Re: Side effects of Aldactone and Inspra (how I got up to 200 mg)

[Guest guest]

I have taken Aldactone (spironolactone) and it did a great job on

lowering my blood pressure but it gave me painful gynecomastia.

When I originally started Inspra, I got horrible headaches and quit. I

said " I am never taking Inspra again. " I did try Inspra again and here

is what I did to get back on Inspra and slowly adjust.

1. I started with 1/4 of the 25 mg tablet which is just 6 mg.

2. I slowly increased to 1/4 tablet twice a day (6 mg in the morning and

6 mg in the evening.)

3. Then to a 1/2 tablet (12.5 mg in the morning) and 1/4 tablet (6 mg.

in the evening.)

4. and then 1/2 tablet (12.5 mg in the morning) and 1/2 tablet (12.5

mg in the evening.)

5. and then up to 1 tablet (25 mg. in the morning) and 1 tablet (25 mg

in the evening.)

6. I continued to titrate upwards until I reached 4 tablets 100 mg in

the morning and 4 tablets 100 mg in the evening.

It took me a long time (years) so don't go fast!

I monitored my blood pressure and potassium level to see what dose is

effective for reducing blood pressure.

I also have tried to be on a dash diet and low potassium and daily

walking.

I got my blood pressure down from 180/120 to 120/75.

I have never experienced nausea from Inspra.

________________________________________________________________________\

________________________

Medications that I have previously tried with horrible side effects are:

1. Aldactone (gynecomastia)

2. Cardizem (bad effect if you miss a dose and uncontrolled blood

pressure)

3. Norvasc (swelling in the lower feet and ankles)

4. Cardura (no effect)

5. Amiloride (insufficent blood pressure control)

6. Maxzide (Hydroclorothiazide with triamterine) (prostate problems with

this drug and lost all my potassium)

7. Vasotec (enalapril) (ACE inhibitor - the worst drug I have ever taken

in my whole life which caused a terrible irritating cough I could not

stand)

8. Tenormin (Atenolol) (beta blocker with which I was so tired I could

not move)

>

> How tolerable are the PA patients here with any side effects to

> spironoloctone or aldactone or inspra? For me side effects such as

> nausia are a problem. Also have any female patients noticed changes in

> their menstrual cycles.... I have.

>

[Guest guest]

Thanks for this - I just started the same schedule, for the same

reasons. You meant high, not low potassium, right?

A couple questions :

1) While you tapered upward on inspra, were you still on aldactone?

Either way, how did you get off of spiro? Were you on 200mg spiro?

2) How long between each 1/4 tablet inspra added? My doc wants me to

try 2 week intervals because that's how long most drugs take to achieve

their maximum effect. My pressure was 118/70 w/aldactone, and as I

added the first 6mg inspra it shot up to 135/80. So, approx 2 weeks to

see if my body really doesn't like eplerenone. If the pressure stays or

goes up, we may have to go to anti-cancer drug and tesosterone replacement.

3) On the first try, did you get other so-called 'side-effects,' or

headache alone? Such as mine : severe insomnia (like 6-8 cups coffee),

up all night? Heart palpitations, difficulty breathing? Dizzy

spells? Was the hadache confined to your cortex (head), or in the

occipital area (where head meets back of neck)?

Thanks, Dave

airlinerg wrote:

>

>

> I have taken Aldactone (spironolactone) and it did a great job on

> lowering my blood pressure but it gave me painful gynecomastia.

>

> When I originally started Inspra, I got horrible headaches and quit. I

> said " I am never taking Inspra again. " I did try Inspra again and here

> is what I did to get back on Inspra and slowly adjust.

>

> 1. I started with 1/4 of the 25 mg tablet which is just 6 mg.

>

> 2. I slowly increased to 1/4 tablet twice a day (6 mg in the morning and

> 6 mg in the evening.)

>

> 3. Then to a 1/2 tablet (12.5 mg in the morning) and 1/4 tablet (6 mg.

> in the evening.)

>

> 4. and then 1/2 tablet (12.5 mg in the morning) and 1/2 tablet (12.5

> mg in the evening.)

>

> 5. and then up to 1 tablet (25 mg. in the morning) and 1 tablet (25 mg

> in the evening.)

>

> 6. I continued to titrate upwards until I reached 4 tablets 100 mg in

> the morning and 4 tablets 100 mg in the evening.

>

> It took me a long time (years) so don't go fast!

