Addressing Male Breast Cancer Side Effects: Dr. Maryam Lustberg's Groundbreaking Insights

By: Lennard M. Goetze, Ed.D & Graciella Davi, PhD

Dr. Maryam Lustberg, Director of the Center of Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center, delivered a powerful and insightful presentation on managing side effects in male breast cancer patients. With years of expertise as Chief of Breast Medical Oncology, Dr. Lustberg provided a rare, in-depth look into an area of oncology often overshadowed by female-centered research and treatment approaches. Her session illuminated critical gaps in current data, shared emerging therapies, and emphasized the importance of individualized patient care.

Understanding the Data Gaps in Male Breast Cancer
Dr. Lustberg began by addressing a fundamental challenge: the limited research specific to male breast cancer. Most toxicity management data are extrapolated from female breast cancer studies, with additional references from bladder and prostate cancer cases. This lack of male-focused data has long created gaps in understanding the true impact of treatments on men, leaving oncologists reliant on approximations rather than precise evidence.

She highlighted recent efforts to make clinical trials more inclusive of male patients. However, much work remains to bridge the disparity, particularly when assessing quality of life and treatment side effects in men undergoing therapies like tamoxifen.

Quality of Life and Treatment-Related Toxicities
Dr. Lustberg shared findings from multiple surveys on male breast cancer patients’ experiences. Despite limited data, results consistently show high rates of fatigue, sexual dysfunction, hair loss, chest wall pain, and emotional stress related to body image changes. She noted that existing surveys often underreport symptoms due to biases in participation, with many men reluctant to voice concerns or feeling they must "tough it out" during treatment.

Tamoxifen, the mainstay therapy for hormone receptor-positive male breast cancer, emerged as a central focus. Dr. Lustberg explained that while effective, tamoxifen can lead to significant side effects—including weight gain, sexual health issues, hot flashes, and emotional strain—which often cause patients to discontinue therapy prematurely.

Emerging Solutions for Hot Flashes and Other Side Effects
One of the most discussed side effects was hot flashes, primarily induced by tamoxifen or gonadal suppression treatments. Dr. Lustberg outlined several pharmacological interventions, including repurposed medications like venlafaxine, gabapentin, and oxybutynin, which have shown promise in reducing vasomotor symptoms. She also presented data on new neurokinin receptor antagonists that biologically target hot flash pathways, with early studies showing a 50–60% reduction in symptoms.

However, she emphasized that these solutions, while promising, are largely drawn from female or prostate cancer studies. Dedicated trials for male breast cancer patients are urgently needed to validate efficacy and safety specifically for men.

Addressing Body Image and Hair Loss Concerns
Dr. Lustberg acknowledged a longstanding minimization of body image issues among male patients. Surgery, scarring, lymphedema, and weight gain significantly impact men’s self-confidence, yet discussions around these topics remain rare in clinical settings. She urged oncologists to actively invite these conversations, ensuring patients feel safe expressing their concerns.

Regarding hair loss, scalp cooling technology—a method proven to preserve hair during chemotherapy—has been historically under-offered to men due to assumptions that they "don’t mind losing hair." Dr. Lustberg challenged this notion, advocating for equal access to these interventions for male patients seeking to maintain their appearance and dignity during treatment.

Sexual Dysfunction and Communication Barriers
Sexual health remains a significant, often unaddressed issue. Studies show that up to 78% of men report diminished sexual interest and function during treatment. Dr. Lustberg highlighted that fear, embarrassment, or lack of clinician inquiry frequently prevent open discussions.

Potential interventions include PDE5 inhibitors, vacuum-assisted devices, hormone injections, and lifestyle modifications. She also mentioned that in cases where tamoxifen side effects are intolerable, low-dose regimens may be considered on a case-by-case basis, despite limited male-specific data.

