Medical Oncologist
Medicines
Why exemestane is taken after food and its steroidal effects
Exemestane is the only aromatase inhibitor recommended after food, and the only one described as steroidal. This page explains how food improves absorption, what the steroidal structure really means, why it is not a cortisone-type or muscle-building steroid, which mild skin and hair effects some women notice, and how to manage them.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- Why is exemestane taken after food, and what does steroidal mean for you?
- Four things the steroidal structure does and does not do
- Practical questions about taking it after food
- The vocabulary, in plain language
- What the steroidal structure has not been shown to do
- Managing skin and hair changes
- Side effects shared with all aromatase inhibitors
- Myths about exemestane's steroidal nature
- Common questions about food and steroidal effects
The short answer
Why is exemestane taken after food, and what does steroidal mean for you?
Exemestane is recommended after a meal because the body absorbs more of it when there is food in the stomach, particularly food containing some fat. Taking it after breakfast or dinner each day helps you get a steady, reliable dose and also makes the tablet easier to remember. The word steroidal refers to its chemical structure. Exemestane is built on the same backbone as androstenedione, a natural hormone that the aromatase enzyme turns into oestrogen. Because it looks so similar, the enzyme takes it up, and exemestane then binds so tightly that the enzyme is permanently switched off. The body has to make fresh enzyme, and exemestane keeps disabling that too. This is why it is sometimes called an aromatase inactivator. The steroidal structure does not make exemestane a cortisone-type medicine. It does not raise blood sugar, weaken the immune system or require a steroid card. It is also not a muscle-building steroid. However, when exemestane is broken down in the body, one of its products has weak male-hormone activity. This may explain why some women notice mild effects such as oily skin, acne, slight scalp hair thinning or a few extra fine facial hairs. There has been interest in whether this activity might protect bones or affect cholesterol differently from other aromatase inhibitors, but the evidence is not firm enough to rely on.
Food helps absorption
Taking exemestane after a meal gives more consistent levels in your blood.
Steroidal describes shape
Its hormone-like shape lets it lock onto and permanently disable the aromatase enzyme.
Mild male-hormone-like effects are possible
A breakdown product may cause oily skin, acne or hair changes in some women.
This page gives general information only. Your oncology team can advise on your own treatment.In practice
Four things the steroidal structure does and does not do
Most women notice no difference from other aromatase inhibitors.
It locks onto the enzyme for good
Exemestane permanently disables aromatase, while letrozole and anastrozole block it reversibly. Both approaches lower oestrogen very effectively.
It may help after other tablets
Because it works differently, exemestane can sometimes still help in advanced cancer that has grown on a non-steroidal tablet.
It does not act like prednisolone
No effect on blood sugar or immunity, no steroid card, and no danger from stopping suddenly in the way seen with cortisone medicines.
Still, never stop exemestane without talking to your team.It can cause mild androgen-type effects
These are usually minor and often settle or can be managed.
Effects some women notice
- Oily skin or spots
- Thinning of scalp hair
- Slight increase in fine facial hair
Food and timing
Practical questions about taking it after food
Question
General answer
Which meal is best?
Any regular meal works; choose the one you eat most reliably each day
How soon after eating?
Straight after, or soon after, a meal is the usual advice
Does it need a large or fatty meal?
No; a normal meal is enough, and there is no need to add extra fat
What if I only had tea?
Have a small snack, such as a biscuit or chapati, before your tablet if you can
What if I forget and take it before eating?
Do not take another; an occasional dose without food is not a concern
Words you may hear
The vocabulary, in plain language
- Steroidal
- Having the same basic chemical ring structure as natural steroid hormones.
- Aromatase inactivator
- A medicine that permanently disables the aromatase enzyme rather than blocking it briefly.
- Androstenedione
- A natural hormone the body turns into oestrogen, which exemestane resembles.
- Androgen
- A male-type hormone, present in smaller amounts in women too.
- Metabolite
- A substance made when the body breaks down a medicine.
- Absorption
- How much of a medicine passes from the gut into the bloodstream.
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Being straight with you
What the steroidal structure has not been shown to do
Some claims about exemestane's structure go further than the evidence.
Bone protection is not proven
Laboratory and early studies raised hopes of gentler effects on bone, but exemestane can still cause bone thinning. Bone checks and care are just as important as with other aromatase inhibitors.
