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Hormones re prostate and breast cancer

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User
Posted 18 Nov 2023 at 21:01

Hi  it seems to me that testosterone needs to be moderated by anti testosterone agents ie estrogen ( preferably plant estrogens - phytoestrogens such as wild yam ) soya products  or inositol to name a few 

Similarly  breast cancer needs to be moderated by anti estrogen agents such as  lithium orotate melatonin , testosterone or DHEA can be used provided you don't have the enzyme aromatose that converts DHEA into estrogen 

It seemed odd to me that testosterone can cause prostate cancer in older men when.testosterone levels are declining I am now wondering if it's testosterone moderaters that are in short supply

Sorry if I havent explained this very well or provided scientific proof 

It was Jane Maclelland that got me thinking when she said arginine feeds prostate cancer - I took a deep dive into this and to me this isnt true because arginine creates nitric oxide which is an anti androgen - prostate cancer needs testosterone blockers also this  is what brings psa down 

My husband has prostate cancer 

Any thoughts ?

Edited by member 22 Mar 2024 at 12:26  | Reason: Add more info

User
Posted 18 Nov 2023 at 23:18

The original work was by Huggins and Hodges in 1941 which showed that Testosterone drove prostate cancer. Given that castration stopped the cancer (for a while anyway), it was assumed that the higher the level of Testosterone, the more likely and faster the cancer would grow. However, there was no research showing this.

Abraham Morgentaler and others looked at this again in the last 10 years, and instead formed the saturation theory. That is that once your Testosterone reaches the lower normal limit, extra Testosterone doesn't increase the risk of prostate cancer. Thus the lower normal Testosterone level is a saturation level, above which no extra risk or growth of the cancer occurs. It's still recognised that castration levels of Testosterone prevent the growth of prostate cancer, which is the principle of hormone therapy treatment. However, some data suggests that low levels of Testosterone but not as low as castrate levels might actually increase the risk of prostate cancer.

GIven that low Testosterone might be a risk factor for prostate cancer, and low Testosterone is certainly a significant risk factor for cardiovascular disease and diabetes/metabolic disease, it's probably not something men should strive to achieve.

After many years of refusing men any access to Testosterone Replacement Therapy (TRT) who have low Testosterone after successful curative treatment for prostate cancer out of fear of recurrence, research showed that TRT doesn't increase the risk of recurrence. This also fits with Morgentaler's suggestions.

So it's not obvious to me that Testosterone needs any moderation, other than for men on hormone therapy.

User
Posted 23 Nov 2023 at 15:01

Diethylstilbestrol is not good for long term use (a significant portion of the men on it died from its side effects), but taking estrogens via skin absorption rather than orally doesn't have these side effects, hence the PATCH trial which used Estradiol skin patches to deliver an estrogen. The catch is that outside of the trial, the Estradiol patches probably aren't approved for ADT. It also needs more monitoring of the Estradiol and Testosterone levels in the blood, as the trial showed skin patches turn out not to deliver very consistent doses, and the number of patches needs to be adjusted from time-to-time.

However, I haven't really understood what Lizzo's concerns are beyond doubting ADT generally.

User
Posted 18 Nov 2023 at 21:01

Hi  it seems to me that testosterone needs to be moderated by anti testosterone agents ie estrogen ( preferably plant estrogens - phytoestrogens such as wild yam ) soya products  or inositol to name a few 

Similarly  breast cancer needs to be moderated by anti estrogen agents such as  lithium orotate melatonin , testosterone or DHEA can be used provided you don't have the enzyme aromatose that converts DHEA into estrogen 

It seemed odd to me that testosterone can cause prostate cancer in older men when.testosterone levels are declining I am now wondering if it's testosterone moderaters that are in short supply

Sorry if I havent explained this very well or provided scientific proof 

It was Jane Maclelland that got me thinking when she said arginine feeds prostate cancer - I took a deep dive into this and to me this isnt true because arginine creates nitric oxide which is an anti androgen - prostate cancer needs testosterone blockers also this  is what brings psa down 

My husband has prostate cancer 

Any thoughts ?

