Breast cancer is the most common neoplasia among women worldwide, representing a significant public health challenge. In Brazil, tens of thousands of new cases are estimated to arise each year, reinforcing the need for effective strategies for prevention, early diagnosis, and proper treatment.

Breast cancer and its relevance in public health

Breast cancer is the most common neoplasia among women worldwide, representing a significant public health challenge.
In Brazil, it is estimated that tens of thousands of new cases arise each year, reinforcing the need for effective strategies for prevention, early diagnosis, and proper treatment.

During Breast Cancer Awareness Month, awareness campaigns draw attention to the importance of screening and women’s health care. However, along with the dissemination of information, myths and doubts about the true risk factors for breast cancer also arise.

What really increases the risk of breast cancer?

It is essential for doctors to be well informed to safely guide their patients, differentiating proven risk factors — such as smoking, alcohol, obesity, and physical inactivity — from those that are often mistakenly associated, such as hormone replacement therapy (HRT) during menopause.

For years, HRT was pointed out as one of the main causes of breast cancer. However, new scientific evidence has revised this perspective.
In a recent panel by the FDA (Food and Drug Administration), specialists highlighted that the relationship between HRT and breast cancer is much more complex than previously thought.

The main conclusion was clear:

HRT, when well indicated and monitored, should not be considered a villain.
 The risk is modest and variable, depending on the type of formulation, duration of use, and, most importantly, the genetic and clinical profile of the patient.

The impact of lifestyle habits on breast cancer

When analyzing population data, it is evident that lifestyle habits have a much greater influence on the risk of breast cancer than HRT.

These factors are modifiable and should be the main focus of prevention strategies.

The role of the physician: information and individualization

More than restricting hormonal therapies that improve quality of life, it is essential that the physician acts as an educator, helping the patient understand her real risks and adopt healthy habits.

Moreover, the risk of developing breast cancer is not the same for all women. It varies according to family history, genetic predisposition, environment, and lifestyle.
Therefore, individualized genetic assessment has become an essential ally in modern medical practice.

Genetics and personalized medicine: the future of prevention

Personalized medicine allows for a better understanding of each patient’s individual risk.
Through specific genetic tests, it is possible to identify variants associated with breast cancer predisposition, such as BRCA1, BRCA2, TP53, PALB2, ATM, and CHEK2.

The MyHormoDNA Breast and Ovarian Cancer Panel is an advanced tool that offers:

This approach promotes a personalized, safe, and evidence-based medical practice.

Conclusion: it’s time to update the debate

The debate on HRT and breast cancer needs to be revised in light of current science.
Hormonal replacement, when well indicated and monitored, should not be seen as a cause of breast cancer.
The real focus should be on modifiable risk factors — such as lifestyle habits — and on individualized genetic assessment.

Do you want to better understand how to assess your patients’ individual risk?
Contact us and learn about the MyHormoDNA genetic tests, designed to offer security, personalization, and clinical precision.

References

Prepared by Dr. Francisco Tostes, Scientific Director at Renewal

Hormone replacement therapy (HRT) in menopause for women with a history of breast cancer remains one of the most complex and debated topics in gynecological endocrinology. For a long time, an extremely conservative approach prevailed, focused on the fear of recurrence. However, new evidence and guidelines now allow for a more personalized and balanced evaluation.

Hormone replacement therapy (HRT) in menopause for women with a history of breast cancer remains one of the most complex and discussed topics in gynecological endocrinology. For a long time, an extremely conservative approach prevailed, focused on the fear of recurrence. However, new evidence and guidelines now allow for a more personalized and balanced evaluation.

Understanding the complexity: the role of tumor biology

Not all breast cancers respond the same way to hormones. Therefore, it is essential to understand the histology and molecular profile of the tumor:

Tumor subtype Hormonal receptors Implication for HRT
Invasive ductal carcinoma ER+ ER+/PR+ Contraindicates systemic HRT
Pure HER2+ carcinoma No hormonal expression Case-by-case evaluation
Triple-negative (ER-, PR-, HER2-) Absence of receptors Greater openness to discuss HRT
Curable in situ carcinoma (DCIS/LCIS) Dependent on subtype May be considered

What do the main evidences say?

