Testosterone for Women – The Final Chapter
Testosterone for Women- The Final Chapter
June 2023
Testosterone in Women does not Stimulate Breast or Uterine Tissue
Just when I thought that the April webinar would be the last in the series of testosterone discussions focused on the use of testosterone in women, I have come upon more important and pertinent studies that I feel are important to know and understand. So, I stand corrected, and this will be the last seminar on this topic where I will pull together all the data and studies that I have been alluding to over the years, that testosterone administration is very safe for all women and that administering testosterone to women does not stimulate breast or uterine tissue and therefore does not require progesterone opposition. I WOULD NEVER NOT GIVE PROGESTERONE TO ALL MENOPAUSAL WOMEN. That’s not my point. My point is that testosterone administration does not raise estradiol levels in WOMEN and therefore there is no worry or concern as to testosterone causing harm to breast or endometrial tissue.
Testosterone in Women does not Aromatize into E2
If you have not listened to last webinar in April, please do so as the paper presented is one of the most important and profound studies of testosterone in women. The authors proved and showed that testosterone administration, particularly in high doses, does not aromatize into E2. The study group was transgender men (women transitioning to men) that were only interested in becoming a male, taking only male hormones, and eliminating any female hormones. Taking it one step further, although most transgenders conceptualize that they do not need or want estrogen, making transgender men estrogen deficient is definitely harmful and not beneficial. Again, they may not conceptualize this, but wiping out their estradiol with testosterone does not change their genetic XX genome. Chromosomally they are still XX and their tissues will suffer from estrogen deprivation as the result of testosterone suppression of E2. Everyone thinks that testosterone will provide an adequate amount of estrogen from aromatization, but it doesn’t as demonstrated in last month’s webinar. Ignoring this will only lead to adverse health consequences suffered by any woman that does not take estrogen (E2).
Testosterone is Beneficial in Preventing Breast Cancer and Treating Active Breast Cancer
This concept is also extremely important for any women with breast cancer that is being treated with testosterone. For years the studies have proven no stimulatory effect on breast, uterine, and cardiovascular tissue. There is always this unproven fear of using testosterone in breast cancer patients or breast cancer survivors, but no study has demonstrated any harm despite the oncologic world rejecting any thought as to the use of testosterone. We should put those fears to rest. There is overwhelming evidence as to the benefit of testosterone in preventing breast cancer, in treating active breast cancer, and in preventing breast cancer recurrence. The endocrine, gynecologic, and oncologic societies ignore these concepts even though it is published throughout their literature. Their unfounded and unsupported fear is that raising estrogen will be harmful, yet there is no scientific support for this. We’ll review the studies that proved no adverse uterine or breast effect of testosterone, which is in line with the paper presented in the April webinar. This also explains the lack of benefit to adding an aromatase inhibitor along with testosterone therapy for breast cancer patients as well as for transgender men. Consensus of opinion is not reality and should not guide our therapy. Reality is what is proven in our science and literature and that is what should guide our therapy, not uniformed consensus of opinion.
Estradiol Decreases Morbidity and Mortality from Breast Cancer
Estrogen deprivation by whatever mechanism results in increased morbidity and mortality from cardiovascular disease, cerebrovascular disease, Alzheimer’s dementia, osteoporotic fractures, diabetes, and cancer. Estradiol can reverse and prevent these illnesses. (Notice that I did not use the term estrogen). The long-term use of AIs and tamoxifen exacerbate the foregoing harm which is why their use beyond 5 years is not recommended. After 5 years of using AIs or tamoxifen, there is also an increase in breast cancer recurrence, probably related to the insulin resistance inside the breast cells. There are over 60 studies demonstrating that estrogen administration decreases breast cancer recurrence as well as the morbidity and mortality from the illnesses listed above. (Read Bluming’s book “Estrogen Matters”). The only drug that decreases breast cancer mortality is estrogen, not AIs or tamoxifen. Transgender males also want to wipe out their estrogen due to the ill-conceived notion that males don’t have or need estrogen either. Transgender men will, therefore, request oophorectomies or Ais, both which can be detrimental to their long-term health. Nevertheless, the system supports the avoidance of estrogen despite evidence to the contrary.
For Optimal Health and Wellness Estradiol should be Administered to all Menopausal Women (excluding active breast cancer patients)
Similarly, the same applies to testosterone. Studies prove that stimulating the androgen receptor via testosterone decreases CVD, plaque deposition, osteoporosis related fractures, diabetes, dementia, breast cancer, and overall mortality from all causes. Avoiding testosterone administration as recommended by the endocrine society, will exacerbate the foregoing. Also, disconcerting is the fact that oral estrogen, including oral E2, will raise SHBG which will effectively bind on to the free testosterone thereby lowering free testosterone levels. This results in testosterone deprivation, like estrogen deprivation, with all the associated morbidity and mortality mentioned above. How do we overcome this? Simply use testosterone. Yes, but the endocrine society recommends against using testosterone. Well, then, we’ll just have to get over that and I’ll review the literature as to why we must ignore the endocrine recommendations (all political and not evidence based) and allow our medical literature and studies to guide our therapy. For optimal health and wellness, estradiol should be administered to all menopausal women (excluding active breast cancer patients) as well as all transgender males on testosterone. And testosterone should be administered to all menopausal women and andropausal men.
Objectives:
1) Review studies whereby estradiol suppression by testosterone administration to women may lead to increased morbidity and mortality in menopausal females and transgender males.
2) Demonstrate the lack of data proving harm of testosterone administration to menopausal women or breast cancer patients.
3) Recognize the harm of oral menopausal hormones in lowering free testosterone levels via the increase in SHBG.
4) Recall the benefits of lowering carotid wall thickness with E2 in women that can be further decreased by testosterone administration.
5) Describe how DHEA increases E2 levels in women; testosterone does the opposite, which is the opposite of what would be expected.
6) Explain how association does not prove causation. This is of utmost importance in understanding and evaluating studies, particularly when it comes to interpretation of baseline levels of E2 and testosterone.
Case Presentation:
Your 58 y/o patient is S/P breast cancer diagnosis 8 years ago, having stopped the AI 3 years ago. Her only hormone regimen consists of testosterone and progesterone. After speaking with her oncologist, she is concerned about his admonition for the continuous use of testosterone, citing concerns that it will aromatize into estrogen which can increase the risk for breast cancer recurrence. As a result, he strongly feels that she should continue the use of an AI to avoid any
increase in estrogen levels. He feels the same about progesterone exacerbating breast cancer recurrence. You provide her confidence and support as well as literature demonstrating that the use of testosterone and P4 are beneficial in preventing breast cancer recurrence. You also provide literature that testosterone does not increase estrogen levels whereas studies prove a decrease in E2 levels. You also provide literature demonstrating a cardioprotective effect of testosterone and P4 which she will need if she remains off of estrogen. She is pleased that you are able to provide literature support for all of the therapies that you have recommended.
Respectfully submitted,
Neal
