Warning: Feminist, anti-patriarchal question on hormonal therapy
Would any drug designed for men be released to the public if about half of those taking the drug could not tolerate the side effects for the prescribed course? If one of the major side effects of this drug was unrelenting penis pain so severe that it prevented intimacy would the words "well tolerated" be used to describe it and would it continue to be advocated as "the gold standard"?
Would an increase in heart disease, stroke, cancer of the reproductive organs, joint pain and broken bones all be accepted as part of the bargain that men must make when choosing among these drugs?
Would strategies to improve adherence to taking the drugs emphasize "education of patients, assessment of the ability of patients to understand their disease and related recurrence factors, and providing adequate support and strategies for good self-management?" Or would the focus be on improving the existing drugs and making better ones?
I'll admit I am ignorant of most drugs designed for diseases that plague my male counterparts, therefore I am not familiar with the side effects, which could also be severe. Like that four-hour erection thing.
Comments
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Lea, c'mon...do tell...which drug are you talking about, so we can all tell you which side effects we have/have not experienced.
HOWEVER, if your post was meant to be a rant and only a rant, I totally understand because I CAN RANT...LOL. In that case, please disregard this post and please carry on.
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'Tis a rant, MO-Beth.
Mainly, I am referring to the array of "hormonal therapy" estrogen suppression drugs: Tamoxifin, Raloxifene/Evista and the 3 aromatase inhibitors, Aromosin/Exemastane, Armidex/Anastrozole, Femara/Lestrozole. They trade off on a variety of side effects, some of which I have experienced and some of which I have yet to experience.
The four-hour side effect referenced above occurs with Viagra or in the his-and-her bath tubs with Cialis. I have no experience with either of those drugs or with a personalized bath tub.
I shall carry on....
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Lea, glad to see a feminist rant on here. You make valid points and had me chuckling besides. Please do carry on!
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How about the fact any lack of estrogen getting to the brain declines cognitive ability. That is a big one for me, and the reason I refused it. There was research done that allows the brain to protect the myelin sheath with MEK inhibitors, but no one has followed through with this study and I can't find an oncologist willing to prescribe it. So, I am risking the return of my cancer because I value my cognitive ability.
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Let’s go one step further...would men put up with the primary surgical option being to cut off their penises and replace them with heavy, numb, silicone implants that have zero functionality?
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love this thread so true.
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Lea - No lie - I was thinking the exact same thing last night as I was massaging one of my BMX scar--- this cracks me up....omg where the mind takes us...
I'll carry on over here... :-) ;-)
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Well, why wouldn't a man taking tamox wade into this debate. And a man who has had a mastectomy and a prostatectomy. First, I have to admit having no side effects on the drug, but I do worry about it losing its efficacy at any time and me moving from stage III to stage IV.
This drug is being used on me with minimal research, basically they are making up its use on men as they go along based on our experiences. Don't get me wrong, I'm happy to be on it, but I had a stroke last November and I can't help thinking the blood clot was caused by this drug. My cardiologist suggests I go off it. That's a bit scary for me, since I have to decide if I should go off the drug and risk recurrence, which involves a slowish death, or stay on it and risk another stroke which, this time, could involve a quickish death.
Anyway, I wish everyone here good luck as you handle hormone blockers.
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I might gently suggest we encourage our daughters and granddaughters to go into medicine. Did I not read recently that there are now more women than men entering medical school? Change will come with the next generation.
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The change has already happened where I live Ingerp. All my treatment for bc was by women: general practitioner, sonographer, breast surgeon, oncologist, radiologist, geneticist,ambulance drivers for an infection emergency, and, of course, the nurses.
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I'm so glad you piped up Traveltext! My daughter (Radiation Therapist) said Tamoxifen side effects for men are pretty awful. This was in response to me complaining about the potential side effects before I went on it. So far 6 weeks in it hasn't been too bad for me but I get the op's rant. Women's sexual side effects often get minimised by Drs. I hope they come up with stuff that's better for more people but the fact is...us women need estrogen but it feeds some types of cancer so the only way to stop this is anti hormonals which have side effects.
