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
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.
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.
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)?
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
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.
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!
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
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.
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.
emma simpson said:
Fingers firmly crossed for you that your endo prescribes goserelin 3-monthly.Glad you are feeling better about having it.I received my prescription for goserelin10.8mg 3-monthly from my endo yesterday ....
I'd be interested to know how it goes Emma. Good luck with the implant next week.
Princess Layla said:
There will obviously have been benefits as I started using goserelin but they werent so obvious you could detect then, its an accumulative thing i guess.
Yes, I think the same Layla. Takes ages and ages. Rome wasn't built in a day etc. Even after about a year on HRT, I have some changes but they have taken a very long time to appear. It took about 9 months to see breast buds, some fat redistribution (off my face), softer skin, reduced hair but I see almost no move to getting some hips and a decent waist, but I am sure I look more "rounded" down below. I hope Goserelin will improve those hips and waist.
Princess Layla said:
There will obviously have been benefits as I started using goserelin but they werent so obvious you could detect then, its an accumulative thing i guess.
Yes, I think the same Layla. Takes ages and ages. Rome wasn't built in a day etc. Even after about a year on HRT, I have some changes but they have taken a very long time to appear. It took about 9 months to see breast buds, some fat redistribution (off my face), softer skin, reduced hair but I see almost no move to getting some hips and a decent waist, but I am sure I look more "rounded" down below. I hope Goserelin will improve those hips and waist.
I saw my endo. Unfortunately he didn't seem to remember that he'd suggest Goserelin so I had to remind him. I also asked about Triptorelin and he had to ask me why I would want it? For the same reasons you suggested it of course! Then said those things were all basically the same. I was quite surprised about his general attitude which was all rather negative and a bit of a disappointment all around. He was very nice the first time. I think he wants to bounce it back to the GP. Moreover, I seem to have been suddenly referred to the CMHT (Community Mental Health Team?) for an assessment. I suppose to see that I'm not mentally ill or in their words, to establish co-morbidity (e.g. other conditions like depression which I used to get often before the hormones). When I went for that appointment, the Doc said she had to leave due to an emergency somewhere else. Didn't have enough time to assess anything although we did establish that she'd like to pass me up the tree to CX GIC. I could have just self-referred! She also told me to stop self medding and only take the Finasteride. Oh yes, like that's going to happen. No way I want to go back to the way it was before. I suppose she had to say that. So I never did get my Goserelin or Triptorelin on that visit and I won't see that endo for ages and being unimpressed I am not sure I want to see him again. As we all probably know, the very recent rearrangement of the GPs commission services and the removal of PCTs will probably mean that if I did get Goserelin it'd be at the behest of the GP via recommendations from CX GIC. I think that's not really a change except the budget will be on the GP, not the PCT. Anyway, I'm in two minds here, wait ages for CX GIC or while I am in Thailand at the end of April, go and see an endo there and get a "orchidectomy test drive" on Triptorelin (cheaper than Goserelin) and to think in the longer term about the actual orchidectomy.