Endocrine Therapy and Sexuality
It is both confirming and disheartening that there has recently been a spate of articles about the negative impact of endocrine therapies on sexual function. As many of you know, endocrine therapies (sometimes called hormonal therapies or anti-estrogen therapies) are routinely used in the treatment of ER positive breast cancers and some GYN cancers. Some hormonal therapies are also part of prostate cancer treatment.
Since the large majority of breast cancers are ER positive, this impacts a lot of women, a lot of couples. I have written and talked for years about the usual diminished libido and responsiveness that accompany these drugs. It has always seemed impossible to tease out how much is drug related and how much is due to menopause, stress, perhaps poor body image after treatment, fatigue, etc. Increasingly, it looks as though the real culprit is the drugs themselves. As one of our oncologists said: "Of course, It is the equivalent of female castration."
This is a thorough and pretty discouraging article from ASCO's education library. I give you the start and a link to read more:
.Endocrine Therapy and Its Effect on Sexual Function
Shari Goldfarb, MD
Breast cancer is the most common malignancy in women and it is estimated that more than 230,000 invasive cancers will be diagnosed this year.1 Approximately three-quarters of all invasive breast cancers are estrogen and/or progesterone receptor–positive. Endocrine therapy is the mainstay of treatment for both prevention and treatment of hormone receptor–positive breast cancers. Hormone therapy is the oldest targeted therapy and was initially described by both Sir George Beatson2 and Albert Schinzinger more than 100 years ago when they noted that bilateral oophorectomies resulted in tumor regression in premenopausal women with advanced breast cancer.3 A key therapeutic approach for treatment of both metastatic and adjuvant hormone receptor–positive breast cancer is estrogen deprivation. This can be achieved by suppressing ovaries, decreasing estrogen production, blocking estrogen at the level of the receptor, or by degrading estrogen receptors. Endocrine therapy is also used for the treatment of some hormone receptor–positive endometrial cancers. Commonly used endocrine therapies can have extensive sexual side effects that affect quality of life (QoL).4–6 This article will discuss different endocrine therapies, their effect on sexual function, and treatment options to improve sexual health.