The Hormone Therapy That Reduces Breast Cancer Risk & More
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The Hormone Balancing Act
We’ve written before about menopausal HRT:
What You Should Have Been Told About Menopause Beforehand
…and even specifically about the considerations when it comes to breast cancer risk:
Menopausal Hormone Replacement Therapy
this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.
Hormone Modulating Therapy
Hormone modulating therapy, henceforth HMT, is something a little different.
Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…
MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,
Isn’t that the opposite of what we want?
You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).
However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.
In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.
Here’s a pop-science article that goes into the details more deeply than we have room for here:
Hormone therapy for breast cancer linked with lower dementia risk
And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:
Want to learn more?
If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:
The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
Take care!
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Topping Up Testosterone?
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The Testosterone Drop
Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.
(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)
This has been called “the male menopause”, or “the andropause”.
Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.
Why “the male menopause” is misleading:
To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).
Why “the andropause” is misleading:
It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.
Is there a better clinical term?
Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.
Terms aside, what are the symptoms?
❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞
…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:
Source: Andropause: Current concepts
Can it be safely ignored?
If you don’t mind the sexual symptoms, then mostly, yes!
However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:
- Depression
- Loss of muscle mass
- Increased body fat
Depression kills, so this does need to be taken seriously. See also:
The Mental Health First-Aid That You’ll Hopefully Never Need
(the above is a guide to managing depression, in yourself or a loved one)
Loss of muscle mass means being less robust against knocks and falls later in life
Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)
See also:
- Resistance Is Useful! (Especially As We Get Older)
- Protein vs Sarcopenia
- Fall Special (How to Proof Yourself Against Falls)
Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.
Will testosterone therapy help?
That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).
See for example:
Testosterone Therapy Improves […] and […] in Hypogonadal Men
(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)
Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:
❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.
The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).
Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞
Source: Effects of Testosterone Treatment in Older Men
We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.
That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).
And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)
Click here to see the results table for the vitality trial
Will it turn me into a musclebound angry ragey ‘roidmonster?
Were you that kind of person before your testosterone levels declined? If not, then no.
Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.
Is testosterone therapy safe?
A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.
As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…
❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.
Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞
Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:
Risks of testosterone replacement therapy in men
See also: Prostate Health: What You Should Know
Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!
For now, take care!
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Improving Women’s Health Across the Lifespan – by Dr. Michelle Tollefson et al.
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We say “et al.”, because this hefty book (504 pages) is a compilation of contributions by about 60 authors, of whom, 100% are doctors and about 90% are women.
As one might expect from a book with many small self-contained chapters by such a lot of doctors, the content is very diverse, though the style is consistent throughout, likely due to the authors working from a style sheet, plus the work of the editorial team.
About that content: the focus here is lifestyle medicine, and while much of the advice will go for men too (most people are unlikely to go wrong with “eat more fruits and vegetables and get better sleep” etc), anything more detailed than that (of which there’s a lot) is focussed on women. Hence, we get chapters on optimal nutrition for women, physical activity for women, sleep and women’s health, etc, as well as topics that can affect everyone but disproportionately affect women—ranging from autoimmune diseases to social burdens that affect health in measurable ways. There’s also, as you might expect, plenty about sexual health, pregnancy-related health, menopausal health, and so forth.
The strength of this book is really in its diversity; it’s very much a case of “60 heads are better than one”, and as such, we’re pretty much getting 60 books for the price of one here, as each author brings what they are most specialized in.
Bottom line: if you are a woman and/or love a woman, this book is packed with information that will be of interest and applicable use.
Click here to check out Improving Women’s Health Across The Lifespan, and do just that!
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5 Grip Strength Exercises Every Woman Over 40 Should Know
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Cori Lefkowith, of “Strong At Every Age” shows us how:
It’s time to get a grip
Grip strength is associated with longevity, overall strength, and lower mortality risk.
That said, it’d be remiss of us to not mention that this is because it’s a proxy for broader physical function rather than something that directly causes these outcomes. If you train your grip and only your grip, then it will only lower your mortality risk pertaining to “having a stronger grip could have saved you from this accident” situations.
All the same, grip is often a weak point, and neglecting it can create exactly those “having a stronger grip could have saved you from this accident” situations that we just mentioned. In our everyday lives, it’s less likely to be about “how long can we hold on to this cliff-edge” and more likely to be about “this cast iron pan whose contents I’m trying to pour into something else is heavier than I thought and now I’m dropping it and now I’m trying to save it and now I spilled hot something on myself and now I moved too suddenly and now I’m dropping it entirely and now I’m slipping and now I’m falling and now I’m breaking a bone”
If you think that’s a very long sequence of events, please understand the whole sequence takes place in about one second flat.