No clear advantage in protection
In early breast cancer, a large trial comparing exemestane with anastrozole found broadly similar outcomes.
What this page cannot tell you
It cannot tell you whether you will notice any androgen-type effects, or whether exemestane suits you better than another tablet. Your oncologist can advise.
Practical help
Managing skin and hair changes
Androgen-type effects are usually mild, but they can still affect how you feel about yourself.
Oily skin and spots
A gentle, fragrance-free cleanser twice a day and oil-free moisturisers often help. Ask a pharmacist or doctor before using strong acne creams, and mention you take exemestane.
Scalp hair thinning
Mild shampoos, less heat styling and loose hairstyles reduce breakage. Thinning is usually gradual and rarely causes bald patches. A dermatologist can advise on treatments suitable after breast cancer.
Facial hair
Threading, waxing or trimming are safe. If changes are marked, tell your team, as other causes may need checking and switching tablets is sometimes an option.
The wider picture
Side effects shared with all aromatase inhibitors
Most side effects of exemestane come from low oestrogen rather than from its steroidal structure.
Common effects
Hot flushes, joint and muscle aches, tiredness, trouble sleeping, headaches and increased sweating are among the most common. Some women also notice nausea or a change in appetite.
Longer-term effects
Bone thinning and changes in cholesterol can develop slowly over years, which is why bone scans and blood tests are part of follow-up.
When to seek advice
Tell your team about severe joint pain, low mood, vaginal bleeding after menopause, or any symptom that worries you.
Commonly believed
Myths about exemestane's steroidal nature
Exemestane will raise my blood sugar like steroids do.
It is not a cortisone-type steroid and is not known to raise blood sugar.
Taking it with food makes it weaker.
The opposite is true. Food helps the body absorb more of it.
It will make me look masculine.
Only mild effects such as oily skin or a little fine hair are expected, and many women notice none.
Steroidal means it protects my bones.
This has not been proven. Bone thinning still happens, so bone care remains important.
Questions we are asked
Common questions about food and steroidal effects
Can I take exemestane with milk instead of a meal?
A glass of milk with a small snack is better than nothing, but the usual advice is to take exemestane after a proper meal. If mornings are rushed, taking it after your evening meal may be easier and more consistent. Choose a time that fits your day and stick with it.
Will exemestane affect my voice?
Voice changes are not a recognised common effect of exemestane. Its male-hormone-like activity is weak. If you notice hoarseness or a change in your voice that lasts more than a few weeks, get it checked, as it may have another cause that needs attention.
Does exemestane cause weight gain?
Some women gain weight during hormone therapy, and a change in appetite is reported with exemestane. Menopause, lower activity and earlier chemotherapy often contribute. Regular movement, balanced meals and watching portion sizes help. Talk to your team if weight changes quickly.
Can the steroidal effects improve my energy or libido?
There is no good evidence that exemestane boosts energy or sexual desire. Tiredness and low libido are, in fact, common with all aromatase inhibitors because of low oestrogen. Support for sexual health and fatigue is available, so raise these concerns at your appointments.
I am diabetic. Should I take exemestane with a particular meal?
Exemestane does not affect blood sugar, so you can take it after whichever regular meal suits your routine. Many women with diabetes take it after the same meal as their diabetes tablets, which makes remembering easier. Keep up your usual sugar checks.
Will I need a steroid card or extra steroids for surgery?
No. Exemestane does not suppress your body's own cortisol production, so there is no need for a steroid card or extra steroid cover for operations. Do tell the surgical team that you take exemestane, and ask whether to continue it around the procedure.
Is hair thinning on exemestane permanent?
Hair thinning linked to aromatase inhibitors is usually mild, and many women find it improves after treatment ends. Some notice partial regrowth during treatment too. A dermatologist can check for other causes, such as low iron or thyroid problems, and suggest suitable treatments.
Would switching to letrozole stop the androgen-type effects?
Possibly. Letrozole and anastrozole do not have the same breakdown product, so oily skin or facial hair linked to exemestane may ease after a switch. Other aromatase inhibitor effects, such as joint pain, may continue. Your oncologist can discuss whether a change makes sense.
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Sources
- MedlinePlus — Exemestane
- National Cancer Institute — Exemestane
- Cancer Research UK — Exemestane (Aromasin)
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