Testosterone, anyone?

[Vic]

I was rereading some older posts and noticed under the "Estrace..." thread back in Oct., 2007, that Hutch and Alaska Angel had talked about Testosterone and Hutch posted this link, in addition to saying she was told to run far away from it, before she read this: http://www.medpagetoday.com/MeetingC...eeting/tb/7729

So, I'm wondering if any of you have been prescribed testosterone to get your groove back. Is it safe for ER-/Her2+++ women or don't they know enough yet.

Alaska Angel, were you in a clinical trial on this?

Apologies for all the questions, but I'm seeing my gyn. next month and I was considering having a more recent testosterone test. I noticed a testosterone test I had in 2004 and total testosterone was <20 and free testosterone was 0.12. (Reference interval: adult males 0.69 - 2.14 NG/DL, adult females 0.04 - 0.20 NG/DL). Percent Free Testost said unable to calculate, result lower than assay sensitivity. DHEA-SO4 was 121. I don't know what all this means, but the idea intrigues me. I just don't want to do anything to hurt myself in the bc arena.

Your thoughts are always welcome.

Vicki from So. Cal.

[AlaskaAngel]

Hi Vic,

I couldn't get the link you posted to work.

Doing a search here using "testosterone" and "trial" brought up most of the past discussions on the topic. Although the clinical trial I participated in did not show a benefit from the use of low-dose testosterone, it did show that low-dose testosterone did not break down into estrogen, as had previously been believed. Take a look at the thread Marjorie posted. That study would indicate that use is still questionable.

To use it, hormone levels would probably need to be periodically measured and tracked, as was done during the clinical trial and recommended.

Because the reason for wanting to use testosterone has been so vastly ignored and avoided as part of informed consent prior to or after cancer treatment, loss of gender and loss of sexuality is in general very poorly recognized or even accepted as human damage, and too easily rationalized away by those virtuous souls who don't suffer from it.

Vaginal atrophy is a physical outcome that can be seen. So some oncs have recognized that it can be real. Thus there are some who will prescribe things for that problem such as the Estring. I hope that even though loss of sexual function is invisible to them and so easy to dismiss, maybe the option of occasional topical use of low-dose testosterone on the cliterois at time of sexual intercourse might become an option, rather than a continuous source such as a testosterone patch. This would not be that much different from the use by men of Viagra, Cialis, etc. I intend to ask for it. I also personally think not prescribing other things that genuinely stand to possibly help enhance sexuality such as marijuana should be medically available to breast cancer patients instead of expecting cancer patients to "do without".

AlaskaAngel

[Vic]

Hi Alaska Angel,

I'm not sure why it wouldn't work, but when I rechecked it from my note, it didn't work for me either. But, when I went to "Search" and put in "estrace" to find Hutch's note, I opened it from there and it worked fine. Go figure. If you can't read it all from here, I would suggest that.

Be well,

Vicki

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<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=breadcrumptd vAlign=top colSpan=3>Home > Meeting Coverage > SABCS </TD></TR><TR><TD class=breadbanner vAlign=top float="left">

• Medical News from
  SABCS: San Antonio Breast Cancer Symposium Meeting

</TD><TD vAlign=top align=left><TABLE cellSpacing=0 cellPadding=5 width=220><TBODY><TR><TD>Coverage of Hormonal Therapies at The San Antonio Breast Cancer Symposium is supported in part by unrestricted educational grants from </TD></TR><TR><TD></TD></TR></TBODY></TABLE> </TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width=500 align=center border=0><!--startclickprintinclude--><TBODY><TR><TD style="FONT-WEIGHT: bold; FONT-SIZE: 17px; COLOR: #003399; FONT-FAMILY: georgia" vAlign=top height=40>SABCS: Testosterone Relieves Atrophic Vaginitis in Breast Cancer Patients

<!--startclickprintexclude--></TD></TR><TR><TD style="BORDER-TOP: #ccc 1px solid; BORDER-BOTTOM: #ccc 1px solid" height=40><TABLE width="100%" border=0><!--endclickprintexclude--><TBODY><TR><TD style="PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px">By Charles Bankhead, Staff Writer, MedPage Today
Published: December 17, 2007
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. </TD><!--startclickprintexclude--><TD style="PADDING-TOP: 5px" align=right> </TD><!--endclickprintexclude--></TR></TBODY></TABLE></TD></TR><TR><TD style="PADDING-TOP: 10px">SAN ANTONIO, Dec. 17 -- Intravaginal testosterone may offer relief from atrophic vaginitis without the risks of estrogen to breast cancer patients taking aromatase inhibitors, according to a pilot study. Action Points <!--- ---> <HR style="BORDER-TOP-WIDTH: thin; BORDER-LEFT-WIDTH: thin; BORDER-LEFT-COLOR: #9b9b9b; BORDER-TOP-COLOR: #9b9b9b; BORDER-BOTTOM: #9b9b9b thin dotted; BORDER-RIGHT-WIDTH: thin; BORDER-RIGHT-COLOR: #9b9b9b" width="90%">

• <LI class=APP>Explain to patients that a cream containing a small amount of testosterone has shown promise for reducing symptoms of treatment-induced atrophic vaginitis in breast cancer patients.
  