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Well, men who are diagnosed with bc also take these drugs. And I've never heard that 50% of users can't tolerate them. But maybe you can link a study.
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Men with prostate cancer often take anti-hormonal drugs also. The often end up impotent and incontinent, so I guess they put up with a lot too.
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Good points, Melissa. I did not know men went through all that.
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MelissaDall: Thank you for pointing this out. Men with prostate cancer who get surgery often land up wearing diapers, not having orgasms, being unable to have erections without artificial assistance, and have brain fog and loss of muscle mass plus osteoporosis from androgen deprivation therapy and hip fractures, not to mention depression from all of this. Thirty thousand men died of prostate cancer last year, often with painful bone metastases, not a nice way to go, Sadly, starting in 2011 government committees trying to save money (under the guise of avoiding unnecessary treatment side effects) decided to encourage docs to stop screening for PCA (and boy were they ready to comply!) , even in high risk men such as African Americans and vets exposed to cancerogenic Agent Orange, and it was not until last year that a modest move back to at least some screening was revived.
Ladies, we suffer, and it sucks, but pretending that men are not also caught up battling diseases with bad side effects and no good drugs, and fighting for government research funding, is not going to help women. I have seen way more pink ribbons and happy-faced marche for BC cures than I have for any men's health in recent decades ( other than HIV) or prostate cancer, and somehow women losing boobs or fighting BC get more coverage and sympathy in media than emasculated men with bone mets from prostate CA.
We are all in this together! Cancer and its treatment are awful, for both sexes, whether delivered by male or female doctors, but I am grateful that thanks to research and innovation, we at least have more options now than we did just a few decades ago, and hope scientists will continue to innovate.
I say this as someone who just woke up with Arimidex-induced soaked sheets, a sore Biozorb site, and a husband who is mentally readying himself to go to the urologist today to talk about major prostate surgery and treatments that might lead to the need for budgeting for Depends, not to mention loss of his profession, which is highly dependent on his brain power.
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Lea - love your rant.
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I hate the "pink ribbons and happy-faced marches" described above. I often feel that there actually isn't that much sympathy for BC because people assume that it's easily curable and somehow not a "real" cancer.
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While I loathe the hype around our disease that the pink charities create in the name of awareness, because it implies just female awareness, I'd have to say that bc men have benefited from the research that has lead to the new drugs used to treat Stage IV patients. Fortunately, the two big treatment advances since my mom died aged 40 with bc, chemo and hormone blockers, have extended survival rates, but 30 years of fundraising and pink hoopla still leaves us with an incurable disease. And, while the annual pink parties celebrating this sexualized disease continue to raise more funds than for nearly all the other cancers combined, so little of these funds end up in stage IV research and up to 60% of contributions end up paying the pink charity admin expenses.
Chronicpain, thanks for pointing out the worst of the prostate cancer experience, but those more radical treatments apply to late stage patients, and as with bc, early diagnosis can lead to better outcomes (PM me for links to sites that can help your hubby through treatment should he need it). Even with early PC treatment, incontinence and importance are very common, and recovery depends on luck as far as how far the disease has spread, and the surgeon's skills in sparing the nerves that control sexual and continence functions.
I'd have to add that my BC treatment was much more traumatic than my PC treatment and I worry far more about recurrence of the former rather than the latter.
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Just want to chime in about PC. My father has it, he is 90 and has been treated with surgery, radiation, and hormonal treatments since it became metastatic about 4 years ago. I can do first hand comparison to the same treatments in BC. In my opinion, PC surgery is more impactful than mastectomy (after all, mastectomy is not invasive and apart from appearance there usually are no issues.) Radiation is also more impactful because it often causes rectal and other issues. Hormonal therapy has all the same side effects as women get with BC (hot flashes, low energy, bones deterioration, etc.) So the guys don't get it easy either.
