After four months of treatment with Letrozole, 11 out of 15 men experienced improvement in either their sperm concentration or motility. For the KKH study, researchers recruited men with low sperm count of unknown cause regardless of their T/E ratios. However, the frequency of this ratio is not as prevalent in our clinical practice," shares primary investigator Dr Liu Shuling, Consultant, Department of Reproductive Medicine, KKH. Nevertheless, the objective findings do suggest a testable hypothesis and likely valid conclusions, which may eventually affect 12.4% of the female population diagnosed with breast cancer. Nevertheless, subcutaneous delivery of an AI is not "standard of care." However, the 8 mg dose of subcutaneous letrozole maintained serum E2 levels below 5 pg/mL, which is the target level of E2 used in comparative (efficacy) studies on oral AIs.20 We know that this patient's tumor did respond favorably to T + L therapy. However, previous case reports and two of the authors’ (RG, CD) clinical experience (unpublished data) have demonstrated similar tumor responses to T + AI combination implant therapy in the neoadjuvant setting.3 T is the major substrate for E2 in postmenopausal patients and has a stimulatory effect via the estrogen receptor. T + AI, testosterone-aromatase inhibitor.aThere was no charge for this patient. The patient's weight remained stable throughout chemotherapy (67.7 ± 0.72 kg). If the use of an aromatase inhibitor is necessary, utilize it only when required, and attempt the lowest possible dose for the purpose of Estrogen control rather than Estrogen elimination. It must first be understood that Letrozole is an aromatase inhibitor, with a wide variety of application in terms of Estrogen control. None of the subjects developed an estradiol level of less than 40 pmol/l. Although the concepts presented in this study are thought to be provoking and biologically plausible, this report is limited by being a single case study. The necessity for an invasive procedure, no matter how simple, may be another obstacle to further investigation of this therapy. Between mid-October and early December (day 0-42), the patient was treated with subcutaneous T + L alone, before initiation of chemotherapy. Once chemotherapy was initiated, the dose of subcutaneous letrozole on subsequent insertions was reduced from 12 to 8 mg for a total dose of 180 mg T with 8 mg of letrozole (180 mg T + 8 mg L). The patient was reluctant to stop therapy because of the significant beneficial effects she experienced on T therapy including improvement in sleep, hot flashes, mood, memory, physical energy, strength, joint and muscular pain, bladder control, and sex drive. The consensus recommendation was that the patient be treated with neoadjuvant chemotherapy. Testosterone (T) implants have been used for over 70 years in both men and women to treat symptoms and various diseases including breast cancer. The long-term benefits of higher testosterone levels in older men remain controversial, however. There is also evidence that aromatase inhibitors can be used in boys with idiopathic short stature and boys with constitutional delay of puberty to increase adult height. Additionally, one short-term study did not show adverse effects of aromatase inhibition in older men on cardiovascular markers. As per the Indian Council of Medical Research (ICMR), infertility is likely to affect approximately million couples in India at any given time . Approximately 85-90% of young women become pregnant within a year of marriage, with the majority conceiving within six months 5-6; percent of couples experience infertility globally . The World Health Organization (WHO) estimates that between 3.9 and 16.8% of Indian couples experience primary infertility . Primary infertility is the most prevalent type of infertility worldwide. Total amount billed for chemotherapy $217,700 ($106,590 covered). There was no significant change on echocardiogram after six cycles of chemotherapy. White blood count (7.7 ± 2.5 k/mm3) and platelet count (228.0 ± 45.3 k/mm3) also remained stable during chemotherapy.
