I just asked my Doc yesterday for low dose tamoxifen to counter the high estrogen levels that are creating man boobs. This is happening because I am taking Nubeqa as a monotherapy, and even though my testosterone is only in the 450 range, a lot of it must be converting to E2 and making my boobies grow. He said there are no studies on the effects of Nubeqa and Tamoxifen together, so he was not in favor of me taking it. Does anyone have any suggestions for other ways to lower E2, and reduce man boobs without Tamoxifen? I am also concerned about the heart effects of high estrogen, and would really like to keep it somewhat in balance.
thanks
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joeguy
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While there are no studies with the new powerful antiandrogen Nubeqa, there are studies with the older, less powerful antiandrogen Casodex. You can email him this link:
I had a heart cath done about a year ago, and it showed I had a 70% blockage in the widow maker area...... not sure if that counts as history of blod clots or not...... aside from the breast growth I am concerned of the effects of high E2 on my heart........ I had a long list of heart issues that came about after being on ADT for a couple of years.
I'm not sure that tamoxifen is any better for the heart than estrogen. Tamoxifen acts as an estrogen agonist in some tissues. Ask your cardiologist. He may recommend anastrozole, which eliminates estrogen entirely. But eliminating estrogen entirely may make you feel like shit.
Yes, it is kind of pissing me off. I am trying to get them to check my E2 level on my next blood draw in a couple of weeks, because they have never even bothered to check it. It seems checking T and PSA is about all they worry about. The only reason I know E2 is high is because I’m growing tits! They suggested radiation to the nipples, but I told them as far as I know it’s too late for that.... should have been done before they developed
As I understand , estrogen is in fact cardioprotective hormone.. that is why women before menopause rarely have heart attacks. Its testosterone which is bigger risk for heart attacks...that is why bald men have higher rate of heart attacks.Tamoxiphen is effective in not letting you have gynecomastia...I think your doctor should read the paper TA has posted above.
On some levels I understand your MO’s reticence to prescribe a med on top of Nubeqa where there is no data as a mono therapy as yet. But, I see NO reason to balk at getting an Estradiol level blood test. My MSK MO would not prescribe Tamoxifen for me (he didn’t elaborate why and I didn’t press him on it at the time)but said radiation was an option, but he did agree to test E2.
I think the hesitancy to provide an E2 test is they wouldnt really know what to do with the numbers once they have them. Testosterone and PSA they have down..... E2, maybe not so much.
Would your pecs be growing like that if you were taking ADT, in addition to Nubeqa? What % of men reported getting gynecomastia during the Nubeqa trials?
There isnt any data on Nubeqa as a monotherapy, but there are currently 2 ongoing trials. I would suspect the percentage of men with gynecomastia on Nubeqa monotherapy is pretty high, just like it is with casodex monotherapy
Interesting, The prostate cancer doctors of America, if there were such I group, should compile a 10 page booklet with useful info like that so we wouldnt have to read this site 50 times a year to discern this kind of info.
His over abundance of caution is reserved for Nubeqa because there are ‘no studies on the effects of Nubeqa and tamoxifen together’?
Nubeqa is almost brand new, no surprise there. His logic is a surprise though.
While you’re finding your way around this, how is your weight, your abdominal fat, your fitness level? Some guys find getting stronger and leaner makes more difference in their chest than they thought possible.
With a history of heart issues I assume you’re exercising regularly-and that you did while you were on ADT (even if you didn’t know about the heart issues yet) just checking.
brisk walks is about the extent of my exercise....... everyone keeps telling me I really need to do more, so I guess i should step up my resistance type training. I originally gained 20 - 30 pounds when I started ADT a few years ago, but I did manage to drop 15-20 when I went on drug vacation a year ago...... currently 5'9" and about 195, so I could stand to drop a few more.
My man boobs have certainly grown on bicalutamide and Lupron and now on darolutamide and Lupron . BTW my Estradiol is less than 5 pg/mL (testosterone 6 ng/dL) but I’m sure I’d want to know what my Estradiol levels are on mono therapy with Nubeqa! I know Lupron also has reduced my E2
That is interesting that you would have breast growth with your E2 that low.....isnt the "normal" level for a man some where around 10 - 30 ? I am anxious to find out what my E2 level is. At this point all I know is Im growing boobs and getting a little bitchy....
This is correct. Estrogen lets your breasts grow while testosterone blocks this. If you get Casodex or Nubeqa monotherapy your testosterone level will rise but even more so your estrogen level. Therefore you get gynecomastia. Tamoxifen will avoid this.
I have heard about it being done, but since I am still blossoming, it might be too early for that sort of thing. My concern about surgery is that it would be considered "cosmetic" and would not be covered by insurance.
well I hear it works well, just might be a little pricey if insurance wont cover it. I actually considered just letting mine go, and then having surgery at some point in the future, maybe after they stop growing. Of course Im assuming I will be around for a few more years. Could turn out there was no need to worry about tits at all...
This review covers surgery for gynaecomastia. There are different types of surgery and the scars are different. After a good surgery the breast should not grow any longer and the breast will be smaller.
I am new to the world of high estrogen, and things like aromatase inhibitors, so I could use some education. It was my understanding that inhibitor type drugs like Arimidex wipe out estrogen all together, but clearly if you are taking it and your E2 is at 20, that is not the case. Is the Arimidex as good at reversing/stopping breast development as Tamoxifen ? Do you happen to know if Tamoxifen or Arimidex have fewer cardiovascular SEs and potential clotting issues? My doctor seemed concerned about the risk of DVTs with Tamoxifen.