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muska, I'd say your father had an open prostatectomy which is indeed a long and traumatic op considering the location of the prostate. Mine was a robotic prostatectomy and you end up with four tiny holes in your tummy where the robotic arms are inserted and a slightly larger hole through which the prostate is removed. You are out of hospital next day and healing is pretty quick. Flashback to my mastectomy which removed pecs and all the breast tissue and included a full axillary clearance, and you have a pretty major op which took six weeks to heal and countless drain emptying. And since guys aren't offered reconstruction, the end result, four years later, is a concave, hairless left chest which is the opposite of what the good side looks like. The pic was taken a couple of months post rads. Unlike body hair affected by chemo, radiation damage is permanent.
So, Lea, I too like your post and agree with your general sentiments, but I know first hand men have many medical issues to contend with including imperfect drugs and imperfect outcomes.
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Carmstr835, cognitive abilities are at the core of who we are and I understand your desire not to sacrifice this. .Didn't know about MEK inhibitors.Thanks for info.
Something slightly hopeful below regarding letrozole.
It is not clear whether tamoxifen acts as an agonist or antagonist in the brain [22,23]. Aromatase is expressed in many regions of the brain, although little is known about its role and implications for cognitive function. The very low levels of circulating estrogen which occur with the use of aromatase inhibitors in postmenopausal women might be expected to result in a deterioration in cognitive function. Conversely, recent data suggest that letrozole administration may enhance cognition in both male and female rats [24,25].
Note 24 Alejandre-Gomez M, Garcia-Segura LM, Gonzalez-Burgos I. Administration of an inhibitor of estrogen biosynthesis facilitates working memory acquisition in male rats. Neurosci Res. 2007;58:272–277. [PubMed]
Note 25 Aydin M, Yilmaz B, Alcin E, Nedzvetsky VS, Sahin Z, Tuzcu M. Effects of letrozole on hippocampal and cortical catecholaminergic neurotransmitter levels, neural cell adhesion molecule expression and spatial learning and memory in female rats. Neuroscience. 2008;151:186–194. [PubMed]
Link to above is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109568/
Peacetoallcuzweneedit, glad I could provide a chuckle.We all need that too!
Teachermom4…,You are right, I don't believe silicon, non-functioning penises would fly. But there does exist a parallel to breast cancer with prostate cancer. Traveltext makes that very personal point, wading into this discussion/rant with several insights. I wish you the very best with your treatment, Traveltext and thank you for taking the time to comment so extensively.
Katiejane777and MelissaDallas, appreciate you bringing the male perspective as well. ChronicPain, your name says it all. You have presented the male and female perspective very well and I am sorry you are in a position to be able to do so. My sincerest well wishes to you and your husband. Muska, thank you for sharing your father's experience and I wish him many more healthy years.
Ingerp – Female doctors may help! Right you are! Also female pharmaceutical scientists and those in the financial end of the business. Men who have had loved ones dealing with a variety health issues may also be more informed and effective if they enter into the medicine and drug fields.
Pupmom, some links are in order for the "half quit treatment" statement and here are 5. Thanks for mentioning it.
The realization and acknowledgement of the high non-compliance rates is becoming more apparent all the time. I would even venture to guess non-compliance may be higher than what is reported because some patients do not want to admit they are not taking their medicine, even anonymously claiming they toss the drugs and lie to the oncologist.
Link #1
https://www.nursingtimes.net/home/behind-the-headl...
Quote from the link:
"Drugs such as tamoxifen are used after surgery in order to prevent the cancer from returning. It is generally recommended that hormone treatments are taken for five years following surgery.
Looking at prescription data the researchers found women were on average less likely to stick to their treatment over time. This is known as adherence to treatment. In the first year, for example, women adhered to treatment 90% of the time. This figure dropped to 50% by the fifth year."
