Cappelletti and Wallen (2016) criticized the commercial promotion of testosterone-replacement therapy for women who had undergone hysterectomies and/or ovariectomies in order to restore sexual motivation and behavior. One of their criticisms was that: estrogen was the sole hormone that could restore sexual motivation and behavior, not testosterone. The doses required to be effective were much larger than those that were found naturally (in control group women or those who had not undergone surgeries). Human female sexual motivation and behavior were unrelated to circulating hormone levels or concentrations. The side effects of hormone replacement therapies were far greater than the benefits produced.
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Refer to a study on hormone replacement therapy. Until 2002, hormone replacement therapy (HRT), taking hormones to replace those the body no longer makes after menopause, was commonly prescribed to postmenopausal women. However, in 2002 the results of a large clinical trial $^{44}$ were published, causing most doctors to stop prescribing it and most women to stop using it, impacting the health of millions of women around the world. In the experiment, 8506 women were randomized to take HRT and 8102 were randomized to take a placebo. Table 6.13 shows the observed counts for several conditions over the five years of the study. (Note: The planned duration was 8.5 years. If Exercises 6.174 through 6.177 are done correctly, you will notice that several of the p-values are just below 0.05 . The study was terminated as soon as HRT was shown to significantly increase risk [using a significance level of $\alpha=0.05]$, because at that point it was unethical to continue forcing women to take HRT). Does HRT influence the chance of a woman getting cancer of any kind?
Inference for Means and Proportions
Hypothesis Test for a Difference in Proportions
High levels of the female sex hormone estrogen increase the risk of some forms of cancer. Thus, some early types of contraceptive pills containing high concentrations of estrogen were eventually withdrawn from use because this was found to increase the risk of cancer of the lining of the uterus. Male transsexuals who use estrogen preparations to give themselves a female appearance have an increased risk of breast cancer. High levels of androgens (male sex hormones) increase the risk of some other forms of cancer, such as cancer of the prostate. Can one infer that estrogens and androgens are mutagenic?
SCIENTIIC INQUIRY Prostate cells usually require testosterone and other androgens to survive. But some prostate cancer cells thrive despite treatments that eliminate androgens. One hypothesis is that estrogen, often considered a female hormone, may be activating genes normally controlled by an androgen in these cancer cells. Describe one or more experiments to test this hypothesis. (See Figure 11.9 to review the action of these steroid hormones.)
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