Thought I'd write a bit about my own gynecomastia (breast growth in men), which I carefully monitored and treated.
I've been on 50mg Bicalutamide for 5+ months (although that's just being changed as it's not a strong enough ADT treatment for me). I read a load of scientific papers on ADT in that first week I was on it, so I knew I had about a 70% chance of breast growth. I asked for prophylactic Tamoxifen or the one-shot breast radio therapy to prevent breast growth, but they said they don't do either.
About 11 weeks in, I got pain in one breast behind the nipple, and wondered if that might be the start. 3 days later, it started in the other breast too, and 2 days after that, I could feel a breast bud (firmer tissue which will become the glands and ducts) in the first one. Apparently, 11 weeks is quite early for this to happen, but it did in my case.
At that point, I asked for Tamoxifen again, and got it the same day, which I wasn't expecting after my previous requests were denied! It had been prescribed by someone I never met, and the instructions were a bit vague after it had been passed to me via a nurse. A 20mg/day dose was prescribed, but it said try just twice a week to start with (which also confused the pharmacist in Boots, not to mention that prescribing Tomoxifen to a man was new to her too, so I had to explain). I did the twice a week dose and it helped the pain (which I didn't really care about) on just those 2 days, but breast buds continued growing on both sides, the left one slightly in the lead. I also tried cutting up the 2 tablets and spreading across the week, but that didn't work either. I gradually scaled the dose up to 20mg/day, and that did work - pain was gone, and the breast buds which by that time were more noticeable (by me) stopped growing, and after a while started shrinking, left one first, so the right overtook it in size. 8 weeks on Tamoxifen, the left breast bud is undetectable by me, and the right one is almost gone. It seems like they've taken slightly longer to go than they took to grow. I've dropped back to 10mg/day and will see if that still works. If it does, I'll then try 5mg, knowing that I can reverse any growth by increasing the dose again. My understanding of woman's breast growth is that it tends to be in bursts (my browser history recently contains many bizzare things), and if this is the same for me, then I may only intermittently need the 20mg/day, but I don't yet know that. Tomoxifen in response to growth is most effective when given quickly and when it is successful, it can completely reverse growth of breast buds. However, once fibrous tissue starts forming to support the glands, the fibrous growth cannot be reversed. I've seen a number of comments suggesting you should take it within a week of growth starting, and there's no point taking it for any growth more than a year old, which it can't reverse. It looks like some of you on 150mg Bicalutamide have been given 20mg/day prophylacticly at the outset, although at that dose, breast growth is going to be even more certain, so maybe prophylactic isn't the right word.
From the published papers I've subsequently read (lots!), it seems there's actually no evidence the prophylactic 20mg twice a week dose works, but the 20mg/day dose does in 70% of cases, which is higher than the success rate with the single shot radiotherapy blast (I think that was 50-60%, but can't recall now). Tomoxifen is not without risks itself and reducing the dose when you can get away with it might reduce those risks too, although I haven't seen any research on that so it's speculation on my part. Some people can't take Tomoxifen at all due to other medical conditions. Single shot radiotherapy is also not without risks - it does cause heart damage later on in 1-2% of patients.
Breasts are not just glandular material - they also contain a lot of fat and I do have some of that (even before the HT, and even though I'm quite slim). I've seen nothing which says if Tomoxifen will protect against fat build up in breasts, or if it's only the glandular material, and I don't have enough experience myself to tell yet. I don't know if I have any extra breast fat formation since starting HT, but certainly not a lot more than was there before. I saw a video of me doing a recent presentation in quite a tight T-shirt, and breasts were noticeable, although not distinguishable from good pecs! (which they aren't). I then dug out a video of another presentation I did before being on HT, and that looked exactly the same, so I don't have any evidence of breast fat growth on HT with Tomoxifen myself.
Not all girls, and therefore I assume not all men on HT who develop breasts will get any pain. It was useful to alert me. However, at the outset of the treatment, I gave the nipple area a really good feel so I knew how it was starting out, and then periodically rechecked for any change. You should do this to check for any growth as you might not necessary get any pain alerting you. The other thing that alerted me besides deliberately checking the area was when I picked up a closed laptop or books to carry in my arm against my chest - it felt like something similar to a marball was trapped in between the hard surface and my chest, but that was in fact the breast bud inside my chest. I think my nipples may have grown too - they look a bit bigger than I remember before although not grossly so, but I didn't measure them at the outset so I can't be sure. They haven't got any bigger since being on the 20mg/day Tomoxifen, the point at which I did start measuring them.
One thing I would say is that I felt a bit on my own during this. The medical team didn't suggest that I should keep an eye out for breast growth, or what the various treatments were, and they refused the initial treatment the pamphlets they gave me suggested. It was only because I read extensively many of the relevant scientific research papers at the outset that I knew to expect it and what to ask for. The confusing Tomoxifen prescription I was given 3rd-hand was another matter. Part of me wanted to go back and double check it, but the other part of me thought I might get someone else who said I could only have 20mg twice a week (the NICE guidelines, although insufficient according to the research papers), or who took it away altogether, given I was refused initially.
Edited by member 15 Feb 2019 at 09:54
| Reason: typo