doctor prescriped anastrozole

[Ax87]

my doctor prescribed anastrozole, an aromatase inhibitor( kind of like rebound xt?) she said i should try this for 3 months before i try surgery.. i cant find too much about this drug however, does anyone know anything about it, anything will help :-D and she also said i should not go to a plastic surgeon if i want surgery, a general surgeon could do it? some1 help me

[hypo]

Anastrozole is nothing like rebound xt!!!!!!!

The former has gone through years of controlled trials to prove its efficacy (worth and safety) the latter has gone through zilch!!! and is a drug cooked up by some chemist to appeal to bodybuilders.

Anastrozole is made by AstraZeneca and is more commonly known by its brand name Arimidex.

It is very effective at lowering blood levels of estradiol, in men it can be too powerful and so needs careful dosing and monitoring (its primary license is in the treatment of breast cancer in women).  

Because it is very good at lowering estradiol it is good at preventing gynecomastia development (whilst it is being taken at least), however it does not seem particularly effective at reducing or resolving gynecomastia.

I take it you had hormone pathology prior to being medicated?

If so what was your estradiol level including reference range and who prescribed it a general physician or an endocrinologist?

Also what dose have been put, how often are you to take it?

[allbah]

This is from UP TO DATE 2005 one of the best references of medicine world wide.
Aromatase inhibitors: testolactone, an aromatase inhibitor, has been evaluated in an uncontrolled trial in a small number of boys with pubertal gynecomastia; there was an average 40% decrease in breast size, but the authors did not report the number who had a complete remission. Thus there is insufficient information to recommend testolactone as initial therapy for gynecomastia, although on theoritical grounds it would seem reasonable to use this drug or one of the newer aromatase inhibitors, such as anastrazole, letrozole, of formestane, a double blind, placebo controlled trial of anastrozole treatment for pubertal gynecomastia failed to show any beneficial effect over placebo.
hope this helps.

[Ax87]

it was an endocronolist who prescribed it, and she did have all my homones checked i can not recall all my levels, and she showed me the same exact statement allbah just copied and pasted... but she said this is safer then trying androgens or antiestrogens and i am supposed to take 1 mg a day for 90 days... she also said we should try medicine before we go to surgery so we can rule out it coming back if i get surgery? the main purpose of me using this drug is actually to reduce my estrogen level lol which i assume is different then estradiol level?  but im 18, i've had this problem since i was 13 so i highly doubt its going to just go away...  in my opinion i should just go to a surgeon and she has given me the option to do so also, because i havent found anything convincing enough that shows this drug will work. so now my other question, will a general surgeon do this surgery or do i have to go through a plastic surgeon?

[hypo]

The problem is here you are in the dark.

You should get a copy of your pathology results for your own records.

If you did this you could post your results here inclusive of reference ranges and at least then people with hormone problems like myself who have looked at hundreds of pathology results could give you a very good layman’s impression of what is going on.

One would presume that you are being given Anastrozole because you have high levels of estradiol (with estradiol simply being the most potent estrogen and the one endocrinologists primarily concern themselves with).

But the questions are;

A) How high is your estradiol level?

and

B) Why is it high?

Quote
she said this is safer then trying androgens or antiestrogens and I am supposed to take 1 mg a day for 90 days
Unquote

Aromatase inhibitors may have been found to be relatively safer than antiestrogens in long term, such as five year use as a treatment for breast cancer in women, but when you are talking about a course that lasts 90 days, the differences are negligible given that overall Tamoxifens safety record is still very good.

And this is the point; Tamoxifen has been shown in a number of clinical trials to resolve gynecomastia in 80% of cases.  

Although admittedly the numbers involved in the trials were not high enough to 100% substantiate the findings- something which has been the problem with trials of the aromatase inhibitors of which Anastrozole has been one.

Clomiphene Citrate has been shown to resolve gynecomastia in 64% of cases in controlled medical trials.

Dihydrotestosterone has been shown to reduce gynecomastia in 75% of cases and of that 75%, resolve 25% of cases.

So Tamoxifen, Clomiphen Citrate, Dihydrotestosterone have all been shown to work more effectively at treating gynecomastia.

Of course Anastrozole is very effective at reducing estradiol, something that one would expect to prevent further gynecomastia development, but for some reason it does not seem particularly effective at reducing or resolving gynecomastia.  

I know this first hand, as I know dozens of men who have been prescribed it for elevated estradiol do to TRT (testosterone replacement therapy) for hypogonadism who have had gynecomastia.  And I myself have been on Anastrozole and it did nothing for my gynecomastia despite significantly lowering my blood level of estradiol.

This is completely at odds with dihdrotestosterone which I was prescribed which reduced my gynecomastia quite a bit.

Quote
i am supposed to take 1 mg a day for 90 days
Unquote

Unless your estradiol is through the roof!! This dosage will make you ill.

If your estradiol is only elevated, this dosage could cause fatigue/lethargy, reduce your libido and give you erection difficulties and may even throw your thyroid function out.

Only a very high estradiol level would account for such a dose!!

And if your estradiol level is that high you should be having investigations to try and ascertain the nature of the problem.

Quote
she also said we should try medicine before we go to surgery so we can rule out it coming back if i get surgery
Unquote

This doesn't make a lot of sense to me.  If you have a high level of estradiol you would want to know why it is high in the first place?  What was causing it to be elevated?  

Just medicating against it now proves nothing, it doesn't tell you one way or another whether or not you have an underlying problem and it doesn't rule out an underlying problem.  

If you do have an underlying problem causing the elevated estradiol and it continues to be undiagnosed and untreated then, once the medication has left your system your estradiol level will probably rise again, which could lead to re-development of the gynecomastia.

