Testosterone + Anastrozole Pellets for ER+ Breast Cancer

What This Treatment Is

• Small pellets placed under the skin release testosterone and anastrozole.
• For women with estrogen receptor-positive (ER+) breast cancer.
• Goals:
  • Relieve menopausal symptoms (like hot flashes, joint and muscular pain, fatigue, low energy, memory issues).
  • Keep estrogen very low to help prevent the cancer from coming back.

Every plan is personalized to your:

• Cancer stage
• Time since diagnosis
• Body weight
• Symptoms and side effects

How It Works

• Anastrozole: Blocks the body from making estrogen.
• Testosterone: Helps improve energy, mood, sex drive, bone health, overall well-
  being, and more.

After Menopause

• Anastrozole works well to lower estrogen.

Before Menopause

• The ovaries still make estrogen, so extra steps are needed:
  • Medicines to turn off the ovaries (like Lupron, Zoladex)
  • Or surgery to remove the ovaries
• Tamoxifen is often used in these cases.

Dosage Basics

Your doctor chooses doses based on your health needs.

• Typical starting dose:
  • 60 mg testosterone + 4 mg anastrozole (two pellets = 8 mg anastrozole total).
• Adjustments:
  • More testosterone may be added if needed to control symptoms.
  • Anastrozole dose may be raised or lowered based on blood tests and
    symptoms.

Special Situations

• Early cancer, over 5 years ago: May use a lower dose of anastrozole or sometimes
  testosterone alone.
• Recent diagnosis (<5 years): Usually need 8 mg anastrozole.
• Active or spreading cancer: Higher anastrozole doses (12–24 mg).
• Long-term (after 5–10 years): Some women may only need testosterone. Continue
  anastrozole as long as it is tolerated.

Monitoring & Safety

Blood tests are very important.

• When to test:
  • 4 weeks after pellets are placed after first insertion
  • Right before the next pellet insertion
  • At least twice per year
• What to test: Estradiol (estrogen), testosterone, FSH, blood counts
• Target estradiol levels:
  • High-risk or metastatic cancer: under 5 pg/mL
  • Lower-risk cancer: under 15 pg/mL (sometimes up to 30 pg/mL may be okay)

If You Are Taking Pills (Oral Aromatase inhibitors)

• Don’t stop oral anastrozole or letrozole unless your oncologist says so.
  • There’s no direct comparison between oral and pellet forms of anastrozole, so checking estradiol levels is crucial to ensure the pellets work. Always get your oncologist’s approval before changing aromatase inhibitor treatment.
• Skip oral doses for 7 days before blood tests to see how well pellets are working.
• If estrogen is too high (>30 pg/mL): Dose of anastrozole may be increased.
• If estrogen is too low (<5 pg/mL) with bad symptoms: Dose may be lowered.

Lifestyle & Other Notes

• Consent form: You must sign because this is an “off-label” use (not FDA-approved for breast cancer).
• Diet: A whole-food, low-sugar diet supports healing and lowers risk of recurrence.
• For ER-negative tumors: Sometimes testosterone alone is used. In some ER-
  negative cancers (HER2+ or triple-negative), testosterone might fuel growth—but in many cases, the benefits (better mood, energy, immune function, bone and muscle health) outweigh this ‘theoretical’ potential risk.

Key Takeaways

• Testosterone + anastrozole pellets may help you feel better, stay healthier, and
  keep estrogen levels very low.
• Blood tests guide treatment and help keep it safe.
• Treatment is customized for each woman.
• Always talk with your oncologist before making any changes.

In short: This therapy may improve symptoms and support quality of life while helping
reduce the risk of breast cancer returning. Close monitoring and teamwork with your
oncologist are essential.