Danger of Suppressing Estrogen and Weakening.Immune Response

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)

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.

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).

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".

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

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.

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.

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.

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

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.

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.

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