So what exactly is being ruled out here?


I am sorry to sound so pessimistic but what your endocrinologist is saying doesn't seem to make a lot of sense.

If I were you I would request a copy of my own results and post them here for layman’s advice and I would take them to another endocrinologist for a second opinion if the layman’s advice seemed to be greatly at odds with your current endocrinologist.

Perhaps your endocrinologist can elucidate exactly as to why she believes you should be on Anastrozole and what the thinking is as to why your estradiol is high enough to warrant such a dose.  Then again maybe she generally specializes in another field like diabetes and is a little out of her depth.

I say this because unfortunately endocrinologists specialize in many different fields and some times you do get one that does not know what they are doing, which may or may not be the case here.  I myself have been seen by at least two endocrinologists who specialized in other areas who knew little to nothing about reproductive issues.

If you do have a problem tell me where you live I will get you the contact numbers and details for endocrinologists in your area that have an active interest in reproductive endocrinology.

If you think I am interfering then I will leave you to it and take no offence and hope you take none either.

Good luck.

[hypo]

Yes Jeff I concur and the reasoning is similar.

[Ax87]

thanks for the help hypo... i didnt realize u were talking about estrogen and no mine isnt even that high, so i think your right, my doctor really doesnt have many patients who have gynecomastia... i live in maryland in the gaithersburg germantown area... but i think i want to see a plastic surgeon instead, if you know of any good plastic surgeons in this area? the only reason i refuse to go back to an endocronologist is because the other endo i went was like no it'll go away in time but its been 5 years, and i dont think they are going to know all that much, medicine has its risks and so does surgery, but i think surgery has a better chance to get rid of it for life, i will post a pic up soon i guess so you guys can see it, its fairly mild mostly puffy nipples...  

[hypo]

Ax87,

I honestly think seeing an endocrinologist who has an interest in reproductive endocrinology could see you and have a good understanding of matters and it may be beneficial as you don't as yet know anything regarding your pathology results.

If you change your mind here, just let me know and I'll get you details of the aforementioned endos.

At the very least though request a copy of your pathology results to be sent to you and post them on the site.

I can tell you if the basic relevant tests have been performed or not and I can tell you if anything is blatantly amiss.

I'm afraid I cannot help with your search for a PS but I am sure there are people who can, maybe ask the same question in a new thread of that title.

[allbah]

I am not trying to pull a fight but the dihydrotestosterone study is small and weak. yes it showed that hormonal ratio was better in the treated group but it did not show significant correlation between the hormonal profile and the reduction in the breast size, in english although all the patients treated had better hormonal profile only some showed good reduction in breast size, so was it the treatment or was it chance!!!!
The clomiphen study was later shattered by another two major studies that showed that only half of the patients had benefit, this benefit was only 20% reduction in breast size and most patient were not satisfied by the results.
May i also add that the time period one has GM for can mean its too late for medical treatment, Having said that you still need to get your hormone right to avoid any possible post op reccurance.

[Ax87]

well i recall my endo telling me all my hormones are fine and that different people react differently to different levels of estrogen so she just wanted to try to reduce it first, but i did request to see my results again so i can pick them up tomorow, and i will post them up here and then you can tell me what you think hypo... i appreciate all the help guys, thanks!

[hypo]

Allbah,

Quote
the dihydrotestosterone study is small and weak
Unquote

There is more than one study.  I have viewed studies that are not weak- you will have to elucidate and detail the study you are referring to.

Regarding Clomiphene Citrate again there have been a number of studies with differing dosages, you will need to detail further the information you are referring to.  You may be correct in what you are saying; I would just like to see the information for myself to see if we are both reading from the same page/same study.

The evidence from studies of both dihydrotestosterone and Tamoxifen in the treatment of gynecomastia both offer more compelling evidence of their effectiveness as treatments than anything that has been shown for Anastrozole.

And that is the real point given that Ax87 has been put on Anastrozole.

In addition to the above I am aware of the subjective feeling on the ground in communities that have trialed Anastrozole. The information that keeps coming back time after time is that Anastrozole whilst being very effective at lowering blood levels of estradiol, it isn't particularly effective in the reduction of gynecomastia.

I also personally found this to be the case when I was prescribed it as part of a trial.  And like I said, this was in contrast to the reduction in gynecomastia I had whilst on dihydrotestosterone for hypogonadism (alternative therapy to testogel).

My personal experience whilst not being in a controlled study, does mirror that of many other people with gynecomastia in the hypogonadism communities and follows from the studies that DHT has been shown to be fairly effective in combating gynecomastia whereas Anastrozole has not.

My opinion regarding dihydrotestosterone (which I came to have after seeing the studies and having been prescribed it) is also the opinion of Dr Eugene Shippen (one of the worlds leading hormone specialists) something I gathered following correspondence I had with him earlier in the year.

[allbah]

Hypo I agree with you.
here are the studies:

1)studies on the treatment of ideopathic gynecomastia with percutaneous dihydrotestosterone.
AU - Kuhn JM; Roca R; Laudat MH; Rieu M; JP; Bricaire H
SO- Clin Endocrinol (OXF) 1983 Oct;19(4):513-20

2) Clomiphene in the treatment of adolescent gynecomastia. Clinical and endocrine studies.
AU - Plourde PV; Kulin HE; Santner SJ
SO - Am J Dis Child 1983 Nov;137(11):1080-2

[Ax87]

hypo... sorry it took me so long to find these but...


lh- 5.0
fsh- 9.2
ESTRADIOL- 23 pg/ml
Testosterone, Serum- 445 ng/dl

and there is a bunch of other ones we got tested too if u need those i will tell you.