Edited by member 22 Mar 2024 at 12:26  | Reason: Add more info

User
Posted 19 Nov 2023 at 08:19

One thing is obvious and that is that older men get prostate cancer - so age  is undoubtedly a factor and testosterone decreases with age

It's similar with breast cancer - it's post menopausal women that get breast cancer the most - estrogen is seen as the cause yet estrogen is waning after menopause. Louise Newson points out that estrogen is needed for the immune system to fight off cancer is that why post menopausal women get breast cancer - because they have hardly any estrogen to fight it off ?

I mentioned in my post how men and women need both sex hormones - women need some testosterone men need some estrogen to modify , counter moderate their main sex hormone and I am interested in this area - of  opposite sex hormone dwindling with age and the deficiency  playing a part in these cancers

My husbands psa has gone up recently after having RP in October 2018 he was advised to have ADT  but I don't think he could handle it bc he leads a very sedentary lifestyle he sits on the sofa in front of the tv all day he is 75 a young 75 he doesn't look it,  the hormone injections he was given  are in the garage, I do think he needs some female hormone though - so I am going to give him some wild yam which I have its a phytoestrogen I use to keep arthritis at bay   I already gave him some aguaje ( a phytoestrogen from Peru) a few weeks ago I went out shopping and when I came back he burst into tears he put weight on his stomach as well, the thing is with an injection you can't retract it and I am fearful of the impact on him. 

 

Edited by member 20 Nov 2023 at 10:03  | Reason: Spelling mistake

User
Posted 19 Nov 2023 at 13:00

Many drugs and therapies are derived from plants and herbs. Chemo drugs ending in *taxol are derived from yew trees, aspirin from willow trees etc. However I don't think you will gain much by repeating the research, large drug companies have done, just using your husband as a guinea pig. The drug companies fortunately have access to many guinea pigs and have probably came up with better treatments than you will be able to discover in your kitchen, yourself.

Occasionally people do make useful medical discoveries in the kitchen, Lorenzo's Oil being a notable example. Also the discovery that Helicobacter Pylori is the cause of stomach ulcers, not stress, was outside of the main stream. A man called Wim Hof is currently jumping into buckets of ice, but the jury is still out on whether he has discovered anything to cure, which is so bad it is worse than his proposed treatment.

For cancer I would suggest taking the standard treatment offered by the standard medics. However if the quality of life is so disrupted by the treatment, accept that a trade off has to be made between quality and quantity of life and make an informed decision based on the knowledge currently available from proven medical practices. 

If your husband decides he is going to refuse standard treatment and die earlier than he needs to, then go ahead and experiment with foods to extend life or improve its quality. Don't make the decision on refusing standard treatment and consequently dieing earlier on the assumption that anything cooked up in the kitchen will prolong life.

Dave

User
Posted 19 Nov 2023 at 15:30

Originally Posted by: Online Community Member
One thing is obvious and that is that older men get prostate cancer - so age is undoubtedly a factor and testosterone decreases with age

Obviously you are quite interested in the topic and have been doing some reading but I think your statement above is wrong. Age is a factor in being diagnosed rather than a causative factor - most men diagnosed with PCA will have had it since their late 30s or 40s, even if they are not diagnosed until their 70s. A large scale EU research project found that 50% of men in their 50s have some cancer in their prostate although most don't know and will never have treatment for it.   

 

Your husband isn't forced to have the treatment his onco has recommended but I hope he understands that your holistic / alternative therapies will probably reduce his lifespan. At what point will you & he decide that proper treatment is needed - have you discussed that? Would it be at an agreed threshold (e.g. when the PSA gets to 5, 10, or 20) or when the doubling time decreases to below 6 months or similar? Has there been any scan done to see where his recurrence is?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Nov 2023 at 21:39
It is possible - some men will need total testosterone blockage via injections but if they don't need something that strong, they can have bicalutimide tablets instead. My husband didn't need injections - your OH's onco believes that he does.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Nov 2023 at 08:16

Lizxi37, we don't know much about your husband's stats and timeline. I had salvage RT back in 2017 ,three years after surgery. SRT to the prostate bed was based on a "very educated guess and years of data". PSMA scans were not widely used then and I was refused a PSMA scan. There was obviously something in the prostate bed because the PSA went down but it was also outside the bed because the PSA started to rise again. I didn't have any HT so the PSA was not being suppressed.

