Veozah

[inthefight]

Thinking about trying Veozah. Is anybody aware of any drug interactions? I'm currently on Leuprolide and ABI plus prednisone.

[Tall_Allen]

A good friend was able to get it. It has almost entirely eliminated his his hot flashes. No side effects or drug interactions. Great stuff if you are able to get it -- it's only approved in post-menopausal women, but his MO was able to get it approved

[inthefight in reply to Tall_Allen]

Thank you as always on your responses. MO is reluctant as it is only approved for women. We shall see if I can convince him otherwise. And then there is the insurance issue ... but all in its own time.

[JWPMP in reply to inthefight]

Jim had the same issue. His MO wouldn't prescribe because she said it hadn't been tested in men undergoing treatment.

[jackwfrench in reply to Tall_Allen]

Do you mean “approved” for insurance coverage? What insurance?

[Tall_Allen in reply to jackwfrench]

Kaiser

[JohnInTheMiddle]

I don't have any hot flashes, possibly because because I'm on GnRH antagonist (Firmagon / Degarelix), but Veozah is interesting.

I'm trying to explore how to mitigate the side effects of ADT-driven low estrogen in another way. It seems that Veozah just hits the hot flashes.

But other side effects of low estrogen are also serious such as brain fog, cardiovascular disease and osteoporosis.

A big picture solution to this is the possibility of low-dose transdermal estradiol.

--------------------------------

WARNING NOTE, JUNE 30TH, 2024 - I've been doing a lot of reading about estradiol. My latest position is that there are risks and I am not ready to try low-dose transdermal estradiol yet. It's a very complex subject and there does seem to be the risk of stimulating progression. This despite clear benefits. (Apparently estradiol has nearly equal Infinity for both the ERα and ERβ estrogen receptors. One retards and the other promotes progression! More research needed!)

[inthefight in reply to JohnInTheMiddle]

Thank you for your reply. At this point I'm trying to work on my hot flashes. Gabapentin, Venlofaxin and acupuncture did not work for me.

[Huzzah1]

I've been on it for about 5 months. It's been my miracle drug! I tried everything else including acupuncture to get some relief with nothing working. I go to the gym regularly and am always very active. I was having severe hot flashes, every 1-2 hours. I would sweat through a couple hankies each time. Since being on Veozah, 98% of them are gone. I was not able to get insurance to cover it. I thought if someone was to come to me in the morning and ask for $18 that day and I wouldn't have a hot flash, I couldn't get to my wallet fast enough. That's my rational for paying out of pocket

[inthefight in reply to Huzzah1]

Glad it is working for you. I like your rational for the cost. I will first have to convince my MO and then check out the insurance issue.

[Mgtd in reply to Huzzah1]

Are you saying it costs $18 a day? That is $540 per 30 days. I assume no insurance coverage.

What type of doctor is the prescriber?

Thanks

[Huzzah1 in reply to Mgtd]

Yes - my MO wrote the script at my insistence. I was the first for him and due to its success he now offers it when asked.

[jackwfrench]

My MO put me on venlaxafine for hot flashes (which is covered) about 4 months ago since Veozah not FDA endorsed. I'm pretty happy with it, just get 2-3 minor flashes per day at this point.

[inthefight in reply to jackwfrench]

I've been on it for over a year. Had a little improvement at first but I don't think it's enough to justify taking SSRI if I don't really need one.

[JohnInTheMiddle]

I propose the following as a potentially useful discussion. My proposed discussion is a comparison between medical approaches to ADT side-effects.

One approach could be described as strategic. The other approach could be described as playing whack-a-mole.

Where ADT-driven hot flashes are concerned, there's a lot of traction on the Veozah discussion. It is an "NK3 inhibitor". And apparently works really well against debilitating hot flashes. Bravo science!

Consider a different approach however. Few people want to talk about low-dose transdermal estrogen add-back. Which also addresses the same problem. In fact this approach addresses the bigger issue. Because low estrogen as a side effect of ADT causes not only debilitating hot flashes, but also brain fog, cardiovascular disease risk, and osteoporosis.

The usual approach for ADT side effects (the whack-a-mole approach) includes for osteoporosis we get Denusomab etc. And for cardiovascular disease we get statins and all kinds of other interventions. And for brain fog I'm taking methylphenidate also known as Ritalin. And now we add Veozah for hot flashes.

There's a big strategic difference here. The whack-a-mole approach says "ignore the big picture" and take drugs for each of the side effects of ADT.

And so we have a cascade of drug taking. Is it possible that each drug has its own side effects?

Apparently it's not uncommon to find senior citizens who were taking dozens of different pills. And then such a surprise that compliance is an issue.

I suggest that there could be a strategic discussion here about the alternatives to ADT side effects.

On one hand treat each side effect separately. On the other hand treat the root cause of ADT side effects which is low estrogen. (There's a sidebar discussion to be had as well about the reported different scale of side effects resulting from taking either a GnRH agonist versus a GnRH antagonist ADT.)

From Occam's razor, the simplest approach that works may be better. Especially given that all these side effects of ADT have a single explanation, ADT-driven male low estrogen. The evidence is growing slowly for transdermal estrogen add-back as an omnibus solution for these side effects.

I'm not saying that the question of low-dose transdermal "estradiol" is the answer. I'm saying there should be a discussion about the two approaches.

P. S. - Transdermal estrogen patches are very inexpensive. I wonder how they compared to the cost of Veozah. Not to mention the cost of treatments for other side effects. The financial motivation of the actors in the medical / healthcare system are not irrelevant.

(As usual my reply is buried in a thread. I'm thinking I should make this into a post, in order to raise the visibility.)

Regardless of this discussion, exercise!

[inthefight in reply to JohnInTheMiddle]

Love your write up. My next 3 month visit is at the end of July and I was going to bring up the patch suggestion. My prior MO was against them.

[JohnInTheMiddle in reply to inthefight]

A big success ITF! I'm in the same boat. Trying to marshal evidence. It's weird though because I find my mental energy isn't where it should be. Ironic.

There's a kind of "doctor anthropology" going on. Doctors "are against it", whatever it is, even if it's not homeopathy. Being against even sensible things, which however are outside a narrowly defined Overton window of approved thoughts, is the ticket for club membership. And sometimes membership is partly defined by systemic, rhetorical artifacts.

They are/were against PSA testing. And now transdermal low-dose estradiol patches. I don't think it's just fear of liability. I could even think of purity tests.

I think there are questions about the patches but the answer is figure that out not refuse to talk about it.

[j-o-h-n]

Just walk into any drugstore and lift it (Veozah) off the shelf........ Walk out like you own the place and no one will bother you (oh yes, I almost forgot, ask the manager for a pack of gum from the vault).

Note: Dressed like a woman can help!!! America, America....

Good Luck, Good Health and Good Humor.

j-o-h-n

[inthefight in reply to j-o-h-n]

😀