ADT/breast pain or breast enlargement

On_A_Journey

https://csn.cancer.org/discussion/comment/1721033#Comment_1721033

You may very well be feeling more emotional because of low testosterone, especially if your natural testosterone/estrogen ratio is out of kilter (they are normally aligned), but bear in mind that there is a difference between de-masculinization and feminization. A big difference.

Whether you wear a dress or not is totally up to you, lol! 😊

Josephg

You definitely can experience more emotions while on ADT. During my PCa journey, I've had 2 1/2 years of time on ADT, and from time to time, I experienced emotions, even tears, at times or in situations that I would never have acted in this manner while not on ADT. I've had times when I blurted out something without thinking, and then finding me asking myself, 'where the he** did that come from?'.

All part of the PCa journey.

On_A_Journey

Well said, Joe. It's all part of the journey. To remind others, I'm not on ADT (yet), but I totally accept anything that comes my way which might result from it. I just think of it as a part of life's rich tapestry, and it should be embraced because of that.

jimekrut

https://csn.cancer.org/discussion/comment/1721085#Comment_1721085

I understand the sentiment, but I'm not ready to accept passively those likely or potential side effects that are safely and simply mitigated, including breast enlargement (and smaller or absent erections). I'm a person who embraces both faith and science, relying on both. Each has to choose his pathway.

Josephg

https://csn.cancer.org/discussion/comment/1721086#Comment_1721086

You are correct in that each PCa survivor gets to make his pathway. But, let's be clear. There is nothing passive about accepting and undergoing ADT therapy. It is a choice that many of us make because it is part of a tried and true pathway to survival for advanced cases of PCa.

jimekrut

https://csn.cancer.org/discussion/comment/1721089#Comment_1721089

I'm sorry not to be more clear. I'm not willing to accept all side effects passively. If I can reduce or eliminate them safely and reasonably, I'll do so. I finish my second month of Orgovyx this weekend, but I'm starting weight training to reduce the loss of muscle mass and beginning Cialis to reduce the severity of permanent damage to sexual function. I'm also moving more vegetarian/vegan to combat the increase of PSA following treatment and struggling against weight gain. These may be inconvenient but workable for long-term health.

On_A_Journey

"I'm not willing to accept all side effects passively."

I think we can all agree with that!

Put 10 of us in a room and we will nominate 10 different side effects that we are willing to tolerate and 10 that we feel we need to deal with! For me, the side effect I dread most is hot flashes. IF they are intolerable and I feel the need to deal with them medically, I would be happy to utilize the most effective treatment - estrogen, in the form of estradiol patches or gel. I wouldn't care if it exacerbated gynecomastia, which in my mind, would be one of the least bothersome side effects. But that's just me. I totally respect that other people would list gynecomastia as the most bothersome side effect.

jimekrut

https://csn.cancer.org/discussion/comment/1721098#Comment_1721098

I started having hot flashes almost immediately, but they're pretty mild. I'll wake up during the night sweating or begin feeling especially warm during the day. My concern with estrogen would be if it causes PSA to rise. One difference between hot flashes and gynecomastia is that the latter is permanent. May your journey be smooth and as side effect-free as possible!

On_A_Journey

"My concern with estrogen would be if it causes PSA to rise."

Yes, there are plenty of studies and research papers around which seem to indicate that early exposure to estrogen increases the likelihood of getting prostate cancer down the track.

Isn't it funny, it was only 50-odd years ago that the gold-standard treatment for prostate cancer beside surgical castration, was in fact, estrogen in the form of estradiol (E2). It competes with androgens binding to their receptors, i.e. it neutralizes testosterone.

As an aside, I found this article the other day and I post it solely because of the information displayed in Table 1 (the loss of which hormone results in which side effect. Hopefully this will help educate anyone reading it and give a greater understanding amongst those who might not have otherwise known) and table 2 (particularly the first column, comparing the results of E2 monotherapy with GnRHa monotherapy). In it, it can be seen that treatment with E2 alone results in the same level of castration after 3 months as what we now call traditional chemical castration. At 6 months, hot flashes are 8% vs. 46%, and then there is the bone density sparing factor as well. The rest of the article is interesting and gives context.

Loss of Estradiol by Androgen Deprivation in Prostate Cancer Patients Shows the Importance of Estrogens in Males | Journal of the Endocrine Society | Oxford Academic