Fatigue, Metabolic Health, and Long-Term Survivorship
Beyond acute side effects, fatigue and metabolic health challenges persist long after treatment ends. Dr. Lustberg encouraged a multidisciplinary approach involving oncological rehabilitation, physical activity, thyroid and anemia evaluations, and cardiometabolic monitoring. She also discussed promising data suggesting that newer GLP-1 agonists may support weight management and metabolic health in survivors, though research is ongoing.

The Call for Patient-Centered Care and Research
Throughout her presentation, Dr. Lustberg underscored the importance of individualized care, open communication, and advocacy. She urged patients to report side effects, ask questions, and participate in research efforts that can shape future treatments tailored to men.

Her closing message was clear: male breast cancer patients deserve equal attention, dedicated research, and proactive management of their quality of life during and after treatment. Only by amplifying their voices and expanding clinical data can the oncology community truly meet their needs.

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Afterthought by Dr. Robert Bard

As someone who has dedicated my career to advancing diagnostic imaging and improving outcomes for cancer patients, I want to commend Dr. Maryam Lustberg for her exceptional presentation on the realities faced by men living with breast cancer. Her ability to shed light on long-ignored side effects and quality-of-life issues is both timely and necessary.

For too long, male breast cancer has been treated as an anomaly, leading to significant gaps in research and clinical care. In my own practice, I have witnessed men struggling silently with the physical and emotional burdens of treatment. The lack of male-specific data often forces us to make educated guesses rather than evidence-based decisions, leaving patients vulnerable to side effects that disrupt their lives.

Dr. Lustberg’s insights resonate deeply with what I encounter daily in diagnostic care. From fatigue and hot flashes to body image challenges and sexual dysfunction, these are not trivial complaints—they are critical aspects of survivorship that deserve equal priority alongside tumor control. Her call for broader research, more inclusive clinical trials, and open dialogue between doctors and patients reflects the future of cancer care we should all strive toward.

As clinicians, it is our responsibility to listen, validate, and innovate. Dr. Lustberg’s work highlights that male breast cancer patients need personalized, compassionate treatment strategies backed by real data—not assumptions drawn from female-centric studies. This presentation is a powerful step toward closing that gap, and I fully support her mission to bring greater awareness and targeted solutions to this underserved community.

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"Hormones, Hubris, and Hidden Risks: The Oncologic Cost of Anabolic Steroid Abuse" An Endocrinologist’s Perspective on Male Breast Cancer and Hormonal Carcinogenesis By: Dr. Angela Mazza Under thorough analysis of anabolic-androgenic steroids (AAS) and their potential cancer risks, these synthetic derivatives of testosterone commonly used to enhance muscle mass and athletic performance are not without RED FLAGS. While their body-building effects are well documented, increasing evidence points to significant cancer-related risks associated with their misuse, particularly with prolonged use and supraphysiologic dosing. Among these, the development of hormone-sensitive malignancies, including male breast cancer (MBC), is of particular concern. As an endocrinologist, I have seen the untoward effects of these drugs.  AAS disrupt the hypothalamic-pituitary-gonadal (HPG) axis, leading to a cascade of hormonal imbalances that do not always resolve after these drugs are stopped.  Exogenous testosterone and its derivatives undergo aromatization to estradiol, resulting in elevated estrogen levels in men. This hyperestrogenic state, compounded by suppressed endogenous testosterone and reduced gonadotropin secretion, creates a milieu that mimics estrogen dominance—a recognized risk factor for the development of gynecomastia and potentially malignant transformation in breast tissue. Case reports and epidemiological data, although limited due to the rarity of MBC, have documented instances of breast carcinoma in men with a history of prolonged AAS use, particularly in those who developed gynecomastia years prior to diagnosis. In addition to hormone-sensitive tissues, AAS have been implicated in hepatic malignancies, including hepatocellular carcinoma and hepatic adenomas, largely due to the hepatic metabolism of 17α-alkylated oral steroids. AAS have also demonstrated genotoxic and epigenetic effects, such as DNA strand breaks, oxidative stress, and aberrant methylation patterns, which may contribute to tumorigenesis. Immunosuppression linked to chronic AAS exposure further reduces immune surveillance, facilitating the progression of transformed cells. Despite these concerns, definitive large-scale prospective studies linking AAS use directly to cancer incidence remain scarce. However, the biological plausibility, supported by mechanistic studies and clinical observations, warrants caution. Given the rising prevalence of AAS use in non-athletic populations and bodybuilders, often in unregulated or illicit contexts, awareness and screening for hormone-related cancers in users should be prioritized. While causality cannot yet be established with high certainty, the evidence supports a credible link between chronic anabolic steroid use and increased cancer risk, particularly in hormone-sensitive tissues such as the male breast. Medical professionals should maintain vigilance and counsel patients on the potential oncogenic consequences of AAS abuse. About Dr. Angela Mazza Dr. Mazza is a triple board-certified endocrinologist, integrative medicine specialist, and founder of Metabolic Center for Wellness in Oviedo, Florida. With a career dedicated to hormone optimization, thyroid health, and functional longevity, Dr. Mazza blends conventional endocrine care with personalized, root-cause medicine. She is nationally recognized for her leadership in advancing patient-centered approaches to hormonal disorders, and she frequently speaks on the links between endocrine disruption and chronic disease—including cancer. Dr. Mazza is a vocal advocate for early detection, particularly in overlooked populations such as men at risk for hormone-sensitive cancers like male breast cancer. Her work empowers both patients and practitioners to understand the broader impact of environmental and pharmaceutical hormone exposures on long-term health. She continues to collaborate with clinical researchers and advocacy organizations to elevate awareness, improve screening protocols, and promote integrative strategies for cancer prevention and endocrine resilience. * Check out additional stories like this from www.DrAngelaMazza.com

