When I asked my URO about using 10 mg Tamoxifen for gynecomastia....she said the following: All of the studies I could find on using tamoxifen were in patients on biclutamide. As far as I understand, the GNRH antagonists shouldn't cause the same shift in the estrogen levels which is what causes the gynecomastia. I am hesitant to use the tamoxifen. Anyone have any info to the contrary?
Gynecomastia and ADT?: When I asked my... - Advanced Prostate...
Gynecomastia and ADT?
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I started firmogon almost the same time as yours. I try to left weight about 3 times a week. I am not sure if my chest looks the way it looks because of the weight lifting or a side effect from firmogon, now I am conscious about this. Sorry, couldn’t offer any help. I have also heard that casodex and estrogen patches cause this.
She is correct. ADT shouldn't cause an estrogen imbalance, but some guys develop an estrogen imbalance on ADT. Maybe check your E2 level.
I am more inclined to Nalakrat’s answer. Lupron (and similar drugs) suppress male hormone production and Tamoxifen suppress female hormone production (both to suppress cancer growth in prostate and breast, respectively. When that balance is drastically changed, i.e., chemical or physical castration, we will/may developed gynecomastia. Androgen antagonist like bicalutamide further disrupt this imbalance too.
It varies from individual to individual. Some men never get it, others do. It's rare in men on Lupron, but it does happen. Bicalutamide doesn't suppress testosterone (T) production as Lupron does, and the T is blocked from being utilized by our cells, so serum levels increase. Estrogen is a major metabolite of testosterone, so it is the consequent estrogen build-up that causes gynecomastia. With Lupron, there is no T build-up (after the first few weeks) from the testicles, so there is no metabolized estrogen. But there are non-testicular sources of testosterone and estrogen in men, and some men are susceptible.
Using Firmagon...assume the same is true? Could soy or milk (yogurt) products have any impact? Increased tofu to help with hot flashes. PSA undetectable and T is range of 14-19.
Soy products are known phytoestrogens. Maybe try aural acupuncture for the hot flashes.
Just started using Black Cohosh daily...see if that works. If not will look to acupuncture. My primary suggested we do .1/mg Clonidine patches to reduce blood pressure (154/99 from usual normal) and sleep interruption from flashes. Have held off using then until I see how Cohosh works.
Been doing acupuncture for hot flashes for 6 weeks or so and it seems to be helping some but has not eliminated them by any means. I am going to continue for a while longer.
One .1 mg estradiol patch per week will eliminate hot flashes
I used Estradiol to control hot flashes after a 6 month Trelstar injection. It was very effective in reducing frequency of hot flashes, but I developed gynecomastia after a few months. I’m PSA undetectable for the moment and off all meds. If have to resume ADT someday, I would still try Estradiol but ask for radiation or other drugs to compensate for gynecomastia.
Gynecomastia Pills - hespac.com/gyno.htm ive been taking this product for about a year and not only have i got a more masculine chest, but also alot of excessive body fat.
When on takes bicalutamide without castration (Lupron or similar) there is an increase in testosterone, because testosterone is not being used due to the androgen receptor block caused by bicalutamide. Some of the excess testosterone is metabolized to estrogen leading to an elevation of estradiol which can affect the breast tissue.
onlinelibrary.wiley.com/doi...
When in ADT only (Lupron or similar) there is a decrease in testosterone and an imbalance between normal estrogen levels and low testosterone .
"The adrenal glands produce a small amount of oestrogen in men. Hormonal treatments lower your testosterone and this changes the balance of hormones in your body. When oestrogen becomes higher, compared to the amount of testosterone, breast tissue can develop. Oestrogen stimulates the growth of breast tissue."
Thanks all....will ask we check E2.
I agree with your URO and Tall_Allen. Estradiol has normal functions in men at normal concentrations. If you are on an LHRH drug, your estradiol levels will be suppressed and typically the lack of estrogen is the greater concern as it increases the risk of hot flashes and osteoporosis. There is some data that suggest it may also be somewhat cognitively protective. And it can help preserve a bit of one's sex drive.