So. What to do about it?
- Farmer’s carry: carry a weight in one or both hands while standing tall, keeping the weight off your legs and gripping with all your fingers. A unilateral carry additionally challenges your core’s ability to resist flexion and rotation, while a bilateral carry allows heavier loading and greater leg involvement.
- Bottoms-up carry: carry a kettlebell or dumbbell with the weight positioned awkwardly so you must grip tightly to stabilize it. Keep your elbow close to your side and engage your lat. This challenges grip strength and shoulder stability.
- Dead hangs and pull-up holds: hanging from a bar strengthens your grip, while unilateral hangs can train each hand separately. A top pull-up hold provides an additional grip challenge while helping develop pull-up strength. Assisted variations can reduce the load when needed.
- Planks with different grips: traditional finger-gripping planks strengthen the hands and wrists while also training the core. Back-of-hand planks and planks with the wrists in extension add wrist strength, mobility, and stability demands. These harder variations can be performed from your knees or an incline initially.
- Finger extensor exercise: place a rubber band or hair tie around the outside of your fingers and push your fingers outward against the resistance. This strengthens the finger extensors and counterbalances repeated gripping and finger flexion. If that’s too awkward, you can do it without resistance and simply do very large fast rep counts (e.g. do 100 as quickly as possible).
For most grip exercises, changing where the weight sits in your hand changes which parts of your grip are emphasized. You can use different dumbbell positions, bottoms-up variations, or a pinch grip to challenge your fingers and hand muscles in different ways—just like in life in general.
For more on all of this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Take care!
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Did You Believe These Skincare Myths?
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Dr. Michelle Wong gives us the insider knowledge:
If you scratch the surface…
Here are some popular myths that just aren’t true, and their continued prevalence has more to do with cognitive biases than anything else:
- “Chemical sunscreens need time to activate”: both chemical and mineral sunscreens start blocking UV immediately after application, and the recommendation to apply them 20–30 minutes before sun exposure mainly exists so the product can dry and thus not get accidentally wiped off.
- “You should avoid layering products under chemical sunscreen”: there’s no special requirement to use fewer products under chemical sunscreen compared with mineral sunscreen.
- “Ingredient percentages tell you how effective a product is”: the listed percentage of an ingredient (such as 2% niacinamide) doesn’t guarantee performance because stability, formulation, packaging, and delivery systems determine how much actually reaches your skin.
- “Peeling gels remove large amounts of dead skin”: the solid mass formed when rubbing peeling gels are in large part the product itself reacting with oils on your skin rather than quite that much skin being removed.
- “Hyaluronic acid can hold 1,000 times its weight in water”: there’s no reliable evidence supporting this claim, and experimental analysis suggests hyaluronic acid binds roughly 40–85% of its weight in water instead.
- “Hyaluronic acid dries out your skin if you don’t use a moisturizer on top”: humectants like hyaluronic acid don’t pull water out of your skin, because hydrogen bonds only work at extremely short distances.
- “Hyaluronic acid must be applied to damp skin to work properly”: serums and moisturizers already contain large amounts of water, so applying them to damp skin doesn’t significantly change hydration results.
For more on each of these, plus a short discussion of the cognitive biases involved, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Skincare “Scams” That Are Actually Very Recommendable
Take care!
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Crohn’s Disease: Cause Finally Revealed!
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If you have Crohn’s, or perhaps someone close to you has it, then you’ll be familiar with the common medical refrain of “we don’t know”.
While this honesty is laudable, it’s not reassuring. So, it’s good that researchers in recent years have been making progress in understanding such things as why many people with Crohn’s may respond differently not only to lifestyle interventions, but also to various relevant drugs—allowing doctors to gradually get better at prescribing the right treatment for the right person.
For example, last year, researchers (Dr. Pradipta Ghosh et al.) created gut organoids from adult stem cells taken directly from Crohn’s patients during colonoscopies. Unlike organoids made from reprogrammed pluripotent stem cells, these retained the “epigenetic memory” of each patient’s gut—its microbial history, inflammation patterns, and oxygen/pH conditions—allowing a faithful replication of the disease environment.
That didn’t tell us the cause, though. But now…
When macrophages go wrong
Dr. Ghosh didn’t stop there; she assembled another team, and—by analysing thousands of macrophage gene expression profiles—identified a 53-gene signature that distinguishes inflammatory macrophages from healing ones—pinpointing girdin (a particular kind of protein) as a critical player in this process.