Male Breast Cancer’s Hidden Mental Health Crisis

By: Dr. Barbara Bartlik

Male breast cancer remains one of the most misunderstood and underdiscussed diagnoses in oncology. For integrative psychiatrist Dr. Barbara Bartlik, the silence surrounding men’s emotional and sexual health in the wake of cancer is a gap that demands urgent attention. Her holistic perspective challenges the status quo and offers hope for survivors navigating the complex terrain of healing.

When most people think of breast cancer, they imagine women fighting a disease that has become a rallying cry for global awareness. But for men, who make up a small yet significant percentage of breast cancer diagnoses, the reality is different—quieter, lonelier, and often laden with stigma.

“Most men keep it very quiet. They don’t share it. They’re embarrassed about it because it seems to be a woman’s problem,” says Dr. Bartlik. This isolation leaves male survivors adrift in a healthcare system that is rarely designed with their unique needs in mind.

As an integrative psychiatrist, Bartlik occupies a rare position at the intersection of physical and mental health. Her work goes beyond traditional talk therapy, encompassing clinical insight into how cancer treatments impact the body, mind, and relationships. “You’re not just therapists at that level,” she explains. “You’re also clinical. That means understanding the real effects of treatments like Tamoxifen, which are killing the sex drive, damaging the immune system, and leaving patients depressed—even suicidal.”

 

The Andropause of Cancer Treatment

Tamoxifen, a mainstay in breast cancer care, is central to Bartlik’s concerns. Commonly prescribed to male survivors post-surgery, it effectively induces a chemical andropause—akin to menopause in women. “They may experience hot flashes, mood swings, fatigue, depression, and a complete loss of libido,” she says. “It’s a long haul because they often have to be on it for five years, sometimes more. Most people do not like Tamoxifen. They’ve lost their energy, and it’s a very unpleasant feeling.”

For many men, these side effects strike at the core of their identity, compounding feelings of shame and alienation. Unlike women, who have networks of support groups and survivor organizations, men with breast cancer often navigate their journey in solitude. “Women have organizations where they can meet with other survivors. But for men, there’s very little support out there. They may never meet another man who has breast cancer,” Bartlik explains.

