HRT - Facts & Myths

Key Findings:

• Estrogen monotherapy beyond the age of 65 is associated with a significant reduction in all-cause mortality among senior Medicare women.
• Continued use of estrogen monotherapy beyond age 65 demonstrates risk reductions in breast cancer, lung cancer, colorectal cancer, congestive heart failure (CHF), venous thromboembolism, atrial fibrillation, acute myocardial infarction, and dementia.
• Estrogen and progestogen combo therapy, particularly estrogen plus progestin and estrogen plus progesterone, show an increased risk of breast cancer. However, the risk can be mitigated by using low doses of transdermal or vaginal estrogen plus progestin.
• Estrogen plus progestin exhibits significant risk reductions in endometrial cancer, ovarian cancer, ischemic heart disease, CHF, and venous thromboembolism. Estrogen plus progesterone demonstrates limited risk reduction, primarily in CHF.
• Risk reductions are more pronounced with low doses of MHT, as well as with vaginal or transdermal administration, compared to oral preparations.

Conclusion

This study shows that menopausal hormone therapy (MHT) beyond the age of 65 can offer substantial benefits, including reduced risks of mortality and various health conditions. However, the specific risk factors and risk reductions associated with MHT depend on numerous factors, including the type, route, and dosage of hormone therapy. Therefore, women considering MHT should consult qualified healthcare professionals to ensure safe and optimal results.

Method
The researchers conducted a thorough search across various databases to identify relevant RCTs comparing TRT with non-active control in men aged 40 and older with hypogonadism or low to low-normal testosterone levels. They included trials with at least 12 months of follow-up. The meta-analysis used statistical software for the analysis and results.

Results
The meta-analysis comprised 17 RCTs involving 9,374 men. The study found no significant increase in all-cause mortality among those receiving TRT compared to the non-active control group. While the incidence of cardiac arrhythmias increased in the TRT group, there was no elevated risk of cardiovascular mortality, stroke, or myocardial infarction.

Conclusions:

• TRT does not increase the risk of all-cause mortality in middle-aged and older men
• TRT does not elevate the risk of cardiovascular mortality, stroke, or myocardial infarction
• TRT may increase the incidence of cardiac arrhythmias

TRT offers numerous benefits, such as improved libido, muscle mass, and bone density. While it doesn’t increase the risk of all-cause mortality, cardiovascular mortality, stroke, or myocardial infarction, it can lead to an increased risk of cardiac arrhythmias. While TRT is generally safe, patients should only consider it after a thorough consultation with a healthcare provider who can assess their age, overall health, and cardiovascular risk profile.

Key conclusions:

• TRT does not increase high-grade prostate cancer risk: One of the most significant findings of this study is that TRT does not lead to a higher risk of developing high-grade prostate cancer. This type of cancer is more aggressive and can be more challenging to treat. Many men and their doctors have been cautious about TRT because of concerns it could increase prostate cancer risk. This study, however, offers reassurance that TRT, when administered under careful medical supervision, does not elevate this risk in men with low testosterone levels.
• No significant difference in prostate health events: Another important conclusion from the research is that there was no significant difference in adverse events related to prostate health between men receiving TRT and those given a placebo. This includes the occurrence of any type of prostate cancer, acute urinary retention (a sudden inability to urinate), and the need for invasive procedures to treat urinary issues. This suggests that TRT is as safe as a placebo in terms of these prostate health outcomes.
• TRT leads to a slight increase in PSA levels: While TRT did not increase prostate cancer risk or adverse events, it did lead to a minor increase in Prostate-Specific Antigen (PSA) levels compared to the placebo. PSA is a protein produced by the prostate gland, and higher levels can be an indicator of prostate cancer. However, this slight increase did not translate into more prostate health issues for those on TRT.

You can undergo TRT without worrying about prostate cancer
For men with hypogonadism or the symptoms of low testosterone, this study provides important reassurance. It suggests that, with proper medical guidance and monitoring, TRT can be a safe treatment option without significantly increasing the risk of serious prostate health issues. This means men can comfortably choose TRT to improve their quality of life.

