testosterone - CAN IT HELP?

SoCalGal · 11-14-2009, 09:53 AM

My oncologist looked online and saw a study out of San Francisco, I think it was UCSF, that used testosterone in treating vaginal dryness & libido probs in woman with ER POS breast cancer. How do I find out what the early clinical trial research is showing, side effects, good results, etc? I hate to try something new and find out the hard way that this gives more headaches than estrogen, or that I will now grow a beard and mustache. My doc was pretty low key, said try it and see if it helps. I wish she'd try it first and report back to me

Has anyone ever used testosterone cream? I am ER/PR negative, but using estrogen cream was giving me migraine problems big time. Totally solved the va-j-j probs, except created tremendous headache probs, so it didn't matter that I was "open for business".

Has anyone who is ER/PR negative considered using the estrogen patch? That is my latest thinking unless I decide to try this testosterone.

I want a healthy sex life, and right now it's a challenge due to physical discomfort. I'm tired of having to "be creative". I just wanna...well, you sisters understand. It's such a rarely discussed by the doctors, but important side effect from treatment. It is all about QUALITY OF LIFE.

Here's the clinical trial recipe:
Testosterone Cream 1% micronized in velvachol - 0.5 gm of cream vaginally each night for two weeks, then 3 times a week for total of 12 weeks of treatment

Thanks for your help. Funny how I won't make a move unless I get feedback from you all!

tricia keegan · 11-14-2009, 02:23 PM

Sorry I can't help Flori, a friend of mine was on testosterone shots or pills to give her a break from chemo when her cancer was very advanced. Obviously the cream would have far less side effects or risk factor's but she was warned her voice would get lower and facial hair would increase.
It did relieve a lot of her symptoms though as her body was worn out from eleven years of chemo.
Hope someone can help you and do sympathize, thankfully despite my early ooph and tx vaginal dryness is one side effect I've managed to dodge so far

Rich66 · 11-14-2009, 10:20 PM

Not sure how to interpret the info but testosterone/androgens seem to be studies in BC:

Steroids. 2009 Oct 24. [Epub ahead of print]
Conjugated and non-conjugated androgens differentially modulate specific early gene transcription in breast cancer in a cell-specific manner.

Notas G, Pelekanou V, Castanas E, Kampa M.
Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion GR-71003, Greece.
The role of androgen in breast cancer development is not fully understood, although androgen receptors (ARs) have been identified in breast cancer clinical samples and cell lines. However the whole spectrum of androgen actions cannot be accounted to the classic AR activation and the possible existence of a cell surface-AR has been suggested. Indeed, androgen, like all steroids, has been reported to trigger membrane-initiated signaling activity and exert specific actions, including ion channels and kinase signaling pathway activation, ultimately affecting gene expression. However, the molecular nature of membrane androgen sites represents another major persisting question. In the present study, we investigated early transcriptional effects of testosterone and the impermeable testosterone-BSA conjugate, in two breast cancer cell lines (T47D and MDA-MB-231), in an attempt to decipher specific genes modified in each case, providing evidences about specific membrane-initiating actions. Our data indicate that the two agents affect the expression of several genes. A group of genes were commonly affected while others were uniquely modified by each agent, including interaction with growth factors and K(+)-channels. In MDA-MB-231 cells, that are AR negative, the majority of genes affected by testosterone were also affected by testosterone-BSA indicating a membrane-initiated action. Subsequent analysis revealed that the two agents trigger different molecular pathways and cellular/molecular functions, suggestive of a molecular or functional heterogeneity of membrane and intracellular AR. In addition, the reported phenotypic interactions of membrane-acting androgen with growth factor were verified at the transcriptomic level, as well as their ion channel-modifying effects. Finally an interesting interplay between membrane-acting androgen with inflammation-related molecules, with potential clinical implications was revealed.

PMID: 19857505 [PubMed - as supplied by publisher]

Exp Cell Res. 2005 Jul 1;307(1):41-51. Epub 2005 Apr 7.
Opposing effects of estradiol- and testosterone-membrane binding sites on T47D breast cancer cell apoptosis.

Kampa M, Nifli AP, Charalampopoulos I, Alexaki VI, Theodoropoulos PA, Stathopoulos EN, Gravanis A, Castanas E.
Department of Experimental Endocrinology, University of Crete, School of Medicine, P.O. Box 2208, Heraklion, GR-71003, Greece.
Classical steroid mode of action involves binding to intracellular receptors, the later acting as ligand-activated nuclear transcription factors. Recently, membrane sites for different steroids have been also identified, mediating rapid, non-genomic, steroid actions. Membrane sites for estrogen and androgen have been found in a number of different cell types, bearing or not classical intracellular receptors. In the present study, with the use of radioligand binding, flow cytometry and confocal laser microscopy, we report that T47D human breast cancer cells express specific and saturable membrane receptors for both estrogen (K(D) 4.06 +/- 3.31 nM) and androgen (K(D) 7.64 +/- 3.15 nM). Upon activation with BSA-conjugated, non-permeable ligands (E(2)-BSA and testosterone-BSA), membrane estrogen receptors protect cells from serum-deprivation-induced apoptosis, while androgen receptors induce apoptosis in serum-supplemented T47D cells. In addition, co-incubation of cells with a fixed concentration of one steroid and varying concentrations of the other reversed the abovementioned effect (apoptosis for androgen, and anti-apoptosis for E(2)), suggesting that the fate of the cell depends on the relative concentration of either steroid in the culture medium. We also report the identification of membrane receptors for E(2) and androgen in biopsy slides from breast cancer patients. Both sites are expressed, with the staining for membrane E(2) being strongly present in ER-negative, less differentiated, more aggressive tumors. These findings suggest that aromatase inhibitors may exert their beneficial effects on breast cancer by also propagating the metabolism of local steroids towards androgen, inducing thus cell apoptosis through membrane androgen receptor activation.

PMID: 15922725 [PubMed - indexed for MEDLINE]

Merridith · 11-14-2009, 11:15 PM

I've used the testosterone cream. It didn't help. Although for some weird reason, it seemed to work (with libido) the first time I used it. But not after. No side effects.

For vaginal dryness, I am using VagiFem. That works great.

Sheila · 11-15-2009, 06:54 AM

Flori
I am like you, i want to know more about all the side effects...what good is it if you feel amazingly sexy right after you shave your beard and mostouche!

LoriE · 11-15-2009, 08:07 AM

My doc won't give me anything with estrogen even though I was ER-PR-. And I don't want to shave, either. I volunteered to be part of a research study at OSU, but haven't heard anything. Can't believe they can put a man on the moon, but they can't solve this problem for ladies like us!

Debbie L. · 11-15-2009, 09:12 AM

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

suzan w · 11-15-2009, 08:52 PM

tried testosterone cream...nope
nothing seems to work...darn
so frustrating.........however, life IS good!!!

rondo · 11-16-2009, 03:21 PM

I have found that testosterone cream is the ONLY thing that helped with libido. It is still working for me after several years. It works a lot better if you don't use it daily. I use it 5 days on and 2 days off-my doc said that way the receptors aren't constantly saturated. I use tiny doses; you will know if you take too much and the effects are reversible if you do. I know to back off if I get acne or become agrumentative.
Also, since my bc diagnosis, I stopped estradiol cream (the most comnmon type prescribed) and am using ESTRIOL, which is a weaker estrogen. I feel it is safer for me. It has to be compounded as there is no FDA approved product. Progesterone is a must, as it may be bc protective and has other benefits, including balancing the other hormones.