This profound sense of isolation is not just an emotional issue—it’s a public health concern. Without adequate mental health support, survivors may spiral into depression, anxiety, or worse. “Cancer in itself is a downturn for a person. It makes everything so bleak. Even just trying to survive it—the depression, the PTSD—it’s massive,” she adds.

 

 

A Call for Holistic Intervention

Dr. Bartlik believes the traditional oncology model, focused on eradicating tumors, often overlooks these critical aspects of healing. “Surgeons and oncologists are focused on killing the cancer. They may not think about bringing in a psychiatrist or helping support the man in adjusting to this new way of life—living with low testosterone, for instance.”

Her approach involves more than just medication. Bartlik incorporates nutritional strategies and natural supplements designed to mitigate some of the sexual and mood-related side effects of cancer treatment. “There are supplements like ginkgo biloba and tribulus to boost sex drive, long jack for erectile function, and amino acids like L-arginine and citrulline that open blood vessels. Magnesium helps too, because it relaxes and opens blood vessels.”

However, she underscores the importance of collaboration. “We have to work with the oncologist because some of these supplements can increase testosterone, and that’s not desirable in certain cases.” This careful balance reflects her integrative philosophy: treating the whole person, not just the disease.

 

Sexual Health as Mental Health

Beyond Tamoxifen, Bartlik highlights how other cancer treatments further complicate male sexual health. “We’re talking about testosterone blockers in men with prostate cancer and surgeries that inevitably affect sexual functioning,” she explains. “Some men are lucky and can retain some of it, but for others, the changes are devastating.”

She notes that early post-surgical interventions can make a difference. “If you take Cialis a month after surgery and continue daily, it can help blood flow and possibly restore some function.” For men struggling with lingering dysfunction, Bartlik’s protocols include both pharmacological aids and natural remedies.

“Sexual health is mental health,” she emphasizes. “When these men lose their sexual identity, it impacts their relationships, their mood, and their overall quality of life. Addressing this is not optional—it’s essential.”

 

Breaking the Stigma

For Bartlik, male breast cancer advocacy is more than a professional interest—it’s a mission. She sees an urgent need to break through stigma and silence, empowering men to seek help without shame. “Pursuing clinical care for men with breast cancer is a huge platform I didn’t even think about until I started realizing how sexual health and depression are all over cancer care—and specifically men’s cancer.”

Collaborations with advocacy groups and publishing her insights could amplify this message. “This is an area where we can make a huge difference in men’s health. It’s lifesaving work—because killing the stigma is just as important as killing the cancer.”

 

Toward a New Standard of Care

As she reflects on her role, Dr. Bartlik envisions a future where psychiatry is woven seamlessly into oncology care for men. “These patients are dealing with far more than just physical illness. They’re coping with loss—of health, of identity, of intimacy. Our job is to help them heal in every sense of the word.” For the men still suffering in silence, her message is clear: help exists, and they are not alone. With the right support, recovery can be about more than survival—it can mean reclaiming a full, vibrant life.

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ABOUT THE AUTHOR

Dr. Barbara Bartlik is a renowned integrative psychiatrist with over three decades of clinical experience, specializing in the intersection of mental health, sexual health, and functional medicine. Board-certified in psychiatry and a fellow of the American Psychiatric Association, she is celebrated for her holistic approach to treating trauma, anxiety, depression, and sexual dysfunction.  As an editor of Integrative Sexual Health (a volume in Dr. Andrew Weil’s Integrative Medicine Library), Dr. Bartlik brings academic rigor to her innovative work. She integrates lifestyle medicine, nutritional strategies, and mind-body therapies into psychiatric care, helping patients achieve transformative healing.

A sought-after speaker and media contributor, she addresses audiences worldwide on topics from PTSD recovery to menopause and andropause support. Based in Manhattan, Dr. Bartlik continues to redefine mental health care for the modern age—bridging science, compassion, and whole-person wellness. 

