Sexuality in the Aging Couple, Part I: The Aging Woman

Irwin W. Kuzmarov, MD, FRCSC; Jerald Bain, BScPhm, MD, MSc, FRCPC, CertEndo, BA

Disclosures

Geriatrics and Aging. 2008;11(10):589-594. 

In This Article

Testosterone Therapy and Breast Cancer

If there is a concern about the use of testosterone in women, the concern lies in the possibility of unmasking or causing breast cancer de novo, at least in a subpopulation of women. There can, of course, be virilizing side effects such as acne, hirsutism, deepening of the voice, or clitoromegaly; these are dealt with by dose readjustments. Breast cancer is a serious and irreversible occurrence.

Tamimi and colleague conducted a prospective cohort study in the Nurses' Health Study from 1978 to 2002 assessing breast cancer risk in postmenopausal hormone regimes containing testosterone.[30] They found 4,610 cases of invasive breast cancer and determined that women receiving hormone therapy that included testosterone had a 17.2% increased risk of breast cancer per year of use. One of the difficulties in interpreting the results of this study was the fact that the "testosterone" being used in 90% of the subjects was not testosterone but was methyltestosterone. Whether this makes a difference is not at all clear.

Tamimi's results stand in stark contrast to those of Dimitrakakis et al.[31] They undertook a retrospective study of 508 postmenopausal women who were on standard hormonal therapy plus testosterone. They observed that adding testosterone to conventional hormone therapy not only did not increase the risk of breast cancer but, in fact, reduced it, returning the incidence to that experienced by the general untreated postmenopausal population.

More recently Schover, in a review of sexual decline in females and the use of testosterone therapy, took issue with the diagnosis of female androgen insufficiency syndrome as a cause of decreased libido.[32] She commented, as did Basson,[7] that there were psychosocial issues that played a larger role in defining the female sexual response and that serum androgen levels did not correlate with degree of sexual interest or arousal. Furthermore, she warned about the probability of an increased incidence of breast cancer in women receiving testosterone therapy for low libido, referencing several large prospective case-controlled studies.

The controversy continues. Guay and Traish, in a letter to the editor commenting on Dr. Schover's critique and warnings about the use of testosterone in women, offered contrary evidence that testosterone therapy conferred no increased risk of breast cancer and that testosterone might even provide protection against the development of breast cancer.[33] Dr. Schover's rebuttal invoked Dr. Guay's associations with the pharmaceutical industry.[34] The debate on the risks and benefits of testosterone use among women is likely to continue.

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