INTRODUCTION: A 31-year old woman with stage VI endometriosis unresponsive to leuprolide acetate was scheduled for total abdominal hysterectomy with bilateral salpingo-oophorectomy and hemicolectomy at John Hopkins Hospital. We hypothesized that the protocol medications with similar but stronger biochemical effects than danazol or gestrinone on sex hormone–binding globulin and free testosterone might offer better suppression of endometriosis.
METHODS: The protocol focused on biochemical mechanisms: 1) lowering estradiol to immeasurable levels and reversing (2) high sex hormone–binding globulin and (3) low free testosterone. The U.S. Food and Drug Administration-approved intramuscular medications of 50 mg Nandrolone and 20 mg Stanozolol were injected weekly (buttock). Nandrolone's unique properties are its 1) strong affinity for sex hormone–binding globulin; (2) ability to block androgen receptors; displacing testosterone, estrogens, and endocrine disrupting chemicals; and (3) its progestational activity preventing conversion to estradiol and dihydrotestosterone.
RESULTS: Stanozolol lowered sex hormone–binding globulin from 280 nmol/L to 28 nmol/L (90%) in 8 weeks. With the addition of nandrolone, the serum testosterone increased from 12 ng/dL to 128 ng/dL (10-fold). The free androgen index increased from 0.012 to 1.37 (100-fold). The patient discontinued pain medication, remained amenorrheic, delayed surgery, and resumed marital relations. Her bone density and weight remained stable. She reported no hirsutism on 200 mg Spirolactone daily. Laboratory tests revealed normal blood count and liver functions. The patient has remained on continuous therapy for 3 years with no intent to discontinue either medication.
CONCLUSIONS: The author theorized that protocol medications successfully blocked sex hormone–binding globulin androgen receptors, thereby interrupting the continuing propagation of endometriosis by estrogens and endocrine disrupting chemicals.
Financial Disclosure: Edward M. Lichten, MD—This author has no conflict of interest to disclose relative to the contents of this presentation.
© 2014 by The American College of Obstetricians and Gynecologists.