I think the reason all the studies were regarding bicalutamide, and not ADT, is that is is FAR more common to have fairly severe breast problems with that drug. Yes, gynecomastia can arise to some degree, for some men on Lupron, maybe 10-20% of them. But the proportion is reversed for bicalutamide, where up to 80-90% have pain, swelling and growth. Because it is a near-universal SE for these men, it makes sense that they are the group studied most.
An alternative is to radiate the breast. This is usually sufficient to avoid gynecomastia when taking Lupron.
I’ve been using estradiol patches in lieu of Lupron for nearly two years. My latest test results ( which are typical of my quarterly tests)were:
Serum testosterone <3
DHEA 7.2
Estradiol 122
Total estrogen 255
PSA <.1
Yes I have gynecomastia but it’s better than pca. I asked my urologist if he thought I should reduce my .1mg patches from 3 to 2 per week and he said if something is working don’t mess with it. Do any of you think I should be concerned about these test results?
Bob
Break 60 I have been on Estradiol patches since Sept 8, 2020 Started with 4 patches twice weekly and within the first month my PSA was 0.03 Testosterone 8 and estradiol 665 We then went to two 0.1 mg estradiol patches twice weekly and the next month PSA 0.03 Testosterone 8 and Estradiol 190 I am wondering about decreasing to 1 Estradiol patch twice weekly.
I also have developed gynecomastia but at 81 it is no big deal to me.
My PSA has dropped from 1.29 on 5/13/2020 to 0.06 on 7/13/2020 due to 50mg Casodex daily 6weeks. The breasts enlarged with this treatment and were sore.
After Casodex my PSA went from 0.06 to 0.40 on 9/08/2020 I then started the Estradiol patches
Lancer
Thanks for the feedback. The dosages I used were based on the PATCH study in the UK. I guess E of 122 isn’t that bad .
My biggest problem now is stress incontinence due to I guess so Much radiation . I’m probably going to have sling surgery early next year.
Bob
Bob that surgery does not sound like fun, but if it helps it would be great. I have to wear a pad all the time and I have noticed since I started the Estradiol patches my incontinence is worse. Any kind of effort Lifting etc results in a squirt. Aggravating for sure but have not asked the URO about it. I still get by with one pad a day which I guess isn't too bad. I don't understand why the incontinence got worse with the higher levels of Estradiol but it sure seems to be . Maybe that is part of your problem as well. I know in castrated dogs, both male and female urinary incontinence can be a problem in the older animals. the older treatment was DES (diethylstilbesterol) and was very effective low dose given intermittently. (I am/was a veterinarian with a private mixed practice 40 years) I am now wondering if it isn't a balance between estradiol and testosterone which influences urinary control. without the bladder sphincter it never will be as it was though. I would like to try the Supraphysiologic testosterone therapy (BAT) if I can get some one to help me with it. Do you have any thoughts on the BAT in addition to Estradiol? I have been looking and can't find any reason to not do it. Most of the Docs I have talked to are pretty resistant to any treatments which fall outside the SOC (standard of care) including Estradiol patches, and I find this aggravating . Luckily I have one Dr that is willing to "indulge" me and hence I have a Rx for the patches. So far they are markedly superior to the ADT (lupron) which I will not use.
Lancer
I agree that Lupron et al are terrible which is why I stopped. I hadn’t heard that estradiol may cause incontinence and hope it’s not true. I knew that radiation eventually caused it and I’ve had plenty ( see my profile) .
I see a sling specialist in late January. I use 1-2 pads a day depending on what my “ activities “ were that day. Working out, laughing, coughing, sneezing , and especially golf cause me to pee.
I also have sciatica at L4-5 and neuropathy in my feet which I’m getting treated. When it rains it pours but being alive is awesome at age 77 (on January 3rd).