Link #2
https://www.karger.com/Article/Abstract/100444
Quote from the link:
"In clinical practice settings, only 2 reports addressed longer-duration (>4 years) adherence to adjuvant tamoxifen use. In these, tamoxifen was prematurely discontinued by 30–50% of the patients. Conclusion: Adherence to prescribed breast cancer hormone therapy has not received concerted attention."
Link #3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731975/
Quote from the link:
Van-Herk-Sukel et al. reported that about 50% of the breast cancer patients discontinued tamoxifen or any endocrine treatment before the recommended treatment period of 5 years [13]. Hershman et al. suggested that only 49% of breast cancer patients took adjuvant endocrine therapy for the full duration.
Link #4
https://hal.archives-ouvertes.fr/hal-00535433/document
Quote from the link, which is the title of the report:
"Half of breast cancer patients discontinue tamoxifen
and any endocrine treatment before the end of the recommended
treatment period of 5 years: a population-based analysis"
Link #5
https://www.sciencedirect.com/science/article/pii/...
Quote from the link:
"Non-compliance rates are similar in patients treated with AIs, tamoxifen (TAM), or a sequence of both, and ranges between 40 and 60%. Reports confirm that these high rates are largely attributable to the presence and severity of adverse effects."
Moth, glad you got a kick out of this rant, which generated thoughtful comments by others.
Meow13, thank you for the nice comment and your kitties are gorgeous.
NotVeryBrave, you are likely more brave than the name indicate. Let's hope those callous individuals without sympathy will be validated and breast cancer IS easily curable soon. Until then, f 'em all.
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I believe quite a few male patients are noncompliant with antihypertensives (I have not looked up studies to support this statement but I have seen this in practice) because of impotence problems. And those meds are considered generally well tolerated.
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Traveltext, so sorry, you should be offered reconstruction. Why should it matter what sex you are? It sure helped me emotionally I want to erase ever having had a mastectomy from my mind. I want to look and feel the way I did before cancer.
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Lea, LOL...well, I knew what you were referring to with the four-hour erection reference. And since this is a rant, I just want to say I think that THOSE BATHTUB COMMERCIALS ARE SOOOOO STUPID! Who thought that was clever?!
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You gals/guys are so brave to decline the hormone blockers. I respect that. I'm not one to believe much that doctors say and I often question run-of-the-mill medicine, but in this case, I'm going to choose to believe that my breast cancer was caused by ER/PR positive factors and that it will help keep it away if I block these hormones, and I'm afraid that my cancer will come back if I don't take the hormone blockers.
Travel, I've been taking Femara for about a year. I don't feel any side effects. Well, I have "cold flashes" instead of hot flashes. Odd. And my bones are probably deteriorating. That is one of the downsides with Femara. But I will soon be taking a med for bone strengthening. Tamoxifen actually strengthen bones; however, blood clot formation is the downside with Tamoxifen. I'm not willing to risk that.
All of my breast cancer care people/doctors/nurses were women, except for one, who was a radiation technician. My daughter has a career/master's degree in something else, but she is looking into studying cancer markers (not sure exactly what that is.)
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P.S. To those of you not taking hormone therapy: My mother-in-law had breast cancer in 1962 when she was in her early 30s. They were in the military. She wasn't given much of a choice, they performed a mastectomy on that breast. No radiation. No chemo. No hormone blockers. She never had a recurrence. She lived a long life and died a few years ago of something else. Just sayin'..................
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Meow, it didn't worry me at the time since I was just so ready to finish treatment that I didn't think of the aesthetics. But looking at things today, and that's pretty much how I look now, minus the burn mark, I'm thinking I could look better. I've never for a minute compared the physical importance of my chest to that of a woman's, and I'm certainly glad that my situation doesn't come with the added cultural baggage that a female's breasts incur. However, the funny part is that I've met lots of bc men and they are all quick to show off their chest scars. That and engage in a big man hug. So, I feel part of a brotherhood of rare guys and that's not really a bad thing.
