Testosterone for menopause related symptoms

Cat123

I am starting chemo this week and then on to tamox so I am already anticipating menopausal symptoms (I'm 47).  One of my friends who is a little older than me was having menopause symptoms a few years ago....feeling crummy, gained weight and lost her mojo, etc.  She went to see a hormonal doctor (found in the Suzanne Somers book about hormones) and she started on testosterone.  She has felt incredible the last couple of years....like she is 18!  Could a breast cancer survivior take testosterone?  Has anyone heard about this?

Husband11

Testosterone is converted by aromatization into estrogen.  That is the reason for using an aromatase inhibitor.  Given that you are ER+, it's potentially not a good idea to increase testosterone levels given that it could be converted into estrogen.

 There are non-aromatising synthetic forms of testosterone.  Anavar for instance.  At one time is was used as a treatment for metastatic ER+ breast cancer.  It's not used any longer.  It would be important to know the reason before trying it.  Talk to your oncologist and and endocrinologist if you want scientific answers.

mathteacher

Evidence out this week from San Antonio

Taking Estrogen Reduces Breast Cancer Rates-- innvestigated as the new therapy

1.  Estrogen Alone is Effective for Reducing Breast Cancer Risk

   [American Association for Cancer Research]

SAN ANTONIO - While endogenous estrogen (i.e., estrogen produced by ovaries and by other tissues) does have a well-known carcinogenic impact, hormone replacement therapy (HRT) utilizing estrogen alone (the exogenous estrogen) provides a protective effect in reducing breast cancer risk, according to study results presented at the 33rd Annual CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 8-12. "Our analysis suggests that, contrary to previous thinking, there is substantial value in bringing HRT with estrogen alone to the guidelines. The data show that for selected women it is not only safe, but potentially beneficial for breast cancer, as well as for many other aspects of women's health," said lead researcher Joseph Ragaz, M.D., medical oncologist and clinical professor in the faculty of medicine, School of Population and Public Health at The University of British Columbia, Vancouver, BC, Canada.

 "These findings should intensify new research into its role as a protective agent against breast cancer," he added. Ragaz and colleagues reviewed and reanalyzed data from the Women's Health Initiative (WHI) hormone replacement therapy trials. WHI is a national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer, and fracture in postmenopausal women. The WHI was launched in 1991 and includes more than 161,000 U.S. women aged 50 to 79 years. "Over the last 30 years HRT has been used almost indiscriminately by women expecting the benefit of reducing cardiac risks, while providing a protective effect against bone fracture, and improving overall quality of life," said Ragaz.

 "The WHI results as originally interpreted led to a major pendulum swing against HRT." The WHI HRT trial consisted of two cohorts of women; the estrogen-alone group of women without a uterus and the estrogen-plus-progestin group of women with a uterus. Ragaz and colleagues reanalyzed the WHI studies in more detail and found that subsets of women with no strong family history of breast cancer who received estrogen alone had a significantly reduced breast cancer incidence. In addition, the 75 percent of women without benign disease prior to the trial enrollment also had a reduced breast cancer risk. "Reduction of rates of breast cancer in the majority of women who are candidates for estrogen-based HRT is a new finding because estrogen was always linked with a higher incidence of breast cancer," Ragaz said, "yet estrogen administered exogenously is actually protective for most women." Based on the results of this current analysis, Ragaz suggested that "while the use of HRT with estrogen alone may reduce the risk of breast cancer and may also be appropriate to manage menopausal symptoms, further research is warranted to elaborate on the optimum treatment regimen, to refine the selection of ideal candidates for estrogen therapy, and to understand the estrogen mechanisms that support the prevention of human breast cancer." "The recommendations based on prior analyses of the results of the WHI HRT studies were not to use HRT, but we are optimistic this will change," he said. "Our conclusion, based on the data presented, should enhance considerations for an early approval of HRT based on estrogen-alone for the majority of selected women suffering with menopausal symptoms and galvanize new research on HRT to define the optimum regimens for individual women."
1.  SABCS 2010: ABSTRACT #P6-09-09: Dual Estrogen Effects on Breast Cancer: Endogenous Estrogen Stimulates, Exogenous Estrogen Protects. Further Investigation of Estrogen Chemoprevention Is Warranted
   1. In selected women - [i.e. the majority of the WHI HRT trial 2 participants, 71.5 - 80%] - the use of HRT based on Estrogens alone may be appropriate to manage menopausal symptoms, as it is associated with a significant reduction of BrCa rates.
   2. The use of Exogenous Estrogen in chemoprevention merits validation, with the optimum Estrogen regimen determination [type of Estrogens; dose; mode of delivery, etc.] high priority.

