My husband is starting the journey of ADT. We read you need to address breast enlargement before it occurs because it is irreversible. His MO began to order estrogen patches but then researched and ordered tamoxifen. His MO has been great knowing the most current approaches so we were surprised he had to research this. Now we are wondering perhaps gynecomastia isn’t that much of an issue? Your comments, please?
( this is a wonderful site and easy to search and use...but my search didn’t exactly answer our question)
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I’ve been on Zytiga Lupron and prednisone for two years and six months. I definitely have boobs. Does it bother me? Not one bit .....I’m alive that’s all that matters
Having the breast radiated is a simple procedure and I would do that. It will not always avoid boobs but it helps. You can also get surgery but I am not sure where to get that done and what side effects can result from this. Finally, you can take 10 mg Tamoxifen pills against breast enlargement. This usually works but some patients do not like to take these pills because they are afraid these may cause side effects.
Tamoxifen helps slowing down the process of gynecomastia. Once there is significant Gynecomastia has occurred ...the only treatments which work are what was suggested by GP24.
Did he mention do nothing. This may be a "What, me worry?" situation. I've seen muscle men with bigger boobs than me. Radiation or surgery makes me cringe. I have many friends who haven't had ADT who have nice little boobies. If I get to a double D I'll join the circus.
The use of an estrogen patch can be beneficial for bone density loss. Search this forum for more info: "estradiol" or "estrogen patch". It is a trade off, because the patch will increase the likelihood of gynecomastia.
I would take the patch, but my MO will not prescribe it for me.
I am more worried about bone density loss through prolonged ADT than the oddity of enlarged breasts. You will likely be on bone-strengthening drugs fairly quickly, so they do have something for that. It is not that you have to take the patch, but I would still take it if I had the choice.
As someone wrote a while back, most American men over 65 have some degree of 'enlarged' breasts due to age, overweight and poor physical conditioning (and other factors, of course). In other words, no big deal - just join the club.
Keep lean and mean. After two years on ADT, I don't have any breast swelling.
I guess our bodies react differently. One never knows.
I've been on Estrogen patches 3.5 years and has been fantastic PSA unmeasurable at <.008, slight gynecomastia but nothing I can't live with.
Considered Tamoxifen but research some says for breast cancer;Tamoxifen attaches to the hormone receptors in the cancer cell, blocking estrogen from attaching to the receptors. This slows or stops the growth of the tumor by preventing the cancer cells from getting the hormones they need to grow.
On that basis unsure if it would compromise the benefits of estradiol on the prostate cancer?
Tamoxifen is an estrogen antagonist in peripheral tissues (like breasts), but an estrogen agonist in other tissues (like bones, where it helps increase bone mineral density). It may have a small anti-prostate cancer activity in its own right. If your estrogen patches are just low dose in addition to Lupron, Zytiga and/or anti-androgens to counter side effects like hot flashes and lean body mass and bone loss, there is no problem. But if you are using estrogen as your sole source of prostate cancer control, I can't guarantee that it won't counteract the estrogen in all your metastasrs. There are no clinical studies.
I asked my oncologist about Tamoxifen at my last visit. Unfortunately he is not recommending it to me as it comes with a risk of blood clots. He did give me a referral to a radiologist. He said radiation can reduce size, but more likely will just prevent further growth. He also told me that radiation might leave some unfortunate marks on the skin where the radiation occurred - maybe a circle around the man boob? Oh my word. Maybe someday I’ll post a before/after pic. Thanks for all your guidance on this site. ✌🏻
Radiation is just not as effective as tamoxifen. Perhaps email him the following link and ask him what is the evidence he has seen for increased blood clots at these doses in men on ADT?
What this meta-analysis says is:
"Tolerability of tamoxifen
Two studies (Fradet 2007 and Saltzstein 2005) reported data on discontinuation due to adverse events. However, only Saltzstein et al. specified the adverse events that led to discontinuation (gynecomastia: two; breast pain: five; moderate rise of liver enzymes: one). [13] There were no significant differences between tamoxifen 20 mg daily and placebo (RR 0.92, 95% CI 0.38 to 2.23, Additional file 1, Table S2) or between tamoxifen 20 mg daily and anastrozole 1 mg daily with regard to discontinuations (RR 0.86, 95% CI 0.29 to 2.55, Additional file 1, Table S3). This was, however, probably due to low numbers of discontinuations."
I take 10 mg Tamoxifen (along w/ my hormonal therapy drug, bicalutamide) and have experienced no side effects after a few months. I have gained a bit of weight, breasts included, but attribute that to current lifestyle more than the drugs.
The drug is considered safe for most men. I believe there is a very slight risk for liver toxicity, which would show up in lab work early on.
Be aware, the estrogen patches would address some other more serious side effect of ADT (bone loss, metabolic changes, etc.) , so perhaps consider both?