Let’s back up slightly and explain:
Macrophages are part of the immune system, specialist white blood cells that “eat” things that need to be removed. There are two kinds, inflammatory and non-inflammatory. The former aggressively “eat” invaders. The latter are more like cellular janitors.
In Crohn’s disease, the balance of these two kinds of macrophage becomes imbalanced, and guess which kind goes on the rampage. If you guessed “not the janitors”, you guessed correctly.
But why exactly they become imbalanced has been a mystery until now, and where science doesn’t understand the cause, it’s difficult to treat anything deeper than the symptoms.
Now we know: in a healthy gut, NOD2 gene binds to girdin in non-inflammatory macrophages, helping them suppress inflammation and promote tissue repair. The most common Crohn’s-linked mutation deletes the part of NOD2 that connects to girdin, disrupting this balance and allowing chronic inflammation to take over.
This discovery was made by very complex statistical modelling, but then it was tested empirically:
How, you ask? Mice bred without the girdin protein developed intense gut inflammation, gut microbiome disruption, and (often fatal) sepsis, confirming the NOD2-girdin connection in maintaining intestinal immune balance.
You can read about this here: Distinct colitis-associated macrophages drive NOD2-dependent bacterial sensing and gut homeostasis
You may be wondering: great, but what am I supposed to do if I have this mutation?
And well, it’s still a case of doing what we can to dial down the inflammation (see for example: How to Prevent (or Reduce) Inflammation)
However, armed with more knowledge, knowing that this has to do with gut dysbiosis, then we can now also focus on addressing that directly, for example: How Much Difference Do Probiotic Supplements Make, Really?
And in order for those probiotics to actually work, see: Stop Sabotaging Your Gut
“But I can’t eat fibrous foods, it all flares up!”, we here you (validly) cry.
…and unfortunately, that changes everything, in terms of what’s usually considered healthiest for most people, i.e. a whole-foods majority plant-based diet.
What stays the same:
- You still ideally want to eat a lot of plants
- You definitely want to avoid meat and dairy in general
- Eating fish is still usually fine, same with eggs
- Get plenty of water
What needs to change:
- Consider swapping grains for potatoes or pasta (at least: avoid grains)
- Peel vegetables that are peelable; discard the peel or use it to make stock
- Consider steaming fruit and veg for easier digestion
- Skip spicy foods (moderate spices, like ginger, turmeric, and black pepper, are usually fine in moderation)
Much of this latter list is opposite to the advice for people without Crohn’s Disease.
To that end, if you take probiotics supplements that come with their own tiny-but-right-there supply of prebiotic fiber (such as inulin), that will probably be enough to help your probiotics “take”, without simultaneously setting your macrophages off because you just fed your entire gut microbiome at once with a big meal full of fiber.
Here’s an example product on Amazon, but by all means feel free to shop around, and if you’re working with a dietician, do discuss it with them, of course.
Take care!
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Reverse Inflammation Naturally – by Dr. Michelle Honda
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
This book is in some ways not as marketable as some; it doesn’t have lots of colorful healthy food on the cover; it doesn’t even have a “woman laughing alone with salad” (you know the stock photo trope), let alone someone looking glamorous in a labcoat with a stethoscope draped over their shoulder despite listening to hearts not being a regular part of their job as an immunologist or such.
What it does have, instead, is a lot of very useful information, and much more than you’ll usually find in a book for laypeople.
For example, you probably know that for fighting inflammation, a green salad is better than a cheeseburger, say, and a black coffee is better than a glass of wine.
But do you know about the roles, for good or ill, of prostaglandins and linoleic fats vs dietary fats? How about delta-6-desaturase? Neu5Gc and arachidonic acid?
Dr. Honda demystifies all of these and more, as well as talking about the impacts of very many foods and related habits on various different inflammation-based disease. And of course, almost all disease involves some kind of inflammation (making fighting inflammation one of the best things you can do for your overall disease-avoidance strategy!), but she singles out some of the most relevant, as per the list on the front cover.
She also talks a lot of “pharmacy in your kitchen”, in other words, what herbs, spices, and plant extracts we can enjoy for (evidence-based!) benefits on top of our default healthy diet free (or at least mostly free, for surely none of us are perfect) from inflammatory agents.
Not content with merely giving a huge amount of information, she also gives recipes and a meal plan, but honestly, it’s the informational chapters that are the real value of the book.
Bottom line: if you’d like to reduce your body’s inflammation levels (and/or perhaps those of a loved one for whom you cook), then this book will be an invaluable resource.
Click here to check out Reverse Inflammation Naturally, and reverse inflammation naturally!
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