New guidelines: more individualization

The NICE (2024) and BMS (2024) guidelines propose a more flexible approach:

Vaginal estrogen: a safe option?

Practical tips for clinical practice

References:

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

Menopausal transition is one of the most challenging phases in a woman’s life, marked by profound hormonal changes that directly affect quality of life. Among the various symptoms, insomnia during menopause stands out as one of the most frequent and debilitating complaints. Studies indicate that nearly 50% of menopausal women face sleep disorders, a prevalence significantly higher compared to women of reproductive age.

Menopausal transition is one of the most challenging phases in a woman’s life, marked by profound hormonal changes that directly affect quality of life. Among the various symptoms, insomnia during menopause stands out as one of the most frequent and debilitating complaints. Studies indicate that around 50% of menopausal women face sleep disorders, a prevalence significantly higher compared to women of reproductive age.

Why is insomnia so common during menopause?

Insomnia during menopause has multifactorial causes, involving hormonal alterations, psychosocial factors, aging, and dysfunctions in the circadian axis. The “3 P’s” model of insomnia (predisposing, precipitating, and perpetuating factors) applies perfectly to this context:

The impact of hormones on women’s sleep

The drop in estrogen and progesterone during menopause directly affects sleep regulation:

Melatonin and aging

The production of melatonin also decreases with age, worsening sleep disorders. This reduction, combined with sexual hormonal changes, contributes to cases of insomnia characterized by difficulty falling and staying asleep.

Hot flashes and night sweats

About 80% of menopausal women report vasomotor symptoms. These symptoms compromise sleep by causing abrupt awakenings and fragmented sleep, directly impacting the feeling of rest upon waking up.

Relationship between insomnia and mood disorders

Insomnia and mood disorders have a bidirectional relationship. Women with anxiety or depression have a higher risk of insomnia, and insomnia itself can trigger or worsen these disorders. This creates a vicious cycle of intrusive thoughts and fear of not being able to sleep.

Risks associated with insomnia in menopause

Chronic insomnia is not only uncomfortable. It is associated with an increased risk of:

These effects are related to an increase in inflammatory markers and dysfunction of the hypothalamic-pituitary-adrenal axis.

How to treat insomnia during menopause?

Treatment should be integrative and evidence-based. The main approaches include:

Conclusion

Insomnia during menopause is a reflection of broad dysregulation of the hormonal, emotional, and circadian axes. To ensure effective treatment, a personalized and science-based approach is essential. Professionals who support women in this phase must master the fundamentals of this condition to provide safe, empathetic, and high-impact therapeutic care.

Prepared by Dr. Francisco Tostes, Scientific Director at Renewal

Most women enter menopause between the ages of 45 and 55, according to the World Health Organization (WHO). However, a new study published in JAMA Network Open highlights that women suffering from premenstrual disorders (PMDs) have a higher risk of developing early menopause — with significant consequences for cardiovascular, bone, and neurological health.

PMD and Early Menopause: Study Reveals Association with Women’s Health Risks

Most women enter menopause between the ages of 45 and 55, according to the World Health Organization (WHO). However, a new study published in JAMA Network Open highlights that women suffering from premenstrual disorders (PMDs) have a higher risk of developing early menopause — with important consequences for cardiovascular, bone, and neurological health.

PMD and Early Menopause: What is the Relationship?

Women who reported PMD symptoms were more than twice as likely to enter menopause before the age of 45, compared to those who did not present those symptoms.

The types of PMD analyzed include:

Long-Term Impacts

Previous studies have already shown that PMDs are associated with more intense symptoms in postmenopause, such as:

Additionally, early menopause is linked to worse health of the heart, brain, and bones, increasing the risk of osteoporosis and neuropsychiatric disorders.

Aggressive Risk Factors

Conclusion: Monitoring and Support Are Essential

The study reinforces the need for clinical monitoring of women with PMD, especially in more severe cases like PMDD. This attention can help prevent future complications during the transition to menopause.

