Estrogen Blockers and Anxiety in Men

Introduction to Estrogen Blockers and Anxiety

The National Comprehensive Cancer Network (NCCN) guidelines recognize that medications affecting sex hormones can impact male sexual and mental health in men treated for cancer, including the potential for anxiety and mood disturbances 1.

The NCCN guidelines acknowledge the broader psychological impact of hormonal manipulation, including the potential for cognitive and mood effects in men treated for prostate cancer with androgen deprivation therapy, which includes estrogen-blocking mechanisms 1.
Cognitive impairment literature suggests that blocking estrogen synthesis or receptor binding may reduce neuroprotective effects, as estrogen receptors mediate antioxidant effects and enhance neuroplasticity through brain-derived neurotrophic factor (BDNF) pathways, potentially increasing the risk of anxiety and mood disturbances 2.

Feminizing hormone therapy, which includes estrogen administration and anti-androgens, is associated with improved mental health outcomes, including decreased depression and anxiety in transgender individuals, suggesting that the anxiety risk from estrogen blockers may be context-dependent 3, 4.

Clinicians should screen for pre-existing mood disorders when prescribing estrogen blockers to men, as individuals with psychiatric history may have increased sensitivity to estrogen fluctuations, and monitor closely during the first weeks of treatment for signs of mood destabilization 5.
The American College of Physicians and other medical societies may recommend monitoring for mood changes, particularly depression and anxiety symptoms, at regular intervals, although specific guidelines are not provided in the article 1, 5.