Further information and findings from the study:

1. Why Women Face a Higher Dementia Risk and How Estrogen Matters: Women have a greater risk of dementia, including Alzheimer’s disease (AD), compared to men. This elevated risk has been linked to the decrease in estrogen levels during menopause. Estrogen is vital for brain functions like adapting to new information, controlling brain inflammation, and safeguarding the brain, and the drop in estrogen during menopause is thought to speed up dementia-related brain changes.

2. When to Start Hormone Replacement Therapy: Another critical factor explored in the study is the timing of HRT initiation. Researchers referenced a “critical window,” which is a specific time when HRT might provide protection for the brain. This window is when women are going through menopause. The study suggests that initiating HRT earlier, especially during this transition, may be more effective. Yunique offers effective menopause treatments in Ocala, Port Orange, and The Villages.

3. Key Findings: The study’s findings show that HRT had a more significant positive impact on cognitive function and brain volumes in women with the APOE4 genotype. APOE4 carriers on HRT performed better in memory-related tasks and had larger brain volumes. Starting HRT earlier in life was associated with larger hippocampal volumes, a crucial brain region for memory, but this effect was observed exclusively in APOE4 carriers.

4. Why Personalization Matters: These findings suggest that how well HRT works could depend on your genes and when you begin treatment. It highlights the importance of personalized medicine and the need to consider genetic factors when determining prevention and treatment strategies for Alzheimer’s disease. The study also suggests that HRT might be a useful approach to lower the risk of Alzheimers, especially in people with the APOE4 gene.

In summary, this study emphasizes the nuanced relationship between HRT, APOE genotype, and cognitive outcomes in women. It suggests that personalized approaches to AD prevention and treatment, considering genetic factors and the timing of interventions, are crucial for improving the understanding and management of dementia-related conditions. Read our FAQ on HRT for women to learn more.

Key findings from the study:

1. Continuation Rate: The study reported an overall continuation rate of 93% after two insertions of hormone pellets, with women having a slightly higher continuation rate than men. This suggests that patients found the therapy effective and tolerable.

2. Complication Rate: The overall complication rate for the procedure was less than 1%. The most common complication reported was pellet extrusion, with a higher occurrence in men compared to women.

3. Benefits for Women: The study highlighted the importance of testosterone therapy for women, even though it’s often associated with men. It found that testosterone played a vital role in women’s health and could alleviate symptoms associated with hormone deficiencies, including improved libido and relief from menopausal symptoms like hot flashes.

4. Safety and Efficacy: The research indicated that subcutaneous hormone pellet therapy was a safe and effective method for hormone replacement therapy, with lower complication rates compared to other forms of hormone administration.

5. Long-Term Use: The study suggested that the convenience of pellet therapy, with infrequent insertions, contributed to high patient retention and the potential for long-term hormone optimization.

In conclusion, the study provided evidence supporting the safety and effectiveness of subcutaneous hormone pellet therapy, particularly in the treatment of hormone deficiencies in both men and women. It emphasized the importance of testosterone therapy for women’s health and suggested that this method could offer disease prevention opportunities in addition to symptom relief.

Myth: Testosterone’s Sole Role in Women is Sex Drive
Contrary to popular belief, testosterone’s influence on women goes far beyond sexual desire. Women have functional androgen receptors throughout various tissues, including the heart, brain, muscles, bones, and more. Testosterone levels decline gradually as women age, leading to symptoms of androgen deficiency, such as mood swings, fatigue, bone and muscle loss, memory issues, and even physical discomfort. Testosterone therapy can address these symptoms and help women reclaim youthful vitality and wellness.

Myth: Testosterone Masculinizes Women
The effects of T on females depend on the dosage. In lower doses, T “stimulates femininity.” While pharmacological doses and those used for female-to-male transgender individuals can lead to facial hair growth, slight clitoral enlargement, and hirsutism, genuine masculinization is unattainable. Undesired androgenic effects can be reversed by reducing the T dose.

Moreover, concerns about T’s effects on fetuses are largely unfounded when administered in the usual medical doses. During pregnancy, T levels naturally increase but are moderated by the placenta, which metabolizes T. This hormone even enhances fertility and has been safely used to alleviate early pregnancy nausea. The notion that T masculinizes women is not supported by scientific evidence.