I was on a trial that included numerous CT and bone scans ,none of scans those picked up anything ,six months later a PSMA scan did. Last years first PSMA scan picked up a lymph node tumor but didn't show a second tumor that was picked up 6 months later. We know from guys on here that a PSMA scan may pick up something at 0.023 or nothing at 200.

Which is better a scan that shows something or a scan that shows nothing. 

Hope you find the right solution for you.

Thanks Chris 

 

Edited by member 21 Nov 2023 at 14:35  | Reason: Auto correct

User
Posted 21 Nov 2023 at 08:33

Originally Posted by: Online Community Member

Yes but why cant the ADT be not so strong ?  I doubt there are any tests to see if lower doses of ADT work just as well

ADT is a saturation treatment, originally aimed at completely turning off Testosterone produced by the Testicles.

There were trials which show even stronger ADT works better, and hence this is now becoming standard practice. Very small amounts of Testosterone are produced in other ways which continue and are not impacted by the injections, and the cancer evolves to use those very small amounts. Turning them off too extends survival, so this suggests that only lowering but not turning off Testosterone would work less well and for a shorter time.

Edited by member 21 Nov 2023 at 08:34  | Reason: Not specified

User
Posted 22 Nov 2023 at 21:47

Originally Posted by: Online Community Member
Lizzo, while we think of testosterone and estrogen as being opposites (male and female) they don't work against each other at the level of cancers. Female hormones don't block prostate cancer, male hormones don't block breast cancer. It is absence or blocking (the way different drugs work) of testosterone which stops prostate cancer cells dividing; having estrogen as well will no doubt affect someone's mood but not the progress of their cancer.

Actually, Testosterone and Estrogen do work against each other, although not at the cancer, but at the Hypothalamus and Pituitary glands, where they both trigger the receptors which are monitoring the Testosterone level in men, and the Estrogen level in women. So if you take a normal man and introduce extra estrogens, the Hypothalamus and Pituitary glands will pick this up thinking he's got too much Testosterone, and tell the Testicles to produce less, so his Testosterone level drops. That's how the original hormone therapy drug Diethylstilbestrol works, which is a synthetic estrogen (and also how Estradiol works in the current PATCH trial).

User
Posted 23 Nov 2023 at 01:10
I was thinking this last night - if Lizzo is concerned about the HT that her OH has been prescribed, she could encourage him to ask for Stilboestrol instead. It may be a bit old-fashioned now but is still an approved treatment for PCa and we have had members here who did remarkably well on it - for example, Devonmaid's husband who lived for 10 years.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Nov 2023 at 19:41

My main concern is that  my husband Geoff couldn't cope with the ADT injections which  he was presribed and that I have since put in the garage 

I thought this ADT treatment was female hormones but after examining it the other day I see  it is rather a treatment to block testosterone at source 

To me this is dangerous meddling with the endocrine system 

So as I said before I will give him plant estrogens - phytoestrogens the best being Peruvian  Aguaje which is becoming very popular and hard to get hold of but luckily my nephew married a Peruvian so I am able to source genuine Peruvian aguaje  I take it bc it stop arthritis - I am female my arthritis is caused by lack of estrogen which I get from aguaje but I also add in DHEA and this is the secret - adding in your opposite sex hormone 

I was reading a post from a guy on Healthunlocked who gets  treated with estrogen patches from a hospital in Germany to control his prostate cancer this bypasses the liver  which is good but phytoestrogens are even better imo bc they latch on to estrogen receptors- which men have - so yes surely its better to fight / counter / moderate  testosterone with phytoestrogens  and the same with breast cancer - try to prevent it with androgens 

https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-6457-8

 

Edited by member 11 Jan 2024 at 22:18  | Reason: Not specified

User
Posted 23 Nov 2023 at 20:07

Is Geoff fully aware of what you are doing?

Dave

User
Posted 23 Nov 2023 at 22:20
I suspect that Lizzo is a troll
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 18 Nov 2023 at 23:18

The original work was by Huggins and Hodges in 1941 which showed that Testosterone drove prostate cancer. Given that castration stopped the cancer (for a while anyway), it was assumed that the higher the level of Testosterone, the more likely and faster the cancer would grow. However, there was no research showing this.

