Any concerns about long term anastrozole use in men?

[ipi]

Anyone here using it for 10 or more years? I am reading that some doctors are concerned about its long time use?

 

[CoastWatcher]

ipi,

It seems that you are terrifically nervous about taking the AI prescription Dr. Saya provided. It's wise to be cautious, many of us on TRT have either had bad experiences with a doctor, been told to take a prescription that was inappropriate, and felt we were adrift without good medical support. The doctors at Defy Medical are two of the best in the U.S. when it comes to managing TRT protocols. You can trust them. They are working with you to deal with your low testosterone, your elevated estradiol, and will, most certainly, respond to the fact that you have significantly high prolactin. All of these issues are serious but can be managed. You will only begin to see the benefits of TRT when your testosterone is in range, your E2 is in check, and your prolactin has been lowered. None of this will happen if you don't work with your doctors by adopting the drug regimens they prescribe. Not mindlessly, you have a right (and an obligation to raise questions), but you are standing at a crossroads unwilling to engage your medical team with the questions that are causing you to hesitate. It is unlikely that your hormonal challenges can be met without pharmaceutical intervention - it's the basic fact.

 

[Gene Devine]

Women have been using AI's for decades now in significantly higher doses than a man would ever use...and they are still walking among us!

The health risks associated with elevated estrogen levels pose a much greater heath risk as opposed to a very low dose of this drug.

As long as estrogen serum levels remain in the optimal range...I wouldn't worry about it...there are other things of much greater risk like driving your car everyday...think about that!

 

[ipi]

Thanks much Gene and Coast Watcher.
I wanted to check if anyone has heard about clotting issues with AI. I read an article on this site (a post from Nelson) from some famous person that even a small dose can cause clotting, that drives me crazy.

Guys I have been hit hard by an antibiotic (Cipro) which eventually brought me to this site.

 

[CoastWatcher]

Antibiotics and drugs such as Anastrozole, and AI, work in entirely different ways with entirely different results.

 

[Vince Carter]

Thanks much Gene and Coast Watcher.
I wanted to check if anyone has heard about clotting issues with AI. I read an article on this site (a post from Nelson) from some famous person that even a small dose can cause clotting, that drives me crazy.

Guys I have been hit hard by an antibiotic (Cipro) which eventually brought me to this site.

I think the stance on AI's by my direct experience and reading and researching is that in some circles Anastrozole is a requirement. It's dosed .25mg EOD and that's what you do, testing has some influence on that but the typical stance is that it's required. Anastrozole is a powerful drug and shouldn't be taken "just because" we're on T and/or HCG. It should only be taken if experiencing physical symptoms in the patient. It should not be taken because of a number on a test or because it goes hand-in-hand with TRT.
Around here you'll typically see Anastrozole not being used, or if it is, it's a very low dose like <.25mg per week. I for instance will sometimes use .15mg, PER WEEK. I think the attitude about it being bad is that it's overused/overprescribed.

 

[Nelson Vergel]

I think in 20 years we will see men now taking anastrozole at a dose over .5 mg per week experience bone loss and fractures. Of course, I am just speculating.

 

[Vince Carter]

I think in 20 years we will see men now taking anastrozole at a dose over .5 mg per week experience bone loss and fractures. Of course, I am just speculating.

I totally agree...I think it'll not be the Anastrozole it'll be the consequence of having low E2 because of it.

 

[ipi]

Thanks guys. I get the E2 logic and I understand that after being on anastrazile it's important that one monitors the E2 frequently. I was also asked by Dr. saya to be on a 0.15 mg per week, just once per week and I am planning to take it on my first dose of the week that is Tuesday.

But Nelson or any one here in your Expereince with HRT/TRT have you seen a person having blood clotting after the use of anastrazole?

 

[ipi]

Have you seen people facing clotting issues after being on anastrazole? Nelson I read your article about it.

 

[Gene Devine]

I think in 20 years we will see men now taking anastrozole at a dose over .5 mg per week experience bone loss and fractures. Of course, I am just speculating.

Why hasn't this happened to women who are on long term therapeutic use of an AI to control excessive E2 serum levels...especially women who had breast cancers?

 

[ipi]

It has not Gene? I am referring to Nelsons article on the first page of excelmale, an interview from some doctor who had a study about clotting.

 

[Nelson Vergel]

Of course, women with breast cancer use higher doses of anastrozole, so I do not expect this kind of bone loss in men using less than 1 mg per week. But it is a good thing to keep in mind.


Effect of Anastrozole on Bone Mineral Density: 5-Year Results From the Anastrozole, Tamoxifen, Alone or in Combination


JCO March 1, 2008 vol. 26no. 7 1051-1057

Purpose The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial (median follow-up, 68 months) has shown that adjuvant anastrozole has superior efficacy and better tolerability than tamoxifen. However, anastrozole reduces circulating estrogen, and low estradiol levels are associated with decreased bone mineral density (BMD) and increased fracture risk. It is therefore important to understand the effects of long-term aromatase inhibitor therapy on BMD.

Patients and Methods This prospective substudy of the ATAC trial assessed BMD changes in postmenopausal women with invasive primary breast cancer receiving anastrozole (1 mg/d) or tamoxifen (20 mg/d) as adjuvant therapy for 5 years. Lumbar spine and total hip BMD were assessed at baseline and after 1, 2, and 5 years.