Reference:

Yang Y, Valdimarsdóttir UA, Manson JE, et al. Premenstrual Disorders, Menopause Timing, and Severity of Vasomotor Symptoms. JAMA Netw Open. 2023;6(9):e2334545. doi:10.1001/jamanetworkopen.2023.34545

Hormone Replacement Therapy (HRT) is widely used to relieve menopausal symptoms and improve quality of life. However, its impact on thromboembolic risk has been a constant concern. In this article, we review the latest evidence on the relationship between HRT and venous thromboembolism (VTE), considering different routes of administration and types of hormones.

Hormone Replacement Therapy (HRT) is widely used to relieve menopausal symptoms and improve quality of life. However, its impact on thromboembolic risk has been a constant concern. In this article, we review the latest evidence on the relationship between HRT and venous thromboembolism (VTE), considering different routes of administration and types of hormones.

HRT and the Risk of Venous Thromboembolism

Studies indicate that oral HRT is associated with a significant increase in the risk of VTE, particularly in the first few months of use. The literature points to a relative risk (RR) of 2 to 4 for users of combined oral HRT compared to non-users.

On the other hand, transdermal HRT presents a lower risk. Meta-analyses show that there is no statistically significant increase in risk with this route of administration (OR 0.97). Additionally, transdermal formulations containing only estrogen have an even lower relative risk (OR 0.95).

Influence of Progestogens on VTE Risk

The type of progestogen used in HRT also impacts the thrombotic risk. Micronized progesterone and dydrogesterone are associated with lower risks, whereas medroxyprogesterone acetate may increase the risk of VTE.

The combination of transdermal estrogen with micronized progesterone is considered a safer option for women with a predisposition to thrombotic events.

HRT in Women with Thrombophilia

The presence of hereditary thrombophilias, such as Factor V Leiden mutation and prothrombin mutation, necessitates careful evaluation before prescribing HRT.

Studies suggest that oral HRT may exacerbate thrombotic risk in individuals with these conditions, especially when additional factors, such as obesity or immobility, are present.

Clinical Considerations and Conclusion

While many healthy women can safely use HRT, those with a history of VTE or thrombophilia require a personalized approach. Transdermal HRT, combined with lower-risk progestogens, is generally preferable in these high-risk populations.

Doctors should conduct detailed evaluations of the thrombotic history before prescribing HRT. In more complex cases, collaboration with hematology specialists may be essential for safe and effective management of hormonal therapy.

La relación entre la terapia hormonal (TH) y la demencia ha sido ampliamente investigada a lo largo de los años, planteando cuestionamientos y nuevas hipótesis con cada estudio publicado. Estudios iniciales sugirieron que la reposición de estrógeno podría reducir o retardar el riesgo de la enfermedad de Alzheimer (EA), especialmente si se iniciaba de forma temprana. Sin embargo, el escenario ha cambiado a medida que nuevos datos han surgido, volviendo el tema más complejo y multifacético.La relación entre la terapia hormonal (TH) y la demencia ha sido ampliamente investigada a lo largo de los años, generando interrogantes y nuevas hipótesis con cada estudio publicado. Estudios iniciales sugirieron que la reposición de estrógeno podría reducir o retrasar el riesgo de la enfermedad de Alzheimer (EA), especialmente si se inicia de manera temprana. Sin embargo, el panorama cambió a medida que nuevos datos emergieron, volviendo el tema más complejo y multifacético.

El Concepto de Ventana Limitada de Tiempo

Investigaciones como el Estudio del Condado de Cache indicaron que el uso de TH durante al menos 10 años estaba asociado a un riesgo reducido de EA. Este hallazgo dio origen al concepto de “ventana limitada de tiempo”, que sugiere que el inicio temprano de la terapia puede ser beneficioso.

Por otro lado, el sub-estudio Women’s Health Initiative Memory Study (WHIMS), realizado en 2003, presentó resultados contrarios. En una muestra de más de 4,000 mujeres de 65 años o más, se identificó un riesgo aumentado de demencia en usuarias de TH en comparación con el placebo.

