[Debbie L.]

Hi Flori,

Yes, we hear you. You must see us - nodding our heads (shaking our heads, we're frustrated, too!). I tried every moisturizer ever made, including replens - and it was not equal to the task.

Tiny bits of estrogen cream (estradiol) has made some difference, but I think I waited too long and there had already been some permanent damage. And yes, a few times it has seemed to trigger a migraine (I get migraines very rarely so it's pretty suspicious to me that it has happened twice, the morning of my little (and I mean LITTLE) dab of estrogen).

So there are several things happening at once, for most of us, when we're trying to make this decision:

1. Will local treatment help the dryness/fragile tissue? Yes, probably both estrogen and testosterone will help with that.

2. Will local treatment help with libido? I don't think estrogen does, particularly - although libido could certainly be suppressed by anticipation of pain so relieving that part of it might improve libido. Testosterone seems to improve libido for some, and not at all for others.

3. And lastly - will using a local hormonal treatment affect the cancer issue? Does it matter that my cancer was ERPR positive or negative? For estrogen creams/pills(vagifem), it's an indefinite, mixed report. Small amounts, once established, do not seem to raise serum estrogen levels much - not beyond, for example, what would be normal for a post-menopausal woman. Estring has been reported to do the best here, with the least rise in serum estrogen levels. (It worked for me for awhile -- several years -- but then it seemed it wasn't enough). I think all studies report a surge in serum levels initially, when treatment is first begun, as the dry tissue literally sucks it up and sends it off -- but as the tissue normalizes, systemic estrogen levels apparently level out (at a very low level, for estring especially). Full-dose creams do raise levels more, but it's possible to get results with far less than full-dose. And again, we do not really know that there's harm in any particular level. So we do have "some" information about local estrogen use r/t serum estrogen levels.

BUT we don't have any evidence that those changes in serum levels have any effect on cancer. Not on ERPR+ cancer, not on ERPR- cancer - we just don't have any evidence, only theory. So that's a bit of a crap shoot already, and then when we begin to talk about testosterone - it gets even muddier. As Rich posted - there may be a role for androgen receptors in some breast cancer. But the bigger issue I think is that aromatase (that enzyme we inhibit with our AI's) converts testosterone to estrogen - so is that a problem? In theory, it sounds like it could be. But there's no evidence to know either way. And then another question - what if we're taking AI's, so the conversion (in theory) isn't happening?

This is just so muddy. Quality of life is so important. Frustrating!

It seems to me that short-term, it can't hurt to try testosterone. Maybe it won't help at all and then you won't have to decide if you're willing to take a (probably small to nonexistent) risk in using it. If it does work - well then you still have to decide if you think it's worth the unknown possible risk (but at least you'll have some fun in the meantime).

I do think it would help if we were more vocal. So many times I talk to women who are told "you just need to make a few more accommodations, use some moisturizer, allow more foreplay time, yada yada yada". And they did not say to the provider: "I HAVE TRIED THAT AND IT DOESN'T HELP". They were embarrassed so they said "Okay, thank you". (I did that, too). Us being more vocal probably won't help US, because finding answers takes a long time. But down the line, it could help others - because the more we point out the need for better answers, the more likely it is that research will get started to help us.

Debbie Laxague