>

> I monitored my blood pressure and potassium level to see what dose is

> effective for reducing blood pressure.

>

> I also have tried to be on a dash diet and low potassium and daily

> walking.

>

> I got my blood pressure down from 180/120 to 120/75.

>

> I have never experienced nausea from Inspra.

>

> __________________________________________________________\

> ________________________

>

> Medications that I have previously tried with horrible side effects are:

>

> 1. Aldactone (gynecomastia)

>

> 2. Cardizem (bad effect if you miss a dose and uncontrolled blood

> pressure)

>

> 3. Norvasc (swelling in the lower feet and ankles)

>

> 4. Cardura (no effect)

>

> 5. Amiloride (insufficent blood pressure control)

>

> 6. Maxzide (Hydroclorothiazide with triamterine) (prostate problems with

> this drug and lost all my potassium)

>

> 7. Vasotec (enalapril) (ACE inhibitor - the worst drug I have ever taken

> in my whole life which caused a terrible irritating cough I could not

> stand)

>

> 8. Tenormin (Atenolol) (beta blocker with which I was so tired I could

> not move)

>

>

> >

> > How tolerable are the PA patients here with any side effects to

> > spironoloctone or aldactone or inspra? For me side effects such as

> > nausia are a problem. Also have any female patients noticed changes in

> > their menstrual cycles.... I have.

>

[Guest guest]

Here is my personal experience as a person with hyperaldosteronism

taking Inspra. I am not a doctor.

What I meant below was I try to eat a dash diet and low sodium. I

accidentally typed low potassium, but I eat high potassium because I am

always drinking orange juice and eating some dried fruts like dried

peaches or dried apricots as well as unsalted raw walnuts and almonds.

I found it is best to soak the almonds in water overnight before eating

them. I also like to eat celery. I eat plain non-fat greek style yogurt

and lowfat sour cream for extra protein.

I also try to drink a glass of water whenever I can, and go to the

bathroom to urinate alot. If I take a hike, I have to urinate in the

bushes 2 or 3 times during a one hour walk. I hike 1/2 hour uphill and

1/2 hour downhill and it takes one hour total. I drink a pint of water

on the hike also. Most people seem to be able to take a one hour hike

without urinating in the bushes at all. It is just me and the dogs who

seem to urinate.

I am always hot and sweaty when I walk uphill and need to take my shirt

off. Other people seem to be cold and wear tshirts and sweaters. I am

talking about 60 degree to 65 degrees outside - much worse when it is

above 75 degrees.

Here are my answers to your questions:

> 1) While you tapered upward on inspra, were you still on aldactone?

> Either way, how did you get off of spiro? Were you on 200mg spiro?

Here is my medication sequence.

1. Aldactone (75 mg.) I stopped Aldactone completely because of

gynecomastia

2. Norvasc (Amlodipine Besylate) Calcium Channel Blocker and Midamor

(amiloride)

3. Midamor alone (discontinued Norvasc because of feet swelling)

4. Inspra alone (I found that I need 200 mg Inspra and only had needed

75 mg Aldactone for blood pressure control) My potassium needs to be in

the range of 4.0 - 4.5 for optimal blood pressure control.

> 2) How long between each 1/4 tablet inspra added? My doc wants me to

> try 2 week intervals because that's how long most drugs take to

achieve

> their maximum effect. My pressure was 118/70 w/aldactone, and as I

> added the first 6mg inspra it shot up to 135/80. So, approx 2 weeks to

> see if my body really doesn't like eplerenone. If the pressure stays

or

> goes up, we may have to go to anti-cancer drug and tesosterone

replacement.

I checked my blood pressure daily and potassum each month. I think I

increased the dose each 2 weeks as my blood pressure was not adequately

controlled, but it was not exact.

Why do you say " If the pressure stays or goes up, we may have to go to

anti-cancer drug and tesosterone replacement? "

I don't know anything about anti-cancer drugs, but testosterone

replacement caused me to get worse seborreah.

> 3) On the first try, did you get other so-called 'side-effects,' or

> headache alone? Such as mine : severe insomnia (like 6-8 cups coffee),

> up all night? Heart palpitations, difficulty breathing? Dizzy

> spells? Was the hadache confined to your cortex (head), or in the

> occipital area (where head meets back of neck)?

On the first try I got headaches alone. They were headaches in the

cortex and occipital area both. I had to use Aleve (naproxen) for the

headaches.

