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July 3, 2019
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Testosterone and Breast Cancer
August 26, 2019
Published by Gerilyn Cross M.D., F.A.C.O.G. on August 14, 2019
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Misconceptions About Testosterone Replacement

Testosterone deficiency may lead to many symptoms including depression, anxiety, anger, irritability, moodiness, decreased self confidence/self esteem, fearfulness, decreased libido/sexual function, decreased stress tolerance and fatigue.  Add to that- confusion; decreased memory, cognitive function, and mathematical ability.  Many seek replacement to alleviate these symptoms. Yet, it is very common to hear patients ask “Will testosterone replacement make me aggressive and angry?” Patients also ask me whether testosterone will cause cancer or heart disease; whether testosterone replacement will result in hair loss or a beard.  Let’s look at the facts, so well reviewed in “Testosterone therapy in women:  Myths and misconceptions” by R. Glaser and C. Dimitrakakis as published in Maturitas in 2013.

Testosterone deficiency may lead to many symptoms including depression, anxiety, anger, irritability, moodiness, decreased self confidence/self esteem, fearfulness, decreased libido/sexual function, decreased stress tolerance and fatigue.  Add to that- confusion; decreased memory, cognitive function, and mathematical ability.  Many seek replacement to alleviate these symptoms. Yet, it is very common to hear patients ask “Will testosterone replacement make me aggressive and angry?” Patients also ask me whether testosterone will cause cancer or heart disease; whether testosterone replacement will result in hair loss or a beard.  Let’s look at the facts, so well reviewed in “Testosterone therapy in women:  Myths and misconceptions” by R. Glaser and C. Dimitrakakis as published in Maturitas in 2013.

Testosterone pellets were first prescribed in 1938 at the Medical College of Georgia, they are also widely used in Europe and Australia.  However, doctors are often taught that the safety of testosterone is in question!

Dr. Glaser lists the top 10 Myths on Testosterone replacement:

1. Myth: Testosterone is only made by men.

Fact: Testosterone is actually the most abundant and biologically active hormone made by women!

2. Myth: Testosterone’s only role in women, is to increase libido or sex drive.

Fact: This amazing hormone does approximately 3,000 jobs in women, estradiol only has 400 jobs but it usually gets all the credit or all the blame! There are receptors for testosterone in almost every tissue and organ in the body including the brain, nervous system, prostate, breast, bones, muscles, heart, lungs, gut, reproductive organs, fat, and skin.

3. Myth: Testosterone makes women look like men.

Fact: Women receive less than 1/10th the dose administered to men and masculine features do not develop. Female to Male transgender patients, receive the same dose of testosterone as would be used in a male with testosterone deficiency and so there is an increase in hair growth and some clitoral enlargement. However true masculinization does not occur.

4. Myth: Testosterone causes hoarseness in the voice.

Fact: Testosterone decreases inflammation and actually decreases hoarseness of the voice.

5. Myth: Testosterone causes hair loss.

Fact: In most women, hair becomes thicker on testosterone therapy. Glaser states, “There is no evidence that T or T therapy is a cause of hair loss in either men or women.” Hair loss is complicated!!  It may be genetic or due to thyroid disorders, nutritional deficiencies, medications or alcohol.  Aging, obesity and stress are also risk factors.  Some may experience thinning due to a hormone called DHT which comes from testosterone.  This thinning can be treated with supplements or medication, which prevent DHT formation.

6. Myth: Testosterone has adverse effects on the heart.

Fact: Over 100 studies reveal that testosterone is cardioprotective. Testosterone decreases both the incidence and severity of atherosclerosis and coronary artery disease.  The incidence of heart attack and stroke is also decreased.  Mortality from cardiovascular disease and overall mortality is also decreased!

7. Myth: Testosterone causes liver damage.

Fact: It is only oral, synthetic testosterone that adversely affects liver enzymes, and has been shown to cause liver cancer. Oral, synthetic testosterone also increases clotting factors ( as do oral estrogen and oral, synthetic progesterone).  These oral hormones increase thrombosis risk as well as cardiovascular risk.

8. Myth: Testosterone causes aggression.

Fact: Testosterone decreases aggression, irritability and anger. It is only  oral, synthetic testosterone that causes aggression and rage.  It is actually estrogen, especially if levels are high, that increases aggressive behavior.

9. Myth: Testosterone increases the risk of breast cancer.

Fact: Testosterone has been shown to help decrease the formation of breast cancer cells, help prevent their division, as well as promote their destruction. Testosterone pellets have been shown to decrease the incidence of breast cancer, and are presently being used to treat menopausal symptoms in breast cancer patients.  T Pellets are also being directly placed in the breast around cancer to treat the cancer (hormone sensitive cancers only which account for 95%). It is estrogen that stimulates cancer.  Medication to prevent testosterone from converting into estrogen, is used when treating cancer patients.

10. Myth: The safety of testosterone use in women has not been established.

Fact: The safety of non oral, bioidentical testosterone has been well established for many years and through much research. Always seek replacement with bioidentical and non oral testosterone.

References:

  1. Glaser et al, “Testosterone therapy in women: Myths and misconceptions, Maturitas, 2013
  2. Glaser et al, “Testosterone and breast cancer prevention”, Maturitas, 2015

AM Traish et al, “Safety of physiological testosterone therapy in women:  lessons from female to male transsexuals (FMT) treated with pharmacological testosterone therapy, Journal of Sexual Medicine, 2010

  1. Jones et al, “Randomized controlled trials-mechanistic studies of testosterone and the cardiovascular system.”, Asian Journal of Andrology, 2/2018
  2. Morgentaler, “Testosterone Therapy and Cardiovascular Risk: Advances and Controversies.”, Mayo Clinic Proceedings, 2/2015
  3. Iellamo et al, “Testosterone therapy in women with chronic heart failure”, Journal of the American College of Cardiology, 2010

 

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Gerilyn Cross M.D., F.A.C.O.G.
Gerilyn Cross M.D., F.A.C.O.G.
Dr. Cross graduated from Georgetown University School of Medicine in 1981. She completed her residency in Obstetrics and Gynecology at Naval Hospital San Diego in 1986 and received her board certification in Obstetrics and Gynecology in 1988, becoming a Fellow in the American College of Obstetrics and Gynecology in 1989. She is the Medical Director for Hormone Therapy of Citrus County and has also served as the Medical Director of Hormone Therapy Centers of America in Dallas, Texas. Dr. Cross continues to teach physicians across the country about Bioidentical Hormone Replacement.

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