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Michael and Xio Caruso

On January 5, 2017, I was on the phone speaking with my daughter when I felt a tug around my chest and stood up to stretch. Suddenly I felt a lump behind my right nipple, which I never noticed during my morning showers. The very next morning my wife, Xio, called our doctor and made an appointment. I saw the doctor a week a later on January 12, and he gave me a full physical and sent me to the local hospital for a mammogram the next morning. Friday the 13^th will forever haunt me. Boy was that fun, not! I had no idea this is the torture women experience on an annual basis. Once it was over, and thank God it was, they told me I needed a biopsy. I was in a rush to get back to my office and did not want to wait around for insurance approval, so I told them to call me and I would return. By noon, they had approval and I was called back for the biopsy, where my wife joined me for my second round of torture. Little did I know I would have a “gentle” mammogram right after the biopsy.

I returned to work not thinking anything of it and the very next day my wife and I were on our way to join my parents in Florida for a week of fun in the sun. It was a three-day weekend, so I was told the results would be communicated to me on Tuesday. On Monday, January 16, I received my diagnosis after a call from our family doctor. There was no way to sugarcoat it, he said, “you have breast cancer”. I was just 49 years old. We sat around looking at each other with a collective feeling of shock. The doctor recommended three possible surgeons for me to see upon returning from vacation. One of them was Dr. Mark Gordon, an oncology surgeon who had treated my wife in the past for minor cysts. My wife immediately called his office and made an appointment for the following Monday. By the end of the day, I had a cancer patient navigator, and an appointment to see a genetics counselor. You see, my mother is a breast cancer survivor. I never did genetics testing because my sister tested negative, so I assumed it had skipped me. I was wrong!

I met with the genetics counselor first, and did my genetics test, then on to Dr. Gordon. He reviewed my pathology report and explained I had ductal carcinoma insitu. Dr. Gordon explained I needed surgery to remove the nipple and all the breast tissue, plus the layer of cells underneath and removal of sentinel lymph nodes (new vocabulary). Everything was moving fast. While waiting for the genetics results we made an appointment with my oncologist. She explained the possible treatment plan, chemo, radiation, and immunotherapy. I was diagnosed with triple positive, HER2 positive, Estrogen positive and Progesterone positive breast cancer. The genetics test confirmed I carried the BRACA-2 gene.

I had my surgery on Valentine’s Day, February 14, 2017. From mid-March until now, my treatment has consisted of chemo medications (Taxol, Adriamycin, Herceptin, and Perjeta to name a few), followed by radiation and now finishing my every three-week treatment of Herceptin and Perjeta. Tamoxifen has been added as a daily pill. I have a daughter who just turned 21 and will have her genetics test done as soon as possible to see if the BRACA-2 has been passed on to her.

Xio and I have made the decision to share my story with as many people we come across as possible in an effort to spread the word that men get breast cancer too. We have received amazing support from our respective employers, friends, and family, and cherish every little moment and milestones along the way. I just celebrated my 50^th birthday on April 3 with my relatives and closest friends and it was truly a celebration of life.

Our journey is not over, right before my big birthday celebration, Xio was diagnosed with a rare but treatable breast cancer, Mucinous Carcinoma (about 1% of women are diagnosed with this type of cancer).  I finished my last infusion on April 24^th, 2018, and she had her surgery in mid-May 2018. We are as prepared as two people can be to battle this dreaded disease. We joke we belong to the 1% club.

According to the American Cancer Society, about 2,550 new cases of invasive breast cancer in men will be diagnosed and many are not as lucky as me. For men, the lifetime risk of getting breast cancer is about 1 in 1,000. If you suspect something is wrong, in any part of your body, don’t ignore it and get it checked.

We have been honored to meet many fellow male breast cancer survivors and their families through organizations such as the Male Breast Cancer Coalition.  Since my diagnosis, we have had opportunities to participate in several events to raise awareness and will continue on that mission of awareness and advocacy.

Education and awareness are the key. Please share this information with your fathers, sons, uncles, brothers, cousins, grandfathers and every male in your lives (I do every chance I get). The fight against this disease can be won but it starts with spreading awareness. Men have breasts too!