I eventually started taking Cymbalta (duloxetine) for the headaches and

fibromyalgia. I have always had a problem with insomnia. I never drink

coffee. Never had problems with heart palpitations or difficulty

breathing. Never had dizzy spells.

Side effects listed for Inspra are:

SIDE EFFECTS: Headache

<http://www.medicinenet.com/script/main/art.asp?articlekey=20628> ,

dizziness, diarrhea

<http://www.medicinenet.com/script/main/art.asp?articlekey=1900> ,

stomach pain, nausea, cough or flu-like symptoms (e.g., fever, chills,

unusual tiredness) may occur. If any of these effects persist or worsen,

notify your doctor or pharmacist promptly. Tell your doctor immediately

if any of these unlikely but serious side effects occur: abnormal

vaginal bleeding

<http://www.medicinenet.com/script/main/art.asp?articlekey=17582> ,

enlarged or sore breasts in males, mental/mood changes, chest pain. This

medication can raise your body's potassium levels. Potassium blood

levels should be checked periodically while you take this drug. If not

treated, high potassium levels can lead to very serious (rarely fatal)

heart rhythms. Tell your doctor immediately if you develop any of the

following symptoms: severe muscle weakness, irregular heartbeat. A

serious allergic reaction to this drug is unlikely, but seek immediate

medical attention if it occurs. Symptoms of a serious allergic reaction

include: rash

<http://www.medicinenet.com/script/main/art.asp?articlekey=1992> ,

itching, swelling, severe dizziness, trouble breathing. If you notice

other effects not listed above, contact your doctor or pharmacist.

DRUG INTERACTIONS: This drug should not be used with the following

medications because very serious interactions may occur: certain azole

antifungals (ketoconazole, itraconazole), certain macrolide antibiotics

(clarithromycin, troleandomycin), nefazodone, potassium supplements,

potassium-sparing diuretics (e.g., amiloride, spironolactone,

triamterene), certain protease inhibitors (nelfinavir, ritonavir). If

you are currently using any of these medications, tell your doctor or

pharmacist before starting eplerenone. Before using this medication,

tell your doctor or pharmacist of all prescription and

nonprescription/herbal products you may use, especially of: ACE

inhibitors (e.g., captopril, enalapril), angiotensin II blockers (e.g.,

losartan, valsartan), other azole antifungals (e.g., fluconazole),

lithium, other macrolide antibiotics (e.g., erythromycin), other

protease inhibitors (e.g., saquinavir), nonsteroidal anti-inflammatory

drugs (e.g., NSAIDs like ibuprofen, indomethacin, naproxen), St. 's

wort, verapamil. Consult your doctor or pharmacist before using

potassium-containing products (salt substitutes) or eating large amounts

of potassium-containing foods (e.g., bananas). Do not start or stop any

medicine without doctor or pharmacist approval.

I would recommend Ambien CR for severe insomnia after a hot bath. But do

not take Ambien CR more than a few days in a row because you will not be

able to sleep without it. For heart palpitations, difficulty breathing

and dizzy spells I recommend getting into a walking routine to relieve

anxiety and stress. But you might have to check with a doctor on that.

Maybe Dr. Grim or another Inspra user could answer some of these

questions also, and feel free to post more questions.

Best wishes,

airlinerg

> > >

> > > How tolerable are the PA patients here with any side effects to

> > > spironoloctone or aldactone or inspra? For me side effects such as

> > > nausia are a problem. Also have any female patients noticed

changes in

> > > their menstrual cycles.... I have.

> >

>

>

>

[Guest guest]

Thanks, great answer, much learned.

In case my body will not tolerate inspra (toxic effects apart from

headache point that way), my sex hormone imbalances have to be

treated. Depression, vision and other problems associated with high

estrogen and low testosterone are bad enough. I cannot recall the name

of the anti-cancer drug, but it is specific to high estrogen, a

correlate of small-cell cancers. If I get seborreah. I'll probably opt

for that rather than a small-cell cancer. High estrogen, and low

testosterone accompany gynecomastia in my case - part of spiro's

anti-androgenic (so-called) 'side effects.'

I call them all 'effects,' and those which are toxic 'toxic effects.'

Those which do nothing, but are non-toxic, 'non-toxic.'

Those which help 'helpful, non-toxic effects.' I am a very angry PA

patient who was misled for 17 years (at least). Arrogance and

ego-centrism shows up in language all over the place, of course, and is

not limited to medicine. Alas, I am a linguist, but no exception to the

revealing nature of language usage.

