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Several years ago, an estrogen-related drug called estramustine phosphate (EMCYT) generated some enthusiasm among doctors in Europe for its ability to diminish testosterone and to kill some cancer cells. (This drug is related to the chemical weapon mustard gas used in World War I.) But more recent studies have shown that, although it uses different mechanisms to achieve its effects, it doesn’t prolong survival any longer than DES. And it can have side effects including nausea.

Therefore, we believe that among oral estrogens, DES is the way to go. It’s relatively inexpensive (far cheaper than some LHRH analogs, for instance) and it accomplishes the same goal as surgery—reducing testosterone to the castrate range.

Now, what’s the right dosage? How much DES do you need to take? This has been a source of great controversy in the medical community. Decades ago, doctors gave high-powered doses of DES—ten to twenty milligrams a day— thinking that this would not only eliminate testosterone, it might also kill cancer cells. This didn’t happen; testosterone was lowered, but that was it. Then, studies by the Veterans Administration showed that lower doses could achieve the same results. But even five milligrams a day proved to be too much. One study found that, over time, men on five milligrams of DES a day died— from heart disease caused by the estrogen, not from prostate cancer! Then doctors tried three milligrams, and then one milligram a day. And one milligram of DES a day proved sufficient to suppress testosterone without endangering the heart. A large study in Europe found that men on one milligram of DES a day showed no signs of irreversible damage to the cardiovascular system.

Other studies have proved that there is no statistical difference between the lifespans of men who were castrated and those who took one milligram of DES a day. (Some doctors argue that it takes three milligrams of DES a day to lower testosterone to the castrate range. This is true. However, if there’s no difference in the length of survival, and the heart-related side effects are fewer with one milligram than with three milligrams, what’s to be gained by taking the higher dose?)

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