well-documented; i.e., it has not been proven in properly controlled studies with an adequate sample size.

Estradiol administered to a castrated male may help elevate libido slightly above the castrate level, but not to the level seen in a eugonadal male. That has been reported for rodents and in one study with humans.

As for the issue of feminizing the face, I know of no evidence that estradiol will accomplish this in any meaningful way. In terms of the skeletal system, males have heavier brow ridges and a more robust jaw structure. Getting off of testosterone and on to estradiol will not change that.

Facial hair is one of the strongest visual features that distinguish males from females in our species. Testosterone leads to facial hair growth and once that growth begins at puberty, getting off testosterone neither stops nor reverses that growth. The majority of female-to-male transsexuals who go on testosterone grow beards and/or mustaches to emphasize their masculinity. Conversely, male-to-female transsexuals have to live with the fact that facial hair will not simply go away by getting off the testosterone and onto estradiol. Many MtFs spent a fair bit of money on laser depilation to remove even a minimal moustache that might visually “mark” them as male.

There are risks involved in taking any hormones. Estrogens, such as estradiol, can increase the risk of blood clots, particularly if those estrogens are taken orally. The safest way of taking an estrogen is probably through the skin using estradiol patches or gel products.

Of the various estrogens, the one that is natural and most common for our species is estradiol. There are cheaper synthetic estrogens, such as diethylstilbestrol (DES), which is still used around the world simply because it is a cheap estrogen. However, it is an oral estrogen and has been associated with a fairly high incidence of blood clots. If one can afford it, one should avoid taking DES.

Richard Wassersug, PhD

Lead author on the 2018 book Androgen Deprivation Therapy

May 1, 2019

[GordonGG (imported)]

I have to add that taking oral E and letting it dissolve under the tongue or between the gum and cheek is much safer than just swallowing them. Your system actually gets more out of it also

[Chesleyt (imported)]

I was just reading that taking the pills has a higher chance of blood clots the patches are better for you and they are bio identical to human hormones and you absorb all of it through your skin Wich releases it in a more normal way like your body would do.

[Varys2013 (imported)]

Thanks so much for this! The timing couldn't be better in my case. I just had an orchiectomy for multiple reasons, but primarily for fending off an all-too-likely recurrence of my G9 5+4 Stage 3 very high risk prostate cancer. I have been intending estradiol for all the reasons stated here. This is just a terrific summary, much appreciated! I'll be using it with my GP at my next appointment (which will involve a bit of a surprise for him!).

[JesusA (imported)]

I have to add that taking oral E and letting it dissolve under the tongue or between the gum and cheek is much safer than just swallowing them. Your system actually gets more out of it also

Estradiol is much safer if absorbed through the skin and into the blood. The danger is greatly increased by running it through the liver (from ingestion).

[AnneK_TG (imported)]

I have to add that taking oral E and letting it dissolve under the tongue or between the gum and cheek is much safer than just swallowing them. Your system actually gets more out of it also

I do that too.

As for the issue of feminizing the face, I know of no evidence that estradiol will accomplish this in any meaningful way. In terms of the skeletal system, males have heavier brow ridges and a more robust jaw structure. Getting off of testosterone and on to estradiol will not change that.

My understanding is that as you lose & gain fat, it will wind up in more "feminine" locations, though surgery may still be required due to the bone structure.