The film " The Corporation " has a couple of landmark inventors of various

chemical " miracles " since the late 1940's warning the audience that " . .

..we have bathed ourselves in hundreds of chemicals that were never seen

in nature until the last 50 years, and wonder what they are going to do

over time. " Medicine goes for 'the good effect' in spite of scant

longitudinal research. Those who insist upon testing are right, but

IMO, don't go far enough.

Thanks, Dave

airlinerg wrote:

>

>

> Here is my personal experience as a person with hyperaldosteronism

> taking Inspra. I am not a doctor.

>

> What I meant below was I try to eat a dash diet and low sodium. I

> accidentally typed low potassium, but I eat high potassium because I am

> always drinking orange juice and eating some dried fruts like dried

> peaches or dried apricots as well as unsalted raw walnuts and almonds.

> I found it is best to soak the almonds in water overnight before eating

> them. I also like to eat celery. I eat plain non-fat greek style yogurt

> and lowfat sour cream for extra protein.

>

> I also try to drink a glass of water whenever I can, and go to the

> bathroom to urinate alot. If I take a hike, I have to urinate in the

> bushes 2 or 3 times during a one hour walk. I hike 1/2 hour uphill and

> 1/2 hour downhill and it takes one hour total. I drink a pint of water

> on the hike also. Most people seem to be able to take a one hour hike

> without urinating in the bushes at all. It is just me and the dogs who

> seem to urinate.

>

> I am always hot and sweaty when I walk uphill and need to take my shirt

> off. Other people seem to be cold and wear tshirts and sweaters. I am

> talking about 60 degree to 65 degrees outside - much worse when it is

> above 75 degrees.

>

> Here are my answers to your questions:

>

> > 1) While you tapered upward on inspra, were you still on aldactone?

> > Either way, how did you get off of spiro? Were you on 200mg spiro?

>

> Here is my medication sequence.

>

> 1. Aldactone (75 mg.) I stopped Aldactone completely because of

> gynecomastia

>

> 2. Norvasc (Amlodipine Besylate) Calcium Channel Blocker and Midamor

> (amiloride)

>

> 3. Midamor alone (discontinued Norvasc because of feet swelling)

>

> 4. Inspra alone (I found that I need 200 mg Inspra and only had needed

> 75 mg Aldactone for blood pressure control) My potassium needs to be in

> the range of 4.0 - 4.5 for optimal blood pressure control.

>

> > 2) How long between each 1/4 tablet inspra added? My doc wants me to

> > try 2 week intervals because that's how long most drugs take to

> achieve

> > their maximum effect. My pressure was 118/70 w/aldactone, and as I

> > added the first 6mg inspra it shot up to 135/80. So, approx 2 weeks to

> > see if my body really doesn't like eplerenone. If the pressure stays

> or

> > goes up, we may have to go to anti-cancer drug and tesosterone

> replacement.

>

> I checked my blood pressure daily and potassum each month. I think I

> increased the dose each 2 weeks as my blood pressure was not adequately

> controlled, but it was not exact.

>

> Why do you say " If the pressure stays or goes up, we may have to go to

> anti-cancer drug and tesosterone replacement? "

>

> I don't know anything about anti-cancer drugs, but testosterone

> replacement caused me to get worse seborreah.

>

> > 3) On the first try, did you get other so-called 'side-effects,' or

> > headache alone? Such as mine : severe insomnia (like 6-8 cups coffee),

> > up all night? Heart palpitations, difficulty breathing? Dizzy

> > spells? Was the hadache confined to your cortex (head), or in the

> > occipital area (where head meets back of neck)?

>

> On the first try I got headaches alone. They were headaches in the

> cortex and occipital area both. I had to use Aleve (naproxen) for the

> headaches.

>

> I eventually started taking Cymbalta (duloxetine) for the headaches and

> fibromyalgia. I have always had a problem with insomnia. I never drink

> coffee. Never had problems with heart palpitations or difficulty

> breathing. Never had dizzy spells.

