Please Scroll Down to See Forums Below 
Testosterone Added to HRT May Protect Against Breast Cancer
By Karla Gale
NEW YORK (Reuters Health) Sept 14 - When added to conventional hormone replacement therapy (HRT), testosterone may reduce the risk of breast cancer in postmenopausal women, results of a small, observational study suggest.
"I hope that this paper stimulates interest in the question of whether a more physiological HRT regimen might have better effects," senior author Dr. Carolyn A. Bondy told Reuters Health. But, she emphasized, "I do not recommend any changes in HRT treatment until we're convinced it's safe and efficacious."
The Women's Health Initiative and the "Million Women" Study, large clinical trials of combined estrogen and progestin HRT, were terminated early when they showed an increased risk of breast cancer. However, these studies did not evaluate the potential of combined treatment that included testosterone.
Dr. Bondy, with the National Institutes of Health in Bethesda, Maryland, and colleagues report the results of a retrospective, observational study of women treated with testosterone and estrogen, with or without progestin, for a mean of 5.8 years. Their findings are published in the September/October issue of Menopause.
Included in the study were 508 postmenopausal women who received testosterone implants containing 50 mg to 150 mg testosterone every 5 months, along with oral conjugated estrogens or estradiol implants (n = 161). Women with a uterus also received medroxyprogesterone with or without norethisterone (n = 347).
During follow-up of 0.7 to 11.4 years, there were seven cases of invasive breast cancer (incidence per 100,000 woman years = 238). One case occurred in the group using estrogen and testosterone only (incidence = 115), while six cases and the only death occurred in the group that was also using progestins (incidence = 293).
In comparison, the incidence of breast cancer per 100,000 woman-years in the estrogen and progestin arm of the Women's Health Initiative was 380. The corresponding incidence was 521 among those who used estrogen and progestin in the Million Woman study. However, the incidence among never-users in the Million Woman study was 283.
Prior to menopause, the ovary produces both androgen and estrogen, co-author Dr. Robert A. Jones, at Memorial Medical Center in North Adelaide, South Australia, explained in an interview with Reuters Health. Conventional HRT "stimulates the mammary epithelium directly, and tends to interfere with the protective effect of testosterone," thus increasing the risk of breast cancer.
"If testosterone had been used by subjects in the Women's Health Initiative study, it may have stopped the rise in breast cancer risk," he added. "It's possible the trial would not have needed to be stopped early."
His group's findings also confirm the suspected increased risk when oral progestin is added to estrogen HRT in women who still have a uterus. That issue could possibly be circumvented by administering the progestin via an intrauterine device rather than orally, Dr. Jones said. After all, he commented, "Why give progestin to the breast when all you want to do is give it to the uterus?"
He noted that testosterone has the added bonus of improving a woman's mood, reducing breast soreness, increasing bone density, as well as restoring energy, stamina, and sex drive.
These findings do not prove that testosterone is protective, Dr. Jones added. For that, randomized, controlled trials will be needed.
Dr. Bondy agreed. "I would love to see a clinical trial, especially for younger women who've had their ovaries surgically removed or who have ovarian failure for some other reason, who have to take HRT. Otherwise, they get terrible osteoporosis and their sexual characteristics disappear at a young age."
Until such studies have been completed, she reiterated, "I do not want people to jump on the bandwagon and do something that is unproven."
Menopause 2004;11:531-535.
By Karla Gale
NEW YORK (Reuters Health) Sept 14 - When added to conventional hormone replacement therapy (HRT), testosterone may reduce the risk of breast cancer in postmenopausal women, results of a small, observational study suggest.
"I hope that this paper stimulates interest in the question of whether a more physiological HRT regimen might have better effects," senior author Dr. Carolyn A. Bondy told Reuters Health. But, she emphasized, "I do not recommend any changes in HRT treatment until we're convinced it's safe and efficacious."
The Women's Health Initiative and the "Million Women" Study, large clinical trials of combined estrogen and progestin HRT, were terminated early when they showed an increased risk of breast cancer. However, these studies did not evaluate the potential of combined treatment that included testosterone.
Dr. Bondy, with the National Institutes of Health in Bethesda, Maryland, and colleagues report the results of a retrospective, observational study of women treated with testosterone and estrogen, with or without progestin, for a mean of 5.8 years. Their findings are published in the September/October issue of Menopause.
Included in the study were 508 postmenopausal women who received testosterone implants containing 50 mg to 150 mg testosterone every 5 months, along with oral conjugated estrogens or estradiol implants (n = 161). Women with a uterus also received medroxyprogesterone with or without norethisterone (n = 347).
During follow-up of 0.7 to 11.4 years, there were seven cases of invasive breast cancer (incidence per 100,000 woman years = 238). One case occurred in the group using estrogen and testosterone only (incidence = 115), while six cases and the only death occurred in the group that was also using progestins (incidence = 293).
In comparison, the incidence of breast cancer per 100,000 woman-years in the estrogen and progestin arm of the Women's Health Initiative was 380. The corresponding incidence was 521 among those who used estrogen and progestin in the Million Woman study. However, the incidence among never-users in the Million Woman study was 283.
Prior to menopause, the ovary produces both androgen and estrogen, co-author Dr. Robert A. Jones, at Memorial Medical Center in North Adelaide, South Australia, explained in an interview with Reuters Health. Conventional HRT "stimulates the mammary epithelium directly, and tends to interfere with the protective effect of testosterone," thus increasing the risk of breast cancer.
"If testosterone had been used by subjects in the Women's Health Initiative study, it may have stopped the rise in breast cancer risk," he added. "It's possible the trial would not have needed to be stopped early."
His group's findings also confirm the suspected increased risk when oral progestin is added to estrogen HRT in women who still have a uterus. That issue could possibly be circumvented by administering the progestin via an intrauterine device rather than orally, Dr. Jones said. After all, he commented, "Why give progestin to the breast when all you want to do is give it to the uterus?"
He noted that testosterone has the added bonus of improving a woman's mood, reducing breast soreness, increasing bone density, as well as restoring energy, stamina, and sex drive.
These findings do not prove that testosterone is protective, Dr. Jones added. For that, randomized, controlled trials will be needed.
Dr. Bondy agreed. "I would love to see a clinical trial, especially for younger women who've had their ovaries surgically removed or who have ovarian failure for some other reason, who have to take HRT. Otherwise, they get terrible osteoporosis and their sexual characteristics disappear at a young age."
Until such studies have been completed, she reiterated, "I do not want people to jump on the bandwagon and do something that is unproven."
Menopause 2004;11:531-535.
