Danger of Suppressing Estrogen and Weakening.Immune Response

Mstein1970

I've been on Arimidex.for 3 years now. And I'm afraid of continuing to take it during the pandemic. It's believed men are dying more than women partly because estrogen is protective. Does anyone else share this concern? I wonder if a respite from the medication would be less harmful than taking a drug that weakens my immunity.

Salamandra

I think this is a fair and timely question, and I hope it's something that medical oncologists are thinking about. It will also impact premenopausal women in chemically-induced menopause.

From what I can see, they haven't confirmed that the gender difference is due to estrogen - it's still a working theory.

The protection from AI continues after stopping - but I don't know what that means about how soon estrogen levels return to normal either.

Can you ask you doctor? (and share here if you get any useful information)

Mstein1970

Hi, Salamandra --

I'm in NYC, too -- in Manhattan. Using Sloan Kettering's online patient portal, I submitted the question to my oncologist yesterday. No response yet.

CinD

I would be interested to hear what your oncologist says. My guess is they'll say that not enough is known regarding whether it is the estrogen that is protective.

As an aside, I take Tamoxifen rather than the AI's and was surprised to read that Tamoxifen is also an antiviral, antifungal, and antiparasitic. With researchers looking into all existing drugs to see if any are effective against COVID-19, I wondered if Tamoxifen had been tested.

Mstein1970

CinD, that's interesting about tamoxifen. Of course it doesn't suppress the production of estrogen. It just keeps it from bonding with cancer cells. So you still have its benefits. I was thinking of switching to it and hope to discuss that with my oncologist.

AdAstra

I’ve recently paused taking anastrozole when things started getting stressful where I am. For me, it was less about estrogen itself and more about not wanting to deal with the side effects while facing so manyextra stressors. I really felt I needed my body and mind to at their best to get through these next couple of weeks (or months).

jessie123

A doctor on FOX also just mentioned that estrogen is potentially the reason women are not getting the virus as often as men. This is interesting.

marijen

Does anybody ever go to breaking news?

Estrogen related....

Hand washing habits or hormones? With nearly 50% more men than women dying from COVID-19, researchers are looking for answers

LONDON, March 4 (Thomson Reuters Foundation) - When Chinese authorities released data on coronavirus deaths, one striking trend emerged - fewer women were dying than men.

Researchers looked at 44,672 confirmed cases of coronavirus in China from late 2019, when the virus first emerged, to Feb. 11. Most experienced only mild symptoms but 1,023 died - an overall death rate of 2.3%. Of these, 653 were men. Despite the fact that roughly equal numbers of men and women in China caught COVID-19 - which is now confirmed to have killed more than 3,000 people globally - the death rate among male victims was significantly higher, at 2.8% compared to 1.7% for women. That represents a 48.89% difference.

Should we be surprised by this? It's hard to say. While no two viruses are the same, looking at similar outbreaks can offer some insights. Other major coronavirus outbreaks - including Severe Acute Respiratory Syndrome (SARS), which originated in China in 2003, and Middle East Respiratory Syndrome (MERS), first reported in Saudi Arabia in 2012 - also killed more men than women. Research on mice also suggests males may be more vulnerable to these viruses.

In depth: Coronavirus and its impact on people, cities, and economy

One theory behind this difference is hormones. Research by Stanley Perlman, a professor of microbiology and immunology at the University of Iowa, showed female mice were less susceptible to the SARS virus than males. But when the female hormone estrogen was blocked, or their ovaries were removed, the female mice were more likely to die.

"Our results would suggest it's probably something intrinsic, and it may be hormonal," said Perlman.

Although the sample is quite large, it is still hard to draw any firm conclusions. Scientists say a number of environmental factors could have played into the statistics, from differences in how male and female patients were treated to lifestyle factors. For example, Chinese men are more likely than women to be regular smokers.

Separately, studies have found that men — even health care workers — are less likely to wash their hands or to use soap than women, a practice that could limit the spread of the virus.

The implications are probably limited at this stage. Perlman said that all else being equal, if two people came down with the disease he "might be a little more worried about the male".

The World Health Organization (WHO) does not distinguish between the sexes in advice on its website, which says only that "older people, and those with pre-existing medical conditions (such as high blood pressure, heart problems or diabetes) appear to be more vulnerable".

Mstein1970

My oncologist responded to my question about taking a pause from Arimidex or taking it less often than once a day. And as I expected, she said simply, without explanation, that I was "not immunocompromised" by taking Arimidex. She advised me to keep washing my hands and practicing social distancing.

Not the thoughtful, less dismissive response I would prefer.

Totallytubular

interesting.. please post if you find more info here. pays to be safe and isolate and be healthy as possible.