Husband11

Math Teacher:

I know you didn't highlight with bold text this part, but the above says "..subsets of women with no strong family history of breast cancer who received estrogen alone had a significantly reduced breast cancer incidence. In addition, the 75 percent of women without benign disease prior to the trial enrollment also had a reduced breast cancer risk.."  It talks about "for selected women it is safe and beneficial..."  What is the criteria for selection?  It seems to talk of the absence of breast cancer risk factors like genetics and benign disease.

Cat123 has an ER+ breast cancer diagnosis.  Can you point out any of the above that suggests estrogen replacement therapy would be safe for her?

 Are they speaking of a breast cancer patient when they state that is safe for most women?

karen1956

My onc Rx 5mg testosterone for me to help with libido....I am fairly strongly ER?PR positive but he feels that this is safe....he also Rx e-string due to vaginal dryness, but is not in favor of estrogene cremes as he feels that they are harmful....not sure how positive effect the testosterone has had as it has not been long enough...I have not taken any AI's in 9 months, so not on any anti-hormonals.

Husband11

karen1956: Can you tell us what kind of testosterone it is?  It's likely a synthetic variant if it's taken orally, as testosterone itself can only be taken by injection or absorbed through the skin.  It may be a non-aromatising variant of testosterone.

mathteacher

Timothy,

The new information above reports reduced risk for women taking supplementary estrogen alone, regardless of their receptor status. If you want to look at diagnosed breast cancer patients taking estrogen, you might want to investigate that specific category of studies. http://jnci.oxfordjournals.org/content/93/10/754.full is one of them but most of the patients were also taking a synthetic progestin.

Husband11

Does the new study include existing breast cancer patients at all?  I see no mention of it in that context.

Husband11

http://www.cancer.gov/clinicaltrials/results/summary/2004/hrt-and-breast-cancer0204

Hormone Replacement Therapy and Breast Cancer Relapse

Key Words
Breast cancer, hormone replacement therapy. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.)

Summary
Breast cancer survivors who took hormone replacement therapy (HRT) to relieve menopausal symptoms had more than three times as many breast cancer recurrences as survivors who did not take HRT, a new study from Sweden has found. The study - which was stopped ahead of schedule because of these findings - was the first randomized clinical trial to examine the effect of HRT in women with breast cancer.

Source
The Lancet, published online Feb. 3, 2004; in print Feb. 7, 2004 (see the journal abstract).
(Lancet. 2004 Feb 7;363(9407):453-5.)

Background
Improved survival among women with breast cancer has meant that more breast cancer survivors are going through menopause, which for some women causes severe symptoms such as hot flashes, night sweats, and loss of sexual desire. For many years, HRT (usually a combination of the hormones estrogen and progestin) was widely prescribed to women to relieve these menopausal symptoms. It was also thought that HRT might reduce the risk of breast cancer, heart disease, and other conditions.

However, in July 2002, a large randomized clinical trial of estrogen and progestin in healthy postmenopausal women (part of the Women's Health Initiative) was stopped early when researchers found that women who took the hormones had an increased risk of developing breast cancer and heart disease. (For more information, see the collection of links at Menopausal Hormone Use.)

The U.S. Food and Drug Administration has since recommended that women discuss with their doctors whether the benefits of taking estrogen and progestin outweigh the risks and that, if used, the hormones should be taken "at the lowest doses for the shortest duration to reach treatment goals."

The effects of HRT on women who had already had breast cancer had not been studied in a randomized controlled trial, considered the "gold standard" in medical research. Because more than half of breast cancers are fueled by estrogen, some researchers worried that use of the hormone could stimulate recurrence of the disease. However, studies that simply observed breast cancer survivors for several years concluded that the risk of cancer recurring in HRT users was low.

The Study
In 1997, Swedish researchers began a randomized trial to determine whether a two-year course of HRT for menopausal symptoms was safe for women who had been treated for breast cancer. A total of 434 study participants were randomly assigned to receive either HRT or non-hormonal treatment for their menopausal symptoms. The research team was led by Lars Holmberg, M.D., of University Hospital in Uppsala, Sweden.

