Transdermal estrogen therapy improves cholesterol levels and lipid profiles in men with prostate cancer

Abstract

8035 Background: Hypogonadal men have adverse changes in lipids and body composition that are reversed by testosterone replacement. Studies of testostorone replacement co-administered with aromatase inhibitors show that these benefits are in part mediated through conversion of androgens to estrogenic hormones. Lipid and body composition changes may contribute to the long-term morbidity of androgen deprivation therapy for prostate cancer (PC). Oral estrogen therapy for PC is associated with an increased risk of thromboembolic complications, but parenteral administration may be safer. As part of a study of transdermal estrogen (TDE) in androgen-independent PC (AIPC) patients, we sought to determine the impact of such therapy on serum lipids and body composition. Methods: We measured serum cholesterol, triglycerides, LDL, HDL (total, HDL2 and HDL3), VLDL-C, Apolipoprotein-B, and Lp(a) before and 8 weeks after starting TDE therapy (six 7.6 mg patches applied every 7 days) in androgen-deprived men with AIPC. We examined body composition with whole body DEXA and fat distribution with an abdominal MRI at the same time points. Results: Mean ± SD for variable that changed are shown in the table. No significant change was observed for HDL3, triglycerides, VLDL, or Lp(a). MRI data were available for 13 of these men. No change was observed in any of the body composition measures including: % fat, fat mass, lean mass, trunkal fat, intra-abdominal fat, or subcutaneous fat. Conclusions: Androgen deprived men treated with TDE had significant improvements in LDL and HDL levels without raising triglyceride levels. The observed changes are sufficiently large to have the potential to reduce cardiovascular risk. Longer-term observation is necessary to determine if improvements in body composition changes would follow. Controlled studies are needed to determine the impact of TDE therapy on cardiovascular risk. No significant financial relationships to disclose.