Myth: Testosterone Induces Hoarseness and Voice Alterations
Hoarseness is a fairly common issue, affecting about 30% of people at some point in their lives. Common causes include allergies, infections, acid reflux, overuse of the voice, medications, and vocal cord problems like polyps. There is no scientific evidence to suggest that testosterone triggers hoarseness. A study involving patients on danazol found no objective vocal alterations attributable to the drug’s properties. Similarly, ongoing research on pharmacological doses of subcutaneous T implant therapy in women has shown no significant voice changes.

Myth: Testosterone Causes Hair Loss
No evidence suggests that T therapy is responsible for hair loss in men or women. Female ‘androgenic’ alopecia doesn’t necessarily indicate that T is the cause; it refers to a male-pattern hair loss pattern in women rather than pinpointing the exact cause. Conditions like polycystic ovary syndrome (PCOS) and insulin resistance, which are associated with higher T levels in some women, don’t necessarily prove a direct link to hair loss.

Factors like insulin resistance, obesity, age, medication use, stress, and nutritional deficiencies can contribute to hair loss in individuals with a genetic predisposition. Research shows that many women experience hair regrowth when treated with subcutaneous T implants, and no patients in one study reported hair loss despite having elevated T levels on therapy.

Myth: Testosterone Negatively Affects the Heart
It’s true that men have higher testosterone levels than women, and men also have a higher incidence of heart disease. However, it’s a misconception to assume that testosterone causes or contributes to cardiovascular disease in either sex. Unlike anabolic steroids and synthetic oral steroids, there’s no scientific evidence to suggest that T has adverse effects on the heart.

In fact, substantial evidence supports the idea that T is heart-protective. T has positive effects on lean body mass, glucose metabolism, and lipid profiles in men and women. It has been successfully used to treat and prevent cardiovascular disease and diabetes. T is a vasodilator with immune-modulating properties that inhibit the formation of artery-clogging plaques and benefit cardiac muscle. T supplementation also enhances functional capacity, insulin sensitivity, and muscle strength in women with congestive heart failure.

Myth: Testosterone Negatively Affects the Liver
Unlike high doses of oral synthetic androgens, which can affect the liver, testosterone therapy administered through subcutaneous implants or topical patches bypasses the liver, so there are no adverse effects on the liver, including liver enzymes and clotting factors. Non-oral testosterone doesn’t increase the risk of conditions like deep venous thrombosis or pulmonary embolism, which are associated with oral estrogens, androgens, and synthetic progestins.

Myth: Testosterone Fuels Aggression
Testosterone therapy does not lead to increased aggressive behavior, even with high doses. The idea that T causes aggression overlooks the fact that T can convert to estrogen (E2), and evidence in various species suggests it’s estrogen, not testosterone, that plays a primary role in aggression through its action on estrogen receptors. In women, subcutaneous testosterone therapy has been shown to reduce aggression, irritability, and anxiety in over 90% of patients treated for symptoms of androgen deficiency.

Myth: Testosterone Increases Breast Cancer Risk
Testosterone has been recognized as antagonistic to estrogen, making it a potential treatment for estrogen-sensitive conditions, including breast cancer. Clinical trials support the idea that T has a beneficial impact on breast tissue by reducing breast cell proliferation and countering the stimulatory effects of E2. The key factor is the balance between T and E2 levels, which can be breast-protective. T therapy doesn’t increase the risk of breast cancer and may even lower it in women receiving estrogen therapy.

Myth: Testosterone Use in Women Is Untested
Parenteral testosterone therapy, particularly through implants, has been used safely in women since 1938. Long-term data spanning up to 40 years show that doses as high as 225 mg remain effective, well-tolerated, and without major health problems. Furthermore, studies on the use of suprapharmacologic doses for transgender patients transitioning from female to male have not revealed increased mortality, breast cancer, vascular issues, or other major health concerns.

Conclusion: Summary of Study
Even as the use of testosterone therapy in men becomes more widespread, questions and concerns regarding testosterone and its application in women persist. This article has drawn upon the findings of an in-depth literature review to debunk prevalent misconceptions about testosterone and testosterone therapy in women. It’s crucial to recognize that optimal T levels are essential for the physical, mental, and emotional well-being of individuals of all genders.