>

> Side effects listed for Inspra are:

>

> SIDE EFFECTS: Headache

> <http://www.medicinenet.com/script/main/art.asp?articlekey=20628

> <http://www.medicinenet.com/script/main/art.asp?articlekey=20628>> ,

> dizziness, diarrhea

> <http://www.medicinenet.com/script/main/art.asp?articlekey=1900

> <http://www.medicinenet.com/script/main/art.asp?articlekey=1900>> ,

> stomach pain, nausea, cough or flu-like symptoms (e.g., fever, chills,

> unusual tiredness) may occur. If any of these effects persist or worsen,

> notify your doctor or pharmacist promptly. Tell your doctor immediately

> if any of these unlikely but serious side effects occur: abnormal

> vaginal bleeding

> <http://www.medicinenet.com/script/main/art.asp?articlekey=17582

> <http://www.medicinenet.com/script/main/art.asp?articlekey=17582>> ,

> enlarged or sore breasts in males, mental/mood changes, chest pain. This

> medication can raise your body's potassium levels. Potassium blood

> levels should be checked periodically while you take this drug. If not

> treated, high potassium levels can lead to very serious (rarely fatal)

> heart rhythms. Tell your doctor immediately if you develop any of the

> following symptoms: severe muscle weakness, irregular heartbeat. A

> serious allergic reaction to this drug is unlikely, but seek immediate

> medical attention if it occurs. Symptoms of a serious allergic reaction

> include: rash

> <http://www.medicinenet.com/script/main/art.asp?articlekey=1992

> <http://www.medicinenet.com/script/main/art.asp?articlekey=1992>> ,

> itching, swelling, severe dizziness, trouble breathing. If you notice

> other effects not listed above, contact your doctor or pharmacist.

>

> DRUG INTERACTIONS: This drug should not be used with the following

> medications because very serious interactions may occur: certain azole

> antifungals (ketoconazole, itraconazole), certain macrolide antibiotics

> (clarithromycin, troleandomycin), nefazodone, potassium supplements,

> potassium-sparing diuretics (e.g., amiloride, spironolactone,

> triamterene), certain protease inhibitors (nelfinavir, ritonavir). If

> you are currently using any of these medications, tell your doctor or

> pharmacist before starting eplerenone. Before using this medication,

> tell your doctor or pharmacist of all prescription and

> nonprescription/herbal products you may use, especially of: ACE

> inhibitors (e.g., captopril, enalapril), angiotensin II blockers (e.g.,

> losartan, valsartan), other azole antifungals (e.g., fluconazole),

> lithium, other macrolide antibiotics (e.g., erythromycin), other

> protease inhibitors (e.g., saquinavir), nonsteroidal anti-inflammatory

> drugs (e.g., NSAIDs like ibuprofen, indomethacin, naproxen), St. 's

> wort, verapamil. Consult your doctor or pharmacist before using

> potassium-containing products (salt substitutes) or eating large amounts

> of potassium-containing foods (e.g., bananas). Do not start or stop any

> medicine without doctor or pharmacist approval.

>

> I would recommend Ambien CR for severe insomnia after a hot bath. But do

> not take Ambien CR more than a few days in a row because you will not be

> able to sleep without it. For heart palpitations, difficulty breathing

> and dizzy spells I recommend getting into a walking routine to relieve

> anxiety and stress. But you might have to check with a doctor on that.

>

> Maybe Dr. Grim or another Inspra user could answer some of these

> questions also, and feel free to post more questions.

>

> Best wishes,

>

> airlinerg

>

[Guest guest]

Thank you for thanking me. It made my day!

I found an interesting article you might want to read at:

http://answers.google.com/answers/threadview?id=149981

In my situation, maybe I have high estrogen levels caused by Inspra

that are causing my symptoms, and I will post that separately.

Here is the text of the article:

ESTROGEN IN MEN:

QUESTION:

What are all the good and bad effects of high estrogen in a man???

What can it do to a man and what blood work do i need to get tested

for to check it out?? Do i check estrogen,estrodial,what ?????

ANSWER:

Subject: Re: estrogen

Answered By: kevinmd-ga on 29 Jan 2003 10:09 PST

Hello,

Thanks for asking this interesting question. You asked the

following:

" what are all the good and bad effects of high estrogen in a man???

what can it do to a man and what blood work do i need to get tested

for to check it out?? do i check estrogen,estrodial,what ????? "

1) What are all the good and bad effects of high estrogen in a man?

a) Adverse effects of estrogen in men

From International Antiaging Systems:

" Along with this decline in testosterone with age and lifestyle, many

men also experience increases in the levels of estrogen. The result

is

a testosterone/estrogen imbalance that directly causes many of the

debilitating health problems associated with normal aging. The vast

majority of men are surprised to learn that estrogen (a `female'

hormone) is also present in their bodies. It is produced in very

small

amounts as a by-product of the testosterone conversion process. In

fact, balanced levels of estrogen in men are essential to encourage a

healthy libido, improved brain function, protect the heart and

strengthen the bones . . . high levels of estrogen can cause reduced

levels of testosterone, fatigue, loss of muscle tone, increased body

fat, loss of libido and sexual function and an enlarged prostate.

