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Gonadotrophin-releasing hormone neuronal activity can be suppressed due to emotional breakdown, weight loss, eating disorders, medication, physical stress, and extreme exercise. Prostaglandin and proteolytic enzyme concentrations in the follicular wall rise due to the luteinizing hormone surge . About hours before ovum release, the luteinizing hormone surge starts, which is the most dependable indicator of imminent ovulation .
T is neuroprotective and cardioprotective.8-11 Androgens, including T, stimulate immune function, prevent inflammation, and have been used as treatment for anemia and bone marrow failure.12,13 Host toxicities can also have an adverse effect on quality of life during and after therapy. Aromatase inhibitors, mostly combined with agonists of gonadotrophin-releasing hormone proved effective for the prevention of premature epiphysial closure in boys with pubertas praecox of various etiologies. Over the years compelling evidence has accumulated that in men estradiol has an important role in gaining and maintaining bone mass, closing of the epiphyses and feedback on gonadotrophin release. In a group of elderly men who obtained exogenous testosterone enenthate, the addition of anastrozole to the injected androgen prevented the androgen induced improvement of verbal memory, but did not affect special memory . The combination with a GnRH analog in order to prevent this increase did not yield beneficial results either . This is in accordance with the data summarized in a recent review , describing similar responses to placebo, tamoxifen and anastrozole in a number of observational studies.
In addition, long-term toxicities from chemotherapy can be devastating in this patient population. One out of eight women will develop breast cancer over their lifetime, which is of great concern to both premenopausal and postmenopausal women, and a significant economic burden on healthcare systems. This novel combination implant has the potential to prevent side effects from chemotherapy, improve quality of life, and warrants further investigation.
These authors used ammonium sulfate precipitation to measure bioavailable estradiol levels whereas if they had calculated bioavailable estradiol levels using the popular Sodergard equation 79,80 their proposed threshold may have been as high as 75 pM. Thresholds should be interpreted with great caution because they rely heavily on the methods used to measure total or bioavailable estradiol levels. Aromatase inhibitors are widely prescribed for hormone-responsive breast carcinoma in postmenopausal women. The combination of testosterone and letrozole, therefore, was tested in boys with constitutional delay of puberty.
Letrozole is also approved for the treatment of post-menopausal female breast cancer patients that are exhibiting symptoms of Estrogen receptor unknown breast cancer. It is also approved for the extended treatment for post-menopausal female breast cancer patients after 5 years of Nolvadex administration. Letro is approved by the FDA for the treatment of post-menopausal female breast cancer patients as an adjunctive treatment when first-line treatments (such as Nolvadex) have failed to work. The T + AI combination implant seems to be a promising therapy that has the potential to simultaneously treat breast cancer, prevent side effects of chemotherapy, and improve health and quality of life in breast cancer survivors. This case report also supports previous data on the safety and efficacy of the combination T + AI on quality of life in breast cancer survivors.6 These preliminary findings may stimulate interest in further research on the prevention of chemotherapy-induced toxicities, and also the treatment of menopausal symptoms in millions of breast cancer survivors worldwide.

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