Testosterone Is Used To Treat Breast Cancer

When Is Hormone Therapy Used For Breast Cancer

Hormone therapy is often used after surgery to help reduce the risk of the cancer coming back. Sometimes it is started before surgery .

It is usually taken for at least 5 years. Treatment longer than 5 years might be offered to women whose cancers have a higher chance of coming back. A test called the Breast Cancer Index might be used to help decide if a woman will benefit from more than 5 years of hormone therapy.

Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.

What Are The Side Effects Of Hormone Therapy

The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .

Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.

Less common but serious side effects of hormone therapy drugs are listed below.

Tamoxifen

• breathing problems, including painful breathing, shortness of breath, and cough
• loss of appetite

What Are The Possible Side Effects Of Testosterone Injection

Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have a tight feeling in your throat, a sudden urge to cough, or if you feel light-headed or short of breath during or shortly after receiving the injection.

You will be watched closely for at least 30 minutes to make sure you do not have a reaction to the injection.

• chest pain or pressure, pain spreading to your jaw or shoulder
• shortness of breath, breathing problems at night
• swelling in your ankles or feet, rapid weight gain
• unusual changes in mood or behavior
• painful or difficult urination, increased urination at night, loss of bladder control
• high levels of calcium in the blood –stomach pain, constipation, increased thirst or urination, muscle pain or weakness, joint pain, confusion, and feeling tired or restless or
• high potassium level –nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement
• liver problems –right-sided upper stomach pain, vomiting, loss of appetite, dark urine, jaundice .
• signs of a blood clot deep in the body –swelling, warmth, or redness in an arm or leg
• signs of a blood clot in the lung –chest pain, sudden cough, wheezing, rapid breathing, coughing up blood or
• signs of a stroke –sudden numbness or weakness , severe headache, slurred speech, balance problems.

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Therapy: Subcutaneous Testosterone And Testosterone Combined With Anastrozole Implants

Subcutaneous implants are composed of non-micronized USP testosterone and stearic acid in a geometric ratio of 20:1, or non-micronized USP T, stearic acid and USP anastrozole in a geometric ratio of 15:1:1. Implants are placed in sealed glass vials and autoclaved for sterility and heat fusion. The sterile implants are inserted into the subcutaneous tissue of the upper gluteal area or lower abdomen through a 5mm incision using local anesthesia and a disposable trocar kit.

Testosterone And Prostate Cancer

Prostate cancer can be a scary diagnosis for a man, but it does not have to be with the right treatment.

Although it was once thought that androgens such as testosterone fueled the growth of cancer cells, Sam Denmeade MD, the professor of oncology at Johns Hopkins University School of Medicine in Baltimore, Maryland says otherwise that there is no evidence that testosterone promotes cancer.

This is good news to men who previously would have had to undergo androgen deprivation which led to depression and other symptoms of Low T for the treatment of prostate cancer.

New research shows that high doses of testosterone could have the ability to inhibit the growth and subsequently kill cancer cells. Lab studies have shown that testosterone interferes with DNA licensing the cell division process in cancer cells. Additionally, testosterone and prostate cancer treatment may cause the prostate cancer cells to make breaks in their own DNA.

The research was done on men with castration resistant prostate cancer that had metastasized to other parts of the body. Treatment exposed the cancer cells to very high and then very low blood levels of testosterone.

Another way we look at testosterone and cancer treatment is as a preventative tool. Prostate health can be affected by testosterone levels. A condition called estrogen dominance occurs when the enzyme aromatase converts too much testosterone into estradiol . Higher levels of estrogen in the bloodstream can lead to prostate growth.

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Testosterone For Breast Cancer Survivors

Most people think of testosterone therapy as a means of improving libido and sex drive, but its effective for far more than that. If youre a breast cancer survivor or experiencing severe menopausal symptoms as a result of traditional cancer treatments, testosterone therapy can help ease the pain and the hormone has protective properties against breast cancer.

What Other Drugs Will Affect Testosterone Injection

Tell your doctor about all your other medicines, especially:

• insulin or oral diabetes medicine
• medicine to treat pain, cough, or cold symptoms
• a blood thinner –warfarin, Coumadin, Jantoven or
• steroid medicine –prednisone, dexamethasone, and others.