Results
The researchers intended to follow the women for a median of five years. However, after a median follow-up of just over two years, they found that 26 women in the HRT group - but only seven in the non-HRT group - had had a recurrence of breast cancer. They terminated the study, concluding that even short-term use of HRT posed an "unacceptably high risk" of breast cancer recurrence.

Note: Results from a longer period of follow-up confirmed these findings and were published in the April 2, 2008, Journal of the National Cancer Institute (see the journal abstract).

Limitations
The study fell far short of its recruitment goal, enrolling just 434 women instead of 1,300 as originally planned. In addition, the study was not blinded or placebo-controlled, two characteristics that are generally considered to strengthen the findings of a clinical trial.

Comments
"In and of itself, this study would not be strong enough to provide conclusive evidence that breast cancer survivors should avoid HRT," said JoAnne Zujewski, M.D., a medical oncologist who specializes in breast cancer at the National Institutes of Health Clinical Center in Bethesda, Maryland.

"However, these results are consistent with those of other studies, including the Women's Health Initiative study," Zujewski added. "As a practical matter, given what we already know about the serious risks and extremely limited benefits of HRT, these findings can be considered definitive."

Zujewski's comments are supported by an editorial accompanying the study report, which says that the "conclusion that even short-term use of hormone therapy poses an unacceptably high risk of breast cancer can now reasonably guide clinical practice for women with breast cancer." The editorial is written by Rowan T. Chlebowski, M.D., of the Harbor-UCLA Research and Education Institute in Torrance, California, and Nananda Col, M.D. of Brigham and Women's Hospital in Boston.

The study also demonstrates the importance of testing treatments in randomized clinical trials, Zujewski said. "You cannot draw definitive conclusions from observational studies. Definitive conclusions come from randomized studies."

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Husband11

Long term follow up to the above:

http://www.ncbi.nlm.nih.gov/pubmed/18364505?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Abstract

BACKGROUND: Hormone replacement therapy (HT) is known to increase the risk of breast cancer in healthy women, but its effect on breast cancer risk in breast cancer survivors is less clear. The randomized HABITS study, which compared HT for menopausal symptoms with best management without hormones among women with previously treated breast cancer, was stopped early due to suspicions of an increased risk of new breast cancer events following HT. We present results after extended follow-up.

METHODS: HABITS was a randomized, non-placebo-controlled noninferiority trial that aimed to be at a power of 80% to detect a 36% increase in the hazard ratio (HR) for a new breast cancer event following HT. Cox models were used to estimate relative risks of a breast cancer event, the maximum likelihood method was used to calculate 95% confidence intervals (CIs), and chi(2) tests were used to assess statistical significance, with all P values based on two-sided tests. The absolute risk of a new breast cancer event was estimated with the cumulative incidence function. Most patients who received HT were prescribed continuous combined or sequential estradiol hemihydrate and norethisterone.

RESULTS: Of the 447 women randomly assigned, 442 could be followed for a median of 4 years. Thirty-nine of the 221 women in the HT arm and 17 of the 221 women in the control arm experienced a new breast cancer event (HR = 2.4, 95% CI = 1.3 to 4.2). Cumulative incidences at 5 years were 22.2% in the HT arm and 8.0% in the control arm. By the end of follow-up, six women in the HT arm had died of breast cancer and six were alive with distant metastases. In the control arm, five women had died of breast cancer and four had metastatic breast cancer (P = .51, log-rank test).

CONCLUSION: After extended follow-up, there was a clinically and statistically significant increased risk of a new breast cancer event in survivors who took HT.

fairy49

Timothy they seem to be talking about synthetic hormones, not bio-identicals.

mathteacher

Timothy, the Swedish study  was stopped.  A  bit of a scandal followed because of serious flaws and it was discredited. Meanwhile, as Fairy points out, another Scandinavian study using biodenticals as the progesterone part was doing great but there was a panic and I think most of the participants dropped out but existing records show they were doing well.

Anyway, there are 30 other studies that back up the O'Meara study I posted. Only the Swedish study doesn't support the 30  and it was discredited, as I said. All this is on the web. If you have time you'll find it.

Husband11

Discredited you say?