MO-Beth, it didn't take long to find the Cialis ads on Youtube. Priapism, an erection lasting more that four hours, now that could be a painful nuisance. ouch
Here's a very funny spoof ad:
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Travel, I am glad you are ok. But I could definitely understand if you wanted it fixed. Luckily, my bathing suit hides the scars especially the ones under my arm and my hip to hip incision. I am going to be 60 but I still think of my self like a 35 year old.
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16 hours ago pupmom wrote:
And I've never heard that 50% of users can't tolerate them.
Icietla writes:
Nor have I. I understand many never even have filled the first prescription therefor. I understand those who get prophylactic endocrine treatment tend to be less compliant than those in adjuvant treatment for cancer. I understand those early stage breast cancer patients having diseased nodes tend to be more compliant than those with node-negative disease state/s. I understand those around either end of the spectrum of patient ages are more likely to be noncompliant. I understand many of those who attribute bothersome side effects to their endocrine treatment cannot fairly rule out that they are experiencing (continuing or worsening) side effects or aftereffects of radiation treatment and/or chemotherapy administered prior to their endocrine therapy. I understand that medicine/s expense (for all the medicines prescribed for any given patient) seems to be a factor bearing on non/compliance. I have memory issues (unrelated to my cancer and its treatment) that could impact compliance; I understand many others have memory issues that could impact their compliance. I understand many women decide to have babies instead of (starting or continuing) endocrine treatment. I understand (without understanding) many are afraid of being "thrown into menopause." I understand many are "terrified" of "the horrible side effects," vague reference/s to which they have seen on the internet.
As we all know very well, as to any sort/s of medical advice, there is always a great deal of noncompliance among patients. Despite their suffering ill effects, many will not quit wearing high-heeled shoes. Many pre-diabetic and diabetic persons will not comply with dietary guidance. Because of noncompliance, we have drug-resistant bacteria. There are many "opioid-associated" deaths from overdosing and/or combining the medicine with some other drug/s, maybe with driving too, but as far as I am aware, nobody has ever died from taking (just) the opioid dose prescribed them, used only as advised/directed/prescribed by their prescribing Physician. Because of noncompliance as to birth control ordered, there are tragic birth defects from Accutane. Most having substance abuse problems will not quit their substance abuse unless/until they must quit it. Etc.---
>>Would an increase in heart disease, stroke, cancer of the reproductive organs, joint pain and broken bones all be accepted as part of the bargain [...]<<
Icietla writes:
As far as I know, increased risks of those health conditions go with getting older, anyway. Is getting older not acceptable?
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>>Would strategies to improve adherence to taking the drugs emphasize "education of patients, assessment of the ability of patients to understand their disease and related recurrence factors, and providing adequate support and strategies for good self-management?"<<
Icietla writes:
Certainly. If the Health Care Providers were doing an adequate job that way, we would not need to do it here. We would not get questions like -- My tumor was excised, so I am cured, so why is this medicine (or chemo course, or radiation course) recommended? -- From outcomes data is predicted only a small incremental benefit at five years, so why is this medicine (or chemo course, or radiation course) recommended? -- I know someone who had breast cancer and seems to be doing fine without this medicine (or chemo course, or radiation course), so why is it recommended for me? -- My cancer was not of the most aggressive grade, so why is this aggressive treatment (medicine, or chemo course, or radiation course) recommended? -- My OncotypeDx testing says I am at low recurrence risk, so why is this medicine recommended? – My mother did not have a BRCA mutation, so I have no risk factors for breast cancer, so why is this medicine (or chemo course, or radiation course) recommended? -- I am postmenopausal, so I have no estrogen in my system, so why is this medicine recommended?
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I think it is the one size fits all when it comes to handing out treatment. So much for targeted personalized medicine.
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