Results One hundred ninety-seven women from the monotherapy arms of the ATAC trial were recruited onto the bone substudy, and 108 were included in the primary analysis. Among anastrozole-treated patients, there was a decrease in median BMD from baseline to 5 years in lumbar spine (&#8722;6.08%) and total hip (&#8722;7.24%) compared with the tamoxifen group (lumbar spine, +2.77%; total hip, +0.74%). No patients with normal BMD at baseline became osteoporotic at 5 years.

Conclusion Anastrozole is associated with accelerated bone loss over the 5-year treatment period. However, although patients with pre-existing osteopenia are likely to require monitoring and bone-protection strategies, patients with normal BMD would not appear to require monitoring beyond the recommendation for healthy postmenopausal women. The effect of anastrozole on bone should be weighed against its superior efficacy and better tolerability profile versus tamoxifen in the main ATAC trial.

 

[Nelson Vergel]

This is what ipi is referring to:

"You also suggest a link between high estradiol with thrombophilia. Can you explain this finding? Would anastrozole or other E2 inhibitor improve outcome if used with TRT?


Dr Glueck: We have data to show that when T is aromatized in the body to estradiol (E2), the high E2 may be the agent which directly interacts with the underlying thrombophilia to produce the clots. We do not have enough data to know whether Arimidex used to lower E2 would be protective, but we know that Arimidex alone is prothrombotic in all of the thrombophilias and hence, probably not a good idea."

Can Testosterone Induce Blood Clots and Thrombosis? Interview with Dr Charles Glueck


I researched oncology studies and it seems that anastrozole at the high doses used in breast cancer is better than Tamoxifen but still present a slight risk, so I am not 100% sold on Glueck's comment:

"A systematic review has shown a 2&#8211;3&#8208;fold increase in the risk of VTE using either tamoxifen or raloxifine alone, equivalent to the risk of hormone&#8208;replacement therapy in women generally.19 The review found a lower but still significant risk with the newer aromatase inhibitor anastrozole (2.1% in patients on anastrozole v 3.5% in patients on tamoxifen).20"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653906/

 

[GEORGE TOULIATOS]

Too low serum estradiol would affect bone density,lipids,mood and libido.

 

[ipi]

What about blood clotting issues?

 

[ipi]

Blood clotting issues, long or short term? Nelson you have seen many people so any examples or cases in last 20 years? Blood clotting on anastrazole?

 

[GEORGE TOULIATOS]

Blood clotting issues appear as estrogens increase (contraceptives use)

 

[BruceWayne]

Why hasn't this happened to women who are on long term therapeutic use of an AI to control excessive E2 serum levels...especially women who had breast cancers?

This has happened to women treated with anastrozole for breast cancer, as has severe depression, atherosclerosis, heart attacks and severe joint and bone pain. Not only in women in some of the latest studies on men taking anastrozole for over one year they had reduced bone density in the hip and lower spine. Make no mistake you need estrogen.

 

[Nelson Vergel]

Long-Term Side Effects of Aromatase Inhibitors in Women with Breast Cancer​

Aromatase inhibitors (AIs) are a class of drugs commonly used in the treatment of hormone receptor-positive breast cancer in postmenopausal women. While these medications have proven to be effective in reducing the recurrence of breast cancer, they are not without their side effects. Here's a look at some of the long-term side effects associated with the use of aromatase inhibitors.

1. Musculoskeletal Symptoms​

Joint and Muscle Pain​

One of the most common side effects experienced by women taking AIs is joint pain or arthralgia. This can range from mild to severe and can impact the quality of life.

Reference:

• "Joint Symptoms are Associated with Aromatase Inhibitors in Women with Early-Stage Breast Cancer" - Journal of Clinical Oncology

2. Cardiovascular Effects​

Increased Risk of Heart Disease​

AIs can elevate the levels of cholesterol and can increase the risk of heart disease, especially in women who already have risk factors for heart issues.

Reference:

• "Cardiovascular Side Effects of Aromatase Inhibitors Versus Tamoxifen" - British Journal of Cancer

3. Bone Health​

Osteoporosis​

Long-term use of AIs can lead to a decrease in bone mineral density, increasing the risk of fractures and osteoporosis.

Reference:

• "Bone Health in Women Taking Aromatase Inhibitors for Early-Stage Breast Cancer" - Journal of Clinical Oncology

4. Gastrointestinal Issues​

Nausea and Diarrhea​

While less common, some women experience gastrointestinal issues like nausea and diarrhea when taking AIs.

Reference:

• "Gastrointestinal Side Effects of Aromatase Inhibitors" - Annals of Oncology

5. Psychological Effects​

Mood Swings and Depression​

Women on AIs may experience mood swings, depression, and other emotional symptoms, although the data is less consistent in this regard.

Reference:

• "Psychological Impact of Aromatase Inhibitors in Breast Cancer Treatment" - Journal of Psychosocial Oncology

6. Sexual Health​

Vaginal Dryness​

AIs can cause vaginal dryness, which can lead to discomfort during sexual activity and a decrease in libido.

Reference:

• "Sexual Dysfunction in Postmenopausal Women Treated with Aromatase Inhibitors" - The Oncologist

Conclusion​

While aromatase inhibitors are a critical component in the treatment of hormone receptor-positive breast cancer, their long-term use is associated with various side effects. It is essential for patients to consult their healthcare provider for a thorough understanding and management of these potential risks.