Factores de Edad y Duración del Uso

Un análisis detallado del WHIMS reveló que muchas participantes ya estaban bien más allá de la menopausia al iniciar el tratamiento. Esto planteó la hipótesis de que la TH administrada durante la transición menopáusica podría presentar un riesgo menor o incluso efectos protectores.

Estudios más recientes mostraron resultados conflictivos:

La terapia con estrógeno aislado no aumentó el riesgo de demencia.
La combinación de estrógeno y progestina se asoció a un pequeño aumento en el riesgo.
El uso exclusivo de estradiol vaginal no influyó en el riesgo de EA.

Un estudio retrospectivo finlandés reforzó la complejidad, demostrando que la vía de administración (oral o transdérmica) y la combinación hormonal pueden desempeñar papeles distintos en el riesgo de demencia.

Directrices Actuales para Terapia Hormonal

De acuerdo con el posicionamiento de la North American Menopause Society (2022), la TH debe ser individualizada, considerando dosis, formulación, vía de administración y duración del tratamiento. Las directrices recomiendan:

Iniciar la TH preferentemente antes de los 60 años o dentro de 10 años del inicio de la menopausia.
Evaluar la relación riesgo-beneficio en mujeres de ≥ 60 años debido al aumento de riesgos absolutos, como enfermedades cardiovasculares y demencia.

Terapia Hormonal de Corta Duración y Inicio Temprano

Un estudio con más de 60,000 mujeres indicó que el riesgo de demencia aumentaba con la duración del uso de TH. Las mujeres que usaron la terapia durante 12 años presentaron un riesgo 74% mayor de demencia en comparación con las no usuarias.

Sin embargo, los regímenes que contenían solo progestina o estrógeno vaginal no se asociaron a este aumento de riesgo.

¿Cómo Interpretar los Datos?

Los datos presentados por estudios observacionales deben ser interpretados con cautela, ya que no permiten establecer causalidad. Además, otros factores, como síntomas vasomotores severos, pueden estar asociados a una mayor formación de amiloide cerebral, un marcador de riesgo para demencia.

Por otro lado, estudios recientes con biomarcadores de imagen cerebral mostraron que las mujeres que iniciaron temprano la TH presentaron:

Mejores puntuaciones de memoria.
Mayor volumen del hipocampo y corteza entorrinal.Estos beneficios se observaron principalmente en portadoras del gen APOE4.

Conclusiones

La decisión de iniciar y mantener la terapia hormonal debe ser personalizada. No hay evidencias que justifiquen la limitación arbitraria de la duración o la prescripción de dosis mínimas. Para muchas mujeres, dosis adecuadas y terapias bien ajustadas son esenciales para aliviar síntomas, prevenir la pérdida ósea y reducir el riesgo de fracturas.

El seguimiento médico especializado es indispensable para evaluar los beneficios y riesgos individualmente, garantizando que la terapia se realice de la forma más segura y eficaz posible.

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

Referencias:

Kesslak, J.P. (2002). ¿Puede el estrógeno desempeñar un papel significativo en la prevención de la enfermedad de Alzheimer?. En: Jellinger, K.A., Schmidt, R., Windisch, M. (eds) Envejecimiento y Demencia Conceptos Actuales y Futuros. Journal of Neural Transmission. Supplementa, vol 62. Springer, Viena. https://doi.org/10.1007/978-3-7091-6139-5_21

Espeland MA, Rapp SR, Shumaker SA, et al. Estrógenos equinos conjugados y función cognitiva global en mujeres posmenopáusicas: Estudio de Memoria de la Iniciativa de Salud de las Mujeres. JAMA. 2004;291(24):2959–2968. doi:10.1001/jama.291.24.2959

Vinogradova Y, Dening T, Hippisley-Cox J, Taylor L, Moore M, Coupland C et al. Uso de terapia hormonal menopáusica y riesgo de demencia: estudios de casos y controles anidados utilizando bases de datos QResearch y CPRD BMJ 2021; 374 :n2182 doi:10.1136/bmj.n2182

Savolainen-Peltonen H, Rahkola-Soisalo P, Hoti F, Vattulainen P, Gissler M, Ylikorkala O, Mikkola TS. Uso de terapia hormonal posmenopáusica y riesgo de enfermedad de Alzheimer en Finlandia: estudio de casos y controles a nivel nacional. BMJ. 2019 Mar 6;364:l665. doi: 10.1136/bmj.l665. PMID: 30842086; PMCID: PMC6402043.

