By; David Miller, RPh, PhD Owner and Chief Formulation Scientist
Over the last two blogs, we have examined what are the symptoms that may necessitate testosterone replacement therapy and the different options available for replacement.
One question remains; What are the potential safety concerns with testosterone replacement therapy?
Probably the most pressing concern regarding testosterone replacement is what we call transference. Transference is the inadvertent transfer of topically applied testosterone from the patient using the testosterone to another person by casual contact. This is especially problematic if the person to whom the testosterone is transferred is a woman or a child.
Signs and symptoms of exposure of a child to testosterone gel include: enlarged penis or clitoris, early development of pubic hair, increased erections or sex drive and aggressive behavior. Signs and symptoms of exposure of women to topical testosterone therapy include: changes in body hair and a large increase in acne.
To minimize the potential transfer of topically applied testosterone to a person for whom it is not intended, you should do the following:
Apply topical testosterone to a place that will be covered by clothing and keep covered until you shower
Wash your hands immediately after applying your testosterone cream or gel
If you expect to have skin-to-skin contact with another person, first wash the application area well with soap and water
If a woman or child makes contact with the testosterone application area, that area on the woman or child should be washed well with soap and water right away.
A second major concern with testosterone replacement is the potential for cancer. Testosterone replacement is contraindicated (that is, must not be used) in patients with breast cancer or prostate cancer. Secondly, testosterone replacement may cause worsening of prostate enlargement, also called benign prostatic hypertrophy or BPH, in some patients. If patients with BPH are prescribed testosterone replacement, their physicians will monitor them closely for this effect.
However, the causality of testosterone with prostate and breast cancer is still controversial. The link between estradiol and breast cancer is well established. Remember from my column a few months ago, that testosterone is converted to estradiol in the body by an enzyme called aromatase. Therefore, it makes sense that testosterone replacement can be a secondary source of breast cancer if the testosterone is being converted to estradiol by aromatase. This underscores the importance of your physician testing not only your testosterone levels, but also your estradiol levels.
Many theories purport that estradiol is also essential for initiating prostate cancer. The studies seem to indicate that estradiol is necessary to start prostate cancer, but testosterone may be necessary to continue the growth of the prostate. Think of it as the estrogen being the match and the testosterone potentially being the gasoline.
Therefore, it is really important, that, if you have a history of breast or prostate cancer or if you have a family history of these diseases, you consult with your physician and receive the appropriate exams to ensure that testosterone replacement is safe and appropriate for you.