Gynecomastia while taking hormone therapy for prostate cancer

I was on Lupron for 25 months and it killed my body's ability to produce much testosterone. Normally a man has a minimum of 300 units of testosterone. I have 15 and have now been off Lupron for three years.

After being off Lupron for about 18 months I was very tired and depleted of energy and discovered my body was not producing sufficient testosterone so my urologist prescribed a testosterone replacement, Andro Gel. After taking it for five weeks I noticed my breasts developing and quit it. The urologist didn't know what to do. I was then told by a radiation oncologist that to prevent my breasts from developing my breasts should have been radiated before I took the testosterone replacement and because that was not done, it was too late to radiate my breasts to prevent their further development if I continued taking the testosterone replacement.

Urologists at Mayo Clinic then developed a plan for me to take Andro Gel and Arimidex with the expectation the Arimidex would prevent further breast development but Mayo would not monitor that treatment.

An MD testosterone expert in Ocala FL said I could not take Arimidex because I had had prostate cancer and The VA said it will not give me Arimidex because studies show it is not effective although Mayo produced a couple of cases where it was but the men in those cases had not had prostate cancer. So far I have not found a doctor willing to implement and monitor the Mayo plan for me.

I wanted to quit taking Lupron after taking it for about 15 or 18 months and my urologist insisted it was important to take it for 24 months so I continued. I wish I had followed my intuition to quit it. Everyone agrees that if I start taking only a testosterone replacement again my breasts will continue to develop and then the only remedy is surgery to reduce their size and I do not want to go through that. It appears I will remain in my current condition for the rest of my life, deplete of energy and tired all the time. Everything physical is a HUGE struggle.

I'd be curious if an endocrinologist could explain this a bit more. I have read some that for men who are overweight (true for myself) fat cells convert testosterone to estrogen (probably that's an oversimplification). Estrogen is related to breast development in puberty. One has to remember that both men and women produce both estrogen and testosterone - obviously at different levels. Is there something about doing ADT that causes more estrogen for men - or simply in the absence of the testosterone that would 'balance' the naturally produced estrogen in the average heathy man, men may have the experience of more estrogen. Armidex is often proscribed for women who have experienced breast cancer that is estrogen sensitive - reducing the amount of extrogen in the body. It may be worth noting that some of the listed side effects of Armidex are: fatigue, feeling weak, and reduced bone mineral density. Since, I think, that those are also some of the side effects of ADT (can say I know whether those are more or less with different ADT drugs) that one might get a "double whammy" effect by doing both.

Doing a google search on "does irradiating the breast prevent breast enlargement? brings up quite a number of studies on mitigating the effects of ADT (including gynecomastia)
I thought the following were interesting:
1. https://pubmed.ncbi.nlm.nih.gov/12559286/ Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 ...
2. https://pubmed.ncbi.nlm.nih.gov/32166452/ Treatment strategies to prevent and reduce gynecomastia and/or breast pain... some comparison of radiation therapy vs tamoxifen
3. https://pubmed.ncbi.nlm.nih.gov/25199619/ The Individualized Diet and Exercise Adherence Pilot Trial (IDEA-P) in prostate cancer patients undergoing androgen deprivation therapy: ...
this included a link to: https://pubmed.ncbi.nlm.nih.gov/29684136/ Effects of a Group-Mediated Exercise and Dietary Intervention in the Treatment of Prostate Cancer Patients Undergoing Androgen Deprivation Therapy...

My own course of ADT was only for four months and considered prophylactic for prevention of metastatic disease. Happening in the midst of the pandemic it is a bit hard to judge the effect on me, since so many other things happened at the same time. I know that I had an emotionally very low point at the four month point (height of the pandemic).

Reading these various studies, your posts here, and other posts on Mayo Clinic Connect and my non scientific sample of men who have shared there stories one-on-one with me makes me think that those going on ADT need to be counseled and/or treated for the potential side effects.