“La declaración de posición de terapia hormonal de 2022 de la North American Menopause Society” Panel Asesor. La declaración de posición de terapia hormonal de 2022 de la North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794. doi: 10.1097/GME.0000000000002028. PMID: 35797481.

Pourhadi N, Mørch L S, Holm E A, Torp-Pedersen C, Meaidi A. Terapia hormonal menopáusica y demencia: estudio de casos y controles anidados a nivel nacional BMJ 2023; 381 :e072770 doi:10.1136/bmj-2022-072770

Kantarci K, Manson J E. Terapia hormonal menopáusica y demencia BMJ 2023; 381 :p1404 doi:10.1136/bmj.p14

Saleh RNM, Hornberger M, Ritchie CW, Minihane AM. La terapia de reemplazo hormonal se asocia con mejor cognición y mayores volúmenes cerebrales en mujeres en riesgo APOE4: resultados de la cohorte de Prevención Europea de la Enfermedad de Alzheimer (EPAD). Alzheimers Res Ther. 2023 Jan 9;15(1):10. doi: 10.1186/s13195-022-01121-5. PMID: 36624497; PMCID: PMC9830747.

Currently, there is much discussion about the safety and efficacy of hormonal implants. Part of this controversy is related to the lack of preparation of some doctors to prescribe and properly follow up with patients using this modality of hormonal replacement.

Currently, there is much discussion about the safety and efficacy of hormonal implants. Part of this controversy is related to the lack of preparation of some doctors to prescribe and adequately accompany patients using this modality of hormonal replacement.

To face these challenges, it is essential for professionals to stay updated and armed with solid arguments to guide their patients and engage in dialogue with other specialists. With this in mind, Renewal maintains Medical Education as one of its fundamental pillars.

In this edition of SottoNews, we highlight the scientific article “Randomized Clinical Trial of Testosterone Replacement Therapy in Hypogonadal Men”, by Ann J. Conway and colleagues, which investigates the efficacy and safety of three routes of testosterone replacement: injectable, oral, and subcutaneous implants (pellets).

Study Methodology

The study was a randomized clinical trial with a crossover design, involving 15 men diagnosed with hypogonadism. Participants were randomly divided into groups to experience, at different times and with “washout” intervals, the three replacement modalities:

  1. Intramuscular injections: Testosterone esters (250 mg) every two weeks.
  2. Oral route: Testosterone undecanoate (120 mg), administered twice daily.
  3. Subcutaneous implants (pellets): Six implants of 100 mg each.

Each treatment phase lasted three months, with “washout” intervals between cycles (4 to 6 weeks). Researchers evaluated:

Results

The results revealed notable differences in the pharmacokinetic profiles and clinical responses of the three administration routes:

Conclusions

All three modalities proved effective in treating hypogonadism, but there were significant differences:

  1. Hormonal stability: Subcutaneous implants maintained more stable hormonal levels and had a lower incidence of adverse effects.
  2. Duration of effect: With a total dosage of 600 mg, the implants ensured therapeutic levels for four months. Higher doses (1,200 mg, using 200 mg pellets) may extend the effect up to six months.
  3. Customization of treatment: The choice of route should take into account convenience, tolerance, and individual response, with continuous medical follow-up.

This study provides robust evidence for clinical practice, reinforcing the use of testosterone implants as a safe and effective option for patients with hypogonadism. And we, at Renewal, are always on top of all the possible information to update our certified doctors and provide ever more well-being and balance to our patients.

