Estrogen preparations

A synthetic form of the female hormone estrogen can lower testosterone levels to the castrate range by blocking the release of luteinizing hormone from the pituitary gland, thereby shutting down the production of testosterone. Daily doses of synthetic estrogen (Premarin) are as effective as surgical castration, though the hormone takes longer to work; testosterone levels fall over a two-week period.

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The most significant side effect of synthetic estrogen is an increased risk of cardiovascular complications. These include heart attack, stroke, blood clots in the lungs or legs, phlebitis (inflammation of the veins) and edema (swelling of the legs). Because of these risks, people with a history of heart disease or thrombophlebitis (vein inflammation due to a blood clot) should not use estrogen therapy. In other people, these side effects can be minimized by using low doses of estrogen. In addition, taking an aspirin every other day helps to lower the risk of heart attach and blood clots; edema can be treated with diuretics (drugs that promote water loss through urine). Estrogen can also cause nausea and vomiting. And, like surgical castration, estrogen can cause breast enlargement and erectile dysfunction.

With the approval of LH-RH analogs, estrogens are no longer widely used. However, there is renewed interest in diethylstilbestrol (DES), a form of estrogen used in the 1960s for advanced prostate cancer. In addition, researchers are investigating the potential of an estrogen patch to lower testosterone levels without the side effects associated with other types of hormone therapy.