What are the potential effects of an adult male taking exemestane (Aromasin) daily?

From the Guidelines

Exemestane is not recommended for daily use by adult males due to its potential to cause significant hormonal disruptions and increase the risk of fractures, among other adverse effects. Taking exemestane daily can lead to decreased estrogen levels, which can cause joint pain, decreased bone mineral density, and negative impacts on cholesterol profiles, such as raising LDL and lowering HDL 1. Men may experience mood changes, fatigue, hot flashes, and sexual dysfunction as a result of exemestane use. Long-term use could potentially increase cardiovascular risks and impair cognitive function. Additionally, exemestane may disrupt the natural testosterone-estrogen balance, potentially causing muscle mass changes and fat redistribution.

Some of the key potential effects of exemestane on adult males include:

• Decreased estrogen levels, leading to increased fracture risk and joint pain
• Negative impacts on cholesterol profiles, such as raising LDL and lowering HDL
• Mood changes, fatigue, hot flashes, and sexual dysfunction
• Potential increase in cardiovascular risks and impairment of cognitive function
• Disruption of the natural testosterone-estrogen balance, potentially causing muscle mass changes and fat redistribution

It is essential to note that exemestane is primarily indicated for breast cancer treatment in postmenopausal women, and males should not take it without medical supervision for specific conditions like estrogen-sensitive cancers or certain hormonal disorders 1. The body requires some estrogen even in males for proper physiological functioning, and artificially suppressing it can lead to numerous health complications. Therefore, adult males should avoid taking exemestane daily unless under the supervision of a physician for a specific medical condition.

From the FDA Drug Label

Exemestane significantly lowers circulating estrogen concentrations in postmenopausal women, but has no detectable effect on adrenal biosynthesis of corticosteroids or aldosterone. Daily doses of exemestane up to 25 mg had no significant effect on circulating levels of androstenedione, dehydroepiandrosterone sulfate, or 17-hydroxyprogesterone, and were associated with small decreases in circulating levels of testosterone. A dose-dependent decrease in sex hormone binding globulin (SHBG) has been observed with daily exemestane doses of 2.5 mg or higher. The most common adverse reactions included hot flushes (13% vs. 5%), nausea (9% vs. 5%), fatigue (8% vs. 10%), increased sweating (4% vs. 8%), and increased appetite (3% vs 6%) for EXEMESTANE and megestrol acetate, respectively.

The potential effects of an adult male taking exemestane (Aromasin) daily may include:

• Decreased estrogen levels: Exemestane lowers circulating estrogen concentrations.
• Decreased testosterone levels: Daily doses of exemestane up to 25 mg are associated with small decreases in circulating levels of testosterone.
• Adverse reactions: Common adverse reactions include hot flushes, nausea, fatigue, increased sweating, and increased appetite.
• Hormonal changes: Exemestane may cause a dose-dependent decrease in sex hormone binding globulin (SHBG) and slight, nondose-dependent increases in serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. It is essential to note that exemestane is not approved for use in adult males, and its effects in this population are not well studied. Therefore, any use of exemestane in adult males should be approached with caution and under the guidance of a healthcare professional 2 2.

From the Research

Potential Effects of Exemestane on Adult Males

The provided studies primarily focus on the effects of exemestane in postmenopausal women with breast cancer. However, we can still discuss the potential effects of exemestane on adult males based on its mechanism of action and available data.

• Hormonal Changes: Exemestane is a potent inhibitor of aromatization, reducing estrogen synthesis in vivo by greater than 97% 3, 4. In adult males, this could lead to a significant decrease in estrogen levels, potentially causing hormonal imbalances.
• Adverse Events: Common adverse events reported in postmenopausal women taking exemestane include hot flushes, nausea, fatigue, increased sweating, and dizziness 3, 4. It is possible that adult males may experience similar side effects.
• Dosage and Tolerability: The recommended dose of exemestane is 25 mg once daily 3. However, dosages up to 600 mg/day have been tested, and the maximum tolerated dose has not been reached in clinical studies 3, 5. The tolerability of exemestane in adult males is unknown.
• Effects on Testosterone and Other Hormones: Exemestane's effect on testosterone and other hormones in adult males is not well-studied. However, as an aromatase inhibitor, it may increase testosterone levels by preventing the conversion of testosterone to estrogen.

Specific Considerations for Adult Males

• Lack of Research: There is limited research on the effects of exemestane in adult males, and most studies focus on postmenopausal women with breast cancer.
• Potential Risks: Adult males taking exemestane may be at risk of hormonal imbalances, particularly with regards to estrogen and testosterone levels.
• Monitoring and Caution: If an adult male were to take exemestane, close monitoring of hormonal levels and potential side effects would be necessary, as the effects of exemestane in this population are not well understood 6, 7.