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Goserelin injections?

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  • Hi there!

     

    Need some advice or at least some comments..

     

    After my last blood test, my endo sent a letter to my GP suggesting that things like Finasteride were weak anti-androgens and unlikely to have much effect on me (currently on 2.5mg Oestrogel plus Finasteride 1mg). 

     

    He's suggesting that I be given Goserelin (Zalodex) as a depot injection (comes in 1 and 3 month varieties, pellet injected under the skin below the belly button) as this would reduce my T levels to almost nothing.  I've never heard of Goserelin but I've been reading up on it.

     

    Anyone had any experience of this anti-androgen? Good or bad?

     

    Rachael x

      February 24, 2013 9:07 PM GMT
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    Hi Rachael, 5.5 years post-op here...
    Finasteride may be considered to be slightly weak "as an anti-androgen", but it is shown to be effective at preventing hair loss. It will have some effect at counteracting effects of testosterone. But if you hope in the near future to have SRS I don't believe there is any reason to worry about effects of testo, presuming your are some years post-puberty. Oestrogen alone will severely inhibit testosterone production.
    I was offered Gosrelin (at Charing Cross), I turned it down. You don't have to take anything you don't want, and they won't mind if you don't.
    I still take Finasteride, I don't need an anti-androgen, but hope it will prevent the onset of any hair loss. (It inhibits DHT, which is said to be the main cause of MPB, if you want to look into the science).
    xx
      February 24, 2013 11:45 PM GMT
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  • Thanks Lucy. The main use of Goserelin seems to be in hormone sensitive cancer therapy and of course, mere mention of cancer tends to become scary. I am well past puberty (I'm 52 - 10 months on hormones which seem to be working nicely). I have an alternative to Finasteride and that's Dutasteride (Avodart) but it's rather pricey for self-medication. We're all taking some risks with our medications but Zalodex seems to have some pretty nasty looking side effects. The one which surprised me was memory loss. There's quite a bit of anecdotal evidence that goserelin causes memory loss but nothing really detailed so I was weighing up whether this drug is worth the risk. I think everything seems to be progressing fine at the moment so I wonder why they want to mess about with the current regime. I have a feeling it might actually be lack of experience of my endo with TG people.
      February 25, 2013 8:28 AM GMT
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  • Finasteride (or Dutasteride) are not anti androgens, what they actually do is inhibit the conversion of testosterone to it's more potent form, dihydrotestosterone. DHT tends to be concentrated in the scalp area and it is this that tends to result in MPB.
    Dutasteride has been shown in clinical trials to be more effective than Finasteride, but has not been licensed for this usage. A cheaper form of Dutasteride is Dutas and is sold for about one third the price of Avodart.
    An alternative to Goserelin, if you are unsure about that is to ask for your doctor to prescribe Androcur (cyproterone acetate) as the anti-androgen.
      February 25, 2013 2:50 PM GMT
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  • Thanks Carol. I have some other medical conditions which limit use of androcur and spironolactone. I asked for spiro and they said, well, maybe later. I suspect because of these other conditions, they think goserelin might be more beneficial. I just thought this was a surprising treatment and wanted to hear about others experiences with goserelin. I'm as yet undecided about if this T-blocker is a good idea. From what I understand it's considered "chemical castration". I guess if I went for it, they'd do the 28 days one to see how it went and then maybe ramp up to the 3 month version if it was Ok. But if anyone actually has had goserelin, I'd be interested to hear how it worked out.

    This post was edited by Rachael Jane Robinson at February 25, 2013 9:22 PM GMT
      February 25, 2013 9:20 PM GMT
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  • Send a PM to Princess Layla, she has been on it
      February 25, 2013 9:23 PM GMT
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  • Hi, Carol mentioned this forum posting so here's my comment.

    In "older" patients oestrogen alone often doesnt supress testosterone levels enough so after six months of observation it becomes appropriate to administer a "gonadotropin-releasing hormone agonist" such as Goserelin or Triptorelin.

    The effect is to all but stop production of testosterone and thus have the chenical equivalent effect of Orchiectomy, but in a reversible way.

    In my experience (and that of my gf April) its a very positive experience.

    In addition to it letting the Oestrogen really go to work it has benefits like no more male smelling armpits etc.

    For April it brought about an inner peace that she had never known her whole life, nothing so profound in my case just that I seemed to blossom.

    I believe there can be adverse side effects but I understand them to me rare and on that basis I chose to use it.

    The choice is yours.

     

    This post was edited by Princess Layla at February 25, 2013 9:50 PM GMT
      February 25, 2013 9:45 PM GMT
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  • Thanks Layla, this is good information for me and I appreciate your comments. I think I'm making pretty good progress as I am but obviously I'll discuss the ins and outs with my endo next time I see him in March . Generally I like the sound of blossoming and well, it is nearly Spring!

