That was not in the plan.

It’s good there is a plan now Chris but I’m with you on not being excited about 6 months of bicalutamide and that this is difficult to deal with. Sending best wishes to you and yours. 

Chris. I didn't find the six months Bical too bad. The gynecomastia was the only side effect of consequence. I wish I had been put on Tamoxifen from the start. Three months after finishing the bical the moobs are still here but the tenderness has thankfully gone. Most body hair disappeared and that has not yet put in a reappearance. Six months passes fairly quickly in the wider scheme of things. I wish you good luck with the SABR. Chris

Hello Chris, the onco's reaction regarding Tamoxifen is disappointing. Tamoxifen does increase risk of DVT, so not normally allowed if you've had a DVT before or at high risk, or coronary artery disease. It does cause non-alcoholic fatty liver disease in about 20% of the women who take it for 5 years to reduce risk of breast cancer recurrence, but that's at 20mg/day, which is a higher dose than is needed to prevent gynecomastia/mastodynia while on anti-androgens (such as Bicalutamide), and liver problems are easily checked with a liver function test in any case, so that issue can be picked up before it becomes a problem.

Moobs is usually more associated with increased breast fat tissue, which is different from gynecomastia (which is breast gland growth). The hormone therapy injections are more likely to cause increased breast fat tissue. It's less likely to happen with anti-androgens, but does happen sometimes. Tamoxifen won't do anything to prevent increased breast fat tissue.

It's important to understand the two types of breast growth:

Gynecomastia (breast gland growth), often with mastodynia (painful nipple sensitivity). This is caused by the ratio of Testosterone to Estrogens changing. Bicalutamide pushes up Testosterone level but prevents androgen receptors from being able to see/use it, so breast gland tissue thinks there's little/no Testosterone. On the other hand, Estrogens in men are manufactured from Testosterone, and the higher level of Testosterone causes a higher level of Estrogens. So breast glands see very little Testosterone and more Estrogens, which is their signal to grow. Tamoxifen is a selective anti-estrogen, and blocks some of the body's estrogen receptors, notably in breast tissue. (It does not block estrogen receptors in bone, so doesn't contribute to osteoporosis.)

The other type is breast fat growth (sometimes called pseudogynecomastia). This is caused by the loss of Testosterone, and the body laying down fat in a more female form. Breast fat growth does not cause mastodynia. Tamoxifen has no effect on breast fat.

Both types of hormone therapy can cause both types of breast growth. Bicalutamide is particularly well known for causing gynecomastia and mastodynia, typically from around 2 months on the medication (so it's not a problem for the 28 day anti-flare dose). You can feel your breasts to detect if there's any breast gland tissue there (firmer), or just breast fat.

Tumeric, apple cider vinegar, ginger and manuka honey help with joint pain. 
I’ve noticed some improvement, over the las5 few moths. I also use my rowing machine and do some weights, I have some significant arthritis in hips  and back, this really helps. 

Hope this helps lads.

Leila