Anastrozole Use in Hormone Replacement Therapy and Testosterone Therapy

Indications and Contraindications

• The American Society of Clinical Oncology recommends anastrozole as an alternative to tamoxifen or raloxifene for breast cancer risk reduction in postmenopausal women, with a dose of 1 mg/day orally 1, 2
• There are no established guidelines supporting routine use of anastrozole for managing estrogen levels in patients on testosterone therapy, according to the American College of Physicians 3, 4

Testosterone Therapy Considerations

• The Endocrine Society recommends that testosterone deficiency should be properly diagnosed with levels below a certain threshold on at least two early morning measurements, and treatment should aim to achieve total testosterone levels in the mid-normal range 5
• Regular monitoring of testosterone levels, hematocrit, and liver function is necessary during treatment, as suggested by clinical guidelines 5

Monitoring and Safety Considerations

• The American College of Clinical Oncology suggests that prior to initiating anastrozole, clinicians should evaluate baseline fracture risk and measure bone mineral density, and use caution in patients with moderate bone mineral density loss 2, 6
• Common side effects to monitor include joint stiffness and arthralgias, vasomotor symptoms, according to the Journal of Clinical Oncology 2, 6

Special Considerations

• Anastrozole should not be prescribed to premenopausal women for hormone management, as recommended by the American Society of Clinical Oncology 2, 6
• History of osteoporosis or severe bone loss is a relative contraindication for anastrozole use, according to the American College of Clinical Oncology 2, 6