Bob
I totally agree being alive is the best! Hope your consult is positive and Your other conditions respond well to treatment. As to estradiol causing incontinence. I don't know just that my incontinences has increased since I started it. May just be natural progression of events. time will tell Wish you and yours a very merry Christmas and good results going forward
Lance
Good for you to be so proactive. I too want to try some form of BAT going forward to try to decrease development of castrate resistance. ( see my previous posts about adaptive therapy approaches. ) Could not gat any doc to prescribe me testosterone. But it is OTC in Mexico and I’ve just returned with a large supply of gel for future use. I plan a carefully monitoring of PSA when starting it(weekly), as it can be very bad in stimulating PC growth in some (30-40%). So I cannot recommend it even though I want to try it. Would not do the rapid cycling of the BAT trial as my PC is slow growing so selective cycling needs to likewise be slow IMO. I would try just one month of T every 6 months or so. This is uncharted and not supported by clinical trials. Perhaps there will be new trials Of BAT for HSPC soon that I could join.
That is a very good result of T level control from patches alone. It is impossible to predict the precise effects of estrogen balance and receptors in PC. It is just too complex and evolves. So we are left with individual monitoring of PSA and progression. Life is certainly better with some E2 on board! Tamoxifen works well for me in preventing gynecomastia.
i went back and read the exchange about adaptive therapies. Very interesting. I am coming at the whole therapy thing from maybe a different angle. I initially followed the urologist advice and had the prostate removed PSA started up so radiation was done AND a lupron injection. That was the tie breaker for me. NO MORE lupron or its copies. That led me to finding the use of Estradiol instead. Interestingly I cannot find much information about the use of Super T with "super estrogen" on board. My thrust right now is to add BAT to the suppressed cancer due to Estradiol. Reasoning is that the suppression of the cancer elicits an increased sensitivity to Testosterone in the cancer cells. High levels of T have been show to Kill these cells. I am trying not to get too far into the weeds on this whole thing. I would sure prefer to not attain Castrate resistant status. I wonder if suppression with Estradiol will also create/allow castrate resistance to occur?
Any thoughts would be greatly appreciated.
Lance
So we are in a very similar situation lancer. The idea is that any powerful treatment that is maintained long enough will select in favor of resistant cancer sub populations. Hence destined to fail ( unless successful initially in curing outright). That is the idea of cancer as a “complex adaptive system “. So any treatment regimen should be changed-up from time to time to disadvantage emerging resistance if it cannot be cured. That is why ADT and even AAR drugs fail sooner or later. BAT seems to be the first attempt to take advantage of this. But the trial was in already very advanced castrate resistant patients. So more difficult at that stage. But still it worked for a significant minority. Applying the logic to E2 patches for ADT would have the same or similar limitations. We know the balance between ERA and ERB receptors is very complex and not fully predictable. And the mutation to ERB2 receptors also is an pathway to treatment resistance. AR receptors can also mutate to be stimulated by estrogens etc. So PSA must be monitored to stop or change course as soon as needed.
See: nature.com/articles/s41467-...
My other focus is on slowing the progression of my cancer through the various stages (Hallmarks) of progression so that I might stay hormone sensitive and just PLN positive ( not yet widely metastatic but possibly micro metastatic). This entails two areas of strategy: minimizing inflammation and protecting against genome degradation. This is different from fighting the current cancer burden IMO. See my previous post about “the Hallmarks of Cancer”. Best of luck. Please keep me informed of your program and course. Paul
thank you for the reply and the very interesting report. I will have to read it much more thoroughly. I have a teleconference with my Dr. on Tuesday to make the case for the BAT addition to the estradiol. He has been willing to go with me on this so far. This may be a bridge to far, but maybe not. This report I will forward to him and hope he has time to read itbest of luck going forward and hope you have a wonderful holiday season in spite of the Pandemic
Lance
I was on Lupron Depot 22.5 mg/12 weeks X 2 and I sort of devellop an A cup breast that just look like nice pectoral that I never had, 6 feet 1 inch and 158 pounds, so not a big man. But I also have many health problems:
ALL my health probleems.
1994 = Discal Hernia that was operated and then became in
2004 = Chronic Acute Lumbagy on Fentanyl 87 mcg/hr patches.
2001 = Chronic Renal Insuffissency Grade 3.
2019 = Lymphoma LNH Marginal Zone.
2020-03 = PCa Grade 3 became 4 after VMAT=RT on Planing CT-Scan.
2020-10 = Severed Emphysema Gold Grade 3.