This list is not complete. Other drugs may affect testosterone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

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No Breast Cancer Risk For Testosterone Use In Menopausal Women

Nancy A. Melville

The use of transdermal testosterone in the treatment of hypoactive sexual desire disorder in postmenopausal women is effective and existing studies show no apparent association with breast cancer.

However, reliable studies are lacking and caution is urged, particularly for women with hormone-sensitive breast cancer, say the authors of a new systematic review, led by Ritika Gera of the London Breast Institute, Princess Grace Hospital, UK.

Transdermal testosterone, used as a gel or patch, is commonly prescribed for HSDD in postmenopausal women. Testosterone is also frequently used in women, off-label, for general menopausal symptoms.

“A consensus is yet to be reached on the safety of transdermal testosterone use for postmenopausal women and the nature of its relationship with breast cancer,” say Gera and colleagues.

“Our systematic review aims to tackle this uncertainty.”

Vii Should Androgens Be Included In Postmenopausal Hormone Therapy Regimens

Whether there is a role for the use of androgens in the management of postmenopausal women remains contro-versial. Clinical studies of supraphysiological testosterone therapy have shown improvements in sexual parameters in postmenopausal women . More recent studies employing more physiological doses have shown benefits in several parameters of sexual function and in mood . At present, a variety of testosterone-containing preparations are being used in clinical practice or in investigational research protocols for the treatment of sexual problems in women. Although the findings of this review indicate favorable effects of nonaromatizable androgens in the breast, in contrast to testosterone, there are few data from large well-designed randomized controlled trials to support the use of methyltestosterone in the management of sexual dysfunction in women . Also, data pertaining to the use of DHT in women are completely lacking. It is clear that whether or not the effects of testosterone on sexual function and mood in women are, in part, dependent on aromatization within the brain needs to be elucidated.

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If Cancer Comes Back Or Has Spread

AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.

What Other Drugs Will Affect Testosterone

Certain drugs may interact with testosterone, including

• Anti-inflammatory drugs, such as oxyphenbutazone

Other prescription and over-the-counter medicines, vitamins, and herbal products may also react with testosterone. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

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Can Pellets Help Shrink Tumor Size

Lastly, testosterone and anastrozole/letrozole pellets are now being investigated to shrink tumor size before surgery and before chemotherapy/surgery. With the exception of one case report, the publication of data is pending. The case report discusses a patient with stage 2, grade 3 breast cancer that was over 3 cm in size. This patient developed cancer while using testosterone pellets with low dose anastrozole. She made a decision to continue the testosterone pellets with a higher dose of the aromatase inhibitor Letrozole . After 41 days, the tumor had shrunk to 43% of the original size after 5 weeks of subsequent chemotherapy, the tumor could no longer be found on imaging. At the time of surgery, there was no remaining invasive breast cancer. Subcutaneous testosterone-letrozole therapy before and concurrent with neoadjuvant breast chemotherapy: clinical response and therapeutic implications. R Glaser et al .

All of these incredible studies have used testosterone in pellet form. Only testosterone pellets result in constant and predictable levels of testosterone in blood and tissue, and are always bioidentical.

Strengths And Limitations Of This Study

This study provides novel insights into the risk of breast cancer in transgender people. The reported risk in the current study is higher than estimates from previous studies, possibly related to cohort size and data quality, including the use of a national pathology database. Furthermore, this study included people with a wide range of ages. This study does, however, have some limitations. Owing to the retrospective design of the study, information about hormone use, family history, genetic mutations, benign breast lesions and breast density, tobacco and alcohol use, and body mass index is missing or incomplete. Although these risk factors for breast cancer should not be underestimated, the most important difference between transgender people and cisgender men and women is the use of hormone treatment. It would be interesting to study these risk factors in more detail, to investigate whether certain factors determine the observed increased risk in trans women. The study participants with breast cancer did not necessarily undergo treatment in our centre, and thus detailed data about type and outcome of the treatment are lacking in most of the cases. Although this would be interesting to study in more detail, it was not the purpose of this study. It would be worthwhile for future studies to investigate whether treatment outcomes of breast cancer in trans women are comparable to those of cisgender women.

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C Implications Of The Detection Of The Ar In Human Breast Cancer

ARs are found in more than 50% of breast tumors , and the significance of ARs in breast cancer has been extensively explored. With regard to nodal metastasis, Soreide et al. reported that when the median value of AR is taken as cut-off , a lower AR content is an independent predictor of the likelihood of axillary metastases . AR amount, however, did not reveal any significant prognostic information concerning relapse-free survival. There appears to be no significant association between AR expression and the degree of differentiation of ductal carcinoma in situ .