The original was published in 2004 in The Lancet and the follow up in 2008 in the Journal of the National Cancer Institute.  Certainly reputable peer review journals.  I'd like to see the criticism published somewhere else equally reputable.  Have you got a reference to it I can read?

Advice to take HRT certainly warrants caution in a HR+ cancer patient.

Back to the original question, Testosterone.  We seem to have taken a divergence from that.

mathteacher

So you already finished reading those 30 other studies?

Who was giving advice?

I'm going to move on now. I mistakenly thought you were interested in fact-finding, not competition.

Best to Bev.

wendy57

Along with having no family history of breast cancer, Dr. Ragaz's findings about "estrogen-only" therapy applies ONLY to women over 60 and without a uterus.

mollyinco

i've had a bio-identical testosterone pellet places under the skin in my hip for years, began getting them to control hormonal migraines that were kicking my butt, prior to my BC diagnosis/treatment the pellets not only cured the migraines but increased my energy, libido and vaginal moisture...my oncologist has encouraged me to continue with the pellets for the migraines but the gynecologist who does the pellets let me know that once i started on tamoxifen and the estrogen production in my body was effected that the testosterone would not be able to compensate for the vaginal dryness that would come, it would and does still help with energy and libido though

karen1956

Timothy....it is Methitest 10mg....I take 1/2 tab (5mg)......the insert that came with the Rx ln common uses lists: teating advance BC in women who are 1 to 5 yeras postmenopause or premenpausal women with a hormone sensitive tumor..I have not googled "methitest" to see its properties.....

rgiuff

I use Androgel, which is a clear topical gel that I apply to the inner arms.  Both my Gyn who prescribed it, and my Onc, said that it was not contraindicated with my breast cancer history.   I currently am on tamoxifen as well.

This news from San Antonio is very interesting.  I will be eager to hear my Onc's opinion on that when I see him next month.

mollyann

How to you like the Androgel? Is it helpful?

That's a commercial RX, right?  My doc prescribes compounded testosterone cream applied to the labia.

AnneW

I used a testosterone patch for a while, and also tried compounded cream. DOn't put it on your genitals. Absorption there will give you a bigger risk of side effects, like clitoral enlargement. Use inner thigh or belly.

I found NO improvement with testosterone. Except a little extra hair growth on my chin and a little more loss on my head. Didn't help my libido one bit.

Anne

wendy57

From Susan G Love Research Foundation http://blog.dslrf.org/?p=291 (Bolds are mine):

    "I was really disturbed when I heard the news this morning. There were two big Symposium-related stories.  One of these stories was based on a poster that will not be presented until Saturday that addresses the use of estrogen alone to treat menopausal symptoms. The other, which will not be presented until later today (Friday afternoon), is on zoledronic acid (brand name zometa) and breast cancer recurrence. This means that what was in the paper and on the news on Friday morning was based on press reports put out by the authors and on data that participants at the meeting had not yet been able to evaluate.

My comments, therefore, are on the estrogen alone study press release and abstract.  Basically, this study is a reanalysis of the estrogen-alone arm of the Women's Health Initiative.  This arm has already been reported as showing an increase in breast cancer. In addition, other studies have shown that it may take longer to see the effect from estrogen only than it does from a combination of estrogen and progesterone.

As you read the media reports, it is important to remember that the estrogen-only arm of the study enrolled only women who had undergone a hysterectomy (removal of the uterus). These are the only women who can take estrogen alone, as doing so can increase the risk of uterine cancer. What we don't know is how many women in the estrogen-only arm of the study also had had their ovaries removed. This is important information to have because removing the ovaries reduces a woman's risk of breast cancer by about 70%.

Also, the data reported in the abstract suggested that the only risk reduction was short-term and that it was only in women who did not have a family history of breast cancer or had had a previous breast biopsy. I would be very interested in whether breast density seen on mammogram was also related to breast cancer risk. Unfortunately, I won't be able to tell you until Saturday, when we get to see all the data. (As you can probably tell, I do not think this poster should have been singled out to be promoted to the media and, if it was going to be promoted, it certainly shouldn't have been done until after conference participants had had a chance to see the data!)"

thenewme

Wendy,

Thanks for sharing this!   Once again, unfortunately, nothing is as simple as some would like us to believe.  It's also a great reminder that, especially with hormone replacement, there isn't a clear-cut one-size-fits-all.  