2020-11 = Severed Depression on Sertraline (Zoloft) 100 mg and multiple R/Vs with a specialized psychologist for peoples with multiple cancers and heath problems.
The brain can not cope with all these problems and need HELP.
If you are developing Gynecomastia there is either an exogenous (from outside the body .... like ADT) or endogenous (produced from inside the body .... like from an abnormal imbalance in the production of hormones; i.e. producing too much estrogen) source. The source of estrogen production needs to be hunted down & shut down. An Endocrinologist, especially one who likes problem solving, might be your best bet. BTW there are "idiopathic" cases of gynecomastia ..... to be clear, "idiopathic" means they cannot find the source --- you likely already know this.
Thanks. Appreciate the response. I have requested an E2 test as a start. Perhaps yogurt and tofu needs to be cut from my diet?
Interestingly my T is 11, my E is 15 and mine have started to grow while on Lupron alone. The women in my family are well endowed, so maybe I will be too. I was a little surprised, but in the scheme of things, it does not bother me at all. I am living with much worse problem from prostatectomy that I am going to have surgery for next year to fix. Everything is relative, but I am more interested in continuing to live and not be in pain.
Thanks...will start with Fractionated Estrogen test...and continue to evaluate. In the interim...more chest exercises!
Eligard caused gynecomastia. Maybe I'm in the unlucky minority, but that was my experience.
I decided "what the hell.... don't hide them, grow them bigger and show them off." So I nail them to the floor and do pushups....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 6:01 PM EST
Ewwwwwwwww ..... ow Ow OW .
Know what’s awkward? .... your wife opens the bathroom door and catches you modeling your new giant set of boobs with one of her bras.
Just say’in 😂😂😂😂😂😂🙀🙀🙀🙀
Don't forget about the thong.....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 6:57 PM EST
Those things aren’t much good when 80% of them disappears when you put it on.
Just say’in 😂😂😂👍
You're right, that's why they refer to them as dental floss for the ass........
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 9:32 PM EST
Oh ..... I thought they were called a “ swinette “
Just say’in 😂😂😂😂
swinette: A swinette is a musical instrument which is made by stretching a cat's whisker across the posterior of a pig. The swinette is played by plucking the whisker with one's teeth. The virtuoso creates tonal variations by squeezing the pig at appropriate places in the abdominal region.
Wow one Hell of an instrument.... funnier than a skinflute....
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 12/18/2020 3:01 PM EST
I took Casodex for six months shortly before, during and after SRT in late 2017 and early 2018. Early on I noticed sore nipples and slight breast enlargement. I took TA's advice and asked my MO for a 10 mg Tamoxifen prescription, which stopped further enlargement.
Please be respectful of those seeking information for their care. I suggest you post your own posting for such ridiculous conversations.
I consider what I’m doing to be VERY respectful and beneficial to everybody’s mental health as well. All of us need to accept our reality for what is and stop living in the past. Right here , right now is what all of us have and nothing else. Being able to step back and have a light hearted laugh at out circumstances is “ very “ beneficial . Obviously not everyone gets that , but you would find it beneficial if you did. Clearly if you are concerned about boob growth, you are “ no where “ as close to peering over the edge as some of us, but you’re gonna be. As you get closer , boobs are going to be the very least of your concerns. If we can look into the abyss and still find some light heartiness, you can too.
Btw: none of my posts on this thread were directed directly at you were they ? They definitely didn’t impair the information you sought and received. I’m imparting information as well ... think about that for a bit ..
Just say’in brother.❤️❤️❤️
If you feel that what you are doing adds any value...then feel free to post your own post and conduct your conversations for those that find them helpful. I am working on my health...and find it disrespectful of all what have taken the time to contribute something productive to the conversation.
In the future I’ll try to refrain from posting on threads you post if I can remember your name ( Lupron fog ). If you don’t get it and you feel these posts are truly ridiculous, then I’ll respect your view and move on. Nolo problemo brother ❤️❤️❤️
I have been on bicalutamide as a mono-therapy for 5 years.I have some breast enlargement but so far do not need a bra.
I am happy to see that some of you are using the estrogen patch. I am in my third month using it and so far no side effects and working well.
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