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For AlaskaAngel and Debbie: Note from Onc. on testosterone safety

Hi AlaskaAngel and Debbie,

I heard from my oncologist on the issue of testosterone safety and her message follows, so I hope it's helpful to you. It appears, from her reply, that it is more of a concern for ER+ women, and overall more studies need to be done. While I am ER-, I have decided not to fill my prescription due to this. btw, she gave you both a very nice compliment. Thanks again for contributing to this discussion, as it really helped me to think more clearly about it.

Your friend from So. Cal.,

Vicki

Vicki, Here is an article which may indirectly answer your question. Your friends make a very persuasive plea for further research on this. I would agree with them. Testosterone can inhibit or enhance tumor growth in preclinical models if you do pubmed search. Then this article relates to your question.

BACKGROUND: Levels of endogenous hormones have been associated with the risk of breast cancer among postmenopausal women. Little research, however, has investigated the association between hormone levels and tumor receptor status or invasive versus in situ tumor status. Nor has the relation between breast cancer risk and postmenopausal progesterone levels been investigated. We prospectively investigated these relations in a case-control study nested within the Nurses' Health Study. METHODS: Blood samples were prospectively collected during 1989 and 1990. Among eligible postmenopausal women, 322 cases of breast cancer (264 invasive, 41 in situ, 153 estrogen receptor [ER]-positive and progesterone receptor [PR]-positive [ER+/PR+], and 39 ER-negative and PR-negative [ER-/PR-] disease) were reported through June 30, 1998. For each case subject, two control subjects (n = 643) were matched on age and blood collection (by month and time of day). Endogenous hormone levels were measured in blood plasma. We used conditional and unconditional logistic regression analyses to assess associations and to control for established breast cancer risk factors. RESULTS: We observed a statistically significant direct association between breast cancer risk and the level of both estrogens and androgens, but we did not find any (by year) statistically significant associations between this risk and the level of progesterone or sex hormone binding globulin. When we restricted the analysis to case subjects with ER+/PR+ tumors and compared the highest with the lowest fourths of plasma hormone concentration, we observed an increased risk of breast cancer associated with estradiol (relative risk [RR] = 3.3, 95% confidence interval [CI] = 2.0 to 5.4), testosterone (RR = 2.0, 95% CI = 1.2 to 3.4), androstenedione (RR = 2.5, 95% CI = 1.4 to 4.3), and dehydroepiandrosterone sulfate (RR = 2.3, 95% CI = 1.3 to 4.1). In addition, all hormones tended to be associated most strongly with in situ disease. CONCLUSION: Circulating levels of sex steroid hormones may be most strongly associated with risk of ER+/PR+ breast tumors.

So my conclusion is testosterone is not safe in hormone receptor positive breast cancer, but should be subject of research in hormone receptor negative breast cancer.

Thanks for sharing the message from your onc, as well as your present decision about using it. I too am hesitant but my question is a bit different, since I am strongly ER+ and PR+ and the response (from what I can tell) doesn't take into account the use of the aromatase inhibitor. What I think especially needs to be studied is this:

If one uses a dose of testosterone (perhaps low level), would simultaneous use of the AI prevent the testosterone use from being a problem? And if it did, would that prevent the use from being helpful for some aspects like libido or not? Would it still provide benefit in regard to bone development, etc.?

Like your onc says -- it needs more research.... Thanks again,

A.A.

More interesting information, but still not ENOUGH information, alas. I'm not sure that we even know if what increases risk of breast cancer also increases risk of recurrence, for example. Plus, this study looked only at endogenous (already naturally present) levels of these hormones - rather than at levels induced by supplementation (that doesn't seem the right word but I can't think what the right word is, other than exogenous and that sounds too confusing). And as AA notes, the use of an AI further increases the complexity of the questions that need answers.

Hard choices for us to make. Perhaps increase risk of recurrence, probably not a lot but probably significantly (statistically speaking), vs. a pretty important quality of life issue. And if we do decide to supplement our hormonal drought in some way - there's little information about which hormone might be safest and offer the best result.

If it were clearly going to make a difference, say if it were to double my risk of recurrence to use estrogen or testosterone to improve my quality of life, I'd almost feel better about it all. Then I would know that there was great benefit for me in putting up with my vaginal desert and other related issues. I'd know that there really was no other choice, and I'd deal with it.

But it bothers me that I may be passing up something that could improve my life now, because of theoretical dangers. Yet that something could someday turn out to be perfectly safe, especially for those of us with ER negative cancer, or for those with ER+ cancer who are taking an AI.

I think I'll continue to use my little dabs of estrogen cream vaginally and leave it at that. It doesn't help enough, which is oddly reassuring of its safety.

I'm sure we'll be revisiting this topic as new evidence appears, and as new people continue to ask these important questions.

Debbie Laxague

back again to natural progesterone

This study supports the idea that natural progesterone might help symptoms safely, even for ER+/PR+? This actually came up this morn when I was asking my holistic doctor about Ruth's latest issue, the "needling" hot flashes (see thread called "pricks")

She said what she would recommend would be natural progesterone, but that oncologists would not agree with this. (I am guessing she is right as much as I like our oncologist) I asked specifically about the ER+/PR+ status, and she said this issue is being currently addressed by one of the others authors on this topic (Dr. Zava I think) My doc said in essence, "Estrogen makes cells divide and multiply, progesterone does not."
The studies I've seen seem to support this, but the common wisdom has been to avoid all sex hormones, and of course it is the "logical" jump for PR+ tumors. She said the receptors for PR+ simply indicate the body is low on progesterone.

It seems to me she is using is using one set of logic for the PR+ than the ER+, but it is obvious to all that the ER is a culprit. It seems that it has never been proven that PR is indeed one.

Aye. What is one to do. While I was on board with Ruth's treatment thus far, my gut says there may be better ways to treat hormonally than the synthetic drugs. Ruth isn't supposed to have flax because flax is being shown to have "tamoxifen" like effects. Given a choice wouldn't it be better to have the flax? (yes, IF the comparison studies were in place which they probably never will be)

Sorry I got off the subject of testosterone, but got sparked when I read your study.

There's a product in a line of supplements that I trust (designs for health) whose ingredients I found interesting...

"LibidoStim-F is a complex formulary blend of nutraceutical and herbal ingredients for the increase of female sexual desire and pleasure. The combination of wild yam, damiana, standardized tribulis, epimedium (horny goat weed), red clover, urtica dioca, Korean ginseng, deer antler, gingko biloba, DIM, and DHEA provide safe enhancement for natural testosterone production, optimization of testosterone and estrogen metabolism, an increased blood flow, and adrenal support. This product is designed to help provide an overall increase in desire and sexual satisfaction specifically for women."

I have no idea how some of these interact with bc...DIM was interestingly recommended to us for additional natural estrogen control by someone off this board.