Testosterone (in combination with an aromatase inhibitor to prevent the conversion of testosterone to oestrogen) has been used to reduce the size of invasive breast cancers, helping to either avoid the need for invasive breast cancer surgery or lessen the impact of the procedure.
"Why aren't we shouting about this from the rooftops?" asks Susanne Mitchell, author of 'The Naked Truth About PERIMENOPAUSE', which takes a deep dive into testosterone therapy as a treatment option for menopausal symptoms.
"It's outrageous that it's so difficult for women to access this hormone through menopause, and that its success in treating breast cancer and other ageing diseases just isn't being reported."
As part of her investigation into testosterone therapy, Mitchell interviewed Dr Rebecca L Glaser, MD, FACS, a retired breast cancer surgeon, who is currently involved in research on testosterone therapy by pellet implant and its impact on health and breast cancer prevention, to ask why.
"Number one, doctors just don't know about it," says Dr Glaser. "Also, there are many myths and misconceptions about testosterone therapy in women despite the evidence."
Some consider it 'alternative' medicine, but Dr Glaser considers it 'evidence-based medicine'.
"Women come to me for treatment at all different stages of breast cancer. I've used testosterone pellets (combined with an aromatase inhibitor) prior to surgery, to help reduce the size of the cancer, so it's a smaller cancer to remove," she says. "You then have evidence that the tumour responds favourably to testosterone implant therapy, so if the patient chooses, we continue the therapy after surgery, not just for tumour control, but symptom control as well."
Through her career Dr Glaser has evaluated and treated more than 1500 breast cancer patients and her research publications have been extensively cited (over 2000 citations) including original data on sentinel lymph node biopsy, which is now the standard of care in breast cancer surgery. Her most recent paper, 'Testosterone Implant Therapy in Women With and Without Breast Cancer: Rationale, Experience, Evidence' which she co-authored with Dr Constantine Dimitrakakis was published last month.
However, the recent 'Global Consensus Position Statement on the Use of Testosterone Therapy for Women' which was published in 2019, currently directs the diagnostic and treatment decisions that our doctors make across the world with regard to the so-called 'male' hormone.
Dr Glaser believes the position statement is a cause for concern due to the impact that commercial conflicts of interest might have on these guidelines. The majority of the authors have significant conflicts and ties to the pharmaceutical industry, which also sponsors/funds the societies that published the statement. Plus, she says it also violates many policies that ensure the integrity of such guidelines.
Most concerning, the guidelines fail to acknowledge the preference of many thousands of women who currently benefit from testosterone therapies for breast cancer, menopause symptoms or other age-related diseases.
It has serious ramifications for those women who could be adversely affected if specialists are forced to follow the recommendations and alter their prescribing practices.
"It's something we must address and build awareness around," says Mitchell. "We need to be talking about this very loudly - demanding to be heard."
Testosterone has been used for over eighty years to treat breast cancer and symptoms of hormone deficiency in pre and postmenopausal. Evidence supports that androgens are breast protective.
Read more detail about the important role testosterone plays in healthy women in the full article here.
Working from her clinic in Dayton, Ohio, Dr Glaser is a well-respected breast cancer surgeon in the area, where she says her work with testosterone as a therapy for breast cancer patients isn't always approved of, despite the evidence she continues to present.
"This is considered alternative and controversial, but my patients show enough evidence that many local doctors who didn't approve in the past have stopped interfering," says Dr Glaser. "In fact, I have received referrals from some oncologists whose patients could not tolerate oral aromatase inhibitor therapy."
Dr Glaser works with testosterone pellets as a neuroprotective therapy too, with patients who have Parkinson's and Alzheimer's disease. In fact, the first patient she treated with a testosterone pellet implant was an elderly man who had Parkinson's disease.
"I researched data on the neuroprotective effects of testosterone," she says. "I had previously treated the patient with a topical gel and the sublingual lozenges which helped his symptoms a little. Then I had him on the intramuscular shots, which were slightly better. I read about the pellets and being a surgeon, I could insert them easily. It was incredible, after days he was a different person - his mood, tremor, jaw movements, and walking dramatically improved."
She then realised the difference was in the delivery, and she found old literature on pellet therapy and began to treat more patients. "The results were amazing," says Dr Glaser.
"The clinical outcomes were what sold me on pellets," she says. "I get testimonials from people who say this is great, but when you see people with a serious disease, the pellets can be game changing. It's the method of delivery, and nothing else does that, not the creams or the patches but the pellets. They mimic the body, delivering adequate amounts of androgens (testosterone) 24 hours a day, 7 days a week."
Pellets are produced by compounding pharmacies under strict regulations, but drug companies continue to fight compounded pharmaceuticals and in the USA the FDA doesn't approve the use of testosterone in women at all.
Could it be that pharmaceutical companies are protecting their bottom line and using the 'Global Consensus Position Statement on the Use of Testosterone Therapy for Women' as a shield? Why? Because you can't patent-protect a hormone such as testosterone unless you change the chemical structure. Read more detail on this and the regulation of testosterone for women across the world in the full article here.
But Dr Glaser says that because it's not a drug company commercial therapy it's hard to get it out there. RCT's are extremely expensive to run, and unless there's a product that can be patented as an end goal, Big Pharma won't fund trials. She believes the only way we can tackle this is from a grass-roots level.
"We need to create awareness on the treatment, so women start going to their doctors and asking to try subcutaneous testosterone therapy," says Dr Glaser. "I get patients at my clinic in Ohio travelling across the United States to access this treatment because it works. I feel bad when a patient with metastatic breast cancer, crippled with bone pain, has to fly from California to receive this therapy."
Dr Glaser treats a patient with testosterone pellets for under $300 USD, which covers around three months of therapy - chemotherapy costs around $230,000.
"It needs someone with very deep pockets to take an interest and fund an RCT to help make it an established weapon in the treatment of breast cancer," she says. "All I can do is keep treating my patients, producing more and more evidence to support the therapy."
Testosterone proving successful for breast cancer, menopause and other ageing diseases
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