The relationship between the number of CAG and GGC repeats has also been evaluated in a population-based study conducted in 524 patients and 461 controls for their relationships to breast cancer risk . This study suggested a reduced risk for breast cancer in young women in whom the number of GGC repeat lengths was greater than 17. In addition, they also suggested that AR repeat length may be partly responsible for the increased risk for early-onset breast cancer in women who use oral contraceptives, although these findings need replication in other populations .

Before Taking This Medicine

You should not receive testosterone if you are allergic to it, or if you have:

• prostate cancer

• if you are bedridden or otherwise debilitated or

• if you take a blood thinner .

This medicine can harm an unborn baby. Do not use testosterone if you are pregnant or may become pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are receiving this medicine.

It is not known whether testosterone passes into breast milk or if it could harm a nursing baby. You should not breastfeed while using this medicine.

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Possible Side Effects Of Ais

The most common side effects of AIs are:

• Bone and joint pain

AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.

Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.

Only Three Studies Could Be Reviewed But Provide Important Insights

The researchers initially identified more than 200 studies by searching PubMed and Ovid, but only three randomized controlled trials sufficiently met their criteria, and even those could not be compared because of substantial differences in age groups and the number of women who were also taking estrogen.

The trials were “too heterogeneous for a meta-analysis. A systematic review was deemed the most appropriate analysis of the data available,” they note in their review, in the December issue of Anticancer Research.

However, the studies “did offer some important insights,” they add.

The first study , of 641 women who became menopausal as a result of surgery and received transdermal testosterone therapy and estrogen, found no significant increase in the occurrence of major adverse effects over an approximately 4-year follow-up however, the study did not include women who were naturally post-menopausal. There were three cases of invasive breast cancer, which is consistent with age-appropriate expected rates.

The second study , of the randomized, placebo-controlled ADORE trial, included 272 naturally menopausal women who received transdermal testosterone or placebo for HSDD twice a week for 6 months, and most participants were not taking other hormone therapy. No occurrences of breast cancer, myocardial infarction, or death were reported during the trial however, there was no post-termination follow-up.

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Testosterone Injection Side Effects

Get emergency medical help if you have signs of an allergic reaction:hives difficult breathing swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have a tight feeling in your throat, a sudden urge to cough, or if you feel light-headed or short of breath during or shortly after receiving the injection.

You will be watched closely for at least 30 minutes to make sure you do not have a reaction to the injection.

Testosterone injection may cause serious side effects. Call your doctor at once if you have:

Women receiving testosterone may develop male characteristics, which could be irreversible if treatment is continued. Call your doctor at once if you notice any of these signs of excess testosterone:

• changes in your menstrual periods

• male-pattern hair growth

• hoarse or deepened voice or

• enlarged clitoris.

• high red blood cell counts

• increased PSA or

• pain, bruising, bleeding, redness, or a hard lump where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

The Safety Of Testosterone In Women

The safety of testosterone in women has been evaluated for the past 80 years. Its been known for at least 70 years that testosterone is anti proliferative to breast tissue and inhibits the stimulatory effect that estrogen can have. Remember that when you reach the perimenopausal age, you have way more estrogen than progesterone so you can get estrogen dominant syndrome, fibrocystic breasts, and uterine fibroids . Testosterone helps this by binding estrogen receptor sites. It is very protective.

In two recent studies of women with testosterone pellets, one showed a 38% reduction in breast cancer and the other showed a 40% reduction in risk of developing breast cancer .

When I use a testosterone pellet in women with breast cancer, I use anastrozole . Then, I follow the levels to make sure theyre not aromatizing any of it to estradiol or any of the other forms of estrogens. In women that just need testosterone, I always do a Cleveland Heart Panel, and usually just use plain testosterone pellets .

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Study Design Setting And Participants

A 10-year prospective cohort study, investigating the incidence of breast cancer in women treated with subcutaneous T implants, was IRB approved in March of 2008 at which time recruitment was initiated. Recruitment was closed 31 March 2013. Methods, including study design, setting, and participants were previously reported in our 5-year interim analysis published in 2013 :

In 2013, the institution was sold and disbanded their IRB due to restructuring. All accrued patients continued to be followed. A second IRB protocol was approved in April 2018 allowing review and publication of collected data .