Other problems associated with excessive levels of estrogen include

(1) The shut down of normal testicular production of testosterone.

Excess estrogen can saturate testosterone receptors in the

hypothalamus in the brain therefore reducing the signal sent to the

pituitary gland. This in turn reduces the secretion of luteinizing

hormone, which is necessary for the gonads to produce testosterone.

(2) Increasing the body's production of sex hormone-binding globulin

(SHBG). SHBG binds testosterone therefore reducing the amount of the

clinical important free testosterone in the blood available to cell

receptor sites.

(3) A reduced effectiveness of the testosterone replacement therapy

due to excess aromatization of testosterone medications to estrogen.

(4) Long-term health risks including an increased risk of diabetes,

heart disease, and some cancers. "

http://www.smart-drugs.net/ias-estrogen.htm

From LE Magazine:

" Through a variety of mechanisms, aging men suffer from the dual

effects of having too little testosterone and excess estrogen. The

result is a testosterone/ estrogen imbalance that can severely

inhibit

sexual desire and performance. In youth, low amounts of estrogen are

used to turn off the powerful cell-stimulating effects of

testosterone. As estrogen levels increase with age, testosterone cell

stimulation may be locked in the " off " position, thus reducing sexual

arousal and sensation and causing the common loss of libido so common

in aging men . . . Estrogen overload is a serious problem in aging

men. One report showed that estrogen levels of the average 54-year-

old man are higher than those of the average 59-year-old woman.

Estrogen is a necessary hormone for men, but too much causes a wide

range of

health problems. High serum levels of estrogen also trick the brain

into thinking that enough testosterone is being produced, thereby

slowing the natural production of testosterone. "

http://www.lef.org/magazine/mag2000/jan00-cover2.html

From RenewYouth:

" Estrogen is a necessary hormone for men, but too much causes a wide

range of health problems. The most dangerous acute effect of excess

estrogen and too little testosterone is an increased risk of heart

attack or stroke. High levels of estrogen have been implicated as a

cause of benign prostatic hypertrophy (BPH) and one mechanism by

which nettle extract works is to block the binding of growth-

stimulating estrogen to prostate cells.

If your blood tests reveal high estrogen and low testosterone, here

are the common factors involved:

Excess Aromatase Enzyme men age, they produce larger quantities of an

enzyme called aromatase The aromatase enzyme converts testosterone

into estrogen in the body. Inhibiting the aromatase enzyme results in

a significant decline in estrogen levels while often boosting free

testosterone youthful levels. Therefore, an agent designated as

" aromatase inhibitor " may be of special value to aging men who have

excess estrogen.

Liver Enzymatic Activity- A healthy liver eliminates surplus estrogen

and sex hormone-binding globulin. Aging, alcohol, and certain drugs

impair liver function, and can be a major cause of hormone imbalance

in aging men. Heavy alcohol intake increases estrogen in men and

women.

Obesity- Fat cells create aromatase enzyme, especially abdominal fat.

Low testosterone allows the formation of abdominal fat, which then

causes more aromatase enzyme formation and thus even lower levels of

testosterone and higher estrogen (by aromatizing testosterone into

estrogen). It is especially important for overweight men to consider

hormone modulation therapy.

Zinc Deficiency- Zinc is a natural aromatase enzyme inhibitor. Since

most Life Extension Foundation members consume adequate amounts of

zinc (30 to 90 mg/day), elevated estrogen in Foundation members is

often caused by factors other than zinc deficiency.

