just had my fourth Lupron shot, three months. Also on Zytiga and finished radiation in December. Everything has been great. I feel excellent physically and mentally. But this Monday after my fourth Lupron shot I became very depressed pissed off and side effects such as hot flashes came back much more frequently and stronger than I had been experiencing. Wondering if it could be my testosterone is climbing as I get near the end of the Lupron shot?
Although I did over-exercise a couple days in a row, made myself very sore and tired and I’ve had a little bit of stress at work, but I’m unsure if it’s because the stress is because I’m in a bad mood and I’m creating stress myself. No biggie but just wondering if anyone else has had the same type of experience?
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pj1121
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You might try different dosages. I did one-month shots spaced out five weeks, and was able to keep testosterone < 12mg/dl. I did it because I'm on the smaller side (145lbs), and these doses are calculated for the average male weight of 190lbs. It could have lowered the SE's.
Interesting, I have gone from 190 to 160 since diagnosis (on purpose). Also, my T went from 700 to 20, 3 weeks after my first Lupron shot and MO said no need to test any more we figure it will keep going down.
Yes it's strange stuff, I had incredible anxiety after switching from the 3 month to a 6 month shot , I did the 3 month shot for a year and a half then 3 weeks after the 6 month shot boom, the only thing I can think of is that it's what can happen when women go through menopause
My response to Lupron was highly variable and I could never make sense as to why it varied. At one point (after maybe 3 doses) I felt absolutely horrible. Severe weakness, major brain fog etc. I did not want to continue living if that was all ther was going to be. Fortunately I was too much of a wimp to kill myself because eventually the serious side effects lessened. It might have been that my body (and brain) just figured out how to deal with this onslaught.
I have since had an orchiectomy so I have essentially no testosterone but I have enough strength to survive, minimal brain fog (for a 70 year old) and I can deal with the hot flashes. Annoying but gettin old is annoying
If hot flashes are intolerable then you can try estrogen patches:
See TA's comment on hot flashes - quote:
"It does diminish over time. If intolerable, you can try aural acupuncture, estrogen patches, Megace, oxybutynin, or Effexor. Recently, Veozah was approved for menopausal women, but works great in men too, if you can get it."
The effects of Lupron are cumulative. You can wonder about various other factors but for myself and many I have known, a year in is where side effects become more prominent.
I felt almost nothing until after 6 months. The fat gain and fatigue were the worst of it but it was mild. How much do you exercise and what kind?
Ask your PCP or GP for a lose-dose, "add-back" prescription of a single, large estrogen patch per week (strength = 0.1 mg/24hr) to treat your hot flashes. They are quite effective, and they will also treat your osteoporosis from Lupron ADT. See attached chart of pros/cons of transdermal estrogen (TDE). Note: compared to older, oral estrogen pills, which caused a high incidence of blood clots, the newer transdermal delivery method does not take a first-pass through the liver and, hence, doesn't have the high incidence of blood clots. Men on TDE still get blood clots, but not any worse than men taking Lupron ADT.
Apply the single, 0.1 mg/24 e-patch to your hip or upper buttocks, for good absorption. You can leave the patch on for 1 week at a time. Or, you can change them twice a week, moving the patch to a different site after 3-4 days to help prevent irritation from the adhesive. Add estradiol to your periodic blood lab tests.
High-dose TDE (e.g., 3-4 large patches at a time), effectively chemicals castrates men and reduces PSA just like Lupron ADT. It can be used as an alternative to Lupron ADT, but without the bad side-effects of Lupron. At that high dose, many men develop enlarged breasts (gynecomastia). If you do go that route, you need to get a genetic test to see if you have mutations to the BRCA 1/2 genes. They offer a free saliva test kit from prostatecancerpromise.org.
Alternatively, many men use estrogen gel from either DIVIGEL.com or ESTROGEL.com. Estrogel.com has an MD on their staff that will write a prescription over the phone, if you explain that you want to use a low-dose of transdermal estrogen to treat hot flashes from Lupron ADT.
regarding your chart Jane Bob one of my biggest side effects is muscle loss although I do anaerobic and aerobic exercise every day including weights so I’m not sure I want to go down the path of estrogel
One of the "negatives" side effects of estrogen therapy is reduced muscle mass and loss of strength. This is due to the fact that high-dose transdermal estrogen chemically castrates men (T < 20 ng/dl), which causes muscle loss and weakness. There is no difference between Lupron ADT and Estrogen ADT in this regard; both have that same side effect. High dose transdermal estrogen is not worse than Lupron ADT in this regard.
You can always consider doing low-dose estrogen "add-back" to treat hot flashes and osteoporosis while doing Lupron ADT.
I felt horrible for a couple of weeks a week or so after my second three month lupron shot. People say I should not because T were already at castrate levels. To me it is plausible that the substance itself (leuproreline) may also trigger some reactions. There are of course high levels after a second injection when the first three month injection are far from worn of yet. I dont know if these side effects are studied.
I was on 4-month dosages for over two years. I had strong mental SE's (Confusion, anxiety, memory loss, and anger. These symptoms initially occurred in the week following the implant and then returned for a couple of weeks before the depot was replaced.
I was told that the longer term depots can dispense dramatically higher doses following the implant, and that if the depot disintegrates quickly in the beginning, the dosage is lower near the end of the cycle.
After two years on Lupron/Eligard (I received both), I had four months of hell whee the bizarre SE's didn't abate over the entire 4-month cycle. My mental SE's intensified and I entertained revenge fantasy's, had to avoid driving on some days due to tremendous road rage, and I suffered from suicidal ideations.
I got my MO to change me to 1-month Firmagon and my SE's have leveled out.
I'm sorry to hear about your side effects of Lupron (but not surprised). You're a perfect candidate for low-dose estrogen "add-back" via estrogen patches or gels. That will mitigate the hot flashes and osteoporosis. There is anecdotal evidence that this also help with mood and cognition.
Thanks JB. I have lobbied my onco to prescribe patches, but to no avail. I am considering ordering estrogen from one of the on-line companies you referenced, but I am a little concerned about adding another variable to my treatment. Inspite of the side effects, I have a pretty damn good life, and I'm still castrate sensitive after 4.5 years on Lupron/elligard/firmagon plus zytiga.
You should not have to put up with side effects. Lupron, etc. depletes your store of estrogen because estrogen is made from testosterone. Supplementing with estrogen will bring it back to your normal levels, as God intended it to be. It's a completely natural hormone.
Estrogen "add-back" will effectively treat hot flashes and osteoporosis.
Attached is a chart summarizing the Pros and Cons of transdermal estrogen vs Lupron ADT.
The best route is to ask your PCP or GP for "add-back" low-dose estradiol patch therapy (one large patch delivering 0.1 mg /24hr of estradiol, changed once per week). They will likely approve that for treating osteopenia (as it is used for PM women) and hot flashes.
There's another route to consider. Contact your local compounding pharmacy and ask for the name(s) of 1-2 doctors that routine prescribe compounded hormones (mostly for women, but also for men). Then, speak to one or both of those doctors. They are typically alternative, integrative types of MDs who understand how important hormones are to good health.
Once you get a subscription, you can order estradiol patches from BlueSkyDrugs.com in Canada. They charge $60 US for a box of 24 of the largest patches (0.1mg/24hr).
Under this regimen, your T stays consistently low; it doesn't start to recover. My experience is that the mental and emotional SEs like those you described come and go seemingly at random.
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