Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?

My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alternative, or 3) wish to avoid injections or oral agents. There are some advantages of E2 patches including lower hot flashes, preserved BMD, and lower fracture rate. While CV risks did not differ, QOL and metabolic risks may improve with E2 patches as well, without compromising ADT efficacy, and thus for some men, E2 patches are a reasonable choice. Given the >80% risk of gynecomastia, my preference would be to offer prophylactic breast irradiatio...