Lifestyle changes (such as reducing alcohol intake) can produce a

dramatic improvement in the estrogen-testosterone balance, but many

people need to use aromatase inhibiting agents to lower estrogen and

to improve their liver function to remove excess SHBG. Remember,

aromtase converts testosterone into estrogen and can indirectly

increase SHBG. SHBG binds to free testosterone and prevents its from

exerting its biochemical effects in the body. "

http://www.renewyouth.com/malehormonemodulationtherapy.shtml

From the Drug Information Handbook, a comprehensive description of

adverse effects is given (obviously some of the risks are

female-specific):

" WARNINGS / PRECAUTIONS — Unopposed estrogens may increase the risk

of endometrial carcinoma in postmenopausal women. Use with caution in

patients with diseases which may be exacerbated by fluid retention,

including asthma, epilepsy, migraine, diabetes, cardiac or renal

dysfunction. Use with caution in patients with a history of

hypercalcemia, cardiovascular disease, and gallbladder disease. May

increase blood pressure. Use with caution in patients with hepatic

disease. May increase risk of venous thromboembolism. Estrogens may

increase the risk of breast cancer (controversial/currently under

study). Estrogen compounds are generally associated with lipid

effects such as increased HDL-cholesterol and decreased LDL-

cholesterol.

Triglycerides may also be increased; use with caution in patients

with familial defects of lipoprotein metabolism. Estrogens may cause

premature closure of the epiphyses in young individuals. May increase

size of pre-existing uterine leiomyomata. Before prescribing estrogen

therapy to postmenopausal women, the risks and benefits must be

weighed for each patient. Women should be informed of these risks and

benefits, as well as possible effects of progestin when added to

estrogen therapy. Safety and efficacy in pediatric patients have not

been established.

ADVERSE REACTIONS — Frequency not defined.

Cardiovascular: Edema, hypertension, venous thromboembolism

Central nervous system: Dizziness, headache, mental depression,

migraine

Dermatologic: Chloasma, erythema multiforme, erythema nodosum,

hemorrhagic eruption, hirsutism, loss of scalp hair, melasma

Endocrine & metabolic: Breast enlargement, breast tenderness, changes

in libido, increased thyroid-binding globulin, increased total

thyroid

hormone (T4), increased serum triglycerides/phospholipids, increased

HDL-cholesterol, decreased LDL-cholesterol, impaired glucose

tolerance, hypercalcemia

Gastrointestinal: Abdominal cramps, bloating, cholecystitis,

cholelithiasis, gallbladder disease, nausea, pancreatitis, vomiting,

weight gain/loss

Genitourinary: Alterations in frequency and flow of menses, changes

in cervical secretions, endometrial cancer, increased size of uterine

leiomyomata, vaginal candidiasis

Hematologic: Aggravation of porphyria, decreased antithrombin III and

antifactor Xa, increased levels of fibrinogen, increased platelet

aggregability and platelet count; increased prothrombin and factors

VII, VIII, IX, X

Hepatic: Cholestatic jaundice

Neuromuscular & skeletal: Chorea

Ocular: Intolerance to contact lenses, steeping of corneal curvature

Respiratory: Pulmonary thromboembolism

Miscellaneous: Carbohydrate intolerance

CARDIOVASCULAR CONSIDERATIONS — It is important to recognize that

estrogens may induce or worsen hypertension. These problems are less

severe with lower doses. Furthermore, estrogens may precipitate

thromboembolic events, particularly in women who smoke. It is

important that patients on long-term estrogens undergo monitoring of

blood pressure and avoid cigarette use. " (1)

UptoDate discusses some complications of increased estrogens in men:

" The most life-threatening complications are cardiovascular sequelae,

which include myocardial infarction, cerebrovascular accident, and

pulmonary embolism. As with most androgen ablation therapies,

estrogens are associated with a loss of libido, impotence, and

lethargy. Gynecomastia and nipple soreness can be particularly

troublesome and can be avoided to some extent by prophylactic breast

irradiation. Prophylactic therapy may be necessary because

gynecomastia and nipple tenderness do not respond well to irradiation

once estrogen therapy is begun, and usually persist even if estrogen

is discontinued. " (2)

Beneficial effects of estrogen in men

Estrogen may have beneficial effects in men with heart disease:

" Although many studies have found that estrogen treatment can reduce

or control heart disease in women, few studies have established

similar benefits in men. One of the few was reported today in CHEST,

the peer-reviewed journal of the American College of Chest Physicians

(ACCP).