Arimidex has been shown to be not as good, statistically, at reversing/stopping breast development as Tamoxifen. Same with radiation. But that does not mean either one of those approaches may not be of some benefit to you, because both CAN work, to some extent, for some men.
I question your doctor's logic. You might ask him if there are specific studies proving it is safe, for example, to take NSAIDs while using Nubeqa, or to eat ice cream while using Nubeqa. The fact is, the are far more things NOT studied than there ARE studied, and it would seem appropriate to have some sort of reason to suspect a potential negative interaction... does he have any such reason? Is Tamoxifen contraindicated with any med or class of meds that is similar to Nubeqa?
On the other hand, there are men like Richard Wassersug who have used tE2 for ADT and have had E2 levels for many years, who prefer NOT to use tamoxifen because they are wary of potential harms. So your doc is not being totally unreasonable, either... but I believe in informed consent, and that if you can convince him the risks are unknown and you accept that risks may exist, then it is YOUR choice to take those risks. Many docs don't seem to see it that way.
No, I don't recall him ever being specific, and I didn't come up with any research on my own discovery mission. I took tamoxifen with my bicalutamide monotherapy and am taking it again as I start tE2 myself. But I will discuss it with my onc in more depth at some point (he doesn't seem too concerned, but that can always change).
I heard RW hint in a recent presentation that the PATCH researchers had some data on tamoxifen that they have yet to discuss or publish, so I will be looking for that.
This is such a controversial subject that I'm reluctant to even get involved! Many of you believe that E2 levels should be kept at levels even less than normal male levels while Richard Wassersug (the tE2 guru) who has been using tE2 for close to 20 years maintains that 'Patch' and gel users keep theirs within in the female premenopausal range. That's where I'm at after using tE2 gel for over three years with a current PSA of 0.003. I do have boobs as my ONLY side effect; however, they stopped growing after about 1½ years and the nipples have since lost their sensitivity.
Given the choice between tE2 applications and LHRH agonist injections I will gladly tolerate the little boobies. Most of us are 'kinda over the hill' anyway so what is the big deal about having some degree of breast enlargement...is it any worse than a belly that resembles a pregnant woman? I live in a country where I'm surrounded by women half my age and none of them ever make comments about my boobs...I'm the one who jokes about them.
Regarding the use of tamoxifen to reduce gynecomastia, Richard W's concern is that of questioning whether or not it may interfere with the efficacy of tE2? I am not aware of any studies that can answer this!
I just recently learned what E2 is...... what is tE2 ??? My boobies have only been growing for a couple of months (maybe a B cup by now), my concern is I dont know how big they will get, and I am not going to be walking around with a DD rack ! I am only 57 and still working.
"tE2" is transdermal estradiol as opposed to oral estradiol. Oral estrogens such as the old DES increased cardiovascular events by about 30% due to the first-pass hepatic metabolism effect. The Patch and E2 gels/cremes are examples of transdermal estradiol which enter the blood through the skin thus avoiding passing through the liver.
Ahhhh yes, I mentioned estrogen patches to my doc a few years back when i was still hormone sensitive (afraid they wouldnt do a thing for me now that I am castrate resistant), but I kind of got the impression they were not being used much in the US..... maybe more popular in Europe?
It seems to me that the only effect of transdermal E2 used for alternative ADT is suppression of the hypothalamic-pituitary-gonadal axis to suppress testosterone to castrate levels. So if one was on estradiol patches (or nubequa or bicalutamide monotherapy) and taking tamoxifen too, then having testosterone <20 is proof that it is working in the desired way and E2 not being interfered with. And if PSA is responding properly then I would not worry that the tamoxifen nor the E2 was making any mischief for the PC. There is no evidence for increased cardiovascular risk for patch ADT vs standard LHRH ADT in clinical trials.
If I was unable to get Arimidex, I would go back 15 years to my non-prescription days & use chrysin. Bodybuilders might counter that it doesn't work, but that's because the liver destroys much of it in the first-pass. Essential to take it with Piperine. I used the combo for several years. Kept estradiol at ~20 pg/mL.
Researching Chrysin I ended-up taking Propolis as a safer alternative. I have preliminary indications that it lowers E2 but still needing more blood counts for a conclusive ruling.
See my reply to RonRonHu above so I don’t need to rewrite. Tamoxifen works and does not interfere with E2 for ADT. And there is no reason to think it will impair the effectiveness of Nubequa as an androgen receptor drug in any adverse way. (Your PSA response when adding it would be a verification).The other solution would be to add back in a base layer of standard ADT such as Firmagon etc.
You could still get RT to your breast tissue to perhaps inhibit it from getting worse even though it will not resolve what is already present? I’d talk to a RO.
I am avoiding any of the chemical castration drugs like firmagon. I have been castrate resistant for a couple of years, so drugs like Firmagon have little to no effect on slowing the cancer. But they did bring on just about every cardiac SE when I was taking them. This is why I am now experimenting with anti-androgen monotherapy..... so far so good ....with the exception of the annoying boobies.
@Hi I was developing man boobs that were rather painful, The Doc did want to give me Tamoxifen. But he referred my to a radiation oncologist and she applied just one session of radiation to the boobs and the pain went away and they stopped growing larger.
Hello rogerwegner, My Doc does NOT want to give me Tamoxifen, because she is concerned with blood clots. After a year, has the radiation for your boob pain been effective? It is something I would be interested in. Thank you lopwillie
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