Started transdermal estradiol (0.0375 mg) in November 2023 to counter negative effects of ADT (relugolix and abiraterone) on bone density. Increased the estradiol to 0.075 mg in January 2024 which accelerated my gynecomastia. I asked my MO about using transdermal tamoxifen along with the estradiol to reduce the gynecomastia. She said she did not know if the topical gel would provide the same benefit as oral tamoxifen and could not find safety data regarding the side effects of compounded formulations.
Is anyone aware of a study/studies which compared the effectiveness of topical gel versus oral tamoxifen for gynecomastia, and/or reports on the side effects of compounded formulations?
Has anyone using transdermal estradiol also applied tamoxifen topical gel to reduce breast enlargement? Did it work for you, and at what dose? How long were you experiencing gynecomastia before starting the tamoxifen? How long did it take to see a reduction in breast enlargement?
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Flydad
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The risk of oral tamoxifen is blood clots. Transdermal can potentially mitigate that. Also, you can apply it directly on your breast. If it doen't help, you can go back to the pills. 20 mg/day is required to reverse existing gynecomastia, 10 mg/day for prevention. There are no studies of the transdermal that I am aware of. It is probably safer for the same reason that transdermal estrogen is safer than oral estrogen.
Yes, I got a baseline DEXA scan in January 2022 just after starting ADT in December 2021, a second DEXA May 2023, a third DEXA scan just prior to starting the low-dose transdermal estradiol in October 2023 and a 6-month follow-up DEXA scan in May 2024. Results summarized below.
I started weight lifting in November 2022 following the Body by Science program (BBS) that I read about in another Health Unlocked post. My conclusion to date is the BBS weight lifting provided a similar benefit in terms of increasing bone mass density as the low-dose estradiol. However, due to a slip on the ice and 2 fractured ribs, I had to stop weight lifting 2 months after starting the estradiol. So, I really have not gotten to see yet if there is an increased benefit on bone mass density with a combination of low-dose estradiol and BBS weight lifting. Next scan in 6 months should shed some light on that. I believe weight lifting has been beneficial in stabilizing my bone loss.
In regards to other benefits of the low-dose transdermal estradiol:
1) I lost my sense of smell after starting ADT and it came back after starting the estradiol
2) Decrease in aching joints
3) Decrease in hot flashes
4) Energy level was unchanged (but I wasn’t feeling particularly fatigued prior to starting estradiol)
In regards to the drawbacks of the low-dose transdermal estradiol:
1) Breast and nipple pain
2) Increased gynecomastia
DEXA Scan Results Summar
T score lumbar spine: -1.0 Jan 2022 (baseline: 3 weeks after starting ADT)
T score lumbar spine: -2.0 May 2023 (16 months after starting ADT; physical therapy program; BBS weight lifting started in Nov 2022)
T score lumbar spine: -1.8 Oct 2023 (just prior to starting low-dose estradiol; doing BBS weight lifting)
T score lumbar spine: -1.8 May 2024 (6 months after starting low-dose estradiol; no weight lifting after Feb 2024 due to fractured ribs from fall on ice)
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T score Femoral neck: -2.2 Jan 2022 (baseline: 3 weeks after starting ADT)
T score Femoral neck: -2.4 May 2023 (16 months after starting ADT; physical therapy program; BBS weight lifting started in Nov 2022)
T score Femoral neck: -2.3 Oct 2023 (just prior to starting low-dose estradiol; doing BBS weight lifting)
T score Femoral neck: -2.5 May 2024 (6 months after starting low-dose estradiol; no weight lifting after Feb 2024 due to fractured ribs from fall on ice)
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T score total hip: -1.5 Jan 2022 (baseline: 3 weeks after starting ADT)
T score total hip: -1.4 May 2023 (16 months after starting ADT; physical therapy program; BBS weight lifting started in Nov 2022)
T score total hip: -1.5 Oct 2023 (just prior to starting low-dose estradiol; doing BBS weight lifting)
T score total hip: -1.3 May 2024 (6 months after starting low-dose estradiol; no weight lifting after Feb 2024 due to fractured ribs from fall on ice)
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T score 1/3 radius (wrist): -2.7 Oct 2023 (just prior to starting low-dose estradiol; BBS weight lifting)
T score 1/3 radius (wrist): -2.6 May 2024 (6 month after starting low-dose estradiol; no weight lifting)
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Trabecular Bone Score Spine Results = 1.274. Normal bone microarchitecture (May 2023)
Trabecular Bone Score Spine Results = 1.292. Normal bone microarchitecture (Oct 2023)
Trabecular Bone Score Spine Results = 1.256. Partially degraded bone microarchitecture (May 2024)
Super thanks Flydad for finding this great resource from Mateo Beach!
(And as a side note, and from Jazzman's effort to find this resource - Health Unlocked is crummy for curating great resources! There's a whole missing functionality here. Including search. It's like we have waves crashing on the seashore and we splash around in any given wave and have a nice dialogue. And then the wave is gone. Kind of like mPCa men show up on the forum and then after a few years disappear. Isn't that what we're supposed to be fighting against?)
This is fantastic analysis and information Flydad! It's real on the big question of bone density and exercise and low-dose transdermal estradiol patches! And you're discussing other side effects from low estrogen.
There's an increasing awareness on the side effects of ADT - not just complaining and random remedies for hot flashes - but real engagement with science.
I'm still wrestling most all this but your post is one of the best reports and analysis I've seen yet. It is much appreciated!
Oral tamoxifen is probably safe, but by all means try either or both. Weight training for the density and more exercise and fat loss in general works wonders for the gyno if you give it time. A stronger upper body with less fat hides it and synergies well with your other efforts.
The randomized, Phase-II trial of transdermal estrogen has demonstrated conclusively that tE2 therapy actually grows bone, compared to Lupron which shrinks bone. Check out the papers by R. Langley et al., and by N. Russell et al.
There are some papers that warn that taking tamoxifen may counteract the benefits of doing tE2, however.
I'm planning on doing electron beam irradiation of my Moobs to reduce their size (I'm taking high-dose transdermal estradiol gel). You may want to consider that route.
I asked for Tamoxifen for gynecomastia and was prescribed anastrozole instead. Urologist didn't explain why. BTW I'll get my latest PSA reading in a week. Have been on dutasteride for the last three months. I consider that 'ADT-lite'.
That's a great question. I'm not sure that it did resolve or prevent the gynecomastia. I seem to be sporting some moobs. How much has it increased since I started the dutasteride? Not a great amount. Is it from the dutasteride or is it because I am overweight and it is just showing up there? I don't detect the kind of firmness I did encounter when I was on 6 months eligard shot almost 8 years ago. That problem did resolve after the one time eligard shot wore off and my T returned to a decent but still hypogonadism level. My latest T level was 399. Nothing to brag about but still somewhat in the game. Oh and my latest PSA level on dutasteride was 1.6. 🙂
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Enzalutamide/Xtandi monotherapy as ADT with fewer side effects than Lupron
Breast tenderness and enlargement?
tamoxifen or prophylactic radiation therapy?
Breast tenderness and pain