Researchers at the University of Pittsburgh reported that conjugated

estrogen (estrogen and progesterone) improves myocardial ischemia

that is caused by exposure to the cold. Environmental exposure to

cold is a common trigger of myocardial ischemia-an insufficient

supply of blood to the heart-particularly in people with existing

coronary artery

disease. In these patients, they noted, cold exposure may decrease

the myocardial oxygen supply by constricting the arteries while

increasing the demand for such oxygen which is carried in the blood. "

http://www.newswise.com/articles/1998/12/ESTROGEN.CCP.html

Estrogen is also used to treat metestatic prostate cancer:

From UptoDate:

" Estrogens exert their effect on prostate cancer growth primarily by

negative feedback on the hypothalamic-pituitary axis; high levels

reduce the release of LHRH from the hypothalamus, thereby suppressing

LH release from the anterior pituitary. As a result, the testicular

Leydig cells stop producing testosterone, although it may take one to

two weeks to achieve castrate levels. High dose estrogens also

compete with androgens for the androgen receptor, and may have a

direct cytotoxic effect on both androgen-sensitive and androgen-

insensitive prostate cancer cells. " (2)

s Hopkins Arthiritis suggests in this study that estrogen plays a

role in prevention of osteoporosis in men:

" These data indicate that E clearly exerts a dominant regulatory

effect on bone resorption in normal elderly men. T may have small

effect, although not significant. Both E and T are important in

maintaining bone formation.

Editorial Comment: This study challenges the traditional concept that

testosterone is the critical sex hormone for maintaining bone

density.

There may be a role for low dose estrogen or selective estrogen

receptor modulators (SERMs) in the treatment of osteoporosis in aging

men. "

http://www.hopkins-arthritis.com/news-archive/2001/estrogen_men.html

The American Society for Bone and Mineral Research links osteoporosis

with low estrogen levels in men:

" In studies begun in 1992 of 400 men with low bone mineral density,

many suffering from tumors or drug-induced (gluco-steroids)

osteoporosis, findings of estrogen depletion were about as frequent

as among postmenopausal women. A combined lack of testosterone and

estrogen was found at least as often as a deficiency in testosterone

alone. "

http://www.asbmr.org/98%20Press%20Releases/newsrel9.htm

2) How do I get tested for estrogen levels?

Lab tests online gives a good description of the various types of

estrogen tests. Estradiol and estrone would be most relevant in men

(estriol is mainly found in pregnant women). A blood test would be

sufficient:

" Estrone tests may be done to aid in the diagnosis of an ovarian

tumor, 's syndrome, and hypopituitarism. In males, it may help

in the diagnosis of gynecomastia or in the detection of

estrogen-producing tumors.

Estradiol levels are used to help evaluate ovarian function. Etradiol

helps diagnose the cause of precocious puberty in girls and

gynecomastia in men. Its main use has been in the differential

diagnosis of amenorrhea (for example, to determine whether the cause

is menopause, pregnancy, or a medical problem). In assisted

reproductive technology (ART), serial measurements are used to

monitor

follicle development in the ovary in the days prior to in-vitro

fertilization. Estradiol is also sometimes used to monitor menopausal

hormone replacement therapy.

Estriol, along with alpha-fetoprotein (AFP maternal) and human

chorionic gonadotropin (hCG) tests, are used to assess the risk of

carrying a fetus with certain abnormalities, such as Down syndrome. "

http://www.labtestsonline.org/understanding/analytes/estrogen/test.ht

ml

I would concur with an apporach suggested at this website - it is a

broad-based approach. They suggest the following initial tests to

look for mail endocrinologic abnormalities:

" The following initial blood tests are recommended for any man over

age 40:

Complete blood count and chemistry profile (to include liver-kidney

function, glucose, minerals, lipids, thyroid (TSH) etc.)

Free and Total Testosterone

Estradiol (estrogen)

Progesterone

DHEA

PSA

Luteiizing hormone (LH)

Homocysteine "

http://www.renewyouth.com/malehormonemodulationtherapy.shtml

Please use any answer clarification before rating this answer. I will

be happy to explain or expand on any issue you may have.

Thanks,

, M.D.

Internet search strategy using Hotbot.com:

estrogen excess in men

estrogen excess

estrogen prostate cancer

estrogen osteoporosis in men

estrogen excess adverse effects

estrogen in men

estrogen benefits in men

Bibliography:

1) Lacy. Conjugated estrogens. Drug information handbook, 2002.

2) McLeod. Initial hormone therapy for the treatment of metestatic

prostate cancer. UptoDate, 2002.

[Guest guest]

Not our area of expertise.

May your pressure be low!

Clarence E. Grim, BS, MS, MD

Senior Consultant to Shared Care Research and Consulting, Inc.

(sharedcareinc.com)

Clinical Professor of Internal Medicine and Epidemiology Med. Col. WI

Clinical Professor of Nursing, Univ. of WI, Milwaukee

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

**************************************

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