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

Blue November is a global awareness campaign focused on the importance of early diagnosis of prostate cancer. Throughout the month of November, the campaign encourages men to take care of their health and undergo essential preventive examinations.

Blue November is a global awareness campaign focused on the importance of early diagnosis of prostate cancer. Throughout the month of November, the campaign incentivizes men to take care of their health and undergo essential preventive examinations.

Prostate cancer is the second most common type of cancer among men, only behind skin cancer. In Brazil, a man dies from this disease every 38 minutes. Despite this, there is still significant controversy over whether Testosterone Replacement Therapy (TRT) can increase the risk of prostate cancer. However, several studies already suggest that this relationship is unlikely.

Recently, research published in the prestigious JAMA thoroughly examined the effects of TRT concerning prostate cancer and other prostatic events. The study, titled “Prostatic Safety Events During Testosterone Replacement Therapy in Men with Hypogonadism”, was a randomized, double-blind clinical trial with 5,246 participants. It compared the effects of TRT with a placebo in men aged between 45 and 80, all with low testosterone levels (below 300 ng/dL). Men with elevated PSA levels (>3.0 ng/mL) or severe urinary symptoms were excluded.

Main Conclusions from the Testosterone and Prostate Health Study

  1. Prostate Cancer Risk: There were no significant differences in the incidence of prostate cancer between the TRT and placebo groups, indicating that testosterone hormone therapy does not increase the risk of high-grade cancer.
  2. Secondary Events and Urinary Symptoms: The incidence of acute urinary retention, procedures for benign prostatic hyperplasia (BPH), and treatments for urinary symptoms also did not differ significantly between the groups. PSA levels increased slightly in the TRT group but stabilized after 12 months, with no significant progression of urinary symptoms.
  3. Monitoring and Safety: This is one of the largest randomized studies on TRT and prostate cancer to date. The evidence is robust and supports that hormone therapy does not increase the risk of serious prostate-related events in men carefully selected for treatment.

Despite the positive evidence, the study has limitations. Individuals with a history of prostate cancer and elevated PSA levels were excluded, and the 33-month follow-up, while extensive, may not be sufficient to fully assess the long-term effects of TRT. Another factor was the high discontinuation rate in both the TRT and placebo groups, primarily due to the COVID-19 pandemic, which affected participant follow-up.

Final Considerations on Hormonal Therapy and Blue November

This study reinforces the safety of Testosterone Replacement Therapy in men with hypogonadism, providing additional support for physicians and patients to make more informed treatment decisions. Although TRT does not seem to increase the risk of prostate cancer, careful patient selection and continuous monitoring are essential to ensure the safety and effectiveness of testosterone hormone treatment.

During Blue November, in addition to focusing on early diagnosis, raising awareness about treatments such as TRT and their impact on men’s health is essential to promote a more comprehensive and safe approach to men’s health.

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

In the month of Yellow September, mental health awareness becomes even more relevant. A crucial topic that directly affects women’s mental health is menopause. This transitional phase marks a significant decrease in hormone production, such as estrogen and progesterone, which can directly impact emotional well-being.

In the month of Yellow September, mental health awareness becomes even more relevant. A crucial topic that directly affects women’s mental health is menopause. This transitional phase marks a significant decrease in hormone production, such as estrogen and progesterone, which can directly impact emotional well-being.

How Does Menopause Affect Mental Health?

During menopause, hormone levels undergo significant fluctuations. These changes can contribute to symptoms like anxiety and depression. In fact, the hormonal variations that occur in the climacteric—the period leading up to menopause—can trigger irritability and mood instability.

Research shows that after menopause, the risk of developing depression can triple. This risk is even greater for women who enter menopause early. Estrogen plays a fundamental role in the brain, helping to regulate the production of serotonin and dopamine, neurotransmitters responsible for mood regulation. Therefore, the drop in estrogen levels can contribute to the onset of depression and anxiety.

Can Hormonal Therapy Help?