Abraham Morgentaler and others looked at this again in the last 10 years, and instead formed the saturation theory. That is that once your Testosterone reaches the lower normal limit, extra Testosterone doesn't increase the risk of prostate cancer. Thus the lower normal Testosterone level is a saturation level, above which no extra risk or growth of the cancer occurs. It's still recognised that castration levels of Testosterone prevent the growth of prostate cancer, which is the principle of hormone therapy treatment. However, some data suggests that low levels of Testosterone but not as low as castrate levels might actually increase the risk of prostate cancer.

GIven that low Testosterone might be a risk factor for prostate cancer, and low Testosterone is certainly a significant risk factor for cardiovascular disease and diabetes/metabolic disease, it's probably not something men should strive to achieve.

After many years of refusing men any access to Testosterone Replacement Therapy (TRT) who have low Testosterone after successful curative treatment for prostate cancer out of fear of recurrence, research showed that TRT doesn't increase the risk of recurrence. This also fits with Morgentaler's suggestions.

So it's not obvious to me that Testosterone needs any moderation, other than for men on hormone therapy.

User
Posted 19 Nov 2023 at 08:19

One thing is obvious and that is that older men get prostate cancer - so age  is undoubtedly a factor and testosterone decreases with age

It's similar with breast cancer - it's post menopausal women that get breast cancer the most - estrogen is seen as the cause yet estrogen is waning after menopause. Louise Newson points out that estrogen is needed for the immune system to fight off cancer is that why post menopausal women get breast cancer - because they have hardly any estrogen to fight it off ?

I mentioned in my post how men and women need both sex hormones - women need some testosterone men need some estrogen to modify , counter moderate their main sex hormone and I am interested in this area - of  opposite sex hormone dwindling with age and the deficiency  playing a part in these cancers

My husbands psa has gone up recently after having RP in October 2018 he was advised to have ADT  but I don't think he could handle it bc he leads a very sedentary lifestyle he sits on the sofa in front of the tv all day he is 75 a young 75 he doesn't look it,  the hormone injections he was given  are in the garage, I do think he needs some female hormone though - so I am going to give him some wild yam which I have its a phytoestrogen I use to keep arthritis at bay   I already gave him some aguaje ( a phytoestrogen from Peru) a few weeks ago I went out shopping and when I came back he burst into tears he put weight on his stomach as well, the thing is with an injection you can't retract it and I am fearful of the impact on him. 

 

Edited by member 20 Nov 2023 at 10:03  | Reason: Spelling mistake

User
Posted 19 Nov 2023 at 13:00

Many drugs and therapies are derived from plants and herbs. Chemo drugs ending in *taxol are derived from yew trees, aspirin from willow trees etc. However I don't think you will gain much by repeating the research, large drug companies have done, just using your husband as a guinea pig. The drug companies fortunately have access to many guinea pigs and have probably came up with better treatments than you will be able to discover in your kitchen, yourself.

Occasionally people do make useful medical discoveries in the kitchen, Lorenzo's Oil being a notable example. Also the discovery that Helicobacter Pylori is the cause of stomach ulcers, not stress, was outside of the main stream. A man called Wim Hof is currently jumping into buckets of ice, but the jury is still out on whether he has discovered anything to cure, which is so bad it is worse than his proposed treatment.

For cancer I would suggest taking the standard treatment offered by the standard medics. However if the quality of life is so disrupted by the treatment, accept that a trade off has to be made between quality and quantity of life and make an informed decision based on the knowledge currently available from proven medical practices. 

If your husband decides he is going to refuse standard treatment and die earlier than he needs to, then go ahead and experiment with foods to extend life or improve its quality. Don't make the decision on refusing standard treatment and consequently dieing earlier on the assumption that anything cooked up in the kitchen will prolong life.

Dave

User
Posted 19 Nov 2023 at 15:30

Originally Posted by: Online Community Member
One thing is obvious and that is that older men get prostate cancer - so age is undoubtedly a factor and testosterone decreases with age

Obviously you are quite interested in the topic and have been doing some reading but I think your statement above is wrong. Age is a factor in being diagnosed rather than a causative factor - most men diagnosed with PCA will have had it since their late 30s or 40s, even if they are not diagnosed until their 70s. A large scale EU research project found that 50% of men in their 50s have some cancer in their prostate although most don't know and will never have treatment for it.   