  <LI class=APP>Note that the compound is investigational and has been evaluated in only a small number of patients.
  
• Note also that the findings were reported at a medical conference and as a published abstract and should be considered preliminary until they appear in a peer-reviewed journal.

Daily use of the investigational compound decreased vaginitis symptom scores by two-thirds after a month of treatment, Sabrina Witherby, M.D., of Brown University in Providence, reported at the San Antonio Breast Cancer Symposium. The total symptom score remained 50% below baseline a month after treatment stopped.

"The results are encouraging and we intend to move forward with a study aimed at identifying the optimal dose of testosterone for treating atrophic vaginitis," said Dr. Witherby.

Vaginal atrophy is a frequent adverse effect of treatment with aromatase inhibitors, which cause more vaginitis symptoms than tamoxifen does, said Dr. Witherby. Systemic or topical estrogen effectively relieves symptoms of atrophic vaginitis, but topical estrogen tends to increase estradiol levels, making the therapy controversial for breast cancer patients.

In contrast, testosterone induces proliferation of vaginal epithelium, but the hormone's conversion to estradiol is blocked by aromatase inhibition. That led Dr. Witherby and colleagues to hypothesize that topical testosterone would be a safe and effective alternative to estrogen for treatment of aromatase inhibitor-induced atrophic vaginitis.

Investigators evaluated a topical compound containing 300 µg of testosterone in a cream vehicle. Ten postmenopausal breast cancer patients receiving adjuvant aromatase inhibitor therapy applied the cream daily to the vaginal and perineal epithelium. Atrophic vaginitis symptoms were assessed at baseline, after 28 days of treatment with the testosterone cream, and four weeks after treatment ended.

Patients rated vaginal dryness, vaginal itching or irritation, and dyspareunia on a scale of 0 (none) to 3 (severe). The total symptom score averaged 6 at baseline, decreased to 2 after 28 days of treatment with testosterone cream (P=0.008), and remained at 3 a month after treatment ended (P=0.065 versus baseline).

Cytopathology showed improvement in the maturation value of the women. Side effects were minimal and included mild vaginal rash in one woman and transient headache and pruritis in another. No thrombosis, hirsutism, or increased acne were noted. The testosterone cream is prepared by a compounding pharmacist and is not commercially available. Dr. Witherby said the next phase of investigation will be an evaluation of a cream containing 150 µg of testosterone.

</TD></TR><TR><TD>
Primary source: Breast Cancer Research and Treatment
Source reference:
Witherby S, et al. "Efficacy and safety of topical testosterone for atrophic vaginitis in breast cancer patients on aromatase inhibitors: a pilot study." Breast Cancer Res Treat. 2007;106(Suppl):Abstract 6086.
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[AlaskaAngel]

Vic,

Thanks! I will be taking the info you posted with me to my appointment when I request the Rx for testosterone.

I posted an article in the articles forum about treatment using testosterone for men with low testosterone levels that received it not for sexual impotence but to treat their depression. I don't see any reason to believe the same would not apply to women with low testosterone levels. At the risk of being repetitive, I will say this again; loss of libido is not just loss of sexual appetite, but the loss of energy and enthusiasm in general.

The problems I've seen posted here include:

1. Loss of sexual appetite

2. Vaginal dryness and vaginitis

3. Depression

I'm hoping to find out whether using it in the genital area occasionally rather than by steady-state patch works for me. I do think the use of it while in the clinical trial improved my mood, but since it was not to be applied to the genital area in that trial I think they may have missed the rest of the boat so to speak.

A.A.

[Vic]

Hi Alaska Angel,

Please let me know what your doctor thinks of this article and I'll do the same as I'm seeing my gyn. next month (a new one) and will ask her, too. I agree that so much more goes into it, the physical and the energy, desire, mood-elevating perspective, as well.

This is totally off topic, but have you tried the Hitachi Magic Wand. It's fantastic and you can google it and find some very accurate opinions about it.

Be well,

Vicki

[Vic]

Hi AA,

How did you get on the testosterone study and was it through NCI?

Also, are you still on testosterone and are you on any other types of hormones (estring, estrace, estrogen cream, etc.)?

Thanks,

Vicki

[AlaskaAngel]

Hi Vic,

It was an NCI study. I kept checking the clinicaltrials.gov website. It wasn't simple to do from Alaska. I had to pay my own travel and accommodations to the clinical trial site and pay for all the blood draws I had for it here in Alaska.

I was on estriol for a while by Rx from the local OB-GYN, a rather fine female doc who has since moved on. She didn't have a lot of knowledge about the use of estriol when I went to her to ask about it. but she researched it for me as her bc patient.

I stopped using the testosterone Rx I had just after completing the clinical trial and never had used it in the genital area. I stopped it because I was considering participating in a different clinical trial which required no use of hormones of any kind. I will check back in here once I've seen my PCP/NP about renewing the Rx.

Thanks for the suggestion, by the way!

A.A.

[TSund]

I'll be curious what you gals come up with on this issue...

TRS