Hormone replacement therapy (HRT), which may include estrogen, progesterone, and even testosterone, is widely recognized for its benefits in relieving physical symptoms such as hot flashes. However, many do not know that HRT can also help improve symptoms of depression and anxiety, promoting a greater sense of well-being.

Although it is an effective and safe option for many women, hormonal therapy may not be suitable for everyone. Therefore, it is essential for each woman to undergo a personalized medical evaluation, carefully considering the risks and benefits of the therapy.

Caring for Mental Health During Menopause

It is important for women to be alert to signs of mood changes during the climacteric and menopause. Guiding patients about these fluctuations is of utmost importance. Hormonal therapy may be one of the solutions, but there are also other approaches, such as alternative therapies and psychological support that we can promote.

If you have questions or wish to share your experience with your patients, please leave your comment below. And don’t forget to share this content with other professionals who may benefit from this information, especially in the month of September when we address mental health.

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

Scientific References:

This article aims to provide a broad overview of the challenges and considerations in managing testosterone deficiency in women, offering an informed basis for clinical practice.

This article aims to provide an overview of the challenges and considerations in managing testosterone deficiency in women, offering an informed basis for clinical practice.

Testosterone deficiency in women is an emerging topic in clinical practice, with significant implications for health and well-being. Although traditionally associated with men, testosterone plays a crucial role in female physiology, influencing libido, energy, muscle mass, and bone density. However, diagnosing and treating this condition in women presents unique challenges.

Challenges in Diagnosis

Non-Specific Symptoms: Symptoms of testosterone deficiency in women, such as fatigue, low libido, depression, and muscle loss, are non-specific and can be confused with other conditions, such as thyroid disorders, menopause, or depression.

Lack of Consensus on Reference Levels: Unlike men, there is no clear consensus on normal testosterone levels in women, complicating diagnosis. Testosterone concentrations in women are naturally low and vary with age and the menstrual cycle, making it difficult to establish a universal cutoff point.

Testing Methods: The accuracy of laboratory tests to measure testosterone in women is limited. Many assays are not sensitive enough to detect low circulating testosterone levels in women. The best options for dosage are mass spectrometry for total testosterone and equilibrium dialysis for free testosterone.

Stigmatization: The cultural perception that testosterone is a “male” hormone can lead to the stigmatization of women with testosterone deficiency, discouraging them from seeking proper diagnosis and treatment. Even today, we see some doctors who do not consider testosterone replacement in their patients.

Treatment Options

Testosterone Replacement: Hormone replacement therapy (TRT) can be administered in various ways, with transdermal gels and subcutaneous implants being the most commonly used options in Brazil. The goal is to physiologically replenish testosterone levels, alleviating symptoms associated with its deficiency.

Lifestyle Modifications: Non-pharmacological interventions, such as resistance exercise, balanced diet, and stress management, can help improve natural testosterone levels and relieve symptoms.

Treatment of Underlying Conditions: It is crucial to identify and treat any underlying condition that may be contributing to testosterone deficiency, such as thyroid disorders.

Evidence and Safety of Testosterone Replacement in Women

Efficacy: Studies show that TRT can significantly improve libido, energy, and well-being in women with testosterone deficiency. However, individual responses to treatment may vary.

Risks and Side Effects: The long-term safety of TRT in women is still being researched. Potential side effects include acne, facial hair growth, and alterations in lipid profiles. While there are concerns about the risk of breast cancer and cardiovascular disease, current evidence does not point to such risks.

Clinical Monitoring: Women on TRT should be monitored regularly to evaluate treatment efficacy and identify any adverse effects. This includes blood tests to monitor hormone levels and periodic clinical evaluations.

Conclusion

The diagnosis and treatment of testosterone deficiency in women are complex and require a careful and personalized approach. While TRT can offer significant benefits, it is essential to consider potential risks and closely monitor patients. Further research is needed to clarify reference levels, long-term safety, and efficacy of interventions, ensuring that women receive the best possible care.

In the refresher courses on hormone therapy with implants at Renewal, we refine the knowledge and provide safety and support for you, the physician, to work with one of the most effective therapies in the world. Join the upcoming classes!

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

References