 

Your husband isn't forced to have the treatment his onco has recommended but I hope he understands that your holistic / alternative therapies will probably reduce his lifespan. At what point will you & he decide that proper treatment is needed - have you discussed that? Would it be at an agreed threshold (e.g. when the PSA gets to 5, 10, or 20) or when the doubling time decreases to below 6 months or similar? Has there been any scan done to see where his recurrence is?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Nov 2023 at 19:41

Originally Posted by: Online Community Member
My husbands psa has gone up recently after having RP in October 2018 he was advised to have ADT but I don't think he could handle it

Was he offered the option of any follow up treatment with radiotherapy?

Jules

User
Posted 19 Nov 2023 at 21:00

Yes the ADT was part of the package which included radiotherapy 

 

User
Posted 20 Nov 2023 at 18:37

 low testosterone being a risk factor for prostate cancer may well involve low estrogen  too ?

Just as low estrogen in post menopausal women may be a risk factor for breast cancer because of the probable  accompanying low testosterone 

User
Posted 20 Nov 2023 at 18:43

Yes but why cant the ADT be not so strong ?  I doubt there are any tests to see if lower doses of ADT work just as well

User
Posted 20 Nov 2023 at 21:39
It is possible - some men will need total testosterone blockage via injections but if they don't need something that strong, they can have bicalutimide tablets instead. My husband didn't need injections - your OH's onco believes that he does.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Nov 2023 at 22:23

Hi Lynn

My husband did have a scan but nothing was found the Dr wanted to radiate his pelvic bed anyway he said if my husband  didn't have the radiation he wouldn't continue with scans

 

User
Posted 21 Nov 2023 at 08:16

Lizxi37, we don't know much about your husband's stats and timeline. I had salvage RT back in 2017 ,three years after surgery. SRT to the prostate bed was based on a "very educated guess and years of data". PSMA scans were not widely used then and I was refused a PSMA scan. There was obviously something in the prostate bed because the PSA went down but it was also outside the bed because the PSA started to rise again. I didn't have any HT so the PSA was not being suppressed.

I was on a trial that included numerous CT and bone scans ,none of scans those picked up anything ,six months later a PSMA scan did. Last years first PSMA scan picked up a lymph node tumor but didn't show a second tumor that was picked up 6 months later. We know from guys on here that a PSMA scan may pick up something at 0.023 or nothing at 200.

Which is better a scan that shows something or a scan that shows nothing. 

Hope you find the right solution for you.

Thanks Chris 

 

Edited by member 21 Nov 2023 at 14:35  | Reason: Auto correct

User
Posted 21 Nov 2023 at 08:33

Originally Posted by: Online Community Member

Yes but why cant the ADT be not so strong ?  I doubt there are any tests to see if lower doses of ADT work just as well

ADT is a saturation treatment, originally aimed at completely turning off Testosterone produced by the Testicles.

There were trials which show even stronger ADT works better, and hence this is now becoming standard practice. Very small amounts of Testosterone are produced in other ways which continue and are not impacted by the injections, and the cancer evolves to use those very small amounts. Turning them off too extends survival, so this suggests that only lowering but not turning off Testosterone would work less well and for a shorter time.

Edited by member 21 Nov 2023 at 08:34  | Reason: Not specified

User
Posted 21 Nov 2023 at 11:21

Hi colwick chris  I don't  think my husband Geoff would fare well from radiotherapy on his pelvic bed willy nilly if they find a target of course I  would want them to zap it with radiation 

Geoff was dx with Pc in 2018 gleeson 8 he had da vinci robotic surgery to remove it in Oct 2018 and his psa was undetectable until earlier this year but we had an extremely bad bout of covid the previous November 

Dr at hospital said he had 2 years to live if he didn't have radiotherapy Geoff had ct  scans which were clear except for a nodule in his right lung he was refered to our local hospitals respiratory dept which did a pet scan on the nodule which was deemed non malignant he has had another scan recently on the nodule again they said it was non malignant they even said they would sign him off if the next yearly scan shows same result but I was relying on them for scans the nice respiratory  doctor said he would scan Geoff s pelvic area at his initial pet scan which didn't find anything 