Totallytubular

I'm in New york too at MSK. Please let us know if you hear more information.

spiralforest

I also just asked my oncologist about this tonight and his response was "No one knows." But I also said I was worried about going to a clinic to get my zoladex shot because of possible exposure to the virus. I was surprised that he told me not to go. He said stop the injection for 8 weeks and stop the anastrazole (as I can't take that unless I have my ovaries suppressed).

Montreal went from having 28 positive to 265 and they are not testing everyone with symptoms. Several people posted on a group in facebook that they went to the drive through test and were told they weren't sick enough. You can also be positive and not have symptoms, so some people might not know they have it.

I don't think that there is enough protective gear that all medical personnel could wear it, but they should.

Salamandra

Hey spiralforest, I'm glad your MD is being supportive. Would he consider prescribing tamoxifen for you while you are off your AI? It might not be as good as an AI for your case, but it's more than nothing.

Mstein, that sucks, that is a pretty dismissive answer.

spiralforest

Hi Salamandra,

He didn't suggest taking something else and I shouldn't take tamoxifen as I have a history of endometriosis (even grew in my liver). This is actually why I am taking zoladex with an AI instead, just because of the endometriosis issue.

I'm fine with taking 2 months off. In fact, I felt this joyfulness when I got his email and knew I didn't have to have that injection this week. I wonder if I didn't get my period again that maybe I wouldn't have to start it again. If they could check my hormones after it. I'll be 55 this summer, so menopause should be soon.

Peregrinelady

I just read the transcripts from a podcast here “what we need to know now” or something like that and the interviewee included hormonal therapy in a list of things causing us to be immunocompromised.

windingshores

The moderators post on COVID-19:

. Some breast cancer treatments — including chemotherapy, targeted therapies, immunotherapy, and radiation — can weaken the immune system and possibly cause lung problems.

I assume "targeted therapies" includes HER2 treatment but not sure about aromatase inhibitors.

There is info online on this but not sure what the source is:

"It is believed that the immune response is more robust during a woman's reproductive years due to higher estrogen and progesterone levels and once menopause begins, estrogen and progesterone levels drop resulting in a lowered immune response.The changes in immune function and activity of certain immune cells seems to be linked to the decrease in estrogen.Furthermore, statistics indicate a dramatic dip in autoimmune disease occurrence in women following menopause."

Makes sense to me intuitively anyway. I am fortunate in being close to 5 years with a Breast Cancer Index showing no benefit from extended treatment so I stopped this week. Not sure how long it takes for estrogen levels, such as they are at 68, to go back up.

ctmbsikia

Thanks for the info here. Never thought about lack of estrogen suppressing ones immune system. Make sense though since I have to shave my chin all while trying to stop the thinning hair on top of my head!!!!

Moderators

Hi All,

You may want to take a look at this podcast COVID-19 and Breast Cancer Treatment Brian Wojciechowski, M.D. where Dr. Wojciechowski confirmed hormonal therapy doesn't affect the immune system. Thinking of all of you!

The Mods

Anonymous

Did those studies look at the death rates between men and women of the same age bracket, that include where women are postmenopausal? If they are equal then there could be a link, but estrogen + other factors (hand washing, more working outside the house, population density, smoking, obesity, pollution levels etc) could also drive greater risk. The data tables in the article above don't break out deaths by sex ratio by age cohort, so its difficult to tell if the estrogen theory holds based on THIS analysis, although another may come out of somewhere more reliable like Italy/France/UK.

windingshores

I personally would not stop aromatase inhibitors for this reason until the info on immunity was proven.

Someone mentioned taking a pill every other day. Due to the half life and also the fact that even 20% of the normal dose works to suppress estrogen (according to the company's own insert),alternating days would not do much to restore previous estrogen levels.

Mstein1970

I was exposed to the virus in my workplace a few weeks ago.

I had a frustrating back-and-forth on the portal with my oncologist, who didn't advise skipping days but finally and seemingly reluctantly said I could go off Arimidex completely until the crisis ends. Last Saturday morning I had a slightly higher-than-normal temperature and decided to go off Arimidex. Needless to say, I'm nervous about what I'm doing and though my temperature was a little high again this morning, I may go back on the drug soon.

2002chickadee

I'm at Memorial Sloan Kettering too, my oncologist switched me to an every 10 weeks Lupron injection to minimize need to come to the center, and said there is nothing in my treatment history that would make me more susceptible or have worse outcomes if infected. I had asked specifically about prior radiation with the lung in the field, which I had. I'm not entirely sure if the switch is to protect me or protect the people with cancer treatment that definitely compromise their immune systems from having more people around. In any case, once I got over a short anxiety spike that happens any time treatment is changed, I decided it was fine and will proceed per recommendation, staying on AI as well.

jennyunderthesun

how are you doing on the longer term lupron? I’ve been wondering about switching to try to consolidate my contacts even further...

NoWhyToIt

I am on longer term Lupron and fine. At first it seemed I was fatigued but now, normal...