As Tall_Allen said: It's an issue if he thinks it's an issue.
For me, after 20 months of ADT, so far it's not an issue. I've always been very skinny while wishing I was more muscular (think old Charles Atlas advertisement), The ADT effect that I do consider to be an issue is the decrease of muscle and increase of fat (almost all if which is a spare tire and protruding belly). Most of us have this complaint. I have some minor gynecomastia, but I like to imagine that it looks like pectoral muscles.
I have this also with five years of adt. It’s really the least of my concerns.. Alittle discomfort of having a gel pac like coating over my pecs and even a bit into the the jar section. I don’t believe that this causes anything else to happen so we just live it . Part of the cost of being above board. It took me about four years to really develop a little Virtue man titties ... Personally I don’t want any pharma to further mess up my organs with extended use . Now you’ve mentioned dementia above. That’s more of a chore to conquer. Best of luck in helping that problem . Ive just had a long time friend stroked out at 67 and doesn’t know who anyone is. Anymore. That’s difficult for the children . Peace ✌️
I've been on ADT for over 6 1/2 years. When I added Xtandi around 3 years ago, I very slowly developed a little bit of "man boobs". It's only a minor issue with me. My ADT belly fat is more of an objective appearance thing, in comparison. Lots of men in the USA who are my age and have never been on ADT have larger breasts due to just plain chest fat. On a day-to-day basis, I did find that I look just fine wearing nice, looser fitting shirts, and T-shirts that are less tight, and are of darker colors which look more slimming.
On a more playful note, the other day my spouse came up behind me and wrapped her arms around me for a nice warm hug. I told her that was really nice, ... then winked and told her, "Congratulations. You just got to Second Base!" Ha. Ha. Ha. Ha.
Hi CW ... sure sporting a new pair of giant manboobs is a life change ... I’ve got a set of doozies myself. Letting yourself get a giant roll of adt hard belly fat kinda hides them a lot ... and it might be a bonus if your bra size fits him too. Just “ hand me down “ your older or stretched out bras for mutual benefit.
The big bonus is that getting a sporting new set of manboobs at our age, means we’ll never have to worry about them falling down to our waist later on. How kewl is that ?
I’m making light of manboobs to illustrate that considering all the nasty QOL sucking changes that stage 4 PCa brings, man boobs are way down on the list and nothing much to worry about in the scheme of things . Its kewl ... no biggie !
Your husband, with advanced prostate cancer, CANNOT BE CURED, as of today. Any and all treatments that he will undertake from now to the end of his life, are going to have side effects, some minor, some major. Great enlargement is a minor issue in my view, and one MUST forget about spending all of ones time in attempting to battle this cosmetic side effect and many others of the same kind.
Focus on living with his cancer, not trying to make like it does not exist, or spend any time in trying to undo time.
Instead, focus on living with his cancer, make up a bucket list and start to live large, ie doing what you love, and spend time with those who you love and love you.
Hey Billy Boy - don’t be so certain about there never being a possible cure ! Science is a constant process of learning. Even a phone today is like something unimaginable from the Jetson’s cartoon of the 1970’s, landing a rover on Mars, people to the moon and back essentially before real computers, and now lu-177 delivering targeted radiation to Sources of PC; immunotherapy training your T-cells to seek and destroy your PC. It’s completely amazing science - if there is a barrier to a cure it’s the current economic engine of the cancer industry. Don’t doubt the potential for science, if there is doubt to be cast - it’s probably a human problem of perspective
The point I was attempting to make was for men and their families to NOT worry about incidentals in their treatment etc. and this ranks at the bottom of the list of important issues. IE, we have a deadly disease, whose only effective treatments are going to have both minor and major side effects. To spend one's last days in attempting to deal with great enlargement is a terrible waste of energy, money and most importantly, TIME, which is what we are trying to get more of!!!-to do important things in life, not worry about one's appearance.
In going on the first experimental treatment many years ago, some men quit the trial early because of side effects-which were MINOR. ALL of these men died long before their time because they were worried about how they would look, could not get erections etc. Enough said.
One other point, do NOT take any more medications or other drugs of any kind in attempting to deal with these side effects, other than for pain. The more stress that you put on the body, the harder it will be to fight the war, and that is the primary purpose of those of us who embark upon the treatments that we do. Give us more time to enjoy life!!!!
I never have had that side effect. I have lost about 25 pounds after beginning a plant-based diet, but I only began that 7/2019, 8 months after starting Lupron. I also do some moderate chest muscle exercise. I never had pain at all.
Everyone that has answered your post has offered your hubby some great advice.
