Testosterone Therapy for Women On Menopause

Foreign. Why use testosterone over estrogen for women with hormone replacement therapy and particularly we're talking about menopause or perimenopause where a woman no longer has periods because of natural menopause or a surgical removal of the uterus and or ovaries. I wrote a book on this. We talked about that a lot. And whereabouts. Why are we seeing more and more use of testosterone? Well, this brief history lesson is back, say 100 years ago we didn't really treat menopause and then we started using ground up sheep ovaries that women would eat. That reduces symptoms of menopause. And I cannot get into the symptoms of menopause. But the class one will be night sweats, hot flash. It does also weight gain and more cardiovascular disease, mental fogginess, earlier onset of dementia, things that occur with menopause that can be potentially mitigated with hormone replacement therapy. The ones that are known to be mitigated the most are the vasomotor symptoms or hot flashes, night sweats. But also we're seeing benefits with hormone replacement therapy for weight loss reduce cardiovascular disease. There's always been the big question about breast cancer and we'll get into that in a moment. And even a neurocognitive decline and longevity, that can be another question. Is there some benefit with hormone replacement therapy after sheep ovaries? We use pregnant mare urine premarin, which was a group of conjugated estrogens that somewhat mimicked the effect of estrogens that woman would make naturally. She would take it as a pill and, and that was very effective for reducing symptoms of menopause. We'd use that along with progesterone because if you use premarital loan the uterus would overgrow. Potentially 13% of women would get uterine cancer unless it's the uterus is mitigated with progesterone. Then we added in Probera, which is a synthetic form of progesterone. And that led to some big studies that were really misunderstood by the public called the Women's Health Initiative trial. And back in 2002 and 2004, we, we kind of abandoned the routine use of hormone replacement therapy because of fear of heart disease and breast cancer. And I'm just going to dig into that a little bit and we'll talk to you about why we're using testosterone. So first off, with the Women's Health Initiative trial that was reported in 2002 and 2004, the general public, many doctors that were not scientific thought that hormone replacement given to Women in menopause increased the risk of breast cancer and heart disease. In fact, they were quite wrong. The study did not look at starting Premarin and Provera Premarin alone in menopause. They looked at starting it at women at any age. And if they started it within 10 years of menopause, there's about a 40% reduction in cardiovascular mortality. So that's a big number. And the Premarin alone had a reduced risk of breast cancer, not increased risk. So that led to doctors sort of bandling the use of estrogen because they assume estrogen must be causing these things. It was of course wrong. And this letting women, you know, live with it or giving them psychiatric drugs to manage symptoms of menopause. Well, during that time, we knew that testosterone was a potential option for women with menopause and it's used in different countries now. Where does that woman's estrogen come from? It comes from her testosterone. In fact, a woman has about 20 times more testosterone in her body than estrogen, 20 times more. And when it gets depleted, we're repleting the estrogen, not to testosterone. Well, testosterone, it turns out, has been FDA approved for women for breast cancer, metastatic breast cancer, since the 50s. In fact. Testosterone is the hormone of which the drug tamoxifen was somewhat based on to block estrogen restricted receptor positive breast cancer. Testosterone does reduce the risk of breast cancer, recurrence and development of breast cancer. Large studies done in the United States, hence to some degree in Europe, have shown that testosterone as a primary solution for menopause had a significant reduction in the incidence of breast cancer. And reduction is anywhere from about 28% to 70%, depending on how long the studies run in different factors, but a significant reduction in menopausal symptoms with or without the concomitant use of estrogen. When I first started paying attention to this, we did not have the studies using testosterone with estrogen. It was just testosterone alone. We saw marked reduction in breast cancer, relief of pretty much all symptoms of menopause. However, we know estrogen use within 6 to 10 years of menopause reduces a woman's risk of cardiovascular disease. And the political mindset at the time was that, you know, estrogen causes breast cancer, you got to stay away from it. Of course, that now has been totally disproven, even though some people may don't believe it because they're remembering studies from 20 plus years ago. That's the truth. Estrogen reduces risk of breast cancer when started in the right timing. Now we think about hormone replacement therapy in a contemporaneous fashion, as testosterone as the dominant hormone, that's about 1 milligram per pound of body weight is a typical dose, plus or minus 10 or 20 milligrams. And then estrogen, usually it's much smaller dose, about one twentieth the dose because it's 20 times less prevalent in your body. And then probably progesterone, we prefer the testosterone pellets. That's because of the ease of use, the inappropriate notes of the injectables, and the side effects of the topicals and erratic absorption of topicals. We use a pellet, it's got the size of a piece of rice. It goes into skin, usually of your buttocks. And then we add estrogen, typically with a pellet as well, because you're already getting a pellet in and estrogen pellets. This little tiny dot and added this makes it very easy and convenient. Progesterone is given as an oral tablet, typically at night. And testosterone. So then the question would be, why would you pick testosterone over estrogen? I really wouldn't. I would say testosterone is what we use all the time. And for significant percentage of women that we're treating within 10 years of menopause, we'll add in estrogen to give them the additional cardiovascular protection. And there's potentially other protections as well. So estrogen clearly helps with bone density. Testosterone likely does as well. But estrogen is very strong for bone density. Estrogen probably works better on the skin. If you get estrogen pellet, your skin will typically be a little bit better, brighter, more vaginal moisture, potentially with estrogen. But most of the vasomotor symptoms are relieved with testosterone alone. So testosterone can be used alone, particularly if your main focus is breast cancer reduction. But now we have studies showing that the breast cancer reduction is also seen when estrogen is added to testosterone. And again, it doesn't prevent you from getting breast cancer, just reduces the risks significantly. We know about one out of seven or one out of eight women we have breast cancer, let's say a number drops down to maybe 1 out of 5, I'm sorry, maybe where it drops down up to 1 out of 10 or 1 out of 12 people, we get breast cancer. So still does occur, but at a lower rate. And when breast cancer does occur, testosterone is actually protective. So testosterone is your dominant hormone when you're premenopause 20 times more than estrogen. We're using hormone replacement therapy to help with vasomotor symptoms, but also help with bone density and cardiovascular risk protection and reduce breast cancer. We would use testosterone and estrogen and progesterone. And the question is how long to use that? Some proponents would say for the rest of your life. Is there a time that you really would want to be back in menopause and having the associated, you know, weight gain and mental issues and mental fogginess that occur with it? We don't know about longevity for sure by any means, but it does appear to enhance the duration of healthy lifespan. That would be good as well. So testosterone strong enough for a man made for a woman. This title of my book, you can read about that, go through the studies that was written in 2017. So in the last few years, then more studies come out supporting the same concept. And at that time we weren't so confident on the use of estrogen along with testosterone. We weren't sure it was necessary. I feel differently now. I. I would more commonly routinely add estrogen if a woman is within six to ten years of menopause. And there's some people that are using estrogen inhibitors with testosterone to reduce the risk of breast cancer. Further, there's not good evidence that that does anything beneficial. We're not recommending or doing that. So thank you very much.