Hormone treatment : breast enlargement

Firstly, it doesn't happen to everyone.
Some hormone therapy (HT) drugs are more likely to do it than others. Bicalutamide (androgen blocker) is probably the worst in this respect.

There are two main treatments:

The radiotherapy blast you mention, which has around a 50% success rate. It also has a 1-2% rate of damaging underlying heart muscle, but this has never been known to cause a problem, and has only been found when scanning the heart afterwards for some other reason. I've seen several different stories on when to have it, such as must be within 1st month of HT, or must be before breast growth starts. My NHS hospital said they don't do it anyway, not even privately (although I subsequently found someone who said they do). I phoned around and found the London Clinic did the procedure privately, but wouldn't do it until symptoms had showed up. So there was no consensus on the treatment protocol.

The other is the drug tamoxifen, which is more commonly used to treat breast cancer. This has a 70% success rate. It's not suitable for all patients - past DVT or cardiac issues would likely rule it out. For patients on bicalutamide, it's sometimes prescribed with the bicalutamide. For patients on other HT drugs, I get the impression its prescribed only if you ask, and often only when symptoms start.

I asked when I started on bicalutamide and I was refused both the radiotherapy blast and tamoxifen. This didn't leave me feeling good about it, and was when I started investigating getting the RT blast privately, but before I found they wouldn't do it until symptoms started, and it only had a 50% success rate, and I think it was about £5k.

After 11 weeks on bicalutamide, the breast pain started (not particularly painful, and by itself, ignoreable), but the following week, I could feel breast bud development. I contacted my Macmillan nurse, and they got me a tamoxifen prescription the same day. It came via several people from an oncologist I never met with some strange instructions - the dose was 20mg daily, but with a note to say try it twice a week to start with. I didn't want to ask too many questions in case they changed their minds, but I interpreted this as adjust dose to symptoms, up to a max of 20mg/day.

I started with the 20mg twice a week, but it didn't seem to be helping, and both breast buds were growing quite rapidly (not noticeable to anyone else yet, but felt like marbles under my nipples). Anyway, I eventually had bumped the dose up to maximum within a month, and by then the breast buds stopped increasing in size. I was quite happy they didn't show, but even more pleased that over the following months they shrunk and vanished.

If you are on tamoxifen, you should get a full blood count and liver function test after about 3 months to make sure your liver is happy with tamoxifen. Mine wasn't, so I started reducing the dose to see what the minimum I could get away with was. Eventually I had reduced it to nothing and I haven't taken any for 2 months now, and breast growth hasn't come back. It probably will, but I'll dose the tamoxifen accordingly when it does. On the other hand, I have switched to Zoladex now, and incidence of breast growth on Zoladex is less than that on bicalutamide, so it might be that I don't get it happening again.

I also read up a lot about tamoxifen. It can reverse recent breast growth - the more recent the growth, the more effective it is. Growth that's been there a year or more cannot be reversed. I am doubtful the normal dosing advice is correct for sudden onset treatment, but probably is correct as a prophylatic dose given when starting bicalutamide (see https://community.prostatecanceruk.org/posts/t17616-Breast-growth-with-bicalutamide-and-tamoxifen#post215572 for the gory details). Also, in response to growing increasing glandular material, your body will also start growing fibrous tissue to support that, and tamoxifen will not reverse the fibrous tissue formation. Mine didn't get anywhere near that far.

If you are carrying a lot of body fat, some of that might migrate to breasts, and I don't believe either the single blast radiotherapy or tamoxifen will prevent fat growth.

Edited by member 06 Jun 2019 at 16:16  | Reason: Not specified

If a man grows breasts and can then demonstrate that these are causing significant emotional harm, he is entitled to breast removal on the NHS - we have members here who have had that surgery. It would be cheaper to give the zap of RT than to offer surgical removal later :-(

PS the health professional that suggested moobs are reversible (and therefore a minor inconvenience?) should spend an hour or two with all the men who feel their lives are ruined by a painful and permanent change to their body.