I have been using estradiol gel (transdermal estradiol...tE2) as my only form of ADT for nearly two and a half years now and I am thrilled with the results in spite of the cute new boobies. My gel regimen is basically the same as the 'Patch'; however less costly, no skin irritation, is invisible, and never falls off while swimming or bathing. Transdermal estradiol also has very few side effects compared to other forms of ADT such as the GnRH analogue Lupron. I am experiencing NO side effects other than the gynecomastia which I view as no big deal, especially for an older guy. I have no hot flashes/flushes, no fatigue, no muscle mass loss, no cognitive impairment (at least that I'm aware of), and my bone density has actually increased since I started this regimen. Some people are concerned about the increased CV risks while on estrogens; however, because the transdermal route bypasses the liver, it is far less likely to cause problems than the old oral synthetic estrogen DES. I also haven't been to a doctor for three years. You can check out some of my posts/pics for additional information if you are interested.
I highly encourage your husband to give this therapy a try before subjecting himself to some of the nasty, expensive, first line dugs that most doctors prescribe. Just my story and I'm sticking to it!
The muscle wasting from the ADT is a farbigger issue to his health, but also cosmetically. The stronger he is the less it will bother him. 10 mg tamoxifen helps, but if he doesn’t lift weights there will be much more serious problems to contend with.
On ADT now for 4 years, man boobs are a given, no tenderness for me. Loss of muscle mass was another issue, has taken a long time to regain most of the muscles as my Mets prevent me from heavy lifting. But time and patience has prevailed. Not as strong as I was but not bad. Keep fighting the monster there warrior 🙏🙏🙏
I have been on ADT 4.5 years...no boobs.....I keep my weight down and lift weights...I have always lifted so I must assume that was the key...My OC said do not worry about it because of my routine......
Well?.........maybe an issue for the man who has it. It IS an issue in this forum and too often MOs are dismissive of the impact of their treatments on those they treat and their families. I say this as both a patient and a physician who has been outspoken to his doctors about how cavalier they are with things like muscle loss, bone loss, gynecomastia, arteriosclerosis, and leaps in cholesterol. Indo not get it. I do not respect it.
Since he is just starting this treatment and does not yet have established gynecomastia there is something else he can do. Go to his radiation oncologist ( or get a referral to one) for radiation treatment of the breast glandular tissue. This does not require much radiation, often just 2 or 3 treatments which are painless. They may be able to use electron beam mode instead of deeper penetrating x-rays since it is right beneath the skin. I had this done as a preventative. I did have a tiny bit of breast bud swelling present so this was technically a diagnosis of gynecomastia and declaring some “tenderness “ to be present made it a therapeutic treatment and not cosmetic so Medicare/ insurance covered it all.
When I later went on estradiol patches for my ADT there was very little breast swelling or tenderness and 10 mg of tamoxifen took care of that. BTW the estradiol is highly recommended whether by itself or supplemental to the usual ADT.
Wear with pride and move on.
GD
While some here just shrug it off I consider gynecomastia an embarrassment. Best to take measures to avoid the problem. Your husband is lucky to have a urologist who is offering prevention. My urologist could have cared less whether I developed this problem or not. He was busy treating the disease and not the person.
He is under care of MO not urologist and had to raise this issue based on research . His dr then studied and wrote the Rx but my husband is debating it due to effects on heart. This site and all of you are so helpful !
I'm the king of man boobs..... I've got big boobies and they hurt.....Don't go to the beach but they let me in ladies shower in the YWCA.... Biggest set in the bunch.....Women soooo envious....BOUNCE THOSE BOOBIES....
I am obviously not the norm here, but my breasts grew when I started casodex and then shrank again. I didn't mind at the time, I actually thought it was pretty funny. The accompanying pain sucked however. My teenage daughter had no sympathy.
Probably, sore and tender breasts. It hurt to run or bound up or down the stairs, but I got used to it. My daughter strongly suggested a sports bra. The pain went away immediately when we added Lupron, so it was a monotherapy issue, specifically casodex. I was on just Lupron for two years and had no breast growth or pain, and I started casodex after a 1 year ADT vacation.
Four years ago, when moving to Florida from Arizona, my urologist stopped Casodex entirely and just went with Lupron. I had been on Casodex with Eligard since 2012 when I was diagnosed. As you know Eligard is a twin of Lupron. I never missed the Casodex .
I doubt I will keep on it much longer. After my vacation my doctor wanted me to restart Lupron, but I was in school and I knew what lupron does to my brain. I asked her if we could start with something less life-interfering and she gave me casodex. It worked, my psa went down for almost a year, then we added Lupron back. My cancer has been responding well overall so I might be taking another vacation soon. We are all on Eligard right now and that shot really hurts compared to Lupron.
A percentage of men do grow larger boobs without doubt. Obviously, for some it is not an issue, but others it is. Radiation at the start of ADT is a good option. Some men get sore nipples I believe which may be a greater issue. You certainly have my sympathy.
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