Hi Mathteacher, you said, "I mistakenly thought you were interested in fact-finding, not competition."   No, no mistake at all!  Fact-finding *is* what most of us are interested in.  Adding relevant studies, questions, and discussion to a topic shouldn't be confused with competition.  Thanks, Timothy, for your useful contributions!

Husband11

I have to tell you that I feel a great burden on my conscience when discussion of treatment options comes up and I chime in.  People coming on here are looking for what amounts to advice when they ask questions.  I could not bear to contribute harm to someone's health.  Where there is potential for downside to an option, I just can't leave it unmentioned.  We are talking about life or death here, and someone asking questions needs to hear both sides before making up their mind.  I'm not taking sides, or picking on anyone.  If someone says white, I have to mention the black, should it exist, and let them make up their own mind.  After that, its an individual's choice as to whether to err on the side of caution, perceived benefit, or to disregard the existence of any debate.  Clearly, this is an area of controversy, and to pretend otherwise would be a disservice to our fellow man or woman.

Janeluvsdogs

So, with the great burden on your concience, did you ever figure out the O'Meara study on breast cancer patients taking HRT? It's been on a bunch of sites since the big announcement from San Antonio, including our local news.

Also, since the new estrogen-as-protective info comes out of san Antonio, there are some rumblings about lawsuits for the bc pts precscribed estrogen blocking.

rgiuff

With the androgel, I don't feel a huge increase in libido, maybe just a little tiny bit, but I do definitely feel a difference with my response and arousal time and the quality of sensations is much improved.  I use it very sparingly because I don't want any male type side effects.  I do 1 pump instead of the 4 recommended on the bottle and now I'm currently experimenting with alternating every other day.  Although not a huge problem for me, I do occasionally feel some vaginal dryness, but once I started on the testosterone, that seemed to disappear.  Have also noticed more positive moods, where before I was prone to frequent bouts of depression.

I'm curious about the type that is applied to the genital area.  Is that just for local effect or is it systemic?  And how well does that work?

mollyann

The effect is systemic because of my mood and energy. I've never had any male type side effects.  The doc absolutely insists NOT to apply the cream anyplace BUT the labia.

 I think the Androgel formulation may have alcohol in it so may not be designed for the labia. It could sting. As long as you're feeling better... 

Doc also said testosterone used to be used as a breast cancer therapy. There are women still alive who used it.

Husband11

Janeluvsdog:  Can you show me where the presentation at the SABC conference on estrogen as a preventative agent speaks to its use on women who have been diagnosed with ER+ breast cancer?  All I've seen is an observational analysis of women in general, in which they say for the majority of them HRT is safe and beneficial.  They also say that would exclude those women with benign breast disease or strong family history of breast cancer.  They talk about more work needed to refine the spectrum of ideal candidates.  Am I wrong that they are talking about women in general, and not making a statement about breast cancer survivors?  Am I wrong that I see nowhere that it endorses it as a treatment to prevent recurrance?  It seems like some women in this forum are taking this as recommending it to prevent breast cancer recurrance as opposed to initial occurance in the 75% that are ideal candidates.  I don't see that in the SABC reporting.  If it's there, please point it out.  I am interested, but I don't want to read anything into it that they didn't intend.   Maybe I missed it, if so, please point out where it includes breast cancer patients would benefit and not just a comment on HRT for select women in general.  My worry is that the ER+ breast cancer survivors may fall in the 25% for which it is not beneficial.

Member_of_the_Club

Speaking of testosterone . . . I saw my onc last week and asked him if, by preventing the conversion of testosterone into estrogen, Arimidex leads to more testosterone.  I asked because since I've gone on arimidex I've had an increase in my libido, energy level, athletic performance (I'm a runner).  He said its quite possible.  Obviously, not everyone gets this boost, but I can't be the only one.

annettek

Oh, that would be great-I am going to to be put on armidex soon and was worried about negative side effects. I realize we are all different but could use a boost:)

fairy49

I had avoided these threads for a few months, due to the fact that it seems we are going backwards instead of forwards with regards to the use of hormones.  I don't think I will be back for a while as I am getting really frustrated.

http://breastcancerchoices.org/files/Hormone_Replacement_Therapy__Real_Concerns_and.1.pdf

Cat123

Hi Fairy49,

 Yes, I am interested in the bioidentical hormone for testosterone.  My friend puts it on her arm and she said it has been fantastic!