I don't get why you would radiate willy nilly or as an American guy on the Inspire cancer forum  called it Whack a mole 

 

Edited by member 21 Nov 2023 at 11:27  | Reason: Spelling mistake

User
Posted 21 Nov 2023 at 13:22
Why? Because it has been proven to deliver curative results for 60% of people treated.
User
Posted 21 Nov 2023 at 13:26
Because years and years of experience & data analysis has shown that, if a man is undetectable after RP and then the PSA rises slowly over the next 5 years or so, the most likely explanation is some active cells have remained in the prostate bed. If the PSA doesn't drop to undetectable straight after RP, the problem is that either the tumour wasn't all removed or it had already spread elsewhere.

I don't think the NHS can afford to play whack-a-mole - RT is very expensive and they will only offer treatment that has a scientific / clinical justification.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Nov 2023 at 20:06
Lizzo, while we think of testosterone and estrogen as being opposites (male and female) they don't work against each other at the level of cancers. Female hormones don't block prostate cancer, male hormones don't block breast cancer. It is absence or blocking (the way different drugs work) of testosterone which stops prostate cancer cells dividing; having estrogen as well will no doubt affect someone's mood but not the progress of their cancer.

You say nothing was found when your husband had a scan. That was the same with me when my PSA started rising some years after having surgery. The oncologist told me that scans only detect cancer when they have grown big enough - but because after surgery my PSA should have been zero much smaller amounts could be detected. The problem with waiting until there was enough to see on a scan is that by then there may also be small amounts of cancer that have spread further and aren't seen - and won't then get targetted by the radiotherapy. Earlier treatment is likely to be more effective.

My understanding is that there are two reasons oncologists like ADT. One is that it doesn't just stop cancer cells dividing but it shrinks them and makes them more likely to be successfully killed by radiotherapy. The other is that some cells whose division has been stopped for a while die by themselves, so it makes it less likely any cells which have already spread beyond the target area will survive. But the prime way of killing the cancer is radiotherapy. It might be worth your husband asking his doctor if radiotherapy without ADT would have a good chance of success in his particular case if the two of you think he might struggle to tolerate ADT.

User
Posted 22 Nov 2023 at 21:47

Originally Posted by: Online Community Member
Lizzo, while we think of testosterone and estrogen as being opposites (male and female) they don't work against each other at the level of cancers. Female hormones don't block prostate cancer, male hormones don't block breast cancer. It is absence or blocking (the way different drugs work) of testosterone which stops prostate cancer cells dividing; having estrogen as well will no doubt affect someone's mood but not the progress of their cancer.

Actually, Testosterone and Estrogen do work against each other, although not at the cancer, but at the Hypothalamus and Pituitary glands, where they both trigger the receptors which are monitoring the Testosterone level in men, and the Estrogen level in women. So if you take a normal man and introduce extra estrogens, the Hypothalamus and Pituitary glands will pick this up thinking he's got too much Testosterone, and tell the Testicles to produce less, so his Testosterone level drops. That's how the original hormone therapy drug Diethylstilbestrol works, which is a synthetic estrogen (and also how Estradiol works in the current PATCH trial).

User
Posted 23 Nov 2023 at 01:10
I was thinking this last night - if Lizzo is concerned about the HT that her OH has been prescribed, she could encourage him to ask for Stilboestrol instead. It may be a bit old-fashioned now but is still an approved treatment for PCa and we have had members here who did remarkably well on it - for example, Devonmaid's husband who lived for 10 years.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Nov 2023 at 15:01

Diethylstilbestrol is not good for long term use (a significant portion of the men on it died from its side effects), but taking estrogens via skin absorption rather than orally doesn't have these side effects, hence the PATCH trial which used Estradiol skin patches to deliver an estrogen. The catch is that outside of the trial, the Estradiol patches probably aren't approved for ADT. It also needs more monitoring of the Estradiol and Testosterone levels in the blood, as the trial showed skin patches turn out not to deliver very consistent doses, and the number of patches needs to be adjusted from time-to-time.

However, I haven't really understood what Lizzo's concerns are beyond doubting ADT generally.

 
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