     

    Some more questions (after reading up this arvo) - Goserelin  and Triptorelin are agonists (=cause reaction) means there would be T "flare" with either of these medications. So, a few more questions if anyone knows so I can be better informed next month at my endo appointment:

     

    What's the generally used as the anti-androgen with Goserelin or Triptorelin to combat the T-flare?

     

    How can Triptorelin be administered?

     

    (My research suggests, some sort of intramuscular or subcutaneous injection - but it does not seem to be available as an implant with slow release which is what I would prefer - hassle of going to the docs to get jabs could be avoided. Implant seems to be the only way with Goserelin with 28-day and 3-month implants, dose seems to be 4mg/month.

     

    Also if one has Goserelin, does it make the DHT blockers like Dutasteride or Finasteride redundant?

     

    Has anyone experience of GnRH antagonists which do not have the side effects of Goserelin or Triptorelin? 

     

    Anyone had any results with Leuprolide/Leuprorelin (seems to be the same sort of thing as Goserelin etc)?

    This post was edited by Rachael Jane Robinson at February 26, 2013 4:03 PM GMT
      February 26, 2013 12:41 AM GMT
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  • Hi Again

    I was told that the T flare could happen but I cant say I noticed it particularly, but in any case I understand its only a matter of a few days.

    I understand Goserelin to be a subcutaneous slow release implant, its administered to the fatty part of the belly, no problems locating that.....

    Im not sure about triptorelin but as its injected into Aprils bum (among other things) Im assuming its intramuscular slow release but Im not certain.

    I carried on using Finasteride because Testosterone is also made by the adrenal glands, not sure if there was any point but thats what I did.

    Unless you have particular reasons I wouldnt get too hung up on the possibility of side effects, go with your endo and enjoy the changes.

    xxxxxxxxx

    Layla
      February 27, 2013 3:14 PM GMT
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  • Ok, thanks a lot Layla, I'll take it all up with him. He didn't mention Triptorelin in any correspondence but it looks like they are all the same kind of thing with almost no differences. I was worried about the T-flare simply because I don't want to to back to having a bushy face or my hair to fall out! Jeez, that would be be bad. I'll have a chat with Dr Endo and see what he's got to say about it further since he's the one who started the discussion. I am grateful to know someone else is also on it and it is mainstream. Thanks again!
      February 27, 2013 5:52 PM GMT
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  • Hi Rachael
    I am in the same position as you having just had the results of my last blood test which show my testosterone level still not low enough.My endo consultation has prescribed Zoladex on a 3monthly basis.This is what the cx endo recommends or Decapeptyl again on a 3monthly basis.To counteract the initial t surge which may occur for the first 2 weeks they recommend cyproterone50-100mg daily.I am happy to go along with that as it seemsto be the best way of reaching the t target of below 3.
    Emma.
      February 27, 2013 11:46 PM GMT
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  • Morning Emma, that does sound like me as well. I looked at my figures in detail and you are right, it would seem Zoladex/Goserelin would be a typical treatment for too much T. If you've already had your Goserelin/Zoladex, I'm interested to know of any side effects - positive or negative! Rachael x

    This post was edited by Rachael Jane Robinson at February 28, 2013 7:11 AM GMT
      February 28, 2013 7:10 AM GMT
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  • Hi Rachel

     

    I was using implants for almost six months.

    They were administered by my GP before I was referred to an Endocrinologist.

    I have to say they were a veritable pain and bother.

    Unless you have someone who is adept at inserting them, I would give them a miss.

     

    Currently, I am just completing a course of pills and will begin intramuscular injections soon.

    Between, pills, implants and injections I personally would choose the injections.

    Implants and injections both bypass the liver but there are problems with implants, as I have pointed out.

     

    Regards

    Chalice. 

      February 28, 2013 10:24 AM GMT
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  • Chalice, What did you experience? Just pain at the insertion site only or something more serious - adverse reaction or something else? I understand Goserelin only comes as an implant but Triptorelin is intramuscular (IM). Which pills are you taking and what's the IM going to be? 

     

    I am in the UK and I guess it would be a different pathway in the UK from elsewhere I presume. Wondered how you got your GP to do it before seeing the endo but I can see form your profile you are in Oz!

    This post was edited by Rachael Jane Robinson at February 28, 2013 12:40 PM GMT
      February 28, 2013 12:39 PM GMT
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  • Hi Rachael
    I have not had it yet.When i get the prescription from my endo i have to collect the Zoladex and then have the implant put in by the urioligy specialist nurse.Why i have to have it done that way i dont know but i will have to go along with it.If i have any adverse affects i will let you know.I am more worried about taking cyproterone because of the 30% risk of depression even though it is only short term.
      March 1, 2013 12:19 AM GMT
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  • Rachael Jane Robinson said:

    Chalice, What did you experience? Just pain at the insertion site only or something more serious - adverse reaction or something else? I understand Goserelin only comes as an implant but Triptorelin is intramuscular (IM). Which pills are you taking and what's the IM going to be?

    I am in the UK and I guess it would be a different pathway in the UK from elsewhere I presume. Wondered how you got your GP to do it before seeing the endo but I can see from your profile you are in Oz!

     

    Even though  the GP was a competent surgeon, he still could never insert the capsule with great difficulty. There was no pain but it became an unnecessarily long and protracted procedure. It was inserted in outpatiets but always took at least twenty minutes.

     

    The injectibles are 'Estradiol Valerate' 10mg in 1ml vials.

     

    I also take half an aspirin twice daily.

     

    GPs wil intervene if they learn you are self-medicating. Then, they will, or should, refer you to someone more qualified.

     

    Regards

     

     

      March 1, 2013 9:40 AM GMT
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  • Thanks Chalice. Ok, good to know about referrals and the hassles of implants. I believe in the UK, if the docs medicate, they become directly involved in "shared care" and take on the responsibility. I'm self-medicating currently for my gender issues but I am just starting on the official NHS (government national health service) pathway. I'm also very supervised due to my other conditions (blood test every month currently!) and they do all the usual hormone tests at the same time. I think my current endo will refer me up the expertise tree next time I see him. I will see if he'll give me the 3-month one to see how it goes but I doubt he'll do it if he'll refer immediately.

    This post was edited by Rachael Jane Robinson at March 1, 2013 11:36 AM GMT
      March 1, 2013 11:34 AM GMT
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  • There shouldnt be any difficulty inserting the Goserelin Implant, even I could do it just from following the instructions included in the box but heres a video.

    http://www.youtube.com/watch?v=xGKjrDhXE20&feature=player_embedded
      March 1, 2013 1:05 PM GMT
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  • That's a good link Layla. I am surprised at the size of the needle and that it was inserted towards one side. I guess it is where you can pinch more than an inch (in my case, for sure). I doubt one could buy Goserelin mail order for self-medication though.

    This post was edited by Rachael Jane Robinson at March 1, 2013 4:31 PM GMT
      March 1, 2013 4:20 PM GMT
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  • You will need a deep purse with lots of money if you are going to order for self medication. I was chatting to the pharmasist who dispenses my prescriptions yesterday regarding the availability of Goserelin and he told me he only orders it when the prescription comes in as it is £335 per implant.
      March 2, 2013 12:30 AM GMT
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  • Hi Emma, yes, I did some checking and the cheapest I could find for 28 days is about 130 EUR (about £100) and 260 EUR (about £200) for 3 months. I saw prices that were enormous. - £800+ for 3 months. I also checked on the patent nd it expires about 2022, so there's no generic treatment around the corner within the next 10 years or so. Unless one has deep pockets and a good well paying job as you say, there's no way to pay the £80 a month for it. I get my self medications in Eastern Europe and Thailand. That's where I saw the cheapest price. I thik it's generally unaffordable except within the state system. I pay about $8 for Oestrogel for 80mg tube, so Goserelin is way off price wise. BTW, I found Triptorelin is about 1/2 price compared to Goserelin and there's a 6-month jab for it in the bum, not under the skin implants. However, the side effects on Triptoelin look pretty dangerous. Same as with any of these things.
      March 2, 2013 1:03 AM GMT
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  • Hi Rachael
    Ouch! those are pretty eye watering prices.I am fortunate to have been in the dhss system from the start so i have not had to pay for Oestrogel either.I share your thoughts regarding Triptoelin but that whole group of medication seems to have some potentually nasty side effects but as you say so do most medications so to quote that old saying you pay your money and you take your chance.
      March 2, 2013 1:53 AM GMT
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  • Yup, Emma, it's mega pricey. I hope that I won't have to pay either eventually when I get on the NHS route. You're right that it's a personal choice. I've read all the leaflets on these medicines and while I'm no expert, you need to be on these medications at 10s x the normal dose and for many months, almost years to suffer from the serious side effects. But anyway, it's one for the docs/endos.
      March 3, 2013 12:41 AM GMT
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  • Hi Rachael,Hope it is not to long before you get unto the NHS pathway.From your previous posts i see that you are very sensibly being very well supervised which is not always the case for those who self medicate..Unfortunately there are still medical practitioners who do not believe gender dysphoria is a medical condition or they believe it is a life choice and will not refer patients for treatment so many choose self medication sometimes at great risk to themselves.I try not to think about side effects as every medication has its side effects but like you say thats one for the professionals and their judgement is usually pretty good.
      March 4, 2013 1:13 AM GMT
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  • I'll post back here when I find out if I will be given goserelin. I'm feeling much better about the idea of having it now. The question is if my endo will give it to me, preferably in the 3-month version as I don't want to be at the docs every 5 minutes. I am currently getting quite nice results on about 2mg of estrogen now but I am quite sure with unopposed estrogen, changes should accelerate rapidly. We'll see!
      March 7, 2013 9:07 AM GMT
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