Abraham Morgentaler: Value of testosterone replacement for women is one of great blinds spots in medicine

[Millard]

View: https://twitter.com/DrMorgentaler/status/1434207108086607872


View: https://twitter.com/DrMorgentaler/status/1434825901754261506


Glaser, Rebecca, and Constantine Dimitrakakis. “Testosterone Implant Therapy in Women With and Without Breast Cancer: Rationale, Experience, Evidence.” Androgens: Clinical Research and Therapeutics, vol. 2, no. 1, June 2021, pp. 94–110. DOI.org (Crossref), https://doi.org/10.1089/andro.2021.0003.

 

[PeterBond]

First sentence of the paper:

Testosterone (T) is the most abundant biologically active hormone in women.

It's not. Testosterone reference range for a women is ball park 15-50 ng/dL. Progesterone reference range during the luteal phase is ball park 20-200 ng/dL. Total t4 reference range is aroud 5.000 - 12.000 ng/dL, etc. (This is not entirely a fair comparison, since a t4 molecule is almost 3x the weight of those steroid molecules, but still its clear that it's concentration is way higher).

I'll have (unfortunate) reservations if someone starts a paper off like this. It indicates a weird bias.

 

[pigeonhed]

@PeterBond are you pointing this out as it changes your ability to agree with the papers' point?

It would seem this was arguing the use or T in HRT for Women. Are you against this? Why?

Are you also against men using HRT?

Curious as I would generally be for more medical research with T and I am a bit confused how research in T with women with breast cancer is a bad thing.

 

[PeterBond]

@PeterBond are you pointing this out as it changes your ability to agree with the papers' point?

It would seem this was arguing the use or T in HRT for Women. Are you against this? Why?

Are you also against men using HRT?

Curious as I would generally be for more medical research with T and I am a bit confused how research in T with women with breast cancer is a bad thing.

I'm pointing this out mainly because it would ring alarm bells with anyone who has some training in endocrinology. If you start your paper with such a 'strong' opening statement, and you couldn't even get that right, it leaves little hope for the rest of the paper. In a sense: if you're an expert on testosterone, how can you not know that it's _not_ the most abundant biologically active hormone in a woman? Even if you're only considering the three sex steroid hormones it's not the most abundant one.

I did some further skimming, and I'm gonna have a day job fact checking this paper, but I have serious doubts about the references supporting many of the statements made in the paper. I also don't see the use of these n=1 stories in a serious paper.

I am not against HRT for neither women or men. I'm against bad science.

 

[PeterBond]

I'm more fond of the controlled trials Bhasin's group is running to adequately assess the effects of testosterone administration (including high dosages) in women:

The effects of testosterone administration on muscle areas of the trunk and pelvic floor in hysterectomized women with low testosterone levels: proof-of-concept study - PubMed

Short-term testosterone administration in women with low testosterone levels was associated with increased trunk muscle area.

pubmed.ncbi.nlm.nih.gov

Functional Voice Testing Detects Early Changes in Vocal Pitch in Women During Testosterone Administration - PubMed

Testosterone administration in women with low T levels over 24 weeks was associated with dose- and concentration-dependent decreases in average pitch in the higher dose groups. These changes were seen despite the lack of self-reported changes in voice.

pubmed.ncbi.nlm.nih.gov

Effects of testosterone administration on cognitive function in hysterectomized women with low testosterone levels: a dose-response randomized trial - PubMed

Short-term testosterone administration over a wide range of doses for 24 weeks in women with low testosterone levels was neither associated with improvements nor worsening of cognitive function.

pubmed.ncbi.nlm.nih.gov

Testosterone dose-response relationships with cardiovascular risk markers in androgen-deficient women: a randomized, placebo-controlled trial - PubMed

Short-term T administration over a wide range of doses for 24 weeks in women with low T levels was not associated with worsening of cardiovascular risk markers.

pubmed.ncbi.nlm.nih.gov

Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial - PubMed

Testosterone administration in hysterectomized women with or without oophorectomy for 24 weeks was associated with dose and concentration-dependent gains in several domains of sexual function, lean body mass, chest-press power, and loaded stair-climb power. Long-term trials are needed to weigh...

pubmed.ncbi.nlm.nih.gov

And systematically performed reviews:

Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data

The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-…

www.sciencedirect.com

Global Consensus Position Statement on the Use of Testosterone Therapy for Women

The only evidence-based indication for testosterone for women is for HSDD. There are insufficient data for using testosterone for any other symptom/conditi

academic.oup.com

 

[pigeonhed]

@PeterBond Thank you!

Not only for taking the time to answer my inquiry but also for the wonderful reading material. You are much more educated and knowledgable than myself on the subject. I will take some time to read up on some of this.

 

[malfeasance]

The vocal study was interesting, especially lack of self reported changes in pitch did not match the objective observations of deepening voices.

Delusion or denial by the women involved?

 

[PeterBond]

The vocal study was interesting, especially lack of self reported changes in pitch did not match the objective observations of deepening voices.

Delusion or denial by the women involved?

I think it might be quite difficult to pick up these changes yourself because they happen gradually and I suppose the self-perception of voice might make it even more difficult. (As in: your voice always sounds completely different to you when you hear it on a voice clip.)

 

[WOU812]

I have at least 12 female clients (ages 40's - 60's) that are on T via several docs in my area. One of them sees Glaser and is a BCa survivor. The T pellet has completely changed her QOL. Being on anastrazole was physically and mentally destroying her life. The sides of T vary widely (from surprisingly few at circ conc of T in the normal range for an older guy to considerable with low doses, upper normal for a female) but I can tell in just about every one, there is some change in voice pitch. It really boils down to virilizing sides vs benefits such as energy, libido, body comp, cognitive, self-esteem, less emotional, etc. Most are willing to accept some mild virilization in exchange for QOL. Often times the slightly deeper (not baritone) voice works to their advantage in a male dominated work place as well as being less emotional. To each her own. I like Bhasin's work as well, a very solid researcher.