Decreased Incidence of Breast Cancer in Women Using Testosterone and/or Testosterone and Estradiol Pellets

Hormone replacement therapy (HRT) is a treatment that involves repleting or “replacing” sub-optimal hormones in the body to treat various symptoms and conditions. Breast cancer and HRT (using synthetic hormones) and BHRT (using bioidentical hormones) remain a controversial topic. Unlike HRT using synthetic hormones, BHRT uses hormones found in plants having the same molecular hormone structure the body produces naturally.

Confusion surrounding HRT has perpetuated since the 2002 Women’s Health Initiative (WHI), linking hormone replacement to breast cancer and cardiovascular disease. The WHI studied women using synthetic hormones. A 2019 publication studying menopausal women using HRT, synthetic hormones estrogen with progestogen, concluded the risk of breast cancer within 10 years of HRT use is twice as great as without using any hormones. This study did NOT assess the risk of breast cancer for BHRT using bioidentical estradiol and progesterone.
Since then, studies on bioidentical hormone replacement therapy (BHRT) have debunked the concerns of increased breast cancer and cardiovascular disease with BHRT and have shown beneficial effects on cancer risk.
At RMC, bioidentical hormones are used to optimize hormone levels and are available in various formulations including patches, pills, creams, lozenges and pellets. Hormone pellet therapy uses bioidentical hormone pellets about the size of a grain of rice inserted just under the skin and absorbed over time.

The focus of this article is on testosterone pellet therapy with or without estradiol pellets.

Conventionally, testosterone is a hormone that is largely misunderstood and ignored in women. Aside from testosterone demonstrating positive effects on the brain, bones and heart, a newly published study shows its effect on breast cancer risk reduction. This article is a review of the largest long-term study demonstrating benefits of testosterone therapy with or without estradiol using pellets in women:

Breast Cancer Incidence Reduction in Women Treated with Subcutaneous Testosterone: Testosterone Therapy and Breast Cancer Incidence Study.

Breast cancer is the second most common cancer and leading cause of cancer death in women in the United States.

One in eight women will be diagnosed with breast cancer in her lifetime. While breast cancer also affects younger women, most breast cancers are found in women 50-75 years of age or older.* Testosterone counteracts any inflammatory effects of estrogen and therefore becomes quite important in the balance of women’s hormones.

Testosterone (T) in Women Quick Facts

• T is the most abundant biologically active hormone throughout the female lifespan
• Every cell in the body has receptors for T
• Low T in women can be just as debilitating as the symptoms produced by low T in men
• T is mood stabilizing, promotes sexual function, bone density, cognition, wound and body healing, energy, and is cardioprotective
• Subcutaneous T has been used since 1937 to treat T deficiency in women
• T has been shown to counteract proliferative effects of estrogen in breast tissue
• Bio-available T is shown to be lower in women with breast cancer

Breast Cancer Incidence Study Using Testosterone and/or Estradiol Pellets

This is a retrospective study investigating the incidence of breast cancer in 2,377 women treated with subcutaneous testosterone BioTE pellets with or without estradiol (E) implants between January 2010 to 2020. Both pre- and post-menopausal women who presented with symptoms of T and/or T and E deficiencies had hormone testing and were treated with hormone pellets.

Women were excluded if there was a personal history of breast cancer. Of the 2,377 participants, 640 received T only and 1,737 received T and E. 76.8% of women were menopausal and 23.2% were pre/perimenopausal. 28% had a family history of breast cancer.

Patients self-reported any diagnosis of breast cancer after pellet insertion. Breast cancer incidence was compared to historical controls from the placebo arm of the WHI who did not receive any hormone replacement.

There was a 56% reduction in invasive breast cancer in women
treated with testosterone pellets alone or testosterone/estrogen pellet implants
compared to women who had no hormone replacement.

Limitations

As cases of breast cancer were self-reported by patients, this could result in lower incidences due to underreporting. While results were compared to historical controls, there was a lack of a matched control group. Progesterone use in this study was not included and could further reduce breast cancer incidence.

No other route of testosterone administration has demonstrated a reduction in the incidence of invasive breast cancer. The method of Testosterone delivery is hence extremely important.

Topical routes of T have failed to show the benefits seen with T pellet therapy. Invasive breast cancer reduction demonstrated with T pellet therapy may not extend to topical or oral methods. Other benefits in the use of T pellet therapy can also be seen in reducing the incidence of Alzheimer’s disease, cardiovascular disease, certain types of other cancers, and osteoporosis.

At RMC, BioTE pellets are used to optimize T levels. Testosterone pellet therapy offers a more consistent hormone release as pellets dissolve at a slow rate directly into the bloodstream dependent on the individual’s cardiac output. Oral and transdermal hormone treatments can produce hormone fluctuations, whereas pellet therapy offers a controlled consistent level throughout the day, avoiding rollercoaster effects.

Many patients prefer pellet therapy as it takes away the maintenance and need to apply topical creams or take oral pills every day. Pellet placement is a quick, painless procedure in which a small incision is made to the upper buttock and inserted in the fatty layer just under the skin. Pellets are typically placed every 3-4 months.

Are there side effects? With pellet therapy, side effects are minimized though some patients do experience mild effects such as facial hair growth, hair loss, acne, and clitoris enlargement. These are mild, decrease with decreasing the dose, and most often do not stop the patient from continuing this therapy.

Hormone optimization improves quality of life
and may be an answer to prevention of cancer and its defeat.

RMC is at the forefront of BHRT. Synthetic hormones have been shown to increase breast cancer risk whereas bioidentical hormones lead to a significant reduction. In the largest and most significant study to date on testosterone therapy in women, there was a 56% reduction in invasive breast cancer incidence.

It is time to dispel myths and fears surrounding bioidentical hormone therapy and cancer. Testosterone is critically important for both men and women. Testosterone may not only